We have submitted our formal response to the Mayor of London’s consultation on his draft health inequalities strategy. Several MFL activists have been reading through the Mayor’s strategy over the last few weeks and sharing our ideas.
In our response we welcome Sadiq Khan’s opening statement that, “cities that are more equal are happier, safer, and healthier.” However we go on to say that the strategy perhaps somewhat misses its mark. Economic inequalities are one of main factors that drive health inequalities, and while the strategy makes this connection we think it could go much further and set out a stronger call for action to make London a fairer city.
In many ways health inequalities are the most direct measure of wider social and economic inequalities. There is a huge body of knowledge that describes how the social determinants of health create health inequalities (things such as differential pay rates, the steepness of status hierarchies, poor working conditions, poor housing, degree of control, the distribution of social goods, poverty). This evidence challenges simple ‘lifestyle’ explanations: that poor diet or lack of exercise are merely the lack of will power or good sense in the individuals affected. This view dominates the media and much public health advice. In public health jargon this is the difference between focussing on the proximate (near) and distal (underlying) causes of health inequalities.
Mind the gap
The draft strategy falls somewhere between these two perspectives. It acknowledges how underlying circumstances create the environments in which people live their lives, and which set the context within which individual behaviours take place, but many of the actions it proposes default to individualising, personal level things, dealing more with the symptoms and not the causes. We believe the Mayor’s strategy would be stronger and make more difference to the lives of all Londoners if it engaged more fully with the deep, structural social determinants of health. We observe that the size of the gap between rich people and poor people in London is one of the primary causes of health inequalities, it makes us all less healthy. So while we strongly support actions aimed at helping people living in poverty (and the Mayor makes some important commitments for action on poverty), we also need strong actions that reduce the gap between rich and poor, and what drives and sustains that gap is the increasing wealth of the rich. We need to narrow the equity gap and this must mean action to reduce the wealth of the rich.
We also shared Michael Marmot’s two parallel lists of ‘top tips for a healthy life’, and suggested that from a fairness perspective the Mayor should devote most of his efforts to tackling the kinds of issues in list number two, things that are hard to change by force of will alone or individual action.
List no 1 - ten top tips for a heathy life