THE danger with statistics about health inequalities is that we become fatalistic about them.
The fact that poor people have a far lower life expectancy than rich people living a five-minute drive away is so familiar it could, if we were not careful, lead to a view that this is simply how the world works.
There is a moral hazard here that must be avoided in any society that dares to call itself civilised. And a good antidote to that hazard is a moment spent examining the latest health inequality figures released today.
Audit Scotland’s report makes for grim and depressing reading. In more affluent areas of Scotland there are 28 GP consultations for anxiety for every 1,000 patients; in the least affluent areas there are 62. Breast-feeding rates when babies are aged eight weeks are 40 per cent in affluent areas and only 15 per cent in deprived areas. In prosperous areas, there are 214 alcohol-related admissions to hospital per 100,000 population; in the most deprived areas the number is an astonishing 1,620. And that is before we get to the now-familiar, but no less shocking figures on life expectancy and health life expectancy.
It is now a truism – albeit a brutal one – that Scots living in poorer areas have multiple health problems. These are a product of a range of factors, including poor housing, poor diet, poor education, joblessness, a high incidence of alcohol and substance abuse, a high incidence of smoking, the lack of access to shops selling healthy food and – it must be said in certain cases – a nihilistic attitude to life in general that is not conducive to a healthy lifestyle.
That these people should also have a poverty of access to health care is a scandal. The distribution of GPs around the country can in no way be said to reflect patient need.
It is hard to avoid the conclusion that the NHS – founded with the highest of motives to ensure health care was delivered where it was needed, rather than where it could be afforded – has failed to organise itself in a way that serves that aim.
In 2011-12, the NHS in Scotland spent £170m on schemes related to health inequalities. This is a lot of money, and there are legitimate questions to be asked about whether it is spent in useful ways. But it pales into insignificance alongside the £11.7 billion on the health service as a whole, much of it on trying to hold together the lives of poor people whose bodies are ruined by ill-health.
As ever, addressing this mismatch of need and resources raises an unforgiving dilemma, especially given that it cannot be dealt with by simply finding additional cash. With NHS budgets already under pressure, the only way for a more equitable distribution in favour of the poorer areas is to divert resources currently going to wealthy areas. Simple, really.
But do our politicians really have the moral will to do that? Are they truly willing to take tough decisions such as this? This newspaper hopes the answer to both these questions is yes.
Look on the bright side on jobs
At last, some good news about the Scottish economy. Yesterday’s unemployment figures were encouraging. The fall of 19,000 to 204,000 meant the Scottish unemployment rate now stands at 7.6 per cent – below the UK average of 7.8 per cent.
There was even better news on youth unemployment – the number of 16-24-year-olds was more than one in four a year ago; it is now just over one in five. This is still an alarming figure, but the trend is at least in the right direction.
It was not all good news, however. Although unemployment fell, so did employment – there were 27,000 fewer people in work in Scotland than three months previously.
How can it be the case, one might be forgiven for asking oneself, that both employment and unemployment can fall at the same time?
The answer is not a very comfortable one. It is that thousands of people are opting out of the job market altogether – they are out of work, but not looking for work. This has always been the case to some limited extent, but its growth as a feature of working-age population is worrying. More research needs to be done on this group of people, looking at their motivation (or lack of it) and their circumstances.
Could a degree of meek acceptance be creeping in, with no sign of an economic recovery and the prospect of a triple-dip recession? Are people simply
losing the will to get up and get out and look for work, and coming to the conclusion that they have little hope of finding a job?
Times may be tough, and prospects grim, but we must guard against an encroaching feelingof despair.