Nursing tries to patch up problems caused by inequality

Twelve years on and Boyzone are touring again and the foxes still know that red means run and the health inequalities between rich and poor are wider than ever.

While reducing the presence of Ronan Keating was never an explicit manifesto promise, addressing health inequalities was, and when the Commons health select committee says that the government has wasted public money in its attempts to reduce health inequalities and that a little more care in the planning and implementation of policies might have been a good idea it is hard to see how anyone could describe the initiatives as a success. Not that that will stop someone from Government Towers trying.

At the heart of the health inequalities programme, like so much else that emerged from the New Labour project, was a set of policies without principles or foundation.  A slightly romantic desire to shepherd the poor towards the truths of health education – which are nestling patiently under the willow tree just beyond the babbling brook over there in a Health Action Zone. Once discovered, all the poor people will embrace these truths and there will be no more smoking or kebab eating. Nor will there be any more unfulfilling work, public health issues, poverty, unhappiness or anything else that might contribute to the unhealthy lifestyles and social circumstances of the non-professional classes. Those people being the ones with at least an eight-year shorter life expectancy.

You don’t mend a wheel by pumping up the tyres

The drive to address health inequalities was propelled by the certain knowledge that it was the right thing to do. Nurses were at the heart of it, working with Sure Start, looking to address issues like Social Inclusion and trying to make sense of a Health Action Zone (what is it like to live just outside one of those?). But at the same time most, if not all nurses knew then that you don’t change the world with a series of briefly piloted initiatives and some well-written leaflets.

The inescapable truth underpinning health inequalities is the wealth gap between rich and poor. The countries which have good health all have less income inequality. Governments can continue to ignore this truth and instead come up with glossy initiatives but the simple truth is our health outcomes are a result of the way we organise ourselves and the values implicit to that. As some disappointed Tour De France rider probably said once: ‘You don’t mend a broken wheel by pumping up the tyres.’

One of the things nursing does that is rarely acknowledged is to address the difficulties implicit to the way we, as a society, organise ourselves. Essentially nursing tries to patch up the problems caused by inequality, deprivation, greed and social exclusion. Nursing in the face of inequality is a civilising and humanising force and thank goodness for that. But one wonders if maybe next time a government decides to address the health of the nation it might look at the fundamental issues rather than the superficial ones.

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