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.