Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more


Should nurses be more concerned about inequality than poverty?

  • 1 Comment

Nursing Times blogger Martin Jones on public health and whether a book can provide some much needed answers.

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

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.

About the author

Martin Jones, Clinical Nurse Specialist HIV, East Sussex Downs & Weald.

Martin Jones has worked in sexual health and HIV since 1986.


*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.

  • 1 Comment

Readers' comments (1)

  • The NMC code states we should "Work with others to protect and promote the health and well-being of those in your care, their families and carers, and the wider community." For many Nurses this is interpreted as narrowly as possibly. I argue that we should embrace this concept fully. Expanding our work beyond the confines of daily practice and challenge an unequal society that contributes to poor health and health outcomes.

    Recently Professor Steve Field and Andrew Lansley have called on individuals to improve their general health and that of their families. This was jumped on by some nurse to bash those who make poorly informed life-style choices.

    It is time for all nurse to be realistic about modern British society. This unequal society is the root of unequal health outcomes.

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.