The best way to tackle health inequalities, Mr Cameron, is to tackle all inequality

This is from Rupert Read:

For once, we can agree with the Adam Smith Institute: David Cameron’s new headline plans to “banish health inequalities to history” by introducing “a health premium that targets resources on the poorest areas” will fail.

The key reason why it will fail was already brought out implicitly on Left Foot Forward a couple of months ago – it is that you cannot attack major societal inequalities, such as health inequalities, without attacking inequality itself.

In other words, by far the most consequential way of reducing health inequalities, it turns out, is to target economic and other societally-central inequalities directly. Not to target absolute poverty or ‘deprivation’, not to pursue economic growth, but simply to reduce inequality (whether by reducing high earnings, or by increasing low earnings).

Here is how Richard Wilkinson and Kate Pickett put this point, in their celebrated recent book (pp. 233-4) ‘The Spirit Level: Why more equal societies almost always do better’ (a book given the plaudit by the New Statesman recently of being their “Book of the Decade”):

“For ten years Britain has had a Government committed to narrowing the health gap between rich and poor. In an independent review of policy in different countries, a Dutch expert said Britain was ahead of other countries in implementing policies to reduce health inequalities.

“However, health inequalities in Britain have shown little or no tendency to decline… Rather than reducing inequality itself, the initiatives aimed at tackling health or social problems are nearly always attempts to break the links between socio-economic disadvantage and the problems it produces.

“The unstated hope is that people – particularly the poor – can carry on in the same circumstances, but will somehow no longer succumb to mental illness, teenage pregnancy, educational failure, obesity, or drugs.”

This passage almost reads as if it were written in response to today’s Conservative initiative. If Cameron’s advisers had taken the trouble to read Wilkinson and Pickett, they would have saved themselves from the embarrassment of this new policy of theirs which is fated to fail.

To use a medical metaphor, the ‘health premium’ policy is a band-aid, which will do no good in curing a degenerative condition.

If Cameron were serious about reducing health inequalities, he would target economic inequality directly, as Wilkinson and Pickett recommend. But that would be very hard for the Conservative Party to stomach, seeing as the Conservatives are the party which, under Margaret Thatcher and John Major, pursued policies which hugely escalated inequality, when they were last in power.

In the Preface to their book, Wilkinson and Pickett note that they almost called the book ‘Evidence-based politics’, on analogy with the term ‘evidence-based medicine’.

The subtitle of Left Foot Forward is ‘evidence-based blogging’. The evidence is in – and it shows very clearly that you cannot cure the nation’s health ills, except by curing the nation of the disease of rampant economic inequality.

Medication of the masses

Being a lowly Green I rarely achieve a national media hit but yesterday I spoke with a journalist from The Times who was writing a piece on whether selenium should be routinely added to wheat and, given the recent furore in Southampton where the residents will soon be medicated with fluoride whether they like it or not, I thought I'd say a little more on why it is wrong to mass medicate people.

For me, the issue is not one to be fought on whether the populations that are medicated would have an overall benefit, whether the increased toxicity of waste water will impact on the environment, or about individuals who will suffer the consequences of receiving a drug or supplement that their body doesn't need. For me, the issue is about choice vs techno fixes.

I am very aware that there are health issues to be addressed within the wider population. Anyone walking down a high st in Britain can see the obseity epidemic unfolding in our communities. Not only are people consuming too much, but many are consuming the wrong types of food. Others are becoming restless, depressed, anxoius and stressed. I could go on and on...

There are three broad approaches to health care. Firstly we can simply pick up the pieces when it has all gone wrong, just as the NHS often does. Secondly we can educate, incentivise and make it easier for people to make healthy choices. Thirdly we can force everyone to take preventative medication, supplements etc.

The power to take individual decisions and to make choices as long as those choses don't harm others is of great importance to me. There is a saying "Do as you will but harm no one" which I particularly like. The Green Party goes further: "The Green Party affirms the importance of individual freedom and self expression. We believe people should be free to make their own decisions on matters which do not adversely affect others. Its importance lies in valuing the opportunity people have to make their own decisions, accept responsibility for them and develop in their own way."

Primum non nocere translated as "First do no harm" should be at the root of health care. Should the needs of some outweigh the damage to others that mass medication can cause? Even if the vast majority benefit from the medication, should we harm the few? I think the answer is still no.

More difficult is if there is no possible harm to anyone or anything by the mass medication. Despite this being very unlikely, I would suggest that mass medication still removes the ability of individuals to choose. We need to make mistakes in our lives, to learn from them and to make better choices next time. This is a bit 'school of hard knocks' but it beats medication of the masses anyday.

Finally, the EU agrees with me... Article 5 of the EU Convention on Human Rights and Biomedicine says: "An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it."

Vote Margaret Haywood for the Nursing Standard's Nurse Awards 2009

Margy was struck off for whistleblowing and is appealing against the decision next month. Please support her by voting for her here.

We need a new national campaign to protect whistleblowers as current legislation is clearly not working. Anyone who is prepared to stand up and be counted should be valued not punished.

US attacks the NHS

The debate about changes to the US health care has kicked off in a big way. They aren't even bothering with lies or statistics, they have gone straight to the damn lies. The US media seem to be on a bit of a roll, even claiming that Stephen Hawking wouldn't get any care if he lived in England. I know the US media seem to think the outside world doesn't exist, but I think Mr Hawking might be this side of the pond.

This piece in the Guardian should be read for the comments as well as the article. One of the best comments is from yogibear: "It's an interesting feeling to be on the receiving end of such misinformation.".

However, Obama and British government do seem to be sitting on their hands in the face of the Republican lies. They need to show some backbone and expose them.

How can any sane person be happy with the most expensive healthcare system in the world, consuming around 15% of their GDP and that still does not provide care for 40 million Americans?

Six new rights - spin not substance

So are the new 'rights' for patients being unveiled by Gordon Brown anything but spin? He has promised to scrap unpopular targets in favour of a list of rights that patients can demand:

• An operation within 18 weeks of patients first seeing their GP
• A free health check-up for all at the age of 40
• Treatment from an NHS dentist
• Die at home if they suffer from a long-term medical condition
• See a cancer specialist within two weeks
• Be treated in accident & emergency departments within four hours.

They all sound great but strangely familiar, except perhaps for NHS dentistry. Firstly, I doubt very much whether these targets will be scrapped in favour of a 'patient' right. I can't see Brown trying to defend himself on why he doesn't know what the length of waits are and I can't see Burnham not getting concerned if the number of people waiting 18 weeks waits was to increase.

Of course ministers will keep a close eye on these areas and they will come down hard on hospitals and PCTs who are seeing increasing waits. Laissez faire is not something that Labour are good at. It would be quite a bizzarre state of affairs to have a government in a position that it doesn't monitor and manage key indicators of accessibility for NHS service.

This is clearly spin rather than substance, but that said, making it clear what patients should expect is welcome.

The dentistry right is the interesting one. Access to NHS dentistry is extremely patchy across the country and needs significant investment and time to get it right. How many people will have their right to an NHS dentist met by a dentist 20 miles away?

HEALTH SECRETARY’S ‘VESTED INTERESTS’ IN SOUTHAMPTON’S WATER FLUORIDATION SCHEME

Green MEP for the South East Caroline Lucas has challenged the Secretary of State for Health Andy Burnham over his position as vice president of the British Fluoridation Society – at a time when health authorities in Southampton were giving the green light to a “mass medication” water fluoridation scheme.

The Health Secretary was instrumental in proposing the inclusion of compulsory water fluoridation in the Government’s 2003 Water Act. He resigned from this position in recent weeks, but Dr Lucas MEP today joined with UK Councils Against Fluoridation (UKCAF) to question why Mr Burnham’s links with the Society were not included in his register of interests, despite strict Parliament regulations stating such interests must be declared.

Dr Lucas MEP said: “It is of great concern that the Health Secretary was able to closely align himself with a body whose sole business it is to promote water fluoridation, at the same time that he was due to make key decisions about the future of the UK’s water supply. Parliament’s regulations on MPs’ interests are supposed to prevent alliances which can fundamentally inform policy – but clearly they are not fit for purpose.”

Earlier this year, the Green MEP warned that the region’s health authorities were setting a “reckless precedent" for future fluoridation schemes in the South East with their decision to press ahead with fluoridation plans in Southampton.

Although 72% of people in Southampton voted against fluoridation in a poll conducted by the Strategic Health Authority, the SHA is pressing ahead with the scheme. A legal case regarding the highly criticised consultation process has been announced and legal aid has been obtained by the person bringing the case against South Central SHA.

Dr Lucas MEP commented: "The ill-advised decision to implement water fluoridation in Southampton demonstrates contempt for the views of many local people - and for the evidence against fluoridation itself.

"Water fluoridation has simply not been proven to be effective for teeth, and some studies have indicated links between fluoridation and serious ill health effects, including thyroid problems, skeletal fluorosis, bone cancers and mental problems.

"The scheme in Southampton amounts to a mass medication of the population. I have made a formal complaint to the European Commission regarding the failure of the UK Medicines and Healthcare Products Regulatory Agency (MHRA) to properly classify hexafluorosilic acid, used in fluoridation of drinking water under the UK Water Act 2003, as a medicinal product. The correct classification would likely mean the UK’s water fluoridation schemes would contravene EU law.

“In place of mass fluoridation, the UK Government could be improving the health of our teeth through targeted schemes such as providing free toothpaste for poor families. This decision in Southampton sets a reckless precedent for future fluoridation plans in the South East, and we must be vigilant of further attempts to affect our water in this way."

ENDS 

Notes to Editors

For more information on UK Councils Against Fluoridation, visit www.ukcaf.org 

Letter to Indy on dentistry

Letter to the Independent on the new dentistry report:

Sir, The renewed debate on NHS dentistry is very welcome and Professor Steele's report contains some useful ideas, however unless the government addresses the real problem that many people simply can't afford to pay for dental treatments, improvements in dental health will not take great leaps forward.

Dentistry could easily be funded through taxation and be free at the point of need, making it a universal service and not one that is 'expensive or slightly less expensive'. Free access to dentistry would cost a fraction of the money spent on NHS IT or running the NHS market, yet would deliver massive benefits to the people who need it most.

It is time that the government addressed the real problem, that NHS dentistry fails the primary test of NHS services - it is not free at the point of need.

Stuart Jeffery
Health spokesperson for the Green Party