As we all picked our way through the debris of what I’m tempted to call the “Foot Locker Riots” in search of deeper explanations than the urgent need for new trainers, I found myself thinking several times of Sir Michael Marmot, the man HSJ likes to call “the guru of health inequalities”.
Neither Google nor I could track down what Marmot thought of the 72 hours of mayhem which swept through London and other cities – on holiday perhaps, or simply prudently reluctant to address complex causes without prolonged thought. But HSJ readers who know his views must suspect that deepening inequality, related hopelessness and social alienation, would be on the Marmot list.
I agree, although I also agree with those who say that, beyond Tottenham where a controversial police shooting triggered the initial disturbances, what we were watching on TV was chiefly prompted by shallow greed and the opportunistic chance to loot, arising from what some social psychologists call “deindividuation”, ie group behaviour.
Sir Michael is a critic of “nudge” theory, favoured by health secretary Andrew Lansley and other ministers. It is doubtful, for instance, if poor people can be “nudged” into buying better food, living healthier lifestyles or even taking a low-paid job. An inner city Labour MP I spoke to about the riots on Sunday night made a similar point. “My kids don’t spend all the time watching terrible video games or eating crap food. Poorer communities are less able to stand up to these pressures.”
But my Labour friend didn’t want to blame it all on the government, its spending cuts or free market policies. He could see that liberal individualism in a social sense had been part of the problem too. After all, here were people – his own constituents – who had been “nudged” pretty easily into robbing their way down the local high street, hurting their own communities, not torching the Ritz. Can ministers not assume that positive nudging – that eloquent appeal for interracial calm by grieving Birmingham father Tariq Jahan, for instance – can sometimes work too?
As the post-mortem began it was noticeable that, for once, the NHS wasn’t in the front line. Mr Lansley was working from home and Simon Burns, minister in charge until mid-August, was not bombarded with complaints from Number 10 or patients. If accident and emergency departments in the riot areas were overstretched (magistrates certainly were) no one told Whitehall. So the disturbing rise in long A&E waits – double 2010? – isn’t riot-driven.
That’s not to say that the riots won’t affect health priorities. With money so tight voters could become less tolerant of drugs, smoking and obesity programmes that help those they deem the ungrateful poor, let alone the riotous. It may be irrational in an unequal society to say “you know what, let’s make it more unequal”, but it may happen as the prisons fill up and hearts harden. David Cameron should resist pressure to be pointlessly tough.
Is it also possible that the riots may trigger a wider revulsion from the moral laxity of our times? I noticed that some MPs who attacked the rioters had their own greedier expenses claims revived by our (imperfect) press? Will it make it harder for (say) David Laws to return to Cabinet, bosses to ignore hooliganism by overpaid players and bankers – or even sacked NHS executives to get excessive payoffs?
But let’s be positive too. The NHS Confederation’s Mike Farrar is calling for patients to become more aware of their “care footprint”, the sheer cost of treatment. Could that be part of the new puritanism too?