Late Sunday afternoon I made myself comfortable to read the latest Commons select committee report on health inequalities before cooking our planned supper of grilled fish and greens.
What happened? By page 22 I was fast asleep.
What does this mean? Not that the report from Kevin Barron’s committee was boring. Far from it - amid all-too-familiar woes several arguments were new to me. No, what it means is that the inverse care law - whereby those with least health need get most attention and vice versa - was at work on my sofa.
I fell asleep because I had swum my Sunday kilometre at the local pool. That and the grilled mackerel (spinach too and only one glass of wine) suggest I am doing what the experts told the committee we should all be doing - and that the poorest, most demoralised, least well-housed and educated are still not, despite the Labour millions spent.
“I can well believe night shifts help you get cancer”
This is depressing, though I must add that even before I fell asleep I had ticked page 10 where it states that growing inequality is only relative: the poorest 20 per cent’s life expectancy today is what the richest 20 per cent’s was just 30 years ago. That is progress. Hang on to that comforting thought.
This report praises the Blair-Brown government’s efforts to address the fact that people live eight years longer on average in Chelsea than in Glasgow, but damns the way it has gone about it. The core problem should be familiar to readers. So keen was inexperienced Blair and his team to do good they “rushed in” after 1997, often not piloting schemes thoroughly. And they certainly didn’t design and implement them in ways that allowed effective measurement of progress - or not.
Thus health action zones (1998: remember them?) were ill thought-out, frequently changed, then dropped. Is the current Healthy Towns initiative any better? No, the MPs suspect. Remember, this is an all party committee, chaired by an unsentimental Yorkshire ex-miner who broke with Arthur Scargill. Alas, theirs is a familiar complaint.
Promoting public health
The report ranges over institutions. Primary care trusts have the primary duty to promote public health, but often that is the budget which gets cut first. The NHS’s role is about treatment and screening as well as promotion. I thought of poor Jade Goody’s cervical cancer prompting tabloid campaigns for smears for under-25s. Not a smart use of NHS funds, I’d say: resist it, Alan Johnson! He was criticised too, incidentally, for not having some basic answers (how much should be spent on inequalities?) when giving evidence. But one success has been GPs’ preventive work in poor areas under their new contracts.
But the most intriguing questions for me were more basic: is directly tackling health inequalities by targeting the most needy (and most publicity resistant) better than a universal approach to better health?
And what about the trade-offs between those treatments authorised by the National Institute for Health and Clinical Excellence and the services which may have to be cut (for the old or mentally ill) to pay for them? And how strong is the consensus which is said to accept the huge shift of funds from better-off areas to poor ones?
Tories from healthy spots like Oxfordshire have been complaining for years about this, arguing that it ignores things like the age demographic in favour of ethnicity and poverty. Hovering over all such questions are lifestyle choices which help determine health: eating, smoking, exercising, booze.
A new report suggests night shift work helps give you cancer. I can well believe it: it never feels natural, unlike smoking, drinking and the fast food chains the committee so deplores.
When I heard Mr Barron on Radio 4 on Sunday I was poised to congratulate his team on a well timed launch until I realised Sir Liam Donaldson’s proposal to charge at least 50p per unit of alcohol had got the media and politicians far more excited. Ministers rubbished it. So did Andrew Lansley. Even the UK Independence Party piled in to save the British boozer. It shows how hard progress is. Perhaps Professor Julian Le Grand was right to warn the MPs it was a mistake to set targets that will only fail.