Inequality kills
Politicians take heed: social injustice is, literally, deadly
By Peter Wilby Published 04 September 2008When a report from the World Health Organisation came out a few days ago, the media highlighted an extraordinary fact: that life expectancy in one deprived area of Glasgow is lower than in India, Philippines, Poland, Mexico and Cuba. This, you might think, is attributable to booze, fags, bad food and lack of exercise.
You would be right - but only partially so. The WHO report (Closing the Gap in a Generation) has a much bigger message, summed up in a single sentence: "Social injustice is killing people on a grand scale." That means what it says. Fat, sugar, cigarettes and alcohol are certainly killers, and a propensity to indulge in them is itself related to income and social status. But even if you eschew bad habits and lead a blameless life, your socio-economic status is likely to get you in the end. Inequality is the biggest killer of the lot.
The evidence was set out in The Status Syndrome, a book published in 2004 by Michael Marmot, the British professor who headed the commission that produced the WHO report. He quoted a study of office-based civil servants that first highlighted health's "social gradient" in the 1990s. It found that, at each grade down the Whitehall hierarchy, mortality increased. Between the ages of 40 and 64, those in the bottom grade were four times more likely to die than those at the top. Beyond retirement, the gap narrowed, but even in their seventies and eighties, men in the lower grade had twice the risk of death. As Marmot put it, "differences in lifestyle provide only a modest explanation". For example, smoking, cholesterol, blood pressure and so on explained only a third of the difference between the top and bottom grades in the risk of dying from coronary heart disease.
Without the right social policies, economic growth “brings no benefit to health”
I do not think we have yet grasped the import of this and similar research. We traditionally assume that health improvement is delivered by medical advances, better hospitals, more doctors and more spending on health services. Most political argument is about how to achieve these ends, with the role of preventative health - improved lifestyles - now adding a further dimension. The WHO report is saying something quite different: health is political in the broadest sense because it is influenced by the distribution of power, income, goods and services. Here are some more facts. US blacks are rich by world standards but, in a highly unequal country, most are very poor by local standards. People from Tunisia, Jamaica, Panama, Libya, Lebanon and Cuba all have higher life expectancies than the US black population. If black mortality rates were the same as those for US whites 886,202 deaths would have been averted between 1991 and 2000. Over the same period, 176,633 lives were saved by medical advances.
The WHO report shows that, if we want to achieve health equity and close the gap between rich and poor, we have to abandon the "Washington consensus" that has dominated western political and economic thinking for 25 years. Take the "flexible workforce" sought by new Labour as well as the Tories. Temporary, part-time and insecure work are all associated with poor health, according to the WHO report. Take the trend towards harsher social security schemes, means-tested and "targeted" at the "deserving" poor. The WHO insists that "generous universal social protection systems are associated with better population health".
Access to free education as well as free health services is important; the WHO deplores the user charges being imposed on many developing countries in the name of balancing state budgets. Progressive taxation, a strong public sector and private-sector regulation are all essential, the report argues. "Community or civil society action," it adds, ". . . cannot be separated from the responsibility of the state to guarantee a comprehensive set of rights and ensure the fair distribution of essential . . . goods . . . Top-down and bottom-up approaches are equally valid." Are you listening, David Cameron?
Above all, we should abandon the belief that everything must be sacrificed to economic growth. Without the right social policies, says the WHO report, growth "brings no benefit to health". Up to a certain, quite low level (which most of sub-Saharan Africa hasn't reached), higher national income brings dramatic health gains. Beyond that, the effect is slight and inconsistent.
The WHO report demands a revolution in current political thinking. The case for social justice, it shows, does not rest on ideology or class envy, but on "an ethical imperative", a preference for life over death.
It should be read, in full, by every politician on earth.
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5 comments
Oh the implication is clear:
We have got it wrong. We need a global mixed economy rather than the global neo-liberal inequality generating machine that is currently exported to us from Washington.
This, along with New Orleans, is another nail in the Coffin. When will the Europeans wake up and see that they have the moral leadership in terms of having a social model that has a viable future (given some massive cut-backs in natural resource consumption.)
Oh the times, they are a changin'
Although there are those (e.g. Monbiot) that argue that an interest based system of monetary creation, and an unregulated banking system built around usary, are bound to lead to an ever increasing money supply.
In order to tackle inflation, when needs an increase in goods and services to match this money supply, leading to an exponential increase in natural resource usage.
Since we have not been able to match this exponential growth with exponential increases in natural resource productivity, nor do we seem likely to achieve this, then this implies the need for major social changes, that call even the European model into question.
If this logic holds, then we really are talking about a revolution.
We are not living in an ideal world such that everyone is happy and satisfied. But this does not mean that the world leaders cannot do just to their own people. I mean it is up to individual government to ensure that the gaps between the have and the have not are reduced. This should be the priority of every government. The problem is being politicians, they are more interested in politics. So the next public defender would be the public servants. These people should avoid corruption because corruption within the public servants is the main culprit in the social injustices and inequalities. Besides that, those who are being deprived of their rightful needs should be more vocal and not depend just on the NGOs and WHO to be their spokepersons.
All those countries get more sunshine than Scotland, and sunshine appears to be a major factor in health due to the critical role of vitamin D in immune system function.
The WHO should perhaps not propose conclusions.
"Take the "flexible workforce" sought by new Labour as well as the Tories. Temporary, part-time and insecure work are all associated with poor health, according to the WHO report. "
Temporary workers are also despised by Trade Union leaders and their members. Peter Wilby should carry his excellent analysis to the TUC and find out why this health inequality was ignored by Harriet Harman in her speech there. When she ran her dirty and illegally funded campaign to stop John Cruddas from becoming Deputy Labour Party Leader, her manifesto included equal rights for temporary workers. Which Trade Union Leader spoke for temporary workers at the TUC? They are too busy asserting the rights of lavishly over stuffed public sector employees and taxing temporary workers to pay for it.
Peter Wilby quotes with approval the WHO's conclusion on the duty of the state to ensure the fair distribution of goods and I agree with him. "Goods", though, must not just relate to the physical distribution of material possessions, but must also refer to the moral attribution of respect for rights and humanitarian values.