Health promotion is based on a clear set of
values. There’s been a lot of debate about its ability to provide evidence of
effectiveness and to be ‘evidence-based’ and evidence-driven. BUT – having said
that, health promotion as an activity and as a discipline is really
values-driven, and we have discussed these in depth in our book and in our
teaching. Health promotion is concerned with social justice, with tackling
health inequities, with fairness, redistributing power, creating strong
cohesive communities, and helping all people everywhere to reach their full
potential without having to worry about their wellbeing, pain, disability and
disadvantage. An ethical thread thus runs deeply through our whole endeavour.
We know a lot about values! It was therefore interesting to see our government
over the last few weeks talk so much about British values, and to assert how
important they are.
These values, according to street
interviews with the British public, are about ‘fairness’, ‘fair play’,
cheeriness, stoicism, everyone pulling together in a crisis. I do agree that
these are to be found in communities around me. It’s when I look at those who
run the country, the decision makers and powerful, that I despair. Here are
some examples over the same few weeks that show to me that Britain does not
demonstrate those values.
Firstly, the number of British households
falling below minimum living standards has more than doubled in the last 30
years. This has just been revealed at the third annual Peter Townsend conference.
(http://www.poverty.ac.uk/take-part/events/final-conference)
For those of you unaware of the
contribution of the great Peter Townsend, he was the chief architect behind the
Black Report of 1979 that showed so clearly how health inequalities are linked
to poverty and deprivation. He was one of the key thinkers who developed clear
measures of disadvantage and his work had a huge impact on people like me,
grappling with how to understand just why so much relative deprivation could
exist in an affluent country. As his
Wikipedia entry says, Townsend was dedicated to studying "very carefully the life
of the poorest and most handicapped members of society". See: http://en.wikipedia.org/wiki/Peter_Townsend_(sociologist)
He co-founded Child Poverty Action and also the Disability
Alliance. (If you Google him of course, you’re likely first to find Pete
Townsend from The Who, so try Peter Townsend, sociologist).
The new research, described as the most detailed study ever of
poverty in the UK shows that 18 million Britons live in inadequate housing, 2.5
million children live in damp homes, and that 12 million are too poor to take
part in basic social activities. The report shows that one in three people
cannot afford to heat their homes properly and 4 million adults and children
are not able to eat healthily. One in five adults have to borrow money to fund
basic day-to-day needs. The Townsend Centre for International Poverty Research
led the research, funded by the ESRC. Professor David Gordon from the Townsend
Centre has said, “The coalition government aimed to eradicate poverty by
tackling the causes of poverty. Their strategy has clearly failed. The
available high quality scientific evidence shows that poverty and deprivation
have increased. The poor are suffering from deeper poverty and the gap between
the rich and poor is widening.”
All in all, the message is that over the last thirty years, the
proportion of households having to cope in ‘below-par’ living conditions has
risen from 14% in the early 1980s to 33% now. What’s fair about that?
A key message from this new research is that poverty is not
especially caused by lack of paid employment, as the majority of children
suffering poverty are in households where at least one parent is employed.
These findings echo those reported a week earlier by the Social Mobility and
Child Poverty Commission, whose recent report has concluded that this will be
the first decade since 1960 not to see a fall in absolute child poverty. The
Child Poverty Act, one of the last acts passed by the previous Labour Government,
set targets to get relative child poverty below 10% by 2020. (Relative child
poverty is the proportion of children living in households on below 60% median
income). The Commission has said there’s not a chance of meeting these targets,
as 3.5 million children are expected to be in absolute poverty in 2020 – five times the target.
The government keeps talking about the way out of poverty being
employment, and that child poverty can be addressed by getting more parents
into work. The Commission though has said that addressing poverty through the
labour market “does not look remotely realistic”, and now the latest Townsend
Centre research confirms that employment is not a sufficient protection against
poverty.
We know that poverty is the key cause of
ill health. It came as no surprise therefore that another report, from the
Office of National Statistics last month, showed that about a quarter of people
are dying prematurely from preventable causes. The report showed that 23% of
deaths registered in 2012 were “caused by certain conditions which should not
occur in the presence of timely and effective healthcare or through wider
public health interventions”.
This statement seems to imply that public health and health
promotion has somehow failed and in my view, it’s being blamed for not ‘saving
lives’. But given the well known links between social status and health
inequalities, dating back to the Black Report and Townsend’s seminal work, and
the recent dramatic increase in poverty, it’s not at all surprising that people
are dying from preventable causes. Moreover, the rise in poverty is happening
alongside the cutting of funding on public health, the dismantling of health
promotion and community health projects and wider cuts such as in Sure Start or
Children’s Centres. It’s also happening at a time of huge change in the NHS. So
even if we did accept that more “timely and effective health care or wider public
health interventions” could
effectively tackle health inequalities, these services are under threat.
Official figures also show how people’s chances of not dying
from preventable causes such as certain cancers, are being threatened by what’s
happening in the NHS. NHS performance data show increasing delays in carrying
out vital tests – the number of people waiting more than six weeks for a scan
is now at its highest level since 2008. In April 2014, 17,000 people with
suspected cancer had to wait more than six weeks for tests, which is twice the
total in the same month last year. In the same week, the Royal College of
Nurses said that by 2025, district nurses, the backbone of community nurses may
‘face extinction’. The decline in their numbers comes despite the increase in
the need for them, given the increase in lifestyle-related diseases such as
type-2 diabetes. (Another recent piece of research from the University of
Leicester, analyzing data from the Health Survey for England, and published in
the BMJ Open, shows that the number of people with pre-diabetes has risen from
11.6% in 2003 to 35.3% in 2011.)
On the 5th of June, Harry Leslie wrote a moving piece
in the Guardian, from his new book, “Harry’s Last Stand”. In his lifetime, (he was born in 1923) he saw
the birth of the NHS and knew what it meant for working class people like him
and his family. See: http://www.theguardian.com/society/2014/jun/04/coalition-attacks-nhs-return-britain-age-workhouse
His sister Marion, paralyzed by TB that spread to her spine,
died aged 10 in the 1920s, in a workhouse infirmary, her life dominated by
having to live in a ‘disease-ridden mining slum’. He concludes the piece with
this:
“It ends where I began my life – in a Britain that believed
health care depended on your social status. So if you were rich and insured you
received timely medical treatment, while the rest of the country got the
drippings. One-fifth of the lords who voted in the controversial act – which
provides a gateway to privatize our health care system – were found to have
connections to private health care companies. If that doesn’t make you angry,
nothing will.
Sometimes I try to think how I might explain to Marion how we
built these beautiful structures in our society – which protected the poor,
which kept them safe at work, healthy in their lives, supported them when they
were down on their luck – only to watch them be destroyed within a few short
generations. But I cannot find the words”.
Indeed.
British values?
I cannot find the words.
