progress is not the elimination of struggle, but rather a change in its terms’ - Aneurin Bevan

as long as you've got your health?

A report on health inequalities, Fair Society, Healthy Lives was published a few days ago; both its findings and its recommendations pose a challenge to public policy.

The Marmot Review's most headline-grabbing finding is that, on average, those living in the poorest parts of England die seven years younger than those in the wealthiest parts. Each year, health inequalities cost the UK economy £33bn in lost productivity.

Policy recommendations include:

* raising the minimum wage to allow a healthy standard of living

* increasing the support given to children in the early years of their lives

* more preventative health measures by the NHS

* and greater partnership working between agencies to tackle inequality.

A sad aspect of this report is that it is issued as the general election draws nearer, with the Tories expected to win office and within months introduce an austerity programme that would push more people into poverty. So when reading the recommendations, it's with the sadness that they are unlikely to be heeded if the Tories gain power, and the hope that such a disaster can be avoided.

The Executive Summary of the review seems to note this mistaken approach:
Simply restoring economic growth, trying to return to the status quo, while cutting public spending, should not be an option. Economic growth without reducing relative inequality will not reduce health inequalities. [p.12]
The Tories plan to end universality - to cut those benefits which are currently received by middle-income families - and instead focus on those in most need. As the saying goes however, "services for the poor are poor services" - especially as cutting benefits given to those on middle-incomes might increase the number of the least well-off. The review agrees with this, saying that
it is tempting to focus limited resources on those in most need. But we are all in need – all of us beneath the very best-off. If the focus were on the very bottom and social action were successful in improving the plight of the worst-off, what would happen to those just above the bottom, or at the median, who have worse health than those above them? All must be included in actions to create a fairer society. [p.11]
The review highlights the work of the London Living Wage Unit, set up by former Mayor Ken Livingstone, which found that the minimum wage would need to rise by 16% to guarantee that low-paid workers were not living in poverty.

It seems obvious that if the minimum wage is not a living wage, then someone is going to pay the cost. At present, it is both low-paid workers individually and society collectively through the increased public spending that results from inequality.

An increase in the minimum wage would be good, but this alone would not empower low-paid workers. In the name of "flexibility", Tory anti-union laws remain on the statute books and employers are able to stop workers from taking effective action to defend terms and conditions by going to the courts. These laws need to be abolished. (Labour has the majority to do it, giving all workers workers - whether temporary or directly-employed - the same rights as are enjoyed by workers in other European countries.)

Institutional change will be needed if wellbeing is to become "a more important societal goal than simply more economic growth" [p.12]. This will mean new ways of measuring success in the economy - cooperative and mutual enterprises are best able to do this because, although many are 'for-profit', they are not focused on profit-maximisation - there are usually social goals which count as a reason for doing business and a culture of social solidarity informing decision-making.

The review suggests that strengthening of democratic participation will make it easier to reduce inequality:
Effective local delivery requires effective participatory decision-making at local level. This can only happen by empowering individuals and local communities. [p.9]
Again, prioritising cooperative and mutual ownership and restoring workers' rights would help to increase participation at the grassroots. But this can only succeed if there is a realisation that some people have too much power, too much wealth - and that they will resist attempts to challenge their privilege.

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