Reducing Health Inequality

Natalie McGarry Excerpts

Thursday 24th November 2016 Commons Chamber

[Natalie McGarry (Glasgow East) (Ind)]

It is a pleasure to follow the hon. Member for Taunton Deane (Rebecca Pow), who makes some interesting points. I also thought the intervention from my neighbour, my hon. Friend the Member for Glasgow Central (Alison Thewliss), about the landscape in Glasgow was particularly pertinent.

Let me begin by commending the hon. Member for Totnes (Dr Wollaston), whose campaigning efforts in health matters, coupled with her ability to challenge her own Government, are second to none. I thank her for securing this debate and the Backbench Business Committee for allowing the time for it to take place in the House today. It is clear from this debate that we are united as a House in wanting to eradicate health inequality, but the issue is how we work together to achieve that.

In her opening speech the hon. Lady referred to the Prime Minister using her first speech to proclaim that her Government would fight the “burning injustice” that plagues our society. I believe it is fair to say that most burning injustices lead back to health inequalities. Inequalities in health are underpinned by greater societal inequalities—the conditions in which we are conceived and born, grow up, live, work and grow old have an immense impact on our lives. Essentially, where there are social and economic inequalities there are health inequalities, and although they are most definitely unjust, they are certainly not unavoidable. Many people—our constituents—will die prematurely and needlessly each and every year as a result of these gross inequalities. This, wherever it occurs, is a human and moral tragedy that shames us all.

During the debate today, right hon. and hon. Members from across these islands will rightly speak about their constituent nations, regions, local constituencies and their particular competences, and England will be a key focus. I would like to complement this debate by talking specifically about Scotland, Glasgow and my constituency, Glasgow East. Despite vast progress in life expectancy in Scotland over the past 150 years, our life expectancy remains lower, and our average mortality remains higher, than our neighbours across the UK and throughout Europe.

The poor health status of Scotland and our largest city, Glasgow, is well documented and is largely explained by the experiences of deindustrialisation, deprivation and poverty. However, there are now greater levels of mortality that cannot be explained by deprivation, known as “excess mortality”. For example, premature mortality rates are 20% higher in Scotland than in England and Wales, even after deprivation is accounted for, and the premature mortality rate in Glasgow is 30% higher than in equally deprived areas, such as Liverpool and Manchester. The former has been dubbed the “Scottish effect”, the latter the “Glasgow effect”. Both account for approximately 5,000 extra, unexplained deaths per year in Scotland—that is, 5,000 people dying prematurely, dying needlessly, over and above normal inequalities in health.

Traditionally, the cause of this has not been entirely understood. Research suggests that it is a combination of a change in political power, increasing income inequalities, disempowerment and deindustrialisation, the last of which has impacted on people in many ways, such as through unhealthy behaviours, psychosocial stress and, of course, poverty. In May this year, the Glasgow Centre for Population Health, NHS Scotland, the University of the West of Scotland and University College London produced a report entitled “History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow” which confirmed this.

The report, which was signed by over 30 academics and health professionals, found that Glasgow’s population was more vulnerable to factors that impacted on health across the UK, such as poverty, deprivation, deindustrialisation and economic decisions taken by the UK Government that have led to the population having poorer health outcomes. Such vulnerabilities arose from notoriously high levels of deprivation over a sustained period; urban planning decisions in the post-war period, such as the creation of monolithic, poor quality, peripheral housing estates; the regional economic policies of the UK Government and its Scottish Office; and local government responses to UK Government policies in the 1980s.

Again, where there are socioeconomic inequalities, there are health inequalities. These inequalities are not a mistake and they are not an accident, they are not inevitable and they are not irreversible. Income inequalities were relatively narrow in the UK until the late 1970s, and health inequalities declined dramatically. However, income and wealth inequalities soared again during the 1980s and 1990s, and so have health inequalities. Again, this did not happen by accident, nor did it happen in countries across the world. It happened in countries which, like the UK, made conscious decisions to roll back the state to the minimum level possible; to slash public expenditure like it was going out of fashion; to reconstruct the tax and welfare system to be less redistributive; and to champion the wants of business and the financial sector at the expense of the needs of workers and their trade unions. This was an ideologically driven Conservative Government hell-bent on pursuing a neoliberal agenda at any cost, come what may.

To break somewhat from the conciliatory tone, there were worrying signs that that approach was being mirrored by the previous Government. However, we have a new Prime Minister, and she has offered encouraging words about her Government’s ambition to fight burning injustice, but what she does matters more than what she says. Hopefully, today’s debate is a starting point.

The interventions the Government could make, which are more likely to reduce inequalities in health, are those that utilise taxation, legislation, regulation and changes in the broader distribution of income and power in society. As Michael Marmot, chair of the Marmot review, said in 2010:

“Simply restoring economic growth, trying to return to the status quo, while cutting public spending, should not be an option. Economic growth without reducing relative inequality will not reduce health inequalities.”

The Government must acknowledge that health inequalities cannot be solved with health solutions alone; they are rooted in poverty and income inequality, as well as across all areas of Government policy. Solutions from the Department of Health or the NHS will not suffice, as ably outlined by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). Therefore, the Government should commit to a joined-up, evidence-based approach of cross-departmental working, with a Minister from the Cabinet Office given specific responsibility for embedding health as a priority in all Government policy.

Inequalities in health are a matter of life and death, health and sickness, wellbeing and misery. They represent misery on the greatest scale imaginable. If the Government are looking to fight injustice, this is it. The only question is: are they up to the job, and are they willing to do it?