Tuesday, August 03, 2010

poor people, poor health

As the new government continues to shift the blame for poor health on to the unhealthy people - arguing that we should further stigmatise obese people as a matter of policy -  a new report in the British Medical Journal studies the disparity in life expectancy between rich and poor.

By the year 2007 for every 100 people under the age of 65 dying in the best-off areas, 199 were dying in the poorest tenth of areas. This is the highest relative inequality recorded since at least 1921.

Elsewhere, Ben Goldacre says male life expectancy in Kentish Town is 70, whereas two miles away in rich Hampstead it's 80.

I know this because I have the Annual Public Health Report for Camden open on the table right now.

This phenomenal disparity in life expectancy – the difference between a lengthy and rich retirement, and a very truncated one indeed – is not because the people in Hampstead are careful to eat a handful of Brazil nuts every day, to make sure they’re not deficient in selenium, as per nutritionists’ advice.

And that’s the most sinister feature of the whole nutritionist project, graphically exemplified by [Gillian] McKeith: it’s a manifesto of rightwing individualism – you are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 78. You deserve it. Not like them.

How can I be sure that this phenomenal difference in life expectancy between rich and poor isn’t due to the difference in diet? Because I’ve read the dietary intervention studies: when you intervene and make a huge effort to change people’s diets, and get them eating more fruit and veg, you find the benefits, where they are positive at all, are actually very modest. Nothing like 10 years.

It's worth pointing out that life expectancy is a good tool for measuring public health, but also something of a blunt one. The poor don't just die younger, they fall into ongoing disability much younger.

Fair Society, Healthy Lives was a government report into this issue, published in February.

people in England living in the poorest neighbourhoods will, on average, die seven years earlier than others living in the richest parts of Britain, the study finds.

Not only is life expectancy linked to social standing, but so is the time spent in good health: the average difference in "disability-free life expectancy" is now 17 years between those at the top and those at the bottom of the economic ladder, the report says.

Goldacre continues, attacking the unqualified media nutritionists like Gillian McKeith for focusing on freakshows rather than confronting the underlying causes of poor diet and poor health.

What prime-time TV series looks at food deserts created by giant supermarket chains, the very companies with which stellar media nutritionists so often have lucrative commercial contracts?

What show deals with social inequality driving health inequality? Where’s the human interest in prohibiting the promotion of bad foods; facilitating access to nutrient-rich foods with taxation; or maintaining a clear labelling system?

Where is the spectacle in “enabling environments” that naturally promote exercise, or urban planning that prioritises cyclists, pedestrians and public transport over the car? Or reducing the ever-increasing inequality between senior executive and shop-floor pay?

However, whilst he says it's a matter of asking 'where's the TV audience ratings?', we can also see Health Secretary Andrew Lansley sweeping free health care and food labelling aside as he and the other Tory ministers ask 'where's the shareholder dividends?'

1 comment:

Dunc said...

On the plus side, at least my shitty life expectancy means I don't need to worry so much about my shitty pension...