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‘More like arbitrary execution’

During the period 1972-6, the gap in life expectancy between social classes I and V was 5.4 years for men and 4.8 years for women. By the time New Labour succeeded the Tories in government, these gaps had risen to 9.4 years and 6.3 years respectively (see tables 1 and 3 in ‘Life expectancy by social class’, UK Government Statistics).

One of New Labour’s purported aims in office was to reduce these inequalities. In 1997 Health Secretary Frank Dobson stated that “Inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you’ll die sooner because you’re badly off”; while Tony Blair himself wrote: “Our society remains scarred by inequalities. Whole communities remain cut off from the greater wealth and opportunities that others take for granted. This, in turn, fuels avoidable health inequalities. The statistics are shocking enough. Families in these communities die at a younger age and are likely to spend far more of their lives with ill-health. Behind these figures are thousands of individual stories of pain, wasted talent and potential. The costs to individuals, communities and the nation are huge. Social justice demands action”.

The interim research indicates that Labour have utterly failed in this aim. Examining Labour’s record, the British Medical Journal reported in 2005 that “inequalities in life expectancy have continued to widen” and that “When individual local authority districts are compared, the difference between the one with the lowest life expectancy (Glasgow City) and the one with the highest (East Dorset) has risen to 11 years. Since Victorian times, such inequalities have never been as high” (‘Health inequalities and New Labour: how the promises compare with real progress’,British Medical Journal, 2005).

This week saw the publication of the third and final edition of ‘Tackling Health Inequalities’, the Department of Health’s own verdict on Labour’s efforts: (‘Tackling health inequalities: 2007 Status Report on the Programme for Action’, Department for Health).

It found that “The latest data for 2004–06 show that the relative gap in life expectancy between England as a whole and the fifth of areas with the worst health and deprivation indicators was wider than at the baseline (1995–97) for both males and females… For males, the relative gap is 2% wider than at the baseline (the same as 2003–05) and for females it is 11% wider than at the baseline (compared with 8 % wider in 2003–05)”.

The report also found that among babies born to families in “routine and manual” occupations, the infant mortality rate “was 17% higher than for the total population in 2004–06, compared with 18% higher in 2003–05 and 19% higher in 2002–04. It was 13% higher in the baseline period of 1997–99”. So far from eliminating health inequalities, Labour has in fact succeeded in increasing them.

Inequality, not poverty

Why is this? After all, there has been record investment in the NHS under Labour’s watch. However, as the World Health Organisation’s figures show, the US spends more on health care per capita per annum than any other country in the world ($6096 at 2004 prices), yet life expectancy there is only six months greater than Cuba ($229) and five years lower than Japan ($2823), so large-scale expenditure is not in itself enough, particularly if the distribution of that spending is highly skewed.

Much of Labour’s so-called ‘investment’ has in fact simply been a transfer of public funds into private hands, via PFI and other various privatisation initiatives. However, this alone does not explain Labour’s failures.

Current research in the field of epidemiology, centred around Richard Wilkinson and Sir Michael Marmot (a New Labour adviser and author of the preface for the Tackling Health Inequalities report) is increasingly finding that it is inequality, rather than poverty, which is the key determinant of health outcomes once a certain minimum level of income has been passed (Wilkinson postulated around $5000 at 1992 prices: (‘Income distribution and life expectancy’, British Medical Journal, 1992).

As Marmot puts it: “Autonomy –how much control you have over your life- and the opportunities you have for full social engagement and participation are crucial for health, well- being and longevity. It is inequality in these that plays a big part in producing the social gradient in health… the lower in the hierarchy you are, the less likely it is that you will have full control over your life and opportunities for full social participation. Autonomy and social participation are so important for health that their lack leads to deterioration in health”.

As the Tories redistributed wealth in favour of the rich, so health inequalities increased. Health inequalities are increasing under Labour because this process of redistribution has not reversed, and is, if anything, increasing. (, p19.)

The consequences of this are not trivial. According to the winter 2007 Office of National Statistics figures, Kensington and Chelsea has the highest life expectancy of any local authority in Britain by a distance (83.1 years for men, 87.2 years for women).

By way of comparison, in the lowest ranked London borough, Islington (399th out of 432), life expectancy is 8.2 years lower for men and 7.2 years lower for women; for Birmingham those figures are 7.9 years and 6.7 years respectively; for Newcastle 7.9 years and 6.9 years; for Liverpool 9.3 years and 8.9 years; for Manchester 10.1 years and 8.6 years; and for the lowest ranked local authority, Glasgow City, 12.6 years and 10.2 years (UK Government Statistics).

Away with excess enemy/ but no less value to property

On an even more localised level, within the London borough of Camden, life expectancy in the wards of Kentish Town, and St Pancras & Somers Town is 7.9 years lower than in Belsize ward; within Kensington and Chelsea, life expectancy in St Charles –north of the Westway- is 11.4 years lower than in Courtfield between the Fulham and Cromwell Roads (UK Government Statistics).

Michael Marmot states in the 2005 textbook Social Determinants of Health that within Glasgow life expectancy in the poorest districts is twelve years lower than in the wealthiest.

It is Richard Wilkinson who best articulates the scale and significance of these phenomena: “We are used to feeling indignation at the human rights abuses in countries where people are imprisoned without trial, or simply disappear, but health inequalities exact a much greater toll. What would we think of a ruthless government that arbitrarily imprisoned all less well-off people for a number of years equal to the average shortening of life suffered by the less privileged in our own societies?

“Given that higher death rates are more like arbitrary execution than imprisonment, perhaps we should liken the injustice of health inequalities to that of a government that executed a significant proportion of its population each year without cause”.

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