Opinion: Better health = a more equal society

I’ve submitted an amendment to the motion accompanying the health policy paper we’ll be debating this weekend at the Lib Dems’ spring conference in Liverpool, and our esteemed editors have asked to me to explain its reasoning.

The amendment aims to add to the list of things we want to do: ‘Concerted action across government to tackle the root causes of ill health and inequalities in health, including high levels of income and wealth inequality, poverty, poor housing and environmental pollution’.

The thinking behind it was triggered by listening to Nick Clegg’s comments when the paper was launched. He used the statistic – familiar from his leadership campaign, and a good illustration of the problem – that someone born in the poorest ward of Sheffield would have a life expectancy of fourteen years less than someone born in the richest ward. ‘And’, he added, ‘the NHS has to do something about this’.

But in fact, as my amendment recognises, it’s not the NHS that’s really the problem here; it’s a much wider range of socioeconomic factors. As far back as 1980, the Black Report, Inequalities in Health, concluded that from birth to old age, those at the bottom of the social scale had much poorer health and quality of life than those at the top. Recent studies show that the gap is still widening – the areas with the highest life expectancy a decade ago are the places that have seen the biggest increase in life expectancy since. The NHS is good at providing emergency care, such as after accidents, and at alleviating a whole range of non-life-threatening conditions, but health care by itself has only a tiny impact on average lifespan. Social and economic factors such as income, wealth, employment, environment, education, housing and transport all affect standards of health more fundamentally, and all favour the better-off.

As I said, this isn’t new – but what is less well recognised, and is something I looked at in more detail in my chapter in Reinventing the State: Social Liberalism for the 21st Century (available from the Liberator stand at Liverpool!) – is that this is not just a problem of poverty. There is a continuous gradient in death rates all the way through society. The higher people’s status, the longer they live. Inequality itself is a killer.

A study of government office-workers in London in the 1970s and ’80s found that death rates from heart disease were four times as high among the most junior office workers as among the most senior administrators working in the same offices; intermediate levels had intermediate death rates. Only a third of these differences could be explained by risk factors such as smoking, exercise and diet. Considering all causes of death, not just heart disease, the most junior workers were three times as likely to die as the most senior.

So levels of income and wealth inequality in a society are bad for your health – and in these terms Britain is one of the most unequal societies in the western world. Humans are social animals, and the scientific evidence suggests that the long-term stress caused by living in unequal environments, where your ability to control your own life is significantly constrained by the point on the income scale you happened to be born into leads to long-term health problems.

So if we’re really concerned about improving health standards for everyone in society, and reducing health inequalities, we need to recognise that we can’t just target our efforts on the poorest – we need to build a more equal society. Something neither of the other two parties are likely to be saying, I would guess, and I hope it can play a prominent part in the next election manifesto.

* Duncan Brack is the Chair of the Federal Conference Committee, and was co-editor of Reinventing the State: Social Liberalism for the 21st Century.

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