By Rab Bruce’s Spider

A couple of weeks ago, Kezia Dugdale attacked the Scottish Government over figures relating to cancer rates in the most deprived areas of Scotland. This led me to engage in a short Twitter conversation with several people when I posted a comment to the effect that it is poverty that is the real issue, not healthcare, and I’d like to explore that a little further.

First of all, it would be sensible to explain something about the official statistics. When we talk about people from deprived areas, what sort of deprivation do we mean? It turns out that an area is defined as poor or affluent based on several indicators relating to the people who live there. So, if an area has a majority of inhabitants who are unemployed, have high levels of poor health, poor educational outcomes, limited access to public amenities, etc, then the area is defined as poor. So, in fact, it is the people who define the level of poverty, not the area. By definition, therefore, people from poorer areas will have more health issues than people from more affluent areas no matter what any Government does to improve things, since it is the health issues that contribute to the area being defined as poor in the first place. So, for example, if everyone in the country were suddenly to experience a significant improvement in health, education and employment, some areas would still be classed as relatively poor if the people there did not quite attain the same levels as people in other areas. When you understand this, you will see that Kezia Dugdale’s specific comparisons are misleading although that is not to say that any Government should not do its best to improve the quality of living of all its citizens and poor health should be countered wherever possible. It is, however, the method of tackling this that is the real issue. Throwing money and resources at healthcare is not a long term viable solution. To find the real answer, we need to understand the problem properly.

One of the common challenges to the issue of poverty is an observation on the lifestyles of people who live in the poorer areas of our society. It can take several forms but is essentially a sneer to the effect that these people would not be so poor if they didn’t smoke / drink / take drugs / go abroad for holidays etc.

I’m sure we all know someone who falls into at least one of those categories and I’ll readily admit that I often despair of hearing people complain that they have no money to purchase food or pay their electricity bill yet still manage to smoke forty cigarettes a day or jet off to Spain for a fortnight’s holiday where they will spend most of their time so drunk they probably don’t know where they are anyway. However, I believe the big problem many of us have is that we recognise these habits as the causes of poverty when, in fact, they are far more likely to be symptoms. While there is no doubt these people would be slightly better off financially if they were able to stop partaking in unhealthy habits, poverty is a much more complex issue than that.

In his post-war development of the social care system most of us have grown up under, William Beveridge recognised that a basic level of income was a prerequisite to good health. This was an extremely progressive insight and has since been proved correct. A long term study in America which looked at children from poor Native American families has shown that children who grow up in an environment where they are financially better off are less inclined to indulge in anti-social, aggressive or intransigent behaviour. Children who grow up in poverty are less inclined to conform within an education system and are more likely to experiment with alcohol, cigarettes and drugs. Peer pressure and a lack of education combine to kick start addictive habits in childhood which prevail throughout the individual’s life and, as we all know, many of these habits lead to health issues, particularly cancer. People from poorer backgrounds are more likely to smoke and therefore more likely to suffer lung cancer but my contention is that these are caused by their poverty.

Even when an individual does their best to avoid unhealthy habits – and I must be clear that the generalisations I have mentioned are not at all intended to imply that everyone who is poor smokes, drinks to excess or takes drugs – living on a restricted income normally leads to an unhealthy diet in which fresh fruit and vegetables simply do not feature. Again, though, much of this is habit. Discount supermarkets such as Lidl and Aldi often sell fruit and vegetables at prices most people could afford and yet someone who has been brought up on a diet of takeaways and processed foods may still not take advantage of this even if they are fortunate enough to live within easy reach of such a store. Again, this must be down to poor education and lack of example from parents and peers. Part of the issue is, of course, that children and young adults have little concept of the future. They often do not care about what might happen to them in thirty or forty years because the warnings appear to have no relevance to their present situation. I am sure we all know young adults who continue to smoke even if older members of their family have died from lung cancer. They may acknowledge that they really should stop smoking but they cannot break the habit and tend to ignore what might happen to them in the future because it hasn’t happened yet. Quite how this sort of resistance can be overcome, I really don’t know. Prevention would be better than cure but, as mentioned above, children from poorer backgrounds are more likely to begin smoking because of their lack of prospects and rebellious attitude towards what they often view as authoritarian preaching.

But let’s not pick on the poor. This habit of doing things that are bad for us is a widespread human trait. There are plenty of relatively well off, well educated people who eat or drink too much even though they know it is not good for their health. Why then, should we place too much blame on people from deprived areas because they cannot break a habit that is unhealthy for them?

IN one sense, it is hardly surprising that a person growing up in a deprived area with few job prospects is likely to seek some sort of solace from alcohol or tobacco, or to take the chance of a cheap holiday abroad even if they really can’t afford it. We all like a break and it is one of the more irritating facets of human nature that the very people who complain about poor people smoking are almost always better off and insist on having a break from the drudgery of life at weekends yet seem to believe that someone with little income does not need any sort of respite from the very real stresses of poverty.

There isn’t an easy answer to this problem and certainly not a short term quick fix. However, the study which was undertaken over a twenty year period among Native Americans suggests that providing job opportunities and a decent level of income to poor families will actually improve the life chances of the children in those families even if it has little impact on the adults. It is a long term, societal change that is needed but it can only come about if the nation’s economy is boosted, jobs are created and life chances offered to those who are currently denied them by circumstances. There will always be some people who would prefer to waste their money on unhealthy habits but, in general, a slight increase in wealth for those at the lower levels of society will eventually lead to a healthier society. Sadly, this requires Government policy aimed at increasing work opportunities and ensuring that the work is paid at a level above mere subsistence. This is, of course, diametrically opposed to the policies of the UK Government which seeks to boost business profits at the expense of the working classes. This is despite the patently obvious economic example that increasing the income of millions of people who are currently on such low income that they require social security payments to supplement their wages, would result in an immediate boost to the economy as their increased spending power created more demand for goods and services. The level of that demand would far outweigh the demand created by a few thousand extremely wealthy individuals who are the current beneficiaries of Government policy. Trickle Down Economics does not work and the past four decades have provided plenty of evidence of that, although Messrs Osborne and Cameron seem oblivious to the views of the vast majority of leading economists. So, while we need a fundamental change of direction in policy, it seems unlikely we will see one within the UK for some years to come. Sadly, that will condemn another generation to lives of poverty with all the health issues that brings in its wake.