Should nurses be more concerned about inequality than poverty?

Back in June I blogged about the coalition government’s emergency budget. This attracted attention from trolls*, friends and fellow nurses, sparking an ideological debate on nursingtimes.net.

I had voiced concerns that health inequality seemed likely to increase under the government’s budget plans, citing Richard Wilkinson and Kate Pickett’s research, published as a book entitled ‘The Spirit Level – why more equal societies almost always do better’. During the debate I promised to come back to this.

Well I don’t like to show off about being the first to anything but ‘The Spirit Level’ was my request to my parents for a fiftieth birthday gift sixteen months ago. Now, according to the Guardian, Labour politicians are falling over themselves to declare support for its principle argument: that in order to reduce the problems associated with poverty, society needs to reduce inequality.

When I was a young nurse in the eighties we lapped up ‘The Black Report’. Commissioned by a Labour government but suppressed by Margaret Thatcher’s Conservative administration, ‘The Black Report’ became a public health manifesto setting out the significant and growing gap in disease and mortality between the poorest social classes when compared with the richest. Almost any indicator of poor health demonstrated a class gradient with those in the lowest social classes experiencing more perinatal mortality, disease whilst living and earlier death.

Wilkinson and Pickett have moved the debate along. ‘The Spirit Level’ is a similar looking academic book filled with compelling statistics and analysis, shifting the focus from poverty to inequality. As a nurse in sexual health I was drawn to the chapter on teenage pregnancy. Twelve years ago in its first flush of post-election optimism New Labour launched its teenage pregnancy strategy declaring this the ultimate health and social problem requiring ‘joined up thinking’. Teenage pregnancy rates would be halved by 2010 through multi-agency working and targeted interventions. Resources poured into our poorest communities… And the teenage pregnancy rate fell by 9%.

‘The Spirit Level’ demonstrates that besides affecting the poorest members of society, teenage pregnancy rates are highest in the most unequal societies. Thus, compared with other countries the UK fares second worst with USA almost off the scale. In chapters on mental health & drug use, physical health & life expectancy, obesity and a variety of social issues the effect of the gap between rich and poor is shown to be more significant than poverty itself.

No wonder the five candidates for the Labour leadership have declared an interest. It will be interesting to see if ‘The Spirit Level’ is any more palatable to the present government than ‘The Black Report’ was to 1980s Conservatives. And it would be marvellous if this could become a new public health manifesto for the current generation of nurses.

*In Internet slang, a troll is someone who posts inflammatory, extraneous, or off-topic messages in an online community, such as an online discussion forum, chat room, or blog, with the primary intent of provoking other users into a desired emotional response or of otherwise disrupting normal on-topic discussion.

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