Guest blog from Prof Clare Bambra, Professor of Public Health Policy, Durham University.
On 29th May, Durham University’s Wolfson Research Institute for Health and Wellbeing and the independent policy think-tank Demos co-hosted a seminar on the effects of recession and austerity on health and health inequalities with a particular emphasis on the North/South divide. It is the first in a series of joint ‘research and policy’ events between the Wolfson and Demos.
The panel consisted of me (Prof Clare Bambra, Durham University), Prof Peter Kelly (Director of Public Health, Stockton on Tees), Prof Ian Greener (Durham University), Claudia Wood (Deputy Director, Demos), Chi Onwurah (Labour MP for Newcastle Central) and Guy Opperman (Conservative MP for Hexham). It was very ably chaired by Chris Jackson from the BBC’s current affairs programme ‘Inside/Out’. Chris has produced his own blog on the event here: http://www.bbc.co.uk/news/uk-england-22721007
The debate covered a variety of issues: Firstly, we discussed the North/South divide in health. This dates back to at least the early 19th century when, for example, life expectancy for all social classes was higher in Bath than in Liverpool. Today, life expectancy is 3 years less on average in the NE than the SE of England.
Secondly, we discussed social inequalities in health within the North and the UK more generally. Again these are longstanding and entrenched – in the 1830s, the gentry had a life expectancy of 55, which was more than twice as long as the 25 years for labourers. However, as the Marmot Review of 2010 has shown, these inequalities persist today. The North East has the highest health inequalities of any English region with life expectancy gaps of up to 15 years in areas such as Stockton on Tees.
Thirdly, the debate examined the effects of the recession and austerity will have on these inequalities. What impact will the global recession, the European currency crisis and widespread reductions in public expenditure have on health in the North of England and between social groups?
Finally, and most importantly we examined the role of politics – specifically the role of the state versus the individual in terms of the causes and solutions to these inequalities.
As Director of the Wolfson Research Institute, I opened the debate by outlining how my research (Work, Worklessness and the Political Economy of Health, Oxford University Press, 2011) addresses each of these issues. I argued that the North/South divide in health was a result of differences in the economy. Historically this was a result of the higher amounts of hazardous industrial work, more recently it is related to the higher rates of worklessness and poverty in the North. I also argued that unemployment is a major determinant of social inequalities in health. There is evidence that health inequalities have increased in England during the current recession, but not in countries (such as Sweden) that have stronger social security systems and have not implemented such far-reaching welfare cuts, health care reform and other austerity measures. Finally, I argued that solving health inequalities and the North/South divide required sustained state action: historically, the great public health changes have required state action from the Factory Acts of the 19th century to the recent smoking ban. I put forward three things to reduce inequalities: increasing employment rates and wage levels (Living Wage); implementing a Minimum Income for Healthy Living for all; and enhancing our social safety net.
I was followed by Prof Peter Kelly (Director of Public Health, Stockton on Tees) who argued that the North/South health divide is indisputable and is because there is more wealth and hence better health in the South than the North. He argued that healthy choices are fine for those with the resources (money, education, family support, jobs, housting etc.) but not so good for those without. He also noted that a new inequality – in childhood obesity – has developed in our lifetime: there was hardly any 40 years ago and no social gradient – now there is a North/South and poor/rich divide of some note.
Prof Ian Greener (Durham University, School of Applied Social Sciences) continued with the theme of state versus collective responsibility, eloquently arguing that we need to be more compassionate and see people engaging in harmful health behaviours as a sign of society going wrong – not blaming and stigmatising individuals. Citing the example of the obesogenic food environment and the high discounting of unhealthy foods by supermarkets, he argued that liberal ideas about choices are all about ‘me’; we will never deal with health inequalities that way. We need to think again about health inequalities and developing a ‘logic of care’, acknowledging that we really are in this together and then doing something about it. Ian has produced his own blog on the event here: http://t1ber1us.wordpress.com/Claudia Wood (Deputy Director, Demos) http://www.demos.co.uk/people/claudiawood said we should call the North/South divide what it actually is – a poor/rich divide. Disposable income is the main driver of health inequalities – she cited research which showed that only one fifth of health inequalities are attributable to unhealthy behaviours. The disposable income in the south is 26% higher than the north, unemployment rates and benefit claimant rates are higher in the north. There is no doubt that austerity is making this worse because the government is taking money out of the north. The CEBR estimates that by 2016 the North East will see unemployment rates of 13% compared to 5.6% in the South East. Cuts to local authority funding are higher in north – e.g Newcastle is losing £174 per dwelling, compared to an English average of £125. Welfare reform is also affecting the North more due to higher claimant rates – Blackpool is worst affected seeing £910 loss per person per year.
Chi Onwurah (Labour MP for Newcastle Central) reflected on her own upbringing in poverty in the North East and argued that it is still grimmer up north – and the roots of health inequality are economic. She argued that our national economy needs to be better balanced towards the regions; London is 7.5 times the size of the next largest city (Birmingham). The government needs to devolve more power over the economy from Whitehall to the regions. She was concerned that the marketization and fragmentation of the NHS under the Coalition government will have dire consequences for inequalities and access.
Guy Opperman (Conservative MP for Hexham) agreed that the North needed more attention. He pointed to the Adonis and Heseltine Reports and said the action would be forthcoming from the government in response to these. He argued that part of the problem with the North/South economic divide was that Whitehall departments need to be much better at talking to each other and progress on this issue is too slow; proper integration of services is needed. He argued that personal responsibility is an important factor behind health inequalities but that we need to make healthier choices easier for people. So for example, he has actively campaigned (in opposition to his own government) for a minimum alcohol unit price as this should be in place to protect public. Supermarkets should also be stopped from selling low price alcohol, especially via displays at the checkout. He also spoke about the need for a shift in health services so that we are less ‘reactive’ and more ‘pre-emptive’ and with more of a focus on specialist hospitals. Guy has produced his own blog reflections on the event here: http://guyopperman.blogspot.co.uk/2013/05/durham-university-healthcare-debate.html
The opening panel comments were followed by a lively audience debate with many questions and comments. Most of these were directed at the two MPs, particularly Guy Opperman in regards to NHS and welfare reform policies of the Coalition government.
Uniting the panel and the audience was a clear consensus that there is too much emphasis on the South East – and on London in particular – in the UK policy process, and that this perpetuates and exacerbates the North/South divide in the economy and health.