The Socialist 5 October 2016 |
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Non-fiction: Health Divides
Review: where you live can kill you
NHS workers marching in Manchester, 4.10.15, photo Sarah Wrack (Click to enlarge)
Clare Bambra provides a good, easy-to-understand introduction to the major causes of health inequality in rich countries.
The opening chapters introduce the concept of 'health divides' - not only across regions, but often within neighbourhoods. One shocking example is Stockton-on-Tees, where life expectancy varies by 17 years between rich and poor parts of the town.
Bambra goes on to explain the multifaceted causes of health inequalities. Denouncing the claim that poor health is due to poor personal choice, she suggests instead it is a mixture of lifestyle and area that contributes to health inequalities.
Poverty is identified as one of the most pertinent determinants of health. It is strongly linked to unemployment, poor education, poor diet and lack of good housing. Bambra also explores how the rapid deindustrialisation of the north of England and parts of Scotland has led to a certain north-south divide in health.
Using the metaphor of a river, Bambra explains that ultimately it is political choices that are the "upstream" cause of health inequality. Political choices to spend less money in working class areas have led to poor education, poor housing, unemployment and the misery and despair those things cause. All this has contributed to health-damaging behaviours such as smoking and excessive drinking.
The book concludes by discussing recommendations from past reports on health inequality, including the Black report and the Marmot report. These identified many of the health issues stemming from unemployment, poor housing and poverty - but governments ignored their recommendations.
Bambra suggests this is due to the neoliberal idea that health is an individual issue. Wider determinants of health are therefore ignored.
While the book explores in-depth the causes behind health inequalities, correctly identifying politics as the root cause, it does relatively little to explain what is needed to resolve it. For example, while commending recommendations such as "building more high quality social housing", the book does not explore in much depth why it is that these policies were not put into practice, and why such large health divides still exist today.
The recommendations in the concluding chapter could also go much further. Bambra suggests we must lobby MPs, and vote in a government that will put through better health policy.
Of course, pressuring political representatives, and campaigning for a pro-working class health policy on the electoral plane, are important parts of any health strategy. But on their own they are not enough to tackle the shocking health inequalities highlighted in the book.
To really overcome health divides, it is necessary to build a mass movement to fight against austerity and for sweeping improvements to reduce inequality. A £10 an hour minimum wage without exemptions, and living benefits for those out of work. A mass programme of public works to create jobs and services. Free education. A fully funded, publicly owned NHS. And high-quality, genuinely affordable housing for all.
Essential reforms like this will not willingly be granted by the capitalist establishment, but need to be fought for and won by the organised working class. Only then will we see a true reduction in health inequalities.
And ultimately, the only way to make such reforms permanent is to transform society. That means fighting for a publicly owned, democratically controlled economy, with a socialist plan of production to meet the needs of all, rather than enriching a tiny minority.
- 'Health Divides: where you live can kill you' by Clare Bambra - £12.99 plus postage from Left Books - www.leftbooks.co.uk - 020 8988 8789