Redistribution of health

There are a couple of stories in the news this morning about inequality; the first is the director of public health for NHS Greater Glasgow and Clyde, Dr Linda de Caestecker, advocating a societal approach to level the playing field. Some of her ideas are good – enforcing age checks for people buying alcohol, encouraging travel on foot or by bicycle and involving parents more in keeping their children healthy. These have worked well. However, she has taken this further by suggesting closing the gap between rich and poor in order to close the gap in health. She would do this by making the wealthy (including herself, as she points out) less wealthy.

This does not make much sense in a country with a national health service. There is a minimum standard of healthcare guaranteed, so health inequalities tend to stem from lifestyle issues. Dr de Caestecker is already addressing these, with great success. Why raise taxes when raising awareness would do the same job?

The second story is that the poorest half of the population account for only one-seventh of medical school entrants. This is saddening as there are clearly many bright people who either feel that they cannot aspire to be a doctor, or are let down by the secondary education system. However, there is also the glaring fact that six years of studying medicine generates an average individual debt of £37,000. Access schemes and diversity drives mean that female medical students are now in the majority and there is a huge ethnic-minority contingent. To be fully inclusive and bring in more people from poorer backgrounds, access schemes are not enough; medical school has to be affordable.

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