How do you reduce health inequalities?

Let me begin by assuring any hostile readers that I, like Labour and the Lib Dems, dislike health inequalities. It does worry me that a man in Glasgow has an average life expectancy to 71, and a man in Chelsea can look forward to reaching 85.

My objection to that is similar to my objection to gross income inequalities. I do not defend gross differences of income between the highest and the lowest paid. My wish is to boost the spending power of the lower paid, but usually not to cut the pay of the higher paid. Similarly, with health inequalities, I would like to help give the Glaswegian a longer life, but have no wish to cut the life of the Chelsea resident. Both these things need to be done in ways which will work. In both cases government has to accept that there are limits to what government can achieve. A lot of it is down to individuals.

The socialist case of health inequalities has two flaws which need to be understood. They argue that the health inequalities are the product primarily of income differentials. The areas with more people on low or no incomes have much worse health, they say. They argue that these differentials are best tackled by pouring much more public money into the public services, especially the NHS, in the poorer areas.

As they believe in the connection between health and income, their wish to lower incomes in the successful areas implies they wish to narrow health inequalities by giving people in the richer areas worse health prospects, as well as taking their incomes down. Let us charitably assume this is an unwelcome or overlooked consequence of their thesis and policy. They have just tested their idea that large increases in NHS spending will cut health inequalities, and discovered that it did not work.

Everyone in the UK is guaranteed sufficient income by the state to ensure a basic standard of nutrition, heating and shelter. Some of the rich could be prone to lifestyle diseases from eating too much rich food, from drinking too much, and from taking too little exercise. Those on lower incomes may of necessity or choice have healthier lifestyles. They cannot afford the chauffeured car and the champagne reception that the super rich expect.

This is important, because doctors tell us that the main causes of health inequalities are lifestyle issues. They tell us that smoking is a prime cause of many terminal diseases. They warn that drinking too much alcohol is bad for us. They advise more exercise to keep fit. There are various dietary recommendations, but many of them centre around eating more cheaper foods, by avoiding the expensive highly prepared dishes in the supermarkets, and by cutting down on rich proteins.

For thirteen years the last government had as one of its aims cutting health inequalities. They put very large increases into the budgets of the NHS, and slanted much of their public spending towards the areas where life expectancy and incomes were lowest. None of this worked. Health inequalities got worse, not better.

We need an explanantion of why this did not work. We need to challenge the assumption that spending more on the NHS in disadvantaged areas will make people healthier. Many doctors will tell us that you need a lifestyle revolution to make people healthier. A larger NHS budget in poor areas relative to rich areas does not stop people smoking or drinking too much.

One of my concerns about the Health Bill now before Parliament is the inclusion of a clause that makes it an aim of the NHS to cut health inequalities. I have no problem with the aim, but I am not sure that the NHS, mainly an illness service, is the way to get those on low incomes to live longer.

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125 Comments

  1. Single Acts
    Posted March 4, 2012 at 6:18 am | Permalink

    Indeed the reality is widely known, cheap to achieve and within the reach of almost everyone. Don’t smoke, drink little and eat some vegetables and go easy on the processed food. Add to that a daily walk, a few push-ups and genetic factors or stray buses notwithstanding, 85 years should be in your grasp.

    Not difficult, not expensive and widely known and understood. If people don’t follow the above edicts, it’s because they choose not to. That is their choice in a free society. The alternative is coercion of one kind or another and we are already too far down that road.

    Further government is not required as you correctly identify.

  2. lifelogic
    Posted March 4, 2012 at 7:05 am | Permalink

    Do all people actually want to live longer? Everyone surely knows that not smoking, not drinking too much, not getting too over weight, a varied diet, not taking illegal drugs and plenty of gentle exercise are likely to be the best way live longer. Also going to the doctor quickly if you do have a problem.

    But climate, genetics and many other factors also have an influence. Greater
    Glasgow NHS Board area has one of the highest smoking prevalence rates at over
    39%, and in some of the most socially disadvantaged areas in Glasgow, smoking rates
    are as high as 63%, the average rate in Great Britain of 26% lower still in Kensington I assume. Surely this is the main reason for the differences.

    Looking at table for average life expectancy at birth then the difference between Japan at the top with 82.6 years and 79.4 for the UK at 20th does not seem very much. Perhaps we just need to eat a bit more sushi (or kippers), fewer fried Mars bars and only smoke our fish not our lungs.

    But do we want to? It was John Mortimer who said … “there is no pleasure worth denying oneself for the sake of a few years in a sunset home in Weston-super-Mare”.

    • lifelogic
      Posted March 4, 2012 at 9:45 am | Permalink

      There is of course no perceived “inequality” or “unfairness” that politicians will not exploit to garner votes from the evil politics of envy. Nor that government and the state sector employees will not use as a ruse to create pointless extra jobs and power for themselves and thus higher taxes and inconvenience for all.

      • zorro
        Posted March 4, 2012 at 5:18 pm | Permalink

        Another sublime truth…(almost Starkeyesque)

        zorro

      • libertarian
        Posted March 4, 2012 at 6:57 pm | Permalink

        Excellent post lifelogic, nail firmly hit.

        At some stage politicians MUST allow people to choose their own lifestyles.

        As far as health cover is concerned, just like other areas of life make the irresponsible pay for their own health care, i.e. cigarette and alcohol duties should be paid directly and only into NHS.

    • Bazman
      Posted March 4, 2012 at 10:07 am | Permalink

      Rab’s doctor tells him he is dying of drink, so he needs a drink.
      Any ideas why people from affluent Kensington would smoke less than those from disadvantaged areas of Glasgow and why this would cause more deaths? Maybe they just perceive “inequality and “unfairness” and decide to smoke more? Going to the doctor quickly? It’s going to be bit difficult if he is charging to see you and you are skint as you propose. Ah! Buy less fags. It really is that simple. Logical even!

    • lifelogic
      Posted March 4, 2012 at 11:47 am | Permalink

      I just heard Norman Lamb Parliamentary Under-Secretary of State for Employment Relations, Consumer and Postal Affairs on BBC1 he sounded even more absurdly anti business than Vince Cable. Do these fools want employment and a recovery or not.

      Easy hire and fire and limits on any unfair dismissal claim of say 3 month pay. Anyone any good can get another job so where is their “real lost” that they need compensation for anyway?

      • sm
        Posted March 4, 2012 at 12:24 pm | Permalink

        Easy hire & fire.
        It could tend to drive wages down wherever surplus labour is available perhaps with a higher minimum compensation to protect low -medium wage earners.
        Perhaps if we trial it at say the £60k plus(exc pension) in the public sector and banks. Banks which enjoy direct and indirect public subsidy including the ability to charge interest on no cost or free money’ courtesy of fractional reserve banking and laws which uniquely allow them this advantage.

        • lifelogic
          Posted March 4, 2012 at 5:50 pm | Permalink

          It would mean businesses become much more efficient and can thus expand and workers will be less likely just to go through the motions as many now do. It would also send a positive signal to industry for once. Rather than just limping more cost on them like the “drank too much while on holiday” one pending and the no retirement rule.

      • Bazman
        Posted March 4, 2012 at 1:19 pm | Permalink

        Not if you are in your late fifties in an unemployment black spot. Could take months to find work.

        • lifelogic
          Posted March 6, 2012 at 9:01 am | Permalink

          Forcing the employer to carry the person as dead weight has cost on the employer, can cost other jobs and renders them uncompetitive. Perhaps forcing them to close and all the jobs go in the end.

          • Bazman
            Posted March 6, 2012 at 6:51 pm | Permalink

            They can pay him compensation from their profits. He is not just the hired help.

      • uanime5
        Posted March 4, 2012 at 5:05 pm | Permalink

        The problem with making it easier to fire people in the UK is that when companies need to reduce their staff in Europe all the staff cuts occur in the UK as it’s so difficult to fire people in other European countries, such as France and Germany.

        If the Government wants to reduce unemployment they need to give employees more protection, not less.

        • libertarian
          Posted March 4, 2012 at 6:58 pm | Permalink

          Wrong, as normal

          • Bazman
            Posted March 5, 2012 at 8:14 pm | Permalink

            What makes you think that there is not already a revolving door recruitment policy in many companies at the already? How promoting this further will create anymore jobs is in your dreams. Most workers employed by the companies that want lax labour laws are employed by agencies anyway. The basis of your ideas lie in making people more desperate and that somehow this will create more work. Not from me as any employer who I suspect would fire me in an instant would get little work ,before I fired him maybe even at the interview. What would you do as an employer with the likes of me. You would Ram it.

        • lifelogic
          Posted March 4, 2012 at 7:48 pm | Permalink

          But where will they set up the new division – where they cannot fire duff employees or where they can?

    • Disaffected
      Posted March 4, 2012 at 11:53 am | Permalink

      The World Free Health Service needs reform like no other organisation. It is a cash cow that the taxpayer cannot afford in its current form. Why should British taxpayers provide free health care for everyone who enters Britain? Time for radical reform.

      Let us leave the living longer debate as an excuse for working longer, paying more tax etc. Anyone who reaches 75yrs has had a good innings.

      Living longer spin is to hide that Osborne has plundered £74 billion from savings and pensions by QE. EU regulation is on its way to devalue annuities therefore another 20% could be taken from private pensions.

      The British public were deceived for the reason behind the increase in NI contributions. The public thought the money was needed to improve the NHS. The truth is that the increase was a straightforward increase in income tax. In any other business or organisation it would be classed as fraud. Politicians really need to raise the standards of integrity and propriety at Westminster in every activity they undertake.

  3. Mike Stallard
    Posted March 4, 2012 at 7:37 am | Permalink

    The government deals in votes, which means that it simply has to please as many voters as it can. Like any other organisation, it survives or fails on public opinion. It is as important that Glaswegian voters as that Islington voters give the same sort of approval rating to a government service for which they are expected to be very grateful.

    Nature doesn’t care a jot about pleasing people. If you live in a mansion, you are just as liable to get cancer as if you live in Mumbai slums. The trick is not to live to excess and to look after yourself and your family and friends. That usually fends off death for some time and allows you to live a useful life for a little longer.

    Which is why the National Health simply will never work. Oh yes, you can build expensive hospitals and overpay the staff. But in the end, health is not Lady Bountiful from Westminster Abolishing Suffering. It must be people looking after themselves in the face of nature. The inefficient vote seeking government ought to have no part in this natural process if you think about it.

    The NHS is not my religion – I am a Catholic – it is an out of date state monopoly. I dare say this: you must not even think it if you want to be re elected.

    Yet.

  4. Caterpillar
    Posted March 4, 2012 at 8:08 am | Permalink

    Perhaps there is not a simple answer to the “lifestyle revolution”. It seems reasonable to accept that this is what is required given the cumulative nature of many health issues (in utero onwards). Labelling the NHS as the NIS is probably a good contrast to raise, seemingly being a post event (whether accident or onset of chronic) driven service, but the cultural and educational shift required will be immense.

    For example I suspect basic school-timetabling, food, health, contraception provision etc. therein would need to change and to think that such integrated consideration will occur is very hopeful. (Again similarly sorting out housing/accommodation is unlikely).

    I do agree with the observation on diet. To switch from those bads that provide confort when stressed/disadvantaged to the goods clearly requires more of a price differential than now present. The PM’s simplistic view of just minimum pricing alcohol (rather than say wet houses to provide support) could go further. If consumption tax were added to the bads (sugar, sodium, disgusting trans-fats) then presumably this could directly transfer to subsidies for the goods, whether pre-prepared or not. How though the communtiy support of pubs etc. is replaced with community fresh food prep’n is presumably much, much harder.

    • Caterpillar
      Posted March 4, 2012 at 8:15 am | Permalink

      I should have also said that I think IDS’s – always better off working will be a positive contribution to improved health.

  5. Atlas
    Posted March 4, 2012 at 8:23 am | Permalink

    It occurs to me that your analysis implies that both the rich and the poor live a sub-optimum lifestyle. The question is really what is an ‘optimum’ lifestyle? This is where one man’s values have a habit of getting imposed on another’s… “Discuss – you may write on both sides of the paper”

    • lifelogic
      Posted March 4, 2012 at 3:11 pm | Permalink

      Indeed it is a matter of personal choice some want to go climbing the Matterhorn or Everest, sky diving, sailing solo round the world, hang gliding, go into space, hunting on horseback, cycling in London traffic or helicopter skiing some even get titles from the Queen as a result.

      Other prefer to have the odd bottle of claret and a cigar and take their risks that way.

      The government should keep out of it in the main.

  6. Martin
    Posted March 4, 2012 at 8:25 am | Permalink

    Of course the other way to even out health inequalities is to move healthy people from Chelsea to Glasgow and vice versa. Maybe that’s why the last Labour Government gave the third Heathrow runway the go ahead.

    Given the link between health and prosperity others might argue that the third runway by giving Glasgow more connections to the rest of the world would increase its prosperity and hence its health.

    • lifelogic
      Posted March 4, 2012 at 9:52 am | Permalink

      Boris seems to want to spend a fortune of, I assume, partly tax payers money, with his silly “vote for Boris” bikes littering the streets and encouraging people in Chelsea and Kensington to ride bikes through the heavy London traffic.

      Perhaps that will help to redress the life expectancy imbalance with Glasgow.

  7. Old Albion
    Posted March 4, 2012 at 9:02 am | Permalink

    As you are so concerned about health inequalities. I trust you will be talking to the PM about prescription charges, dental/eye check up costs, hospital parking charges and the witholding of drugs from patients on the basis of cost.
    These inequalities of course, apply only to patients in England. I won’t hold my breath…………

    • Electro-Kevin
      Posted March 4, 2012 at 3:37 pm | Permalink

      x2

  8. Paul Danon
    Posted March 4, 2012 at 9:04 am | Permalink

    Insofar as we’re all guaranteed sufficient income, is this an issue at all? As voters and politicians, our consciences can be clear. We pay (more than) enough taxes to ensure a universal basic living standard. The rest is lifestyle-choices. The father of eight in a council-flat who exists on deep-fried burgers is doing so because he’s free to. And we’re paying for it. No-one can say we’re not helping and, if we intervene, we’re undermining his freedom. The alternative is a series of state-sponsored burglaries committed against people whose wealth is rightfully theirs and who already pay 50% tax. God himself only wants 10%.

    • Bazman
      Posted March 4, 2012 at 11:05 am | Permalink

      The answer being to starve them of even cheap deep fried burgers?
      The problem in the past was diseases caused by malnutrition. Maybe you think they deliberately starved themselves?
      The answers lie in background and education of which you are clearly also lacking as shown by your simple world view.

      • Paul Danon
        Posted March 4, 2012 at 2:09 pm | Permalink

        Yet I think John is right that, in the UK at least, enough support is provided by the state to prevent starvation. The rest is choice. If a person has a drug- or alcohol-problem, our (also tax-funded) health-service will help them if they ask. In extremis, children whose parents can’t cope are taken into state-care.

        At root, British benefits seem to be enough and it also seems that child-benefit (and the associated subsidised housing) is sufficient to incentivise the growth of at least some big families – the sort of family we need to maintain the workforce that will keep on paying those taxes which fund our welfare-system.

        The taxpayer also funds a school-system which can enable someone from a humble background to get good A-levels. State-backed, interest-free loans then enable them to access tertiary education (which is also subsidised) and, if they don’t earn much in later life, the debt is forgiven. They’ve now even got a tsar to discriminate against socially privileged university-candidates.

        Our taxes thus cascade massive amounts of wealth to the poorer classes, including through subsidies for transport and regions. It’s surprising that businesses manage to turn a profit and that the well-off have very much left over for a comfortable lifestyle. Yet it seems to work and many are now alive, fit, fed, schooled and housed who might not have been any of those things without the welfare-state.

        Sure, a free market may have led to greater wealth for all (the way it has in Hong Kong), but we chose the welfare-route and must now live with its consequences, both good and bad.

        • uanime5
          Posted March 4, 2012 at 5:17 pm | Permalink

          Most people would have large families even if they didn’t get child benefits. Planned parenthood isn’t common among those who are feeble-minded or poorly educated.

          Businesses make a profit because the taxes on their profits are less than 100%.

          Hong Kong has an even greater Gini coefficient (income disparity) than the UK because it doesn’t have a welfare system. The free market only provides great wealth for a few, not everyone.

          • libertarian
            Posted March 4, 2012 at 9:26 pm | Permalink

            The free market provides wealth for everyone and anyone who can be bothered to do anything to make it.

            Your assertion about profit and taxes is another one of your ridiculous, baseless incorrect assertions.

          • Paul Danon
            Posted March 6, 2012 at 3:25 am | Permalink

            I suppose it’s fair to say that the “market only provides great wealth for a few”, but it also provides a great deal of moderate wealth for a great many people. You’d think that the examples of the two Germanys, the two Koreas and the two Chinas would win the left/right argument, but I guess socialism needs its class-war so it must continue to allege that markets make us poor, the state rich, despite so much evidence to the contrary.

  9. Alan Wheatley
    Posted March 4, 2012 at 9:18 am | Permalink

    Another well argued piece, JR.

    As for incomes, low incomes are (with some exceptions) more of a symptom than a cause.

    The cause of many social ills is poor education. A study recently reported that 19,000,000 adults in the UK have a maths ability equivalent to a child leaving primary school. If so, then it is no wonder that many people struggle to make a success of their lives.

    The BBC current affairs programmes picked this up and asked has being poor at maths become culturally acceptable, which if so is equally depressing.

    An “aim” to cut inequality is so vague as to be meaningless. It is also dangerous as it provides cover for doing the wrong thing, and concern is warranted, to say the least.

    • lifelogic
      Posted March 4, 2012 at 3:23 pm | Permalink

      You ponder “Has being poor at maths become culturally acceptable” indeed it has people seem very proud to “boast” about being be poor at maths and science they then often go on to tell you what a good thing green renewable energy is – even though they clearly do not have a clue what they are taking about.

      I, as a scientist by training, never insist on telling people how bad I am at Anglo-Saxon yet then insist on explaining to them the true meaning of Beowulf at great length. Why do they?

      I think the BBC is much to blame for this attitude, why else would they have Melvyn Bragg presenting science programs on radio when he is clearly nearly always out of his depth. Why does any TV scientist have to be portrayed as a mad boffin on TV?

      • Alan Wheatley
        Posted March 4, 2012 at 5:13 pm | Permalink

        The BBC exhibits a strong bias in favour of the arts to the disadvantage of science, and even more so to engineering.

        Lifelogic, spare a little sympathy for Melvyn, he does his best, and he is chairing a panel of experts, not pretending to be one.

        BBC TV often does far worse.

        • lifelogic
          Posted March 4, 2012 at 7:58 pm | Permalink

          It is when he say “so what you are saying Professor xyz is ……………………..” and I shout at they radio “No you idiot that is not what he is saying at all”.

    • Denis Cooper
      Posted March 4, 2012 at 5:16 pm | Permalink

      19 million adults out of 40-odd million – surely that means that about half the population learn no more maths after they’ve left primary school, or if they do learn some more at secondary school they later forget it?

      Actually I could believe that, because if as an adult you rarely have any occasion to use something that you learned at school then you will tend to forget it, whether it’s maths or French or whatever.

    • Bob
      Posted March 4, 2012 at 5:20 pm | Permalink

      More evidence of the failure the state schools, as if it were needed!

  10. Rebecca Hanson
    Posted March 4, 2012 at 9:25 am | Permalink

    Thank you for your interesting post John.

    I have to say if I read a headline about reducing health inequalities I would assume we were talking about reducing the postcode lottery effect whereby people are entitled to different treatments depending on where they live which is, of course, an entirely reasonable aim. Is that aim part of the health bill?

    I think it is not enough for people to have sufficient food and shelter for them be healthy. If they cannot work and are unable to escape feeling excluded from society they will not thrive.

    • Mike Stallard
      Posted March 4, 2012 at 4:47 pm | Permalink

      Have you ever been unemployable yourself?
      There is always work to do. Always.
      The problem is this: can you or would you be able to stick it? And for how long?

      • Rebecca Hanson
        Posted March 4, 2012 at 6:20 pm | Permalink

        I’ve spent a long time working with some of our most vulnerable teenagers Mike and coming to understand the complex challenges they face in trying to take coherent journeys into having the self confidence which comes from them feeling they are a meaningful part of society.

        I’ve also known through my own experiences and those of others what it’s like to be unemployed for all sorts of reasons and have always appreciated that I’ve managed to get past the barriers I’ve faced in a way which appreciates that things for me and others may have been otherwise had the cookie crumbled differently or had I had less confidence, eloquence or support in asserting myself and my rights.

        • Max Dunbar
          Posted March 4, 2012 at 11:33 pm | Permalink

          Cookies never used to crumble so easily. They must be made of inferior ingredients now.

    • Alan Wheatley
      Posted March 4, 2012 at 5:20 pm | Permalink

      The “post code lottery” is clearly hard to take if you are being denied and others are not. However, I would rather put up with such inequalities than have imposed uniformity.

      I would hope that the way the system would work would be for local initiatives to be encouraged and improvements above the norm rewarded so that others can pick up on what improvements they too can make. Bit idealistic, I know, but why not.

      • Rebecca Hanson
        Posted March 4, 2012 at 6:24 pm | Permalink

        I do a lot of work in discussions forums for new mums, mums-to-be and hopeful mums-to-be Alan. No-one really understands why we have so many anomalies such as people at one end of a street being offered two rounds of IVF while people at the other are offered none.

        Please could you explain why this system is so much better than everyone being offered on round?

        • Rebecca Hanson
          Posted March 4, 2012 at 6:26 pm | Permalink

          in this case ‘work’ = hanging around and chatting – unpaid of course. Just thought I should clarify.

        • JimF
          Posted March 4, 2012 at 7:39 pm | Permalink

          Well perhaps the answer is for neither end of the street to be offered IVF. I just don’t understand, given that we don’t have a state edict to increase our population by maximal breeding, why this is paid for by the state.
          The NHS is there to make ill people better, and as a maternity service, not to satisfy peoples’ whims on whether they have babies added or removed by artificial means.

          • Rebecca Hanson
            Posted March 6, 2012 at 2:15 pm | Permalink

            If you want to understand why it is paid for by the state Jim you should talk to those who decide to go through the grim process.

            Having said that I’m not arguing for everyone to get lots of it. I’m suggesting we could do with a clear explanation as to why the currently post code lottery is better than a national standard.

    • Mr. Frost
      Posted March 5, 2012 at 6:11 am | Permalink

      Surely, ending the post code lottery is the BEST argument for private sector intervention? Otherwise we are forced to take what the state gives us based on where we live without no other choice…

  11. fox in sox
    Posted March 4, 2012 at 9:32 am | Permalink

    Dear John,

    Health inequality does correlate with income as you say, but correlation is not causation. There is a strong correlation between health inequality and education, which is more likely to be causative.

    An example of highly educated people with low incomes would be clergy, who are notoriously longlived. If we look at people with low education but high incomes, such as professional footballers we do not see longevity.

    If you look at educational achievers in Glasgow you will see longevity, in Chelsea those with few qualifications will die younger. In summary, smart people look after their own and their families health.

    I suspect that improving the educational attainment of communities with poor health would also improve their income as well as their health. The same communities who despise educated people are those who smoke, eat and drink to excess. They will not be an easy solution.

    • lifelogic
      Posted March 4, 2012 at 10:19 am | Permalink

      You make some very good points about correlation & causation surely the most likely causation is: Poor health is very, very likely to cause you to be unable to work hard and thus become poorer.

      Last time I saw some figures on life expectancy by profession I recall that postal workers came out very well – dentists, doctors and sports people rather badly. It seems regular but gentle exercise seems to be rather good for you as does being female of course.

      I see that average life expectancy for all pro US football players including all positions and backgrounds is reported to be 55 years. And they have, one assumes, already made it to 20 or so in order to be one. So this translated to “life expectancy at birth” is very, very low indeed.

      Why is the government so keen to promote professional sport and cycling one wonders?

    • Winston Smith
      Posted March 5, 2012 at 10:24 am | Permalink

      At last, somebody who speaks sense. The rhetoric from the socialists on education is the same: bring down quality for all and curtail self-determination.

  12. Antisthenes
    Posted March 4, 2012 at 10:01 am | Permalink

    When something is free there is no incentive for responsible action so that changing attitudes towards improving lifestyles is not going to happen . A monopoly as the NHS is makes for no incentive to give value or quality. As much as equality is to be desired coercion and redistribution is not going to make any appreciable difference. A dysfunctional and under achieving state education system exacerbates the problem. Coupled with which humans are not all of equal ability so there will always be winners and losers. There is no complete solution to the health inequalities conundrum it will always exist but it can be vastly improved upon. Some improvements can be made if Lansley’s bill sees the light of day. However the only way to achieve the best equality in health provision is a radical reform of both the provision (mostly privatisation) and funding (a mixture of private and state).

    • uanime5
      Posted March 4, 2012 at 5:23 pm | Permalink

      “A monopoly as the NHS is makes for no incentive to give value or quality. ”

      Always hiring the lowest cost provider to perform operations has the same effect at best and leads to a decline in quality at worse. So Lansley’s bill will make this situation worse, not better.

      • Antisthenes
        Posted March 5, 2012 at 6:37 am | Permalink

        Not if there is competition and choice it doesn’t.

  13. Mazz
    Posted March 4, 2012 at 10:13 am | Permalink

    As you say, John – “Everyone in the UK is guaranteed sufficient income by the state to ensure a basic standard of nutrition, heating and shelter”. So, it is not money that is to blame for unhealthiness. Walking in the fresh-air is one of the best precautions against ill-health and that is free.

    As far as mental health goes, I would say that, in general, as much as anything else it is a question of attitude. From being young, children should be taught to make the best out of what they have. Teach them to be confident and positive in whatever they do and to be proud of their efforts. You also teach by example, of course.

  14. Lindsay McDougall
    Posted March 4, 2012 at 10:49 am | Permalink

    The way to change lifestyles is to charge for health care at the point of consumption, even if it is only at the 10% level. The way to cope with the chronically sick and the ultra poor is to allow GP practices and hospitals to create charities with good tax breaks. Those with medical knowledge would decide who deserved to be recipients of the donations; they are the people best placed to distinguish between the deserving and the undeserving. And such a charity would not have financed a George Best liver transplant.

    • uanime5
      Posted March 4, 2012 at 5:29 pm | Permalink

      “The way to change lifestyles is to charge for health care at the point of consumption, even if it is only at the 10% level.”

      So if you charge people with cancer to remove their tumours they’ll be less likely to suffer a relapse? Do you have any evidence to back this up?

      “The way to cope with the chronically sick and the ultra poor is to allow GP practices and hospitals to create charities with good tax breaks.”

      What a horrible thing to say. The Government should be providing healthcare to these people, not relying on charities and goodwill.

      “Those with medical knowledge would decide who deserved to be recipients of the donations; they are the people best placed to distinguish between the deserving and the undeserving.”

      What happens if there are more deserving people than there is money available? Let the excess people die?

      The American healthcare system doesn’t work in the USA, so why would we want to import it here?

      • Winston Smith
        Posted March 5, 2012 at 10:25 am | Permalink

        It does work if you compare outcomes, such as cancer survival rates.

      • Lindsay McDougall
        Posted March 5, 2012 at 10:37 am | Permalink

        The point about charging is that it encourages people to adopt better lifestyles while there is still time, by measures such as stopping smoking and reducing alcohol consumption before they suffer.

        If GP practices and hospitals were allowed to set up charities with good tax breaks, the level of funding would be determined by the general public and would be a barometer of public opinion. Public opinion might differ from the opinion of the government of the day (and that would never do, would it?). So if ‘some excess people died’, that would be a result of public opinion.

        The big problem with the American healthcare system is litigation costs, which are beginning to be felt here. What we need is a UK law of medical negligence (Statute Law) that makes a clear distinction between errors of judgement and negligence.

  15. Bazman
    Posted March 4, 2012 at 10:58 am | Permalink

    A bit disingenuous to imply that a taxing the hyper rich more will somehow effect their health. I doubt it.
    My father was self employed and is very fit at 84 even when compared to many 30 somethings. Hundred of miles per week on a bike must have something to do with it as well as a lifelong aversion to smoking, drinking and ‘unhealthy’ foods. Traditional English foods in small amounts is his way.
    Health is related to work or lack of it as John omits. Having a physical job is good, but often these jobs work the body like a machine and have dust and fume problems. My last employer constantly tried to avoid buying quality fume masks and improving extraction of fume. I refused to work without adequate protection and have no lung problems. Many were negligent of this and are now paying the price. Who’s fault? Ultimately theirs, but if you are not so smart and swallow the elf and safety lie from desk jockeys threatening your job? The desk jockeys have their own problems and you can see it in their pasty faces.
    Out of work, redundant. All the time in the world to exercise? I did this year in the council subsidised multi-million pound gym, the very best equipment and good advice. A local scandle by the way. During the last redundancy the 90’s I drank the money, but was only 23 and then left the area. Different story if you are 53 living in an unemployment blackspot as many were at the time.

    • uanime5
      Posted March 4, 2012 at 5:32 pm | Permalink

      It’s a pity that John omitted how work can also be the cause of good or ill health. I suspect that if the Government worked harder to promote the good health of employees the number of chronically ill people would be greatly reduced.

  16. Charles
    Posted March 4, 2012 at 11:03 am | Permalink

    It is difficult enough for many to heat their homes and to eat healthy foods. The Government loves to tax people more making it even more difficult for them to heat their homes and eat the right foods.

  17. alan jutson
    Posted March 4, 2012 at 11:14 am | Permalink

    Yes I know this will not be a policially correct statement but:

    From a simple but very noticeable observation made when collecting for Charity, outside a range of Supermarkets over the Christmas period.

    You get far fewer grossly obese shoppers in Waitrose, than you do in some of the other supermarkets.

    I percieve ( I have no figures to substantiate it) that you seem to get fewer grossly obese people as a percentage, in the higher earnings bracket, than you do in the lower incomes.

    How often have you heard of those on Benefits or low earnings, getting all of the family a fish and chip supper, or a takaway pizza for dinner cost in excess of £20.00 for four (an expensive meal when on a low income) when home cooked meat and vegetables would be a much more cost effective and healthy option.

    Yes, those on a higher income could afford to stuff themselves full, but it would seem few do (other than perhaps with drink).

    Perhaps it is in our genes, and it is just a fear of not knowing when the next meal will come from ?
    Or
    Perhaps its all about Education, Lifestyle choice and a personal pride in appearance.

    One thing is for sure, throwing money at it is not a solution.

    • alan jutson
      Posted March 4, 2012 at 11:19 am | Permalink

      It has often been said that the Uk population was at its most healthy when we had rationing during World War II.

      This may or may not be true, but perhaps it would be worth further investigation.

      No, I am not suggesting we ration now, and yes I am aware that the black market offered ways around the rationing system, but in general terms many people were far more physically active then, than we are as a population now.

      Why pay for gym membership when you can dig over your own garden, plant some vegetables, and walk to the shops.

      Food for thought !

      • alan jutson
        Posted March 4, 2012 at 11:21 am | Permalink

        Amazing when people go to the gym by car, they all seem to want to park as close as possible to the entrance.

        Anyone else noticed this !

        Why ?

        • lifelogic
          Posted March 4, 2012 at 11:58 am | Permalink

          Also joggers always cut corners to shorten the route – surely they are only doing it for the exercise anyway – the longer the better!

          If the want a shorter route just do not bother.

        • forthurst
          Posted March 4, 2012 at 1:19 pm | Permalink

          Obviously they are in a hurry to get some proper excercise on a walking machine.

        • Richard
          Posted March 4, 2012 at 3:45 pm | Permalink

          I agree Alan,
          The reduction of jobs where some physical effort was required and the reduction of home economics and cookery education in schools has not helped the health of the nation.

        • stred
          Posted March 5, 2012 at 12:05 pm | Permalink

          We joined our expensive local sports and fitness centre during a bargain offer. The cycling suite was full of new machines and we decided to give it a try. Unfortunately, this had to be done during a ‘session’ with a trainer shouting encouraging instructions to speed up while his programme of deafening dance musak, was blasted from large loudspeakers behing him.

          So I left and now use a cheap exercise bike in the attic.

    • StevenL
      Posted March 4, 2012 at 2:25 pm | Permalink

      In my experience, lots of rich people are fat – look at MP’s and Peers for a start.

      • Bob
        Posted March 4, 2012 at 5:30 pm | Permalink

        @StevenL
        Are you referring to would be Police Commissioner Lord Prescott by any chance?

    • uanime5
      Posted March 4, 2012 at 5:36 pm | Permalink

      The poor tend to be fat because cheap foods are bulked with fat or sugar. The fat and sugar contents in biscuits, bread, breakfast cereals, cakes, fizzy drinks, and sweets is truly shocking.

      • alan jutson
        Posted March 4, 2012 at 7:46 pm | Permalink

        Unamine5

        The foods you list are expensive and an unneccessary purchase if you cannot afford proper nutritional food.

      • libertarian
        Posted March 4, 2012 at 9:31 pm | Permalink

        At last a trues statement from uanime5 !!!

        The other interesting fact is that “cheap foods” are actually MORE expensive than healthy fresh food, but the problem with fresh stuff is you have to be bothered to cook it yourself.

  18. James Reade
    Posted March 4, 2012 at 11:22 am | Permalink

    More of the same. Assertions without the facts. Where are the links? If they are genuine facts, I’ll applaud you for raising them and suggesting ways around them (and focussing on lifestyles is clearly better than on the NHS – but how do you propose doing that?).

    But there are no links in this post, no reference to any studies on the supposed health inequalities. Additionally, no evidence presented they’ve got worse, just assertion. And, as I’ve pointed out before, I don’t believe politicians unless they provide some independent evidence (not something one of their think tanks has produced).

    • Richard
      Posted March 4, 2012 at 3:46 pm | Permalink

      But where are yours?

      • uanime5
        Posted March 4, 2012 at 5:37 pm | Permalink

        Why would he need to provide links for his comments about an article at the top of the page?

      • zorro
        Posted March 4, 2012 at 6:16 pm | Permalink

        He’s probably a bit hacked off because John never quotes his studies!

        zorro

        • zorro
          Posted March 4, 2012 at 6:19 pm | Permalink

          I’m sure studies are very good but what is wrong with the collective of personal experiences from posters on this blog. We are quick to challenge when necessary.

          zorro

          • Richard
            Posted March 4, 2012 at 10:24 pm | Permalink

            You are quite correct Zorro,
            Not every post requires Harvard referencing and links to statistics and research for every word that is written by contributors.
            I think the aim is to stiffle comment to only those academics with research to quote from thus cutting out those of us who wish to make their opinions known based just on their experiences.
            Like you, I’m happy to have my views criticised by others and be shown evidence to back that up rebuttal, but continual shouts of “where are your stats” from Rebecca and James are getting dull.
            I suspect even if you did show stats and research the inevitable next counter would be that to say your research and your figures are faulty

  19. James Sutherland
    Posted March 4, 2012 at 11:26 am | Permalink

    Is “inequality” really the right thing to focus on? Of course it would be better if men in Glasgow and Chelsea could both expect to live to 85 – but more realistically, supposing a new development meant Glasgow men living to 72 and Chelsea men living to 88: is that a bad thing, because the gap is wider, or a good thing, because both are living longer?

    Like the old joke about a genie giving a man three wishes – but whatever he wishes for, his ex-wife will get double: if you could make the healthy healthier (or the rich richer, the intelligent more so…), would you? I would – but that is the exact opposite of the stated aim of “reducing inequality”, which is why I for one *do* have a problem with that as a goal. The aim should be to improve health – whether it reduces or increases “inequality”. Now, it may turn out that £1m spent in Glasgow gives better results than spending that £1m in Chelsea – but if the opposite is true? The previous lot would have spent it less efficiently for ideological reasons, their “inequality” fixation; I would like to see us move beyond that.

  20. backofanenvelope
    Posted March 4, 2012 at 11:41 am | Permalink

    There is one big difference between Glasgow and Chelsea – the Labour Party!

    • lifelogic
      Posted March 4, 2012 at 12:01 pm | Permalink

      Yes perhaps it is voting Labour, the socialist mental attitude/genes and the evil politics of envy or living off the work/taxes of others that is so unhealthy!

      • uanime5
        Posted March 4, 2012 at 5:38 pm | Permalink

        Perhaps the Conservatives take care of their own by giving them high paying jobs.

        • lifelogic
          Posted March 4, 2012 at 10:14 pm | Permalink

          That is more the labour, socialist way but certainly the Tories do it too.

  21. David John Wilson
    Posted March 4, 2012 at 12:04 pm | Permalink

    One way of making the NHS more cost effective is to move it away from being an “illness” service to being a”prevention of illness service”
    Taking smoking as an example on average the cost of stopping one person from smoking far out ways the cost of tresting the effects of that person smoking.
    The same comment applies to obesity, excessive alcohol consumption etc.
    This leads to a number of conclusions not least of which is the need to stop under age access to cigarettes and alcohol. The greater number of people with problems caused by alcohol and smoking developed their habits under the age of 16.

    Obesity has many of its roots in childhood developed habits. This obviously includes alcohol but also but the eating habits of small children. I frequently see children being collected from nursery by overweight mothers and being given a bag of crisps to eat on the way home. My children were given an apple in the same situation which incidently costs a little less.

    We need an NHS that is proactive in desease prevention.

  22. Ferdinand
    Posted March 4, 2012 at 12:07 pm | Permalink

    I think the only way to remove all inequalities is to privatise the whole of the Health Service and work on a voucher system with certain illnesses and certain levels of income covered by special voucher conditions.

  23. David John Wilson
    Posted March 4, 2012 at 12:33 pm | Permalink

    How about an NHS that gets involved in some positive marketing following the practices of commercial companies. Lets get our children (and adults?) collecting red tractor stickers or the stickers that the supermarkets put on their fruit. The costs of an apple and a bag of crisps are very similar. The health differences are obvious. The rewards could be personal or equipment for your local school or nursery.

  24. sm
    Posted March 4, 2012 at 1:03 pm | Permalink

    Everyone in the UK is guaranteed sufficient income by the state to ensure a basic standard of nutrition, heating and shelter.

    Just to earn enough interest to pay council tax of £1500 would require £50,000 at 3%. To have income of £65 per week to live on=£3380 would require an additional £112,000.

    Savings above £16k mean you are on you own. Another reason to be wary of un-employment stats.

    It is possible to have low to zero income with zero public support whilst being taxed via Council Tax,Vat,Fuel and inflation another issue relating to QE/ZIRP.

    Something you could do would be to reduce the direct costs of ill health, prescription charges,hospital parking etc. Tax beer/wine/fags transfats…sure… but hyopthecate it for medicines or similar education medical research.

  25. John B
    Posted March 4, 2012 at 1:10 pm | Permalink

    Oh good grief! Inequality.

    It is because that is what happens when there are zillions of possible genetic permutations – we all come out different and so end up different because we are all unequal in abilities, cunning, desires, ambitions, stamina, etc.

    Some will be clever, some thick as bulls’ lugs. Some will spend as they earn; some will live in apparent poverty because of their obsession with thrift; some will be so dull and unambitious they will never earn enough to make a decent living, or really care; some, just like Goldilock’s porridge, will be “just right”; others will be selfish greed-mongers.

    And some will like deep fried Mars bars and others Champagne and canapés.

    Enter politicians who don’t like “inequality” (have a word with God maybe, Darwin’s busy) and imagine that outcomes can be determined and that they are competent to do this – incompetent to do anything else but this they can manage as the last 60 years of social legislation and redistribution (destruction) of wealth shows.

    Result: we are told, the poor are getting poorer; the rich, richer. So the redistribution/fairness/equality thing has really worked well. Eh?

    There are, we are told, health inequalities between people in Mediterranean Countries and those in the North: the former living happy, skinny healthy lives; the latter waddling, ailment plagued fatties not long for this Earth.

    That ubiquitous North/South divide thingy.

    The Med folk are olive oil swigging, “poorer” people living a near (but for the CAP) agrarian, subsistence compared with the rich, urbanised, industrialised Northern folk who slather animal fats over everything they eat.

    But because correlation is absolute proof of causality de pending of course on the preferred political argument/research grant application, “poverty” is not the supposed reason in this case, it is olive oil.

    I suggest then pay everyone in olive oil and end wealth and health inequality.

  26. S. Donald
    Posted March 4, 2012 at 1:23 pm | Permalink

    Would it be extremely politically incorrect to say that the people who live in Glasgow are much more likely to have worked in Traditional Industries unlike I suspect, those who live in Chelsea.
    It,s getting increasingly boring with the anti smoking/ anti drinking bandwagon claiming these two things cause every ailment known to man. It,s also extremely annoying that my party is following the same path regarding these issues, or is it that the conservative party members chose the wrong leader.

  27. Peter Whale
    Posted March 4, 2012 at 1:35 pm | Permalink

    I do not know how to make anything equal but I have a simple cost effective way to make health and education better. Everyone employed by the state including local government and quangos, as a prerequisite of the job can only use the NHS and the public funded education system for themselves and immediate family. This means that the people running the system cannot use the private sector. The same goes for pensions we all get the same state pension. No company pensions or gold plated public service pensions we all get the same unless you want to top up in a private scheme with earned income open to all.

    • rose
      Posted March 4, 2012 at 10:55 pm | Permalink

      Nice idea in theory. Socialist ministers have always used the National Health Service. They go in when it suits them, and they get a private room. Probably the consultant of their choice too, and better nursing. So that is not the solution, any more than it was in the USSR. When Mrst Thatcher had an operation at her convenience, and a room of her own, she paid for it all herself, and took a lot of criticism. Which was worse? Mrs Thatcher’s way or Mrs Castle’s? And which had a better effect on what the rest of us got? It might work better with schools and transport.

      • Peter Whale
        Posted March 5, 2012 at 1:41 pm | Permalink

        The point is en masse it makes a huge difference. There will always be favoritism.

  28. forthurst
    Posted March 4, 2012 at 2:17 pm | Permalink

    Firstly when discussing healthcare and longevity, it would be more relevant to discuss medians rather than averages. It would also be more responsible to not throw taxpayers’ money at a problem without analysing it properly in the first instance. The medical profession can hardly be blamed or the resources with which it is provided if the presentation with serious illness by Glaswegians is more frequent than in other parts. The problem may be far more cultural or even genetic than of ‘deprivation’.

    Are there specific cultural problems in Glasgow? Are the doctors able to understand the Glaswegians or vice-versa? There is a lot chatter about how long it ought to take for a patient to be referred to hospital for investigation, but what about the time it takes some ‘doctors’ to recognise the presentation of symptoms of a potentially serious condition? What of the comparative surgical failure rates in different regions? The way to deal with poorly performing doctors is not to give them more money or even attempt to provide them with the training they purported to have received already, but to remove them and possibly deport them.

    There is an impression that a lot of people who live off takeaways and pre-prepared ‘food’, can’t cook; to that extent they do not have an immediate choice. For some people, probably a lot of people, it might be more important to teach them about nutrition and lifestyle and how to cook than to achieve 5 GCSEs etc. Perhaps unemployed Glaswegians should be provided with lifestyle and cookery classes? There is also the problem that most television, particularly from the BBC, is certainly unwatchable in a sober state, so further instruction on alternative leisure pursuits may be appropriate.

  29. Electro-Kevin
    Posted March 4, 2012 at 2:22 pm | Permalink

    So 71 years of age is no longer good enough and we must push to get everyone living to 85.

    An explosion in the population of geriatrics.

    Goodness. Is there no end to the list of economic demands we’re going to place on young people ?

  30. Tom William
    Posted March 4, 2012 at 2:25 pm | Permalink

    Two points to consider.

    Attempts to improve school food by Jamie Oliver were countered by parents giving unhealthy, but popular, food and snacks to their children. Depressing.

    I was a boy during the war and post war rationing. I am 5′ 11″ and, at a reunion in 1965, virtually everyone there (out of a hundred or so) was the same height or taller. Rationing did us no harm and perhaps some good.

  31. Barbara Stevens
    Posted March 4, 2012 at 2:32 pm | Permalink

    Mr Redwood, speaking as a person on the ‘ground’ so to speak, been round a bit, so understand the social things that make people tic; and having spent 8 years with the CAB, know to some extent what I’m talking about. People who are working, but not well off, people who are not working are relatively poor, bad health stikes them all, it does not define the rich or poor. As a former nurse, I know what good health is and what’s bad. When a person needs professional help within the health service it should be there for their needs, whatever background they come from. The majority of people, having personal debt cannot afford private health care, and the poor certainly not. Yes, lifestyle should be a concern to all sections of our society, but affordablity does come into play when deciding what you can afford to eat, and pay the bills. That’s the simple facts of life. The last government did increase money into the NHS, and rightly so, for it lacked true funding and was starved of it in the Thatcher era, many of us who needed care then had to wait for 18 months just for operations etc. We had them much earlier in less than 18 weeks after the Labour government invested in it. Why should we or anyone be forced to wait more time and suffering while you do so. If we as a nation can afford foreign aid at the level Cameron as suggested we increase it to, then we can afford decent health care for our own citizens. To suggest foreign aid is more important is flawed and won’t wash, I know you sir have not suggested this, but I’m talking of government policies between foreign aid and the health service. People are worried about this new bill, they are concerned its the first step to privatisation, and I believe it is. If this does come to be true then the Conservatives will rue the day for there are far many poor people and those who are working who cannot afford the fees that would ensue from privatisation. People won’t forget. This bill is not necessary as alteration could have been done within the NHS as it is, it’s a Consevative whim which they will regret. I’m sorry they’ve ventured to do this, when they didn’t introduce it within their manifesto. To me that’s an awful deciet. If you’ve money you can go elsewhere, if you’re poor you’ve little choice, but the choice can fester into something more hateful if a person is made to suffer because of the lack of funds. Human nature is like that, and that’s something governments cannot have to order.

  32. Bazman
    Posted March 4, 2012 at 2:51 pm | Permalink

    Difficult questions. A bit like why do Russians drink so much and so much hard spirits? Tsars have tried various methods to reduce the love affair with the mistress vodka with little success and what better reason than having a bad day under the communist for a drink? Gorbachev’s controls produced laughable graphs showing vodka production down and rises in sugar consumption correlating to this. The average lifespan for men fell through the floor to 50 something at the same time. Third world levels. They really do like vodka. Remember the pop wagon? It’s like that, mixed with some very impressive vodka shops. The noise of a human falling backward onto concrete is truly shocking.
    The idea that this consumption is not linked to income is false. Many Russians lack hope as well as income so buying a new electronic toy or a pair of shoes as an escape is not an option. This combination often leaves vodka as an attractive and cheap option.
    It’s fair to say it’s pretty dangerous to be a Russian man and in my opinion this is inextricably linked to economics and hopelessness. The same could be said here about health.

  33. Bernard Otway
    Posted March 4, 2012 at 2:52 pm | Permalink

    John did not Abraham Lincoln say “you cannot make the poor rich by making the rich poor”
    and that was over 100 years ago,what was true then was true 2000 years before that and will
    be one million years from now.Which is why socialism only works for a relatively short time
    before it hits the buffers just like a runaway train,an unstoppable [or so it thinks] force meets an immovable object [too many poor and not enough rich].I once sat and talked to Cyril Ramaphosa [one of Nelson Mandela’s top advisors] I told him that if when the ANC took over
    IF it confiscated ALL private wealth and equally distributed it among the previously disadvantaged as they are labelled,each one would get about R1500 as a ONE OFF amount, this would require actually selling corporate south africa to willing buyers and at
    that mainly overseas buyers to have the cash,I asked him what would the ANC then do when ONE MONTH LATER the R1500 was spent and South Africa in it’s entirety belonged to overseas owners,while the millions wanted more and more.I postulated that reconfiscating the assets from their overseas owners would not be a good thing, as to realise the assets again would need other buyers,and I said they only MAYBE existed 200
    LIGHT years away,no other overseas buyers would TRUST the ANC again. By the way he is now a CORPORATE TITAN in SA worth ( a substantial sum-ed),having been the general secretary of COSATU [same as the TUC]. SOCIALISM DOES NOT WORK AND NEVER WILL. How many Steven Jobs or Bill Gates or Bransons came out of the USSR when it was at it’s height. I REST MY CASE.

    • APL
      Posted March 4, 2012 at 9:22 pm | Permalink

      Bernard Otway: “each one would get about R1500 as a ONE OFF amount”

      Similar arithmetic applies to the USA the only in their case if the confiscated all private wealth in the US it would last the government about 300 days.

  34. Derek Emery
    Posted March 4, 2012 at 2:56 pm | Permalink

    I wouldn’t expect politicians or bureaucrats to come up with answers that work in the real world. Politicians always start from knowing what answers they want politically and then ask their advisers to prove the case by working backwards.

    A recent example is where politicians wanted the answer for meeting emission targets to be solar and wind turbines.

    KPMG looked at the problem dispassionately rather than starting from the highly expensive solar/wind power solution favoured by politicians but their answer was not wanted.
    However their report has come to light and shows that the UK could save £34 billion by 2020 and £150 billion by 2050 if coal fired stations were replaced by gas fired and nuclear rather than the solar and wind power solution politicians prefer.

    • lifelogic
      Posted March 4, 2012 at 6:03 pm | Permalink

      As you say “The UK could save £34 billion by 2020 and £150 billion by 2050 if coal fired stations were replaced by gas fired and nuclear rather than the solar and wind power solution politicians prefer.” I believe the report is correct on this.

      Not that warming from C02 is really such a problem in the first place anyway.

      So why on earth do we have these pointless turbines and Photo Voltaics littering the place at vast expense generating tiny amounts of energy at random times?

    • Mark
      Posted March 5, 2012 at 11:55 pm | Permalink

      They could probably save even more if they were replaced by newer coal stations when really required too.

  35. David B
    Posted March 4, 2012 at 4:35 pm | Permalink

    I find it frightening that you have to start your post by saying that you want to improve healt outcomes. This is why the left have so successfully dominated the debate with spend more and only on the public sector.

    Reply Surely anyone sensible wants a healthier population – we can argue over how this can be achieved, as the piece goes on to do. Who wants a sicker population?

    • zorro
      Posted March 4, 2012 at 6:35 pm | Permalink

      Reply to reply – I think that everyone has the freedom to pursue happiness within the law. What right is it of mine to impinge on the freedom of others to do that? People have choices and are responsible for what they do with their bodies and should be responsible for ensuring that they contribute to the cost of their health as appropriate. Do I care about whether the life expectancy is different in Glasgow and Chelsea? No, I don’t. It has nothing to do with ‘health inequalities’. It is because the people I know from Glasgow and family members who have dealt extensively with Glaswegians are aware that they smoke and drink to excess, and there is a horrendous drug problem there. Enough is already done to try and remedy this problem. I am sick of public money being poured down the drain again and again.

      This is nothing but busybody socialism, always interfering. A lot of people enjoy smoking, drinking and doing drugs and will continue to do so no matter what. Their choice, their life – not my problem.

      zorro

  36. lojolondon
    Posted March 4, 2012 at 4:44 pm | Permalink

    Life is not fair. ‘fairness’ is a Labour excuse to tax the rich and spend the money on their core voters, that is all. Like affirmative action, it has never produced positive results for the disadvantaged, and is just a massive, inefficient inconvenience. And it is NEVER easy to raise the bar for all, which is why the Labour solutions always focus directly on disadvantaging the hardest triers.
    What is achievable, is through the removal of ‘local NHS trusts’ and centralising the whole NHS with one small organisation, is that the ‘postcode lottery’ will be eliminated.

  37. uanime5
    Posted March 4, 2012 at 5:00 pm | Permalink

    1) There is a connection between levels of income and health. Those who can afford to live in decent houses, heat these houses, and eat a healthy diet tend to live longer than those who can’t.

    2) Reducing the wealth of the richest does not automatically mean that their healthcare will decline and it is dishonest to claim that it will. If there was a proportional relationship between wealth and health then the only people who would live to be over 100 would be billionaires.

    3) Given that the NHS has to treat those who suffer from lifestyle illnesses it’s logical for the NHS to engage in preventative medicine in areas of poor health to reduce the number of people who will need treatment. After all private healthcare companies won’t engage in preventative medicine because it reduces the number of future customers.

    4) It would be easier to reduce obesity if the Government introduced the traffic light scheme on food so that people can easily tell what’s high in fat, salt, or sugar. Caving into the demands of the junk food industry doesn’t benefit the UK in the long run.

    • lifelogic
      Posted March 4, 2012 at 8:22 pm | Permalink

      “what’s high in fat, salt, or sugar” packets of butter, bottles of oil, and bags of salt and sugar I assume. Things that taste salty are usually high in salt and things that taste sweet usually high in sugar and things that are oily are usually high in fat. Do we need any more labels?

    • libertarian
      Posted March 4, 2012 at 9:41 pm | Permalink

      1) And those who can’t are prevented from decent heat and homes entirely due to the taxes levied on them by government

      2) Increasing the wealth of the poorest doesn’t automatically mean their healthcare will improve

      3) Silly nonsense a) All 17 of the WHO worlds best health care countries have their care provide by private companies, b)
      preventative medicine is as valuable as treatment ( proving you haven’t got a clue how to run a business)

      4) Just about ALL food I see in the shops has labelling telling you this information and it hasn’t made any difference so far. What demands have the junk food industry made? Even McDonalds now has the fat, salt and calorie content identified on their products

      Why do you continue to assert stuff that is just part of the left’s mythologies and lies and is so easily disproved by anyone ( i.e. all of us on here reading what you post) who can type into google?

      • sm
        Posted March 5, 2012 at 10:49 am | Permalink

        Google countries the health effects of
        1) regulations to reduce/eliminate transfats. 2)smoking. Although i would not make them illegal i support making them available in a controlled manner.

  38. Damien
    Posted March 4, 2012 at 5:03 pm | Permalink

    Surely the best way to reduce health inequality is to educate people about healthy lifestyles and that would ideally start in schools.

    The ways of tackling health inequality are so ill defined that once it becomes an NHS law it could become a convenient excuse for all sorts of expenditure.

  39. Denis Cooper
    Posted March 4, 2012 at 5:04 pm | Permalink

    My wife, who has some knowledge of these matters, recalls that as long ago as the 1970’s there were studies to try to establish the causes of the abnormally low life expectancy in Glasgow, and at that time one explanation centred on the use of lead pipes for the water supply. Clearly that couldn’t have been the whole story, but it’s not as if the problem has only just been noticed, or it has been noticed in the past but ignored.

    • Mark
      Posted March 5, 2012 at 11:51 pm | Permalink

      Perhaps they played too much Cluedo? Rev Green in the Library with the Lead Piping…

  40. Iain Gill
    Posted March 4, 2012 at 5:16 pm | Permalink

    one of the biggest issues is the way GP catchment areas work. you live in postcode X and you are only allowed to register with GP A, B or C (if youre lucky in practise for many people there is no choice). you cannot see a GP near work. if you have more than one address or move address frequently for work you are not permitted to keep going back to one GP for consistency you have to keep moving GP (and loosing your place in any NHS queue every time). there is little/no market forces on GP’s to improve their game and extremely poor GP’s can make a good living over a long period in this country, because the patients dont really have the power to vote with their feet, and they are paid per patient not per consultation or outcome. so having been a middle class person who wanted to live in an inner city area one of the biggest problems was the dire GP’s anyone with that postcode is forced to use, and sitting in the waiting room with folk you KNOW to be local drugs dealers and gang leaders is not nice, this situation doesnt arise for normal folk in any other western democracy where patients simply walk with their feet to another practise. so nice middle class folk move away from postcodes with such GP’s and leave those with no choice behind. similar to the school catchment area nonsense in this country we are dividing our society by forcing people to live where they can get a decent GP and school rather than where they would otherwise choose to live. All of this needs sorting. The difference is standards across the country is massive. GP’s in Bristol I have seen are first rate, their equivalents in (another named place-ed) are truely terrible, and massive inconsistencies in treatment of same symptoms. Lots of simple treatments can significantly increase your chances of living much longer for minimal drugs spend, for instance medicaing high blood pressure costs little but is proven to extend average lifetimes by tens of years potentially, problem being that those 30% that could benefit are not well identified by the system and it is middle class folk who tend to have the knowledge to seek out such treatments etc. All in all much we could learn from other countries.

  41. NickW
    Posted March 4, 2012 at 5:20 pm | Permalink

    Before inequalities are tackled, we need more information as to how the statistics differ from area to area.

    What ages of people are dying younger in Glasgow, and why?

    Is the higher mortality occurring in children, teenagers, younger workers, older workers, pensioners—?

    If the elderly are dying younger in the North, it may well be because of their lifestyle in their childhood and young adulthood, factors which cannot now be changed, however much money is spent.

    Before there is a knee jerk response to “Inequality”, there needs to be a closer analysis as to where and why the inequalities are occurring. Once that has been done, the next question is whether spending money now can or will make the slightest difference.

    If it won’t, don’t spend it.

  42. Bob
    Posted March 4, 2012 at 5:41 pm | Permalink

    How do you reduce health inequalities?
    Through education. Next question.

  43. Bernard Otway
    Posted March 4, 2012 at 5:49 pm | Permalink

    John ,WHY? must I be Ed.[Censored] in my stating the man’s wealth,on a daily basis in many articles,the wealth of people is published or their house value or many other things
    throughout the press. I DO NOT UNDERSTAND WHO ARE YOU DEFENDING OR PROTECTING,this actually is a matter of public record as it is published OFTEN in the SA press.

    Reply: It is not a figure I can prove, so I prefer to use a general statement to avoid a challenge from someone who says the facts are wrong about them. In my experience estimates of people’s weelth in newspapers is often widly out.

  44. rose
    Posted March 4, 2012 at 6:08 pm | Permalink

    The only way to remove health inequalities is politically, morally, and philosophically unacceptable. Probably impossible practically, too. Besides, it was discredited, if not once and for all, then certainly for a very long time ahead, by the events during the 2nd world war.

    To reduce them, rather than remove them, is probably not what the Left want. After all, Beveridge just wanted a temporary NHS, to bring the working class up to a certain level of health and then let them fend for themselves, as others did. That was probably achieved by the end of the 1960s – before obesity, drug addiction, binge drinking, and welfare dependancy brought a new affluent form of ill health to the nation.

  45. Max Dunbar
    Posted March 4, 2012 at 11:45 pm | Permalink

    Apparently the average life expectancy for men in Calton which is a council ward in central Glasgow is 54. I have lived in Glasgow virtually all my life. One year to go and then its all over for me. No more roll-ups, super-lager or chips’n’cheese.

  46. Winston Smith
    Posted March 5, 2012 at 10:46 am | Permalink

    There are important differences between Glasgow and K&C. The vast majority of Glasgow’s poorest constituency would have been born and bred in the area. The vast majority of residents in K&C would have been born and bred elsewhere, many of them abroad. I’m sure if you compared the wards that include the North and West Kensington council estates with wards, in say Govan, the differences would not be so stark. The reason: education. The Marxist educationalists have reduced self-determination and personal responsibility.

  47. peter davies
    Posted March 5, 2012 at 12:29 pm | Permalink

    You said it yourself John, the NHS is a fixer of health. It is there to pick up the pieces when our health goes wrong so simply pumping money into it to fix ‘health inequalities’ is a load of codswallop – one has to go to root causes in the way that IDS did before he came into government with regards to the long term unemployed.

    What do they do – pump a load of money into their advertising budgets to advise people to do this and that….? – the people they are targetting will not listen probably because they dont care.

    The way for people to make themselves healthier is through education and ambition with the attitude that they should better themselves through the careers they wish to follow and of course their lifestyles.

    I think theres a cultural issue here as well, some areas, especially those with high unemployment have too many people with little outlook and little to look forward to so don’t give a **** about their health – and why should they?

    Resources need to go into identifying such groups and changing their outlooks with some sort of mentorship so they get themselves into positions to better themselves so hopefully the attitude changes will follow – after all smoking is not about poverty (I couldn’t afford to smoke), going out drinking cant be about poverty (I cant afford to go out drinking more than a couple of times per month) and eating takeaway food is expensive – this is all about education, family structures and values – you do not need to be well off to live a healthy lifestyle, you just need a reason to follow that path.

    I used to service vending machines in pubs and some were full to the rim of drinkers at 11am on a week day – these people must get their money from somewhere, I cant afford to do that so how does throwing money at something solve the problem?

    The jobs program is a start for many though not helped by several wingeing do gooders who say it isn’t fair that people should be forced to go out and get some experience on their CV.

  48. Robbo
    Posted March 5, 2012 at 3:57 pm | Permalink

    Health / wealth correlation is tricky. Wealthy people may look after themselves better – personal trainer anyone ? But also people with significant health problems very often have reduced earning power. My own view is that health professionals should keep it simple and treat the patients in front of them to the best of their ability. Playing God over statistical outcomes is a wasteful diversion of energy from that goal.

    • Bazman
      Posted March 6, 2012 at 6:53 pm | Permalink

      Any health system or business must have an eye on improving the statistics. Even sport does so I’m told.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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