{"id":182,"date":"2020-02-29T14:08:33","date_gmt":"2020-02-29T14:08:33","guid":{"rendered":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/?p=182"},"modified":"2020-02-29T16:17:49","modified_gmt":"2020-02-29T16:17:49","slug":"marmot-10-and-the-grim-prognosis-for-health-equity","status":"publish","type":"post","link":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/2020\/02\/29\/marmot-10-and-the-grim-prognosis-for-health-equity\/","title":{"rendered":"Marmot +10 and the grim prognosis for health equity"},"content":{"rendered":"\n

Most readers will now be aware of the release on 25 February of the ten-year followup<\/a> to the 2010 \u2018Marmot review\u2019 of health inequalities in England.\u00a0 To say that the report makes depressing reading is putting it mildly.\u00a0 Despite the epidemiologist\u2019s caution expressed in Sir Michael Marmot\u2019s foreword \u2013 \u2018We were reluctant to attribute the slowdown in health improvement to years of austerity because of difficulty in establishing cause and effect \u2013 we cannot repeat years without austerity just to test a hypothesis\u2019 \u2013 the report as a whole offers a devastating portfolio of evidence of the human damage done by a decade of austerity.\u00a0 Its accumulation of graphs and charts makes a compelling case for the point I try to bring home to postgraduate students at every opportunity: public finance is a public health issue.\u00a0 An especially bitter irony, of course, is the emerging recognition across much of the political spectrum, and of the economics profession, that the decade was not only unnecessary but even counterproductive in macroeconomic terms. <\/p>\n\n\n\n

Unfortunately, that kind of evidence is not relevant to the broader post-2010 project of redistributing income, wealth, and opportunity upward <\/em>within British society.\u00a0 (The brilliant and iconoclastic economist Branko Milanovic has pointed out<\/a> that the rich have much more to gain from such upward redistribution than from stimulating growth across an entire national economy; their ready access to tax avoidance opportunities unavailable to the rest of us further distorts the incentive structure.) \u00a0Neither does evidence of macroeconomic (in)effectivess bear on what might be called the micro-level attack on the poor, marginalised and precarious.\u00a0 The day after the release of Marmot +10, The Independent <\/a><\/em>reported<\/a> that the Department of Work and Pensions had shredded \u2018up to 49\u2019 internal reviews of suicides that occurred after people\u2019s benefits had been cut off.\u00a0 This followed an earlier report<\/a> of 69 suicides among benefit claimants in the past five years, which is almost certainly a low figure.\u00a0 <\/p>\n\n\n\n

Just a few\nitems from the report deserve flagging. \nFewer than 200,000 workers in the UK were on zero hours contracts in\n2010; by late 2018 the figure was close to 900,000.  For the poorest tenth of English households,\neating healthily would require three-quarters of all<\/em> their disposable income after housing costs.  And the targeted financial destruction of\nlocal government has led (for example) to an England-wide reduction of 42\npercent in local spending on transport and a 52 percent cut in housing.  As the report points out, \u2018councils have used\nreserves, sold assets and reduced spending on the non-statutory services they\nare not legally required to deliver\u2019. <\/p>\n\n\n\n

None of\nthis matters to Mr. and Mrs. Range Rover, of course.  An Arizonan interviewed by US journalist Ken\nSilverstein captured\nthe underlying political economy<\/a> a decade ago: \u2018People who have swimming pools\ndon’t need state parks. If you buy your books at Borders you don’t need\nlibraries. If your kids are in private school, you don’t need K-12. The people\nhere, or at least those who vote, don’t see the need for government.\u2019  And The\nTimes<\/em> recently\nreported<\/a> that residents in some of London\u2019s ultra-wealthy boroughs pay less\nthan \u00a31 in council tax for every \u00a31,000 of property value, whilst those in ten\npoor local authorities in the Midlands and the North such as Hartlepool,\nMiddlesbrough, Gateshead and Stockton-on-Tees pay between ten and fourteen\ntimes as much (unfortunately behind a paywall; contact me if you would like the\nfigures.)<\/p>\n\n\n\n

 It is hard to know how to respond to such\nsituations, beyond despair and resignation. \nThese responses are heightened by the fact that many of the new report\u2019s\n\u2018case studies,\u2019 seemingly intended as success stories, are at best sticking\nplasters, doing little to address the critical upstream drivers of inequality \u2013\nthe \u2018toxic combination of poor social policies and programmes, unfair economic\narrangements, and bad politics\u2019 correctly targeted by the 2008 Commission on\nSocial Determinants of Health.  I have to\nremind myself more and more often that the last word in Albert Camus\u2019 famous\nessay on suicide is hope.  One hope is\nthat public health researchers and practitioners might disengage themselves\nfrom producing yet more systematic reviews of the evidence, organised around\nimpossibly and inappropriately high epidemiological\nstandards of proof<\/a>, and turn attention, energy and pedagogy to more\npractical questions such as what to do when government adopts homicidal social\npolicies and then destroys the evidence.  <\/p>\n","protected":false},"excerpt":{"rendered":"

Most readers will now be aware of the release on 25 February of the ten-year followup to the 2010 \u2018Marmot review\u2019 of health inequalities in England.\u00a0 To say that the report makes depressing reading is putting it mildly.\u00a0 Despite the … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1834,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[4,15,31,14],"class_list":["post-182","post","type-post","status-publish","format-standard","hentry","category-uncategorised","tag-austerity","tag-health-equity","tag-marmot-review","tag-social-determinants-of-health"],"_links":{"self":[{"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/posts\/182","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/users\/1834"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/comments?post=182"}],"version-history":[{"count":4,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/posts\/182\/revisions"}],"predecessor-version":[{"id":186,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/posts\/182\/revisions\/186"}],"wp:attachment":[{"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/media?parent=182"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/categories?post=182"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/theodoreschrecker\/wp-json\/wp\/v2\/tags?post=182"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}