I’m not from round these parts, being – forgive me – a west coaster.
But even coming from sunny Greenock I know there are two things you don’t do in our capital city. One is to ask for salt and vinegar on your chips, the other is to drop the word “trams” into casual conversation. I’m about to break at least one of these rules, but it is a matter of life and death . . .
The parliament’s health and sport committee recently held a debate on health inequalities. As convener of that committee I gave the first speech. MSPs don’t usually use props but I chose to wave about a graphic from NHS Health Scotland which shows the reduction in life expectancy as you travel eastwards by train along the Argyle line in Glasgow. The NHS has produced a similar one for Edinburgh. It shows that if you take a tram from Balgreen to Bankhead – only two stops and two miles apart – average life expectancy is cut by 11 years for a man and by eight years for a woman. Can you believe that?
The committee knew this would be difficult when we began our inquiry. Sir Harry Burns, Scotland’s former Chief Medical Officer, said the story of health inequalities was “bedevilled” by people who knew the answer. We don’t have the answer but we do have plenty of questions. Why is it more equal societies enjoy better health outcomes? How important is a sense of community? When do a family’s stress levels become intolerable? Is a zero-hours poorly-payed low-skilled job better than no job at all?
Sir Michael Marmot, the experts’ expert on inequalities, told us “a health service for the poor is a poor health service”. But this isn’t just about the divide between haves and have-nots. It’s about the divide between low-paid and no-paid, male and female, old and young, disabled and non-disabled. And we can’t blame the problem on one moment in history, or on one government, or even on one word – austerity. The economic policies of the 1980s must be an underlying factor, but inequality continued to grow in the late 90s and into the noughties, a decade of growth in public spending. Begging the question: when we had the money, did we spend it wisely?
In 2008 the World Health Organization’s commission on social determinants in health stated: “Social injustice is killing on a grand scale”. Sir Michael chaired that commission and his stance has anything but softened. Poverty wasn’t down to people shirking. “It’s because” – he said in a stage whisper – “people aren’t paid enough.”
The committee’s inquiry was lengthy but what did we learn? We learned that inequality is complex and has many components but that it’s far from inevitable. Can we fix it? Ask Barack Obama, somebody with a thing or two to say about social inequality. In his recent speech at Selma, the President said: “action requires that we shed our cynicism. For when it comes to the pursuit of justice, we can afford neither complacency nor despair”. And it doesn’t matter where you come from. This scandal of our times should be of concern to us all.
Duncan McNeil MSP is convener of the Scottish Parliament’s Health and Sport Committee and Labour MSP for Greenock and Inverclyde