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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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For the first time in my life I have a sworn enemy – and I don’t even know her name

The cyclist, though, was enraged. “THAT’S CLEVER, ISN’T IT?” she yelled. “WALKING IN THE ROAD!”

Last month, I made an enemy. I do not say this lightly, and I certainly don’t say it with pride, as a more aggressive male might. Throughout my life I have avoided confrontation with a scrupulousness that an unkind observer would call out-and-out cowardice. A waiter could bring the wrong order, cold and crawling with maggots, and in response to “How is everything?” I’d still manage a grin and a “lovely, thanks”.

On the Underground, I’m so wary of being a bad citizen that I often give up my seat to people who aren’t pregnant, aren’t significantly older than me, and in some cases are far better equipped to stand than I am. If there’s one thing I am not, it’s any sort of provocateur. And yet now this: a feud.

And I don’t even know my enemy’s name.

She was on a bike when I accidentally entered her life. I was pushing a buggy and I wandered – rashly, in her view – into her path. There’s little doubt that I was to blame: walking on the road while in charge of a minor is not something encouraged by the Highway Code. In my defence, it was a quiet, suburban street; the cyclist was the only vehicle of any kind; and I was half a street’s length away from physically colliding with her. It was the misjudgment of a sleep-deprived parent rather than an act of malice.

The cyclist, though, was enraged. “THAT’S CLEVER, ISN’T IT?” she yelled. “WALKING IN THE ROAD!”

I was stung by what someone on The Apprentice might refer to as her negative feedback, and walked on with a redoubled sense of the parental inadequacy that is my default state even at the best of times.

A sad little incident, but a one-off, you would think. Only a week later, though, I was walking in a different part of town, this time without the toddler and engrossed in my phone. Again, I accept my culpability in crossing the road without paying due attention; again, I have to point out that it was only a “close shave” in the sense that meteorites are sometimes reported to have “narrowly missed crashing into the Earth” by 50,000 miles. It might have merited, at worst, a reproving ting of the bell. Instead came a familiar voice. “IT’S YOU AGAIN!” she yelled, wrathfully.

This time the shock brought a retort out of me, probably the harshest thing I have ever shouted at a stranger: “WHY ARE YOU SO UNPLEASANT?”

None of this is X-rated stuff, but it adds up to what I can only call a vendetta – something I never expected to pick up on the way to Waitrose. So I am writing this, as much as anything, in the spirit of rapprochement. I really believe that our third meeting, whenever it comes, can be a much happier affair. People can change. Who knows: maybe I’ll even be walking on the pavement

Mark Watson is a stand-up comedian and novelist. His most recent book, Crap at the Environment, follows his own efforts to halve his carbon footprint over one year.

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood