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Forget healthcare: the trick to making people well is to make them more equal

You can't make people healthier without making them richer.

Good news! By 2030, you can expect to live to the ripe old age of 90 – as long as you live in a wealthy area. Research published today in the Lancet has concluded that national progress on life expectancy has come at the cost of quickly rising inequalities between rich and poor, and that this disparity is set to not only endure, but widen by as much as two to three years.

The life expectancy gap between rich and poor in the UK is already stark: ONS data shows that a man living in an affluent area of the south-east can expect to live almost 9 years longer than a man in one of the poorer north-west regions. This is also true when we look at healthy life expectancy – men living in the most prosperous local authority can expect to enjoy almost twenty more years of good health than those in the most deprived. How have we ended up like this?

The common refrain among politicians and the media is that people’s lifestyles are to blame for their poor health, and a shorter life is a consequence of wilful refusal to take personal responsibility. While public health interventions and good information are important, lifestyle choices alone cannot explain something as shocking as dying decades earlier than you should. The social gradient tells us that inequalities in health are related to inequalities in social status, so the poorer you are, the more likely you are to suffer from a range of mental and physical health conditions. Urging people in deprived areas to eat more healthily can never compensate for the devastating effects of economic disadvantage.

Instead, policymakers and commentators need to address the problem at its root by acknowledging that income inequality is a major cause of health inequality, not just an indicator. The yawning chasm in health demonstrates a society pulled apart at the seams. In a rich country like the UK, we should find it unacceptable that poor people have inferior health and shorter lives. But we shouldn’t care only for that reason. Evidence shows that in unequal countries like ours, everyone – rich and poor – has worse health outcomes than in more equal countries.

We have known about the link between economic inequality and health for years, but with new research forecasting an even greater divide, we cannot afford to ignore this crisis any longer. Politicians know that the most effective way to reduce the health gap between rich and poor is to reduce the dramatic gap in wealth and income between them. The solution is there for the taking, are our politicians willing to grasp it? 

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The EU’s willingness to take on Google shows just how stupid Brexit is

Outside the union the UK will be in a far weaker position to stand up for its citizens.

Google’s record €2.4bn (£2.12bn) fine for breaching European competition rules is an eye-catching example of the EU taking on the Silicon Valley giants. It is also just one part of a larger battle to get to grips with the influence of US-based web firms.

From fake news to tax, the European Commission has taken the lead in investigating and, in this instance, sanctioning, the likes of Google, Facebook, Apple and Amazon for practices it believes are either anti-competitive for European business or detrimental to the lives of its citizens.

Only in May the commission fined Facebook €110m for providing misleading information about its takeover of WhatsApp. In January, it issued a warning to Facebook over its role in spreading fake news. Last summer, it ordered Apple to pay an extra €13bn in tax it claims should have been paid in Ireland (the Irish government had offered a tax break). Now Google has been hit for favouring its own price comparison services in its search results. In other words, consumers who used Google to find the best price for a product across the internet were in fact being gently nudged towards the search engine giant's own comparison website.

As European Competition Commissioner Margrethe Vestager put it:

"Google has come up with many innovative products and services that have made a difference to our lives. That's a good thing. But Google's strategy for its comparison shopping service wasn't just about attracting customers by making its product better than those of its rivals. Instead, Google abused its market dominance as a search engine by promoting its own comparison shopping service in its search results, and demoting those of competitors.

"What Google has done is illegal under EU antitrust rules. It denied other companies the chance to compete on the merits and to innovate. And most importantly, it denied European consumers a genuine choice of services and the full benefits of innovation."

The border-busting power of these mostly US-based digital companies is increasingly defining how people across Europe and the rest of the world live their lives. It is for the most part hugely beneficial for the people who use their services, but the EU understandably wants to make sure it has some control over them.

This isn't about beating up on the tech companies. They are profit-maximising entities that have their own goals and agendas, and that's perfectly fine. But it's vital to to have a democratic entity that can represent the needs of its citizens. So far the EU has proved the only organisation with both the will and strength to do so.

The US Federal Communications Commission could also do more to provide a check on their power, but has rarely shown the determination to do so. And this is unlikely to change under Donald Trump - the US Congress recently voted to block proposed FCC rules on telecoms companies selling user data.

Other countries such as China have resisted the influence of the internet giants, but primarily by simply cutting off their access and relying on home-grown alternatives it can control better.  

And so it has fallen to the EU to fight to ensure that its citizens get the benefits of the digital revolution without handing complete control over our online lives to companies based far away.

It's a battle that the UK has never seemed especially keen on, and one it will be effectively retreat from when it leaves the EU.

Of course the UK government is likely to continue ramping up rhetoric on issues such as encryption, fake news and the dissemination of extremist views.

But after Brexit, its bargaining power will be weak, especially if the priority becomes bringing in foreign investment to counteract the impact Brexit will have on our finances. Unlike Ireland, we will not be told that offering huge tax breaks broke state aid rules. But if so much economic activity relies on their presence will our MPs and own regulatory bodies decide to stand up for the privacy rights of UK citizens?

As with trade, when it comes to dealing with large transnational challenges posed by the web, it is far better to be part of a large bloc speaking as one than a lone voice.

Companies such as Google and Facebook owe much of their success and power to their ability to easily transcend borders. It is unsurprising that the only democratic institution prepared and equipped to moderate that power is also built across borders.

After Brexit, Europe will most likely continue to defend the interests of its citizens against the worst excesses of the global web firms. But outside the EU, the UK will have very little power to resist them.

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