We have just welcomed our new
cohort of students to our MSc Public Health – Health Promotion. It’s always an
exciting time of year, not only seeing how many students we have, but welcoming
new faces, new backgrounds and beginning to form a new group of interested
minds with interesting experience to bring.
It’s important that we outline, at
the beginning, our philosophy of what we think health promotion is all about.
Of course it’s a bit too late for students to change their minds at this stage
and decide it’s not for them! But we presume too that they have read our websites
and have some idea of what we’re about. It’s important for us that students
know that they will not emerge as experts on epidemiology, or having detailed
knowledge of particular diseases, or knowing about health care systems. What
they will come out with is an in-depth understanding of the social determinants
of health, of how to tackle health inequalities, and an understanding of the
politics of health. In short, they will be clear that there is a great deal of
health injustice in the world. A global dimension inevitably emerges from the
composition of the class – this year we have students from the UK, Pakistan,
Kenya, Uganda, Ghana, Cameron, Nigeria, Sudan. There will be those who know
first hand the effects of conflict, and the destruction of primary health care
as a result; about the progress towards the Millennium Development Goals; about
rural-urban inequalities. Those who have practiced principally in the UK will
be able to share their experiences of the changing fortunes and structures of
public health in England.
One of the first things we do is
to discuss inequalities in health, with a session on the facts – the empirical
data on inequalities, together with their possible causes, and then next week,
a session on the ethical dimensions of inequalities – the normative aspects,
which asks how the world could and should be different. Students from overseas
might be surprised to find glaring inequalities in the UK, such as a ten-year difference
in life expectancy between certain groups depending on social class and neighbourhood.
There are also groups about which detailed data is missing (an interesting fact
in its own right), such as travellers and gypsies, who are reputed to have a life
expectancy for men of only about 48 years. And of course some of the ‘developed’
countries have huge levels of inequality - the USA for example, ranks as the
fourth least equal society in the world in terms of wealth. (Russia, Ukraine, and Lebanon are above it).
The Millennium Development Goals
aimed to decrease inequalities in poorer countries. Failure to meet all the
MDGs has led to some analysis of those policies put in place to achieve them
and also to what is becoming known as the Post-2015 framework. The Post-2015
Framework emphasizes the importance of decreasing inequality, which is known to
have an independent effect on a range of other social variables (see Wilkinson
and Pickett 2009 The Spirit Level). More unequal societies appear to experience
more health problems, social unrest and economics ills, irrespective of their
level of development. Apart from the moral imperatives to tackle inequity, the
strategy of improving life chances and wellbeing through addressing inequality
is an important plank of policy alongside the other main approaches to
development, viz. addressing the situation of only the poorest, and of using a
whole population approach.
One of the influential thinkers
about development and inequality whose work we admire, is that of the Indian
economist and Nobel Laureate Amartya Sen. His book published in 1981, Poverty and
Famines: An Essay on Entitlement and Deprivation showed that hunger was not simply
because there isn’t enough food. Rather, hunger is caused by inequities in the mechanisms
that distribute food. Later, in an article titled ‘Equality of What?’ he
developed the ‘capability approach’ which emphasizes
the importance of understanding how people in different groups are able to
mobilize resources to improve their lives, and of how governments and other
policy players can mobilize resources on their behalf. Sen has always declined
to specify exactly which capabilities are important, preferring instead to
leave this to the exact context of the country in question, in contrast to
Nussbaum’s “ten central capabilities”. (These are easily found on Google – see
especially her book “Women and Human Development”). Sen’s stance mirrors the fact that we do not
have adequate knowledge of which policies and actions enable people to develop
capabilities to control their environments, just as we do not have robust
enough evidence of which policies and actions decrease inequalities.
This is the first year that we
have our own textbook available, which of course, we have recommended students
to buy, as we structured it to follow the modules that make up our Masters’
course. See Dixey, R. (2012) Health Promotion: Global Principles and
Practice http://bookshop.cabi.org/default.aspx?site=191&page=2633&pid=2454
Any comments on the book or feedback will be gratefully received
– you can email me on r.dixey@leedsmet.ac.uk
Here’s a short quiz that we will be using as a little group
exercise. Answers below!
The Quiz: Inequalities - 12 entirely
arbitrary questions on inequality compiled by Rachael Dixey, September 2013
1.How
many people live below the poverty line globally?
2.
Which African country is at the bottom of the Human Development Index?
3.What’s
the average life expectancy in Chelsea and Kensington (England)?
4.What’s
the average life expectancy in Glasgow city (Scotland)?
5.Which
group in the UK is widely agreed as being the most ‘at risk’ of health problems
and dying younger than any other group?
6.In
the USA black people make up 12% of the population. What proportion of new HIV
cases are black people?
7.How
many people globally live in slums?
8.What
proportion (percentage) of total wealth do the poorest 50% of the American
population have?
9.Out of 141 countries, the U.S. has
the 4th-highest degree of wealth inequality in the world. Which three
countries have more wealth inequality?
10.Malnutrition (measured by
stunting) affects what proportion of children in developing countries?
11.How much does Wayne Rooney make
per day?
12.What’s the average wage in the UK?
Answers:
1.How
many people live below the poverty line globally? 1300 million
2.
Which African country is at the bottom of the Human Development Index? Niger
3.What’s
the average life expectancy in Chelsea and Kensington? 82.4 years
4.What’s
the average life expectancy in Glasgow city? 72.9 years
5.Which
group in the UK is widely agreed as being the most ‘at risk’ of health problems
and dying younger than any other group? Gypsies and travellers
6.In
the USA black people make up 12% of the population. What proportion of new HIV
cases are black people? 50%
7.How
many people globally live in slums? 800 million
8.What
proportion (percentage) of total wealth do the poorest 50% of the American
population have? 2.5%
9.Out of 141 countries, the U.S. has
the 4th-highest degree of wealth inequality in the world. Which three
countries have more wealth inequality? Russia, Ukraine, and Lebanon.
10.Malnutrition (measured by
stunting) affects what proportion of children in developing countries? 32.5%
11.How much does Wayne Rooney make
per day? £28,571
12.What’s the average wage in the UK?
£26,000
