The Politics of Health Group (PoHG) has set up the New Politics for Health project to champion the elimination of health inequalities and highlight how the health of every citizen might be improved. Although difficult to define and often considered to be something in the gift of the health service, we consider that following is a good way of viewing health:
“The extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities.” (Health promotion: a discussion document. Copenhagen, WHO, 1984.)
Using this definition as a basis, it is now very clear that in the UK the opposite is often too true. Many people are struggling to meet their aspirations because of the lack of opportunities, are failing to have their needs met because of insecure work and low income or the high costs of nutritious food and housing and are finding it difficult to cope with the environment because it is fast paced, highly competitive and often discriminatory. These difficulties are playing out on people’s bodies and minds in ways which we recognise as forms of ill health. Two sensitive indicators of the way in which good health has been undermined are the obesity epidemic and the exponential rise of stress, anxiety and depression.
We attribute this directly to the political and economic decisions that have been taken over the past 40 years. Neoliberalism has five main characteristics all of which are detrimental to health and we consider these worth elaborating:
- THE RULE OF THE MARKET.Liberating “free” enterprise or private enterprise from any bonds imposed by the government (the state) no matter how much social damage this causes. Greater openness to international trade and investment. Reduce wages by de-unionizing workers and eliminating workers’ rights that had been won over many years of struggle. No more price controls. All in all, total freedom of movement for capital, goods and services. Where an unregulated market is considered the best way to increase economic growth
- CUTTING PUBLIC EXPENDITURE FOR SOCIAL SERVICESlike education and health care. Reducing or eliminating the welfare state, and even maintenance of roads, bridges, water supply — again in the name of reducing government’s role. Of course, neoliberals don’t oppose government subsidies and tax benefits for business.
- Reduce government regulation of everything that could diminish profits, including protecting the environment and safety on the job.
- Sell state-owned enterprises, goods and services to private investors. This includes banks, key industries, railroads, toll highways, electricity, schools, hospitals and even fresh water. Although usually done in the name of greater efficiency, which is often needed, privatisation has mainly had the effect of concentrating wealth even more in a few hands and making the public pay even more for its needs.
- ELIMINATING THE CONCEPT OF “THE PUBLIC GOOD” or “COMMUNITY”and replacing it with “individual responsibility.” Pressuring the poorest people in a society to find solutions to their lack of health care, education and social security all by themselves — then blaming them, if they fail, as “lazy.”
(Amended from Corpwatch http://www.corpwatch.org/article.php?id=376)
Tackling the domination of neoliberalism, its direct affect on health and the way it has created massive inequality which itself leads to poor health, is a challenge of major proportions and not one that a small network of people can or should take on itself. We are further concerned about the emphasis placed by Government on individualised solutions to poor health and the fantasy that this approach will solve the problem – see PoHG Blog No 1 http://www.pohg.org.uk/blog/neoliberal-governments-and-health-inequalities-a-fantasy-paradigm/#more-42
PoHG does however consider that the issue of health is a focus around which people can be rallied because of its personal importance. The New Politics for Health Project is our attempt to reach out to organisations and individuals to work more closely together to inform people about the way our political and economic system affects health and to champion an alternative agenda for health. A full account of the activity to date can be found here: http://www.pohg.org.uk/support/np4h.html Please get involved. Without your support, the project will not make progress.
What does the Labour reshuffle mean for the development of its NHS policy?
For the first time since June the Labour Party has a full Shadow health team for England. Only Justin Madders MP continued in post throughout the chaotic summer period that included a failed coup and a similarly unsuccessful challenge to the leadership of Jeremy Corbyn. Post-reshuffle, and with Diane Abbott promoted to shadow home secretary, what can we expect from the new health team led by Jonathan Ashworth?
Corbyn’s re-election as Labour leader with an increased mandate of almost 62% of those voting, followed an extraordinary window in Labour Party governance. With most of his shadow cabinet resigning en masse, Corbyn was obliged to promote many of his less experienced parliamentary supporters to shadow cabinet roles. The result was both paradoxical and positive – a thinly populated but enthusiastic and very progressive opposition front bench.
The first front bencher to resign in the coup was shadow health secretary Heidi Alexander, who subsequently criticised both Corbyn’s leadership style and also the actions of shadow chancellor John McDonnell.
Alexander’s replacement as shadow health secretary was Corbyn ally Diane Abbott. During the next three months Abbott published a series of speeches, articles and blogs very much more radical and progressive than those of her predecessor, in terms of supporting the NHS workforce and of reinstating a publicly provided, national health service. This culminated in her speech to the Labour Party conference on September 27. Abbott told us that Labour stands with the junior doctors. She said that NHS England’s Sustainability and Transformation Plans (STPs) “seem like a vehicle to drive through cuts and closures” and that “where they are purely about cuts, Labour will fight them.” She pledged that “under Jeremy Corbyn’s leadership the Labour Party will be committed to halting and reversing the tide of privatisation and marketisation of the NHS… Labour in government will repeal the Health and Social Care Act”. And she stated that “The NHS will be returned to a publicly owned, publicly funded, publicly accountable universal service, as outlined in the NHS Reinstatement Bill now being piloted through Parliament by my colleague Margaret Greenwood MP, with the support of the Labour leadership.” Continue reading “After a summer of crisis and opportunity, can Labour’s progressive NHS policies be sustained?”
I want to give a broad political overview of what’s happening in the NHS in England and of the background to the current situation.
As you’ll know, the English NHS is in a bad way, with practically every part of the country in financial deficit. Many hospitals and many services are being closed down, cut back or rationed. At the same time, many long term contracts for the provision of NHS services are being awarded to private sector companies – though often people are unaware of this because the likes of Virgin, Carillion and SpecSavers are allowed to operate under the NHS logo.
By definition, these arrangements are wasteful, because private companies have a duty to make profits and to give those profits to their shareholders. That means that public money is haemorrhaging out of the NHS – whereas when a public provider of NHS services makes a surplus it is reinvested in the NHS.
There is also a substantial legacy of (mainly Labour initiated) private finance initiative (PFI) funded hospitals, whose exorbitant loan interest payments have to be made before NHS funds can be spent on routine services. And it’s no coincidence that people’s inboxes are filling up with adverts for health insurance, with their invitations to jump the NHS queues. Everything I’ve described forms part of what in my view is an intentional strategy by the Conservative government to create financial, managerial, professional and public chaos throughout the NHS, so that private provision of NHS services, alternative private health services, health insurance, and NHS co-payments and ultimately charges will be seen as inevitable.
This ‘cultural revolution’ takes many different and apparently unrelated forms whose destructive nature is denied by the government – which continues to assert that it has the public interest at heart and that it is factors like the ongoing impact of the credit crash, the increasing costs of drugs and medical equipment, the ageing population and our unhealthy lifestyles which are the true problems facing the NHS. The building blocks for privatisation to which I have referred currently include: the aforementioned awarding of NHS contracts to private bidders – often asset strippers who provide poor quality services, fragment and undermine the cohesive public ethos of the NHS; the creation by the Treasury of NHS deficits and of regulations which forbid them; enforced rationing of services to extend waiting lists and encourage patients to seek private alternatives; manufactured confrontations with doctors and other members of the NHS workforce; the imposition of ‘new models of care’ which undermine NHS hospitals and create community based healthcare structures ripe for privatisation; personal health budgets, designed to link with health insurance. There are many more and I can provide documented evidence for all of them. It is a national scandal. Continue reading “NHS – on life support”
For the purposes of budgeting, politicians discuss welfare and healthcare separately. Of course, in reality, the two are closely linked. If the welfare of patients is compromised then a higher demand for healthcare often follows as vulnerable people, who do not enjoy the best of health, can quickly become high risk patients with a significant deterioration in health. The ongoing welfare reforms have been demonstrated to be an ideological choice not a financial necessity, as government propaganda since 2010 has been relentless when attacking those who need help the most but who rarely have a voice to challenge the many unsubstantiated government claims. The welfare reforms have been demonstrated to be causing preventable harm, as those surviving on a modest income now live with uncertainty and with the possibility that a political decision has enforced a return to employment regardless of health or medical opinion.
When it comes to the British government imposing severe welfare reforms, whilst citing academic research to justify government claims of vast numbers of people ‘languishing’ on long-term sickness benefit, reference was made to research commissioned by the Department for Work and Pensions (DWP) that did not require peer review prior to publication. The fact that the cited 2005 research was sponsored by UnumProvident Insurance, an American corporate healthcare insurance giant, is never mentioned in political circles and the general public are very easily misled.
The long-ago plan to dismantle the welfare state began with the 2006 Green Paper: A New Deal for Welfare ~ empowering people to work. The Green Paper introduced the ‘reform’ of Incapacity Benefit, which really meant the demolition of the income replacement benefit paid to people of working age who are unfit to work. However the DWP, not for the first time, overlooked the reality that someone, somewhere, would challenge the credibility of their argument, as demonstrated so well by Professor Alison Ravetz.
Continue reading “American influenced punitive UK welfare reforms”
While it can be politically expedient for governments to engage with health inequalities, in a neoliberal world they struggle to realistically propose actions which will substantially reduce them – such as tackling power inequalities, patriarchy-sustaining institutions or class inequality. A dominant ‘policy paradigm’ prioritising economic growth restricts even their ability to imagine alternative, equitable scenarios. In this context, politicians, policy makers and some researchers have devised a parallel fantasy world in which proximal, downstream and easily tackled exposures are put forward as viable solutions to health inequalities (and sometimes even positioned as the causes). The consequence of this is a widespread public sector culture in which well-meaning policy-makers, practitioners, researchers and the public collude in sustaining a ‘cargo cult’ around the ‘worship’ of health behaviourism.
It’s now widely accepted that health inequalities – unfair, unjust differences in health determinants and outcomes within and between populations – have serious immediate and long-term negative impacts on individuals and societies. As a result, many governments have at least a rhetorical commitment to reducing of health inequalities. It is rare for national inequality reduction strategies to include any analysis of the causal pathways that result in health inequalities and rarer still for them to suggest interventions that seek to tackle the fundamental causes of health inequalities. Instead, most policy approaches (even the few that acknowledge material and structural causes) put forward lists of ‘downstream’ (proximal) health determinants, such as smoking, unhealthy dietary choices, poor housing conditions, or failure to use contraception, whose social patterning – ie, greater prevalence among working class people – is itself presumed to represent the cause of the relevant inequality. Continue reading “Neoliberal governments and health inequalities: a fantasy paradigm”