Warning: inequality kills

The nanny state is far from dead: league tables of school results, of the sort published this week; curfews on unruly children; campaigns to stop people smoking; counsellors for prospective divorcees. All such measures are intended, in one way or another, to help the poor - to give them better schools and better health, crime-free environments and more stable family lives. What politicians are reluctant to contemplate, however, is a simpler solution: to give them money or, alternatively, to see to it that many of the goods and services they need to use are cheaper.

That is the message from Sir Donald Acheson's report on health inequalities, published last week. As Acheson records, health inequalities in Britain have widened alongside income inequalities. In the early 1970s, death rates for unskilled men of working age in Britain were almost twice those for professional men. Now, they are almost three times higher. The picture is similar in America. In contrast to what has happened to incomes, there has been no absolute decline in life expectancy for any section of society. We should note, all the same, that a 30-year-old black man living in Harlem is likely to die younger than a 30 year old in rural Bangladesh. We should note, too, that each year in Britain 80,000 poor people die who would have lived longer if they had been rich and that this makes poverty twice as big a killer as lung cancer.

Commentators such as Melanie Phillips in the Sunday Times argue, in effect, that the poor have only themselves to blame: if they stopped smoking, drank less, ate up their greens, went jogging and stayed married, the differences would disappear. This is quite simply wrong. Substantial research evidence, quoted in Richard Wilkinson's Unhealthy Societies (1996), shows that such lifestyle differences account for only half the inequalities in mortality rates. A barrister and a road-sweeper may both smoke 20 cigarettes a day; the barrister will still live longer. Indeed, the relationship between social status and life expectancy is so precise as almost to defy belief. One study of 18,000 civil servants - by Professor Michael Marmot, a member of Acheson's advisory group - found that even small differences in the hierarchy, like that between chief statistician and senior assistant statistician, influenced the chances of a fatal heart attack. Overall, the elite administrative class civil servants were only a quarter as likely to suffer fatal heart attacks as assistant clerks and data processors. Other studies show that for nearly all major causes of death - infection, cancers, respiratory diseases, accidents, nervous and mental illness, for example - mortality rates for blue-collar workers are higher than for white-collars. Can all this be the fault of the poor? Are they just too stupid to look after themselves?

The argument is similar in education, where the link between social class and attainment is as firm as that between class and health. Nobody likes to suggest that poor children are dumb, so they blame the teachers instead. But the first explanation may well be better: poor nutrition depresses IQ, not just in early childhood but in the last three months of pregnancy, a crucial period for brain growth. League tables, more parental choice, tougher inspections, the national curriculum - all these were supposed to narrow the gap between supposedly "failing" schools in poor areas and those in the middle-class suburbs. They have not done so. If anything, the gap has widened because, as the critics warned would happen, the changes have made it easier for better-off parents to keep their children out of working-class schools.

Richard Wilkinson and other academic authorities have concluded that inequalities of health and education are not merely the products of income differences. Inequality itself, they argue, is a killer, because it creates stress, a negative self-image and a sense of powerlessness. Yet over the past 20 years, governments have largely abandoned what is pejoratively called social engineering; even for new Labour, the reduction of inequality is a muted objective, to be achieved, if at all, by stealth. The poor, though, cannot be entirely ignored, if only because of their propensity to riot, mug and burgle. So we have social tinkering: guidelines for children's homework, curfews, health visitors, advice on eating habits and so on. On the broader picture, new Labour moves only cautiously. The true purpose of education action zones, which could be used to pour money into deprived schools, remains mysterious. Welfare reform - the key to a better life for the truly poor - is inhibited by the more antediluvian sections of the left. But Acheson suggests that new Labour must eventually think what is now unthinkable.

This article first appeared in the 04 December 1998 issue of the New Statesman, Just get out and have fun!