‘Realistic’ Public Health Interventions

By | September 30, 2015

In his recently published The Health Gap, Michael Marmot reports on two lists of ‘top ten tips’ for health. The first was published by England’s Chief Medical Officer in 1999 and contains the following items:

1 Don’t smoke. If you can stop, stop. If you can’t, cut down.

2 Follow a balanced diet with plenty of fruit and vegetables.

3 Keep physically active.

4 Manage stress by, for example, talking things through and making time to relax.

5 If you drink alcohol, do so in moderation.

6 Cover up in the sun, and protect children from sunburn.

7 Practice safer sex.

8 Take up cancer-screening opportunities.

9 Be safe on the roads: follow the Highway Code.

10 Learn the First Aid ABC: airways, breathing, circulation.

As Marmot remarks, it is an unobjectionable, indeed commendable, list for those in developed societies. Moreover it is evidence-based, so what’s to dispute? And yet, here is an alternative framed by David Gordon and colleagues at the University of Bristol:

1 Don’t be poor. If you can, stop. If you can’t, try not to be poor for long.

2 Don’t live in a deprived area. If you do, move.

3 Don’t be disabled or have a disabled child.

4 Don’t work in a stressful, low-paid manual job.

5 Don’t live in damp, low-quality housing or be homeless.

6 Be able to afford to pay for social activities and annual holidays.

7 Don’t be a single parent.

8 Claim all benefits to which you are entitled.

9 Be able to afford to own a car.

10 Use education to improve your socio-economic position.

Now herein, as Marmot suggests, lies an alternative narrative; and it is one he has sympathy for. It too is founded on evidence. Marmot’s follow-up question is: ‘whose responsibility is health?’ It is a question to which there is a socio-epidemiological reply, and an alternative sociological reply.

So what would my (more sociological) list look like? It too is evidence-based, if maybe a red rag to a socio-epidemiological bull:

1 Open yourselves to education about a ‘social’ beyond social aggregates.

2 Acknowledge that the ‘causes of causes’ of health inequity lie deep in enduring social structures.

3 Confront these structures: of class, gender, ethnicity, age and so on.

4 Recognize that you can and must combine with others to effect social change.

5 Adopt a strategy of ‘permanent reform’, which allows for immediate collective action against agreed targets in the short-term.

6 Anticipate personal as well as collective costs, since the neo-liberal state has husbanded its resources around surveillance and dissent (e.g. anti-terrorist powers).

7 Prepare for state oppression/repression if/when your head appears over the parapet.

8 Do not be put off or discouraged by short-term failures, since engagement and protest are banked investments for future revolutionary change.

9 Work with others whilst committing to 5-8: to draw up possible alternative future scenarios (a) for addressing general corporate health irresponsibility at one end of the scale, and (b) for contesting particular organizational issues like the selling off of local school playing fields on the other.

10 Always remember that ‘fairness in society’ has always been fought for; no fighting amount to submission.

Well, how can these prescriptions be helpful. There is of course nothing wrong with the first list (as Marmot concedes). The second list pulls fewer punches (as Marmot celebrates). But what of my third?

My message is one I have perhaps laboured too long and hard, so for once I will be brevity personified

WEALTH BUYS POWER, an easier and slicker purchase in post-1970s financial capitalism than in postwar welfare capitalism. POWER FIGHTS FOR THOSE WHO FUND IT AND FOR SHARED VESTED INTERESTS, whenever necessary extending beyond the police’s use of the likes of water cannon to armed forces on the streets. Brave and patient CIVIL DISOBEDIENCE is the optimal route to the revolutionary social changes required to tackle health inequity.

Maybe Jeremy Corbyn’s election to the Labour leadership will facilitate/trigger permanent reform, but unless he can engineer or provoke what in the mid-1970s Habermas so presciently called a ‘legitimation crisis’, and even if he can, he will likely be faced either with slippery-slope compromise or extra-parliamentary resistance on Britain’s streets.


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