Health is a right. Just not for everyone.
Article first published on CommonSpace.scot.
“Wonderful weather, isn’t it?”
“Are you travelling for business or pleasure?”
My 65years-old fellow passenger on a busy 4-hour flight was extremely bored and desperately trying to talk to anyone around him. But then, he said something that I will never forget. It isn’t some sort of philosophical quote, but, it seems pretty deep to me. I mean it isn’t that deep but I will say it anyway. He told me that “health is a business that is always going to be around”.
And he was right.
Many people think that health is something that doesn’t directly involve them; that concerns researchers, advocates, practitioners, health professionals, charities and NGOs, medical students and consultants. They think that there are things more important, more popular, more ‘relevant’, worthy for media coverage and attention than talking about health. However, what they don’t understand is that health isn’t something that should be seen out of context. Economics, politics, feminism and gender norms, budget cuts and social policies, racism and xenophobia, cultural norms, architecture, environment and climate change, they all are relevant to health.
Simply put, as long you aren’t dead, health is relevant to you and to the person next to you(unless that person is a blood thirsty vampire or some other mythical and extremely hostile creature).
If you’re one of the intelligent, beautiful people that read this article, academics and public health researchers, politics geeks and activists, you will say something like: Duh! This is so yesterday’s news or why are you boring us with this?
Before you move to the article on how you can raise you own silkworms, please hear me out. Certain bizarre individuals among us find fascinating talking about health and about what determines good health. These creatures can write about this for hours and have fun (sort of) while doing it. But, what about the normal people around us?
In this parallel world, reality is pretty simple and straightforward: people are obese because they eat too much, they smoke because they want, they develop addictions because they are too weak, they are poor or unemployed because they are lazy and did I mention that politics is boring? Well, add this on the list, as well.
And it makes sense. I used to believe it and not to be bothered about it. However, my fellow normal humans, the truth is much more complicated and it sucks. It really sucks.
For example, between 2010 and 2012, if you were an English man you were likely to live until 79.1, but if you were Scottish, well, tough luck. You could be dead by the age of 76.6.Women in Kelvinside and Jordanhill are likely to live until the age of 81.3 and men until 76.3. However, our friends, family, colleagues, ourselves or anybody else that we know and care about that live in Ruchill and Possilpark, are likely to die almost 10 years younger than their two-miles neighbours (to be precise at 72.1 years old for women and 63.4 years old for men). Over the years, there are fewer people spending time in ill-health, so, good job everyone, things are getting better! Well, actually, this is truth for some of us. Between 2011 and 2012, men living in the least posh neighborhoods, could spend up to 22.7 years in “not good” health status in comparison to 11.9 years for our compatriots living in the most posh areas. For our sisters living in the least affluent areas things are even worse: they may spend up to 26.1 years in “not good” health, compared toonly 12.0 years for their richest sisters.
It will take lots of words and figures to fully explain what we mean by the term (health) inequalities and probably I will have lost you along the way. However, I know that you want to know more, so, just admit it, don’t be shy! Oh well, if you insist. Would be enough to tell you that there’s even a social patterning in greenspace availability? The ones among us, who live in ‘rich neighborhoods’, having received some sort of education, are much more likely to play football in their private garden[i].
That’s tough you will say and probably you won’t be completely wrong. But, what if I told you that lack of access to garden space is related with hyperactivity problems, peer problems and conduct problems?Please, add to this the GENDER factor, meaning that boys are more sensitive to the lack of park access than girls. But it’s not just that. Even though we can’t show any significant effect during childhood, we CAN show an association between access to green space and mental health in later life, especially for women and less privileged individuals in terms of socioeconomic resources.You know what else is pretty shocking? For the lucky ones that, as children, could go out and enjoy their awesome garden, as they grow older, their brain will work better than the ones not having access to green space.
And this is not all. There’s a social patterning in suicide rates[ii]. Those who are unemployed are 2-3 times more likely to commit suicide and those living in the least affluent areas are twice as likely to get admitted to hospital due to non-fatal self-harm. A Scottish study showed that if you belong in the lowest income class and live in thepoorest geographicalarea, you might be 10 times more likely to express suicidal behaviour than your richest fellow citizens, living in the most poshneighbourhoods. By now, you have probably guessed that inadequate unemployment benefits, poor (or non-existent) active labour market programmes, low income, poverty, bankruptcy, loss of home, unmanageable debt, lack of local job opportunities, closure or downsizing of local workplaces can make a person think of the unthinkable.
What I mentioned here is a fraction of the available evidence on this issue. We have observed that there’s social patterning in: obesity, alcohol-related hospital admissions, smoking and spread of non-communicable diseases – to name a few. Yes, life is unjust, but, this injustice can actually kill ourselves, somebody we know or we could have known if we weren’t living in two parallel worlds. I hate being melodramatic or cliché, but, it is worth drawing attention to these issues whenever and wherever we can; it is our duty to hold policy makers accountable for their actions (or absence of them). At the end of the day, we need to keep fighting,so that positive change may disproportionally benefit the people that need it the most.
[i] Pearce, J. (2017). Built environment, health & inequalities. Presentation at theHealth Inequalities Cross Party Group, Scottish Parliament, on 30th March 2017. The facts presented are based on evidence presented by Jamie Pearce (University of Edinburgh) in that meeting.
[ii]This paragraph is based on presentation by James Jopling(2017). Dying from inequality: socioeconomic disadvantage and suicidal behaviour at the Health Inequalities Cross Party Group, Scottish Parliament, on 30th March 2017.