Labour isn't working

Alex Scott-Samuel describes why government health inequalities
policies are failing

Public Health News, October 17th 2005

Many people were surprised when the Tackling health inequalities
status report, published in August, revealed that between 1997
and 2003, trends in both of the government’s headline indicators
- which measure the social class gaps in life expectancy and
infant mortality - showed that health inequalities had in fact
increased.

I wasn’t as surprised by this as other NHS colleagues. Having
closely followed progress on inequalities over the last 30
years, it seems to me that the current situation represents a
clear indication that good intentions and effusive rhetoric are
not enough to turn the tide. The only way to address
inequalities is to eliminate their root causes.

People could, however, be forgiven for expecting better news.
After all, Labour’s election victory in 1997 was followed by the
Acheson report on health inequalities, along with a wide range
of strategies, policies and projects aimed at reducing
inequalities. But Labour’s attitude to the fundamental causes of
inequality changed radically after Frank Dobson and Tessa Jowell
left the Department of Health in 1999.

The Saving lives: our healthier nation green and
white papers had explicitly adopted a holistic,
socio-environmental model of the determinants of health. None of
their successors followed this path - most of them reverted to
the ‘downstream’ approaches of previous Conservative governments
by focusing public health action on diseases and their immediate
antecedents. While the health promotion focus of the recent
Choosing health white paper is welcome, the individualistic
gimmickry that characterises its approach is unlikely to make
any impact on health inequalities.

The failure of New Labour’s policies to reduce health
inequalities can hardly be seen as bad luck. After all, we have
the evidence from 18 years of divisive Conservative government.
And we have a long history of gathering statistics on social
class and mortality from which to learn.

This evidence - showing no diminution in inequality during the
20th century - teaches us that focusing on diseases is a waste
of time. Just as the introduction of antibiotics improved
average life expectancy but failed to impact on inequality, it
has long been apparent that reducing diseases more prevalent
among poor people merely results in new inequalities, caused by
different diseases which take their place - what epidemiologists
call competing risks of death.

The bottom line is that, while the NHS has to deal with the
health inequalities caused by the government’s policies, the
root causes of those inequalities lie elsewhere - in the impact
of the growth-obsessed economy, the open market in trade and
services, and the patriarchal culture of foreign and domestic
policy which surrounds us. There is a large body of evidence
demonstrating the damage such approaches cause to health, equity
and social democracy.

So what is to be done? It seems unlikely that Tony Blair’s
‘Christian Democrat’ government will change its policies while
he remains prime minister. That being so, we are unlikely in the
short term to see any improvement in the root causes of health
inequality. I’m referring here to reductions in income and
wealth inequalities, a reversal of the increasing privatisation
and diminution of our welfare state, acknowledgement of, and
action on the excessive masculine gender roles (aggression,
risk-taking, emotional illiteracy) instilled into our young people.

These latter characteristics not only create envy, greed, and
competitiveness rather than collaboration, they are also linked
with greater levels of both domestic violence and political
conflict. What we so badly need is to move towards a society in
which those who govern us – and in turn, we ourselves –
genuinely value, are valued by, and support each other. No area
of government should be exempt from fully observing these
principles. Once we have that, we can set realistic targets for
cutting health inequalities.


Dr Alex Scott-Samuel is joint chair of the Politics of Health
Group. See www.pohg.org.uk

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