Thursday 23 November 2006

The Impact of Inequality: How to Make Sick Societies Healthier

Professor Richard Wilkinson at Café Scientifique, Nottingham, 13 November 2006

Café Scientifique is a nationwide network that regularly put on debates around scientific issues. Their branch in Nottingham is held at Wax bar, a rather poky but very welcoming little place in an area of the city more famed for its binge focused super-clubs than its cultural events. Inside, the crowd is not your usual Nottingham bingers either; whilst not everyone was middle aged, my companion, a fellow student, and I did have the feeling of lowering the average age by a couple of years at least.

This Monday night, we were here to see Professor Richard Wilkinson, an epidemiologist at the, and author of The Impact of Inequality: How to Make Sick Societies Healthier, talk about some of the issues raised in his book and work more broadly.

Before the talk, the professor handed out a formidable bundle of graphs, documenting the correlations between income inequality in developed nations and ill health. His talk essentially followed these lines, demonstrating how nations like the US, UK and Portugal fare poorly when compared to the Japanese and Scandinavians. His research seemed (from my lay perspective) pretty convincing; and his data echoed that of the Radical Epidemiologists of the 1970s, a group of leftist doctors who blamed much of the ill health within our society on its inherently unequal structure.

When we got stuck into the questions and answers, however, it became clear that Wilkinson’s solutions were in a far more Blairite mould than the (literally) revolutionary measures suggested by these earlier doctors and researchers. My question to him focused on the increasingly interventionist health policies enacted by this government; if inequality was a major contributor to obesity, heart disease and the rest, surely fixating on people’s individual eating habits was at best a palliative, and at worst increasing the problem, by victimising and alienating the groups that most need help? He conceded that health promotion was often ineffective and costly, and suggested there could be better uses for our resources, but stopped there, with no recognition of its coercive implications.

It became clear that Wilkinson’s focus was very much on relative rather than absolute poverty. He spoke about the psychosocial implications of inequality - the effect of being looked down upon, of feeling inferior to others. He used a study on dominance relationships within baboon populations to back up his point (rather bizarrely I am informed, as there was a 1970s study showing exactly this kind of effect in British civil servants - no need for apes). Wilkinson also questioned the usefulness of economic growth, at least after the initial round which moves a society from Third World conditions to industrialisation. To this end he quoted Richard Layard’s work on happiness, very much the theorist du jour for everyone from Tony Blair to David Cameron and beyond.

However this focus on merely the psychosocial aspects of poverty neglects the real material problems that face thousands of people still. A single mother living on £45 per week in bad quality housing will suffer the stress and depression that will contribute to ill health not just because she has feelings of inferiority. Free childcare, decent housing stock, and a living dole, all provided by economic growth, would help her more than any rebalancing of ‘happiness’ in society.

In one digression, Wilkinson even ended up advocating carbon rationing; the fact that the poor would essentially no longer be able to travel abroad when they are forced to sell their ration didn’t seem to register. His performance begged the question whether to him the problem with poverty is its malign effect on abstract ‘public health’, or the destructive effect it has on the lives and human potential of its victims.

Professor Wilkinson’s problem, and what separates him from the tradition of the radical epidemiologists (to which he may well claim allegiance), is the uncritical acceptance of the market. To be fair, the drastic political changes of the intervening 30 years have made it almost impossible to think outside that particular political box. But that doesn’t excuse the negative implications of that position; namely that real people, and their potential to take charge of their own lives take a back seat to an obsession with statistics and low expectations.

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