UK report calls for policies to halt growing inequalities in health
BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7171.1471 (Published 28 November 1998) Cite this as: BMJ 1998;317:1471All rapid responses
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It is obvious that the cheapest way of reducing inequalities in health
and education provision is to reduce the standard of service to the
wealthy. Thus, closing grammar schools, making the motorist pay for
hospital treatments of accidents, introduction of a means tested charges
for such luxury items as sports injury clinics, antenatal clinics, etc
would have the desired effect of reducing the educational and health
status of the wealthy. This would improve the inequality ratio, which is
of such concern to Health and Government Statisticians and SAVE money.
Surely this Old Labour reflex "of beggar my neighbour" which Dr Colin
Guthrie appears to be advocating is something that should be avoided. The
Acheson Report should be welcomed and should not be used as ammunition to
fight ancient class wars, but as a springboard to new initiatives which
might improve the overall health of the Nation.
Competing interests: No competing interests
As a GP in Glasgow I find this report toothless and duplicitous.
Taking some of these key recommendations....
* All policies likely to affect health should be evaluated in terms
of their impact on health inequalities.
We have a Council determined to build a new motorway on the south
side of the city which will pollute from increased traffic levels and run
the very real risk of releasing chromium into the environment ( from old
car manufacture in the sixties )The area affected, the Gorbals, houses a
deprived community who will suffer further injustice just to ensure that
the more affluent can commute more speedily from their leafy cul-de-sacs.
It looks as if this socially devisive and destructive M74 extension may
get the go-ahead due to the economic clout of a small group of self-
serving Glasgow businessmen. Where is the equity here?
Can anyone medical ever forget the million pounds taken from
Bernie Ecclestone by the incoming Labour administration and the agreement that all
racing cars can bristle with tobacco logos until well into the next millenium?
Smoking is linked with deprivation and we know from a recent Lancet study
that boys who follow motor-racing are twice as likely to start smoking.
* Reducing income inequalities and improving the living standards of
households receiving social security benefits.
I see a lot of families who are at the brink of such payments and are
in a peculiar financial limbo where their income is damned whatever they
try and do.
*Improvement in the availability of social housing for the less well
off.
Certainly not in Glasgow. This council is now arranging for the total
privatisation of it's housing stock. debts are so huge the only way out is
to sell the everything to a private company. The tenants are pracically up
in arms about it. If a private company owns the housing then their will be
no such thing as 'social housing'. This Government is therefore
encouraging a company to profit from housing the most vulnerable section
of society. What chance will there then be of any 'improvement in
availability'?
*Policies to increase the availability and accessibility of
foodstuffs to supply an adequate and affordable diet.
This is rich coming from an administration that has just ditched its
long promised Food Standards Agency.
This agency might have brought some legislative teeth to our food industry
which is a very unhealthy monopoly with high prices and poor quality being
maintained by three supermarket chains.
The poor need cheap,good quality,nutritious food provided locally in their
area.They do not have transport to get to supermarkets and yet this
administration continues to permit large supermarket developments on the
edge of out towns and cities.This deprives the poor of what limited choice
they once had as their High street shops curl up and die in the face of
this unfair competition.
Social exclusion? No, this is much worse than that. The middle classes
have taken from the deprived what little they had left and used it for
ourselves with the continuing connivance of policy makers.
This must be social collusion.
Competing interests: No competing interests
Re: Reducing inequality is a two-edged sword.
Dr Guthrie does not seem to be advocating 'reducing the quality of
care given to the wealthy', just a fair deal for all. Acheson's key point
seems to me to be that redistributove taxes are going to have to be key
part of reducing inequality in health, as in inequality in any other
matter.
Unfortunately, the Labour government was elected on the premise that
they would not increase taxes, leaving them with little room for manouver
on housing, ecucation etc. It remains to be seen if they are going to get
anywhere in reducing inequality without a large injection of cash to those
parts of the country like Glasgow that are in a pretty serious sate of
decline. I know of places in my own patch, Leeds, where civilisation has
all but ceased to exist, crushed under crime, deprivation, depression and
the sheer apathy they bring to both the population and the authorities
they expect to do something about it.
Another good point raised by Dr Guthrie is the democratic deficit.
Much development is in the interests of the developers and no-one else. I
think he is going a bit far in his conspiracy theories, but I think he is
right to say that money is only spent on development where it will give a
quick and obvious return of more money for the investor. This is the
unacceptable face of capitalism - cash only exists to make more cash, and
bugger the human element. Markets must be restrained by democratic
accountability and we just haven't got that. Go and talk to your local
tree sitting fraternity - most are bats, but you will find a tidy number
of people that are doing what they are doing out of a sense of
disempowerment and disenchatment with the current political system. It
would be nice if their energy could be harnessed to something more
substantial than saving snails.
Competing interests: No competing interests