Without walls: towards health and wellbeing in the 21st century
Scotland’s poor health record has its roots in income inequality, says Dr RICHARD SIMPSON
We have some of the worst health in Europe, despite our very good health service. And that’s because of the gap between the rich and the poor and an NHS where hospitals are too powerful.
In the last couple of decades we’ve built many new hospitals and trained thousands more doctors and nurses. But even though we now spend up to the European average on the NHS, our health in the UK, and especially in Scotland, remains one of the worst in Europe. People in Scotland can still expect to live shorter lives than most of their European counterparts.
We have confused good medicine with good health. We have lots of “good medicine” – but our poor health is now even threatening to overwhelm some parts of the NHS. The massive increase in obesity, for example, which hospitals can’t control, is sending more and more people into hospitals for cancers, for diabetes, and for fat-reducing surgery. At a time when public services are having to watch every penny, letting our nation’s health slide, as the government may do, is going to be very expensive.
So why, when our medicine is good, is our health not as good as it should be? The “wrong” lifestyles and poverty are two of the reasons normally given. But those aren’t the root causes. The poor health record of Scotland, indeed the whole UK, exists not just because poor people in poor communities are less healthy than they should be, though they are. Our poor health is a consequence of inequality, the size of the income gap between rich and poor.
People don’t like to hear that, but you look around the world and you see it’s true. The USA is richer than us, spends more on health but is more unequal, and people die younger. Spain is poorer than us, spends less on health services but is more equal, and people live longer. Thatcher and Major increased the gap between rich and poor. That’s had a massive impact on people’s health.
There are important lessons for us now. The drastic changes the Conservative/Liberal Democrat government wants to make to the way we deliver medicine in England are unlikely to mean better health. In fact, our nation’s health will likely get still worse as cuts and higher taxes hit the poorest hardest; even more so if they cut all the cheaper things, like proper home care for elderly people, that keep people out of hospital. Worse health will pile even more pressure on the NHS.
The lesson is simple: in times when money is short, government needs to focus on health, not just medicine. We should think beyond just what the NHS does in hospitals because our health is more to do with all the other community and local public services – protect them and you protect the NHS. That’s why, in their last manifesto, Scottish Labour set out plans to merge the national primary and community health budget with the local budgets for elderly social care, learning disability and mental health. Run by existing Scottish Community Health Partnerships, this national care service would have been more accountable through the increased involvement of local councillors.
Our health will improve if we narrow the gap between rich and poor. For the sake of our health, the government should recognise the public mood to increase fairness and take radical steps to reduce income inequality, placing the heaviest burden on the broadest shoulders. If we want to be better, in health and much else, we have to be fairer.
Dr Richard Simpson MSP is Labour’s Shadow public health spokesman in the Scottish Parliament. This article is based on the Socialist Health Association discussion document written by Dr Simpson and Professor Trevor Davies. The full discussion paper can be downloaded here.