Inequality kills

Politicians take heed: social injustice is, literally, deadly

When 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.

Peter Wilby was editor of the Independent on Sunday from 1995 to 1996 and of the New Statesman from 1998 to 2005. He writes the weekly First Thoughts column for the NS.

Photo: Getty Images/AFP
Show Hide image

Why is the government charging more women for selling sex but turning a blind eye to buyers?

Since 2013, the number of women charged for selling sex gone up while the number of men charged for buying it has gone down.

It’s no surprise that prostitution policy is an area rarely visited by our legislators. It’s politically charged - a place where the need to prevent exploitation seemingly clashes head on with notions of liberal freedom; where there are few simple answers, a disputed evidence base, and no votes.

There’s also little evidence to suggest that MPs are different from the rest of the population - where one-in-ten men have purchased sex. It is little wonder therefore that our report on how the law should change, published in 2014, was the first major cross-party intervention on the subject in twenty years.

Some take the view that by removing all legal constraints, it will make the inherently exploitative trade of prostitution, safer. It’s not just me that questions this approach, though I accept that - equally - there’s no consensus that my preferred measure of criminalising the purchase of sex, while decriminalising the sale, would fundamentally change the scale of the problem.

Where all sides come together, however, is in the desire to see women diverted from the law courts. It is still possible for women (and it still is women; prostitution remains highly genderised) to go to prison for offences related to prostitution. Today, in 2015.

The total number of prosecutions for all prostitution offences in England and Wales has been decreasing since 2010, but not in a uniform fashion. This does not reflect a reduction in the size of the trade, or the violent nature of it.

There were once consistently more prosecutions for kerb crawling, profiting, and control of prostitution. But since 2013, there have been more prosecutions for soliciting or loitering than for profit from prostitution and kerb crawling each year.

In simple terms, offences committed by men with choice, freedom and money in their pocket are having a blind eye turned to them, while women are being targeted - and this trend is accelerating. In the law courts, and in prosecutions, it is the most vulnerable party in the transaction, who is taking the burden of criminality.

Take on-street sex buying as an example. In 2013-14 just 237 prosecutions were brought for kerb crawling, but there were 553 - more than twice as many - for loitering and soliciting.

There is a similar pattern in the 2014/15 figures: 227 charges for kerb crawling reached court, while 456 prosecutions were initiated against those who were selling sex. Just 83 prosecutions for control of prostitution, or ‘pimping’, were brought in that same year.

These are men and women on the same street. It takes a high level of liberal delusion to be convinced that prostitution is caused by a surge of women wishing to sell sex, rather than men who wish to buy it. And yet women who sell sex are the ones being targeted in our law courts, not the men that create the demand in the first place.

This situation even goes against the Crown Prosecution Service’s (CPS) own guidance. They say:

“Prostitution is addressed as sexual exploitation within the overall CPS Violence Against Women strategy because of its gendered nature… At the same time, those who abuse and exploit those involved in prostitution should be rigorously investigated and prosecuted, and enforcement activity focused on those who create the demand for on-street sex, such as kerb crawlers.”

Why then, is this happening? For the same reason it always does - in our criminal justice system stigmatised, poor women are valued less than moneyed, professional men.

My debate in Parliament today raises these issues directly with the government ministers responsible. But to be honest, the prosecution-bias against women in the courts isn’t the problem; merely a symptom of it. This bias will only be tackled when the law reflects the inherent harm of the trade to women, rather than sending the mixed signals of today.

That’s why I welcome the work of the End Demand Alliance, composed of over 40 organisations working to end the demand that fuels sex trafficking and prostitution, advocating the adoption of the Sex Buyer Law throughout the UK.

This would criminalise paying for sex, while decriminalising its sale and providing support and exiting services for those exploited by prostitution. Regardless of these big changes in the law, I don’t see how anyone can support the current state of affairs where there are more prosecutions brought against women than men involved in prostitution.

The authorities are targeting women because they're easier to arrest and prosecute. It goes against their own guidance, common sense and natural justice.
And it needs to stop.

Gavin Shuker is MP for Luton South and chair of the All Party Group on Prostitution and the Global Sex Trade.