An unequal crisis

It is strange how distant the pandemic feels. Just 18 months ago schools, shops and restaurants were shut and we were confined to our homes. The lockdowns were seismic events, set to determine politics and society for a generation. But do we talk about it now? Or think about it much? I certainly don’t. The pandemic has become an unpleasant blip which we just want to forget.

That’s fine as a way to deal with our feelings (although a therapist might say differently). I want to forget and move on from the pain of separation from my loved ones, the damage it did to their health and missed time with friends. But it is unacceptable that the pandemic has almost disappeared from our political debate. Our children missed months and months of school. My niece sat her A-levels this summer and they were the first exams she has sat since her Sats in Y6. But when is the last time you heard about plans for school catch-up? Lockdowns precipitated a new mental health crisis, but I did not notice the candidates for PM even mention it during this summer’s Conservative leadership campaign.

And there is another public policy challenge that we must not forget: the brutal reality of health inequality. I was working for Keir Starmer on our Covid response during the pandemic, and the statistics are imprinted on my mind. People from poorer areas were four times more likely to die than those in the richest.

It was the pandemic that drove Keir to put preventative healthcare at the centre of his offer on health – in his words at the Fabian Society conference in January he wants a healthcare system “as much about prevention as it is about cure”.

I saw how influenced he was by Sir Michael Marmot’s research on health inequality, and by the report he commissioned from Doreen Lawrence on race inequality. Now the challenge is to keep that commitment front and centre.

There are two arguments used against Labour talking more about health inequalities. The first, from those who think talking about inequalities is perhaps a little too ‘retro Labour’, is that it isn’t widely popular with the electorate. The second is that the policies to help address it are either too wide-ranging or completely unexciting.

With colleagues at Public First, I have just published a report for the Health Foundation which challenges both of those arguments. We spoke to people in places with low healthy life expectancy (the age at which you can expect to live before getting a chronic condition) and ran a nationally representative poll.

We found that the nay-sayers are wrong: there is strong public support for action to tackle health inequalities.

A significant majority of the public (69 per cent) support the government’s levelling up target on health inequality, and just 8 per cent think that health inequalities are not much of a concern. Perhaps most significantly we found that any worsening of health inequalities or decrease in healthy life expectancy before the next election both significantly reduces the likelihood of 2019 Conservative voters to vote Conservative in the next general election (−37 per cent net decrease for both measures).

Sadly that deterioration in health inequalities now seems likely. We are in the midst of a cost of living crisis and have a new PM who looks unlikely to deliver the scale of support people need. who looks set to refuse the support that people need. As one of our focus group participants told us: “We’ve got kids eating turkey twizzlers and the parents eating nothing…we are never going to get there.” This is on top of a decade of austerity which meant that life expectancy stalled – and started to fall for some people – for the first time ever before the pandemic hit.

We also found that policies to tackle health inequalities are popular and can help Labour win the next election. The most popular policy to tackle health inequalities is to significantly expand screening services. We showed half of the sample this policy as a Labour announcement, and half as a Conservative announcement. Some 53 per cent of those shown the Labour arguments said that expanding screening would make them much more or somewhat more likely to vote for Labour at the election – the highest overall score. We also found improving green spaces to be highly persuasive, with 52 per cent who saw it as a Labour argument saying it would make them more likely to vote Labour.

We then analysed the data by 2019 voting record and found that screening expansion and green space policies would be highly effective at persuading 2019 Conservative voters to come to Labour this time. 36 per cent of people who voted Conservative in 2019 said a screening expansion policy would make them more likely to vote Labour this time, and 42 per cent of the same sample said a policy to improve green spaces would also make them more likely to vote Labour.

We also found that policies to tackle health inequalities must be rooted in a politics of place – and must tackle the wider determinants of health. Our research found that people living in areas of very low healthy life expectancy tend to be more negative about their area and see a healthy place as one with good housing, low crime, green spaces and good jobs.

The importance of improving community links was a particularly striking finding, with many talking about the importance of connection to the community to a person’s health. One person compared the importance of community to a pride of lions – a sense of belonging makes you feel better in yourself. Another said “human contact makes you healthy”. Another called for: “…somewhere to go, somebody to see, somebody to speak to, and to join in and become part of the community. So it makes you healthier on the inside, it makes a healthy mind, healthy mind, healthy body is what they say.”

Others focused on the importance of crime. Participants talked about how they did not feel safe letting their children out to play in local parks, and that concerns around safety were stopping them walking or exercising in their community too. This chimed with our poll which showed people in very low healthy life expectancy areas have significantly higher levels of dissatisfaction with crime than people in very high healthy life expectancy areas.

Tackling health inequality must be one of the defining missions of the next Labour government.

This is not a straightforward challenge. The problems we face are entwined with most aspects of social policy. But instead of ignoring it because we think it is too hard or not popular enough with the electorate, Labour’s strategists must recognise that the ambition and policies are popular – and drive forward a policy agenda that improves places and improves health. Every community must have safe, well-maintained green spaces and community services which bring people together – and we must support people through these incredibly hard times so we don’t see a further deterioration in people’s health.

Image credit: N Chadwick, CC BY-SA 2.0 via Wikimedia Commons

Image credit: Michael Trolove, CC BY-SA 2.0 via Wikimedia Commons