Thursday, July 1, 2010

Crocodile tears for health inequality - "its politics stupid"

Iona Heath sums up the difficulties of addressing health inequalities.  I remember the excitement of the reinvigorated social determinants of health war cry in the late '90s.  Public health practitioners were yelling raw uncontrollable truths about the impact of social inequalities on health - this was the real cause, this was our battle. I printed hundreds of copies of the WHO Solid Facts on the Social Determinants of Health by Marmot and sent it to mayors of councils, heads of social welfare organisations, anywhere I could.  This was a reinvigoration of the excitement that surrounded the release of The Black Report in 1980 and Margaret Whiteheads' The Health Divide in 1987.  Enthusiasm was rediscovered, collaborations were renewed. But then what.  Its 2010, enthusiasm is waning and maybe its harder than we imagined to change the power structures that produce the inequalities  - have we just been crying crocodile tears over health inequalities as Iona Heath suggests in this BMJ article? The rapid responses are also worth reading.  Here is her closing paragraph:

"So why is it that all those academics and others, like me, who participated in and benefited directly from the documentation of health inequalities, are not campaigning vociferously for more progressive taxation in the UK? Could it be because we have a fundamental conflict of interest in that almost all of us, situated on the gaining side of health inequality, would be expected to pay more tax if such a policy was implemented? If this is true, then it really is a case of crocodile tears."

It may not be that our conflict of interest is so direct as fear of income loss through progressive taxation, a reduction of inequalities requires  a shake up of all power structures within society and government agencies - an unpopular and often short-lived task.