Yesterday I was at a 'development session' for Bradford's Health and Well-being Board and getting a bit irritated by the interminable mission creep (not to mention bucketloads of nannying fussbucketry). I appreciate that we have to 'tick everyone's box' in drawing up a five year strategy but there seems an almost wilful blindness to the big challenges facing Bradford's health economy. The first of these is a challenge everywhere - the rising cost of healthcare is outstripping society's ability to pay - but the second, while not unique to Bradford, is more specific. It is poverty.
And I say this in capital letters with flourishes and knobs on - the main reason for Bradford's poor health outcomes is poverty. It's not drinking. It's not smoking. It's not a big south Asian population. It's not obesity. It not illegal drug use. It's not road safety. It's not air quality. It is quite simply that being poor, always and everywhere, leads to a shorter and less healthy life.
Then I was corrected. Oh no, it's not poverty but something called "health inequality". Mostly, it seems because we have a strategy on combating "health inequality" but no strategy for reducing poverty. And this raises a very important issue by exposing again the conflation of poverty and inequality. With the result that we attend too much to enviously looking at how much richer, happier and healthier the residents of Burley-in-Wharfedale are compared with their counterparts in Barkerend.
What we should be doing is attending to the fact that people in Barkerend are poor not to the gap between their circumstances and the circumstances in Ilkley. But the conceit of the left (and of too many public services planners and managers) is the view that inequality and poverty are either inextricably linked or essentially the same thing. With the consequence that policy becomes about withdrawing from universal services in wealthy areas rather than the intelligent direction of resources to the alleviation of - with the end of eliminating - poverty.
This conceit - and its associated false dichotomy - is exemplified by this profile of Simon Willis who runs the Labour-supporting think tank, The Young Foundation:
"Let's say that we had a vigorous debate," he says. "The most important point Young made is that the opposite of inequality is not equality, it's fraternity … it's community and cooperation."
There we have our essential error about inequality. To say that the opposite of inequality is something other than equality is a deceit. It may be that fraternity, community and cooperation are more prevalent in a more equal society but it does not follow that equality leads to these things - nor do I see any supporting evidence. It also repeats the myth - a myth exposed time and time again only to be warmed over and reissued - that your riches are the cause of my poverty. But this time it is worse - Willis argues that the problem is 'meritocrats' because:
"They mistakenly think all their power and money and success is down to their own individual brilliance and hard work."
Again a familiar argument. Except that I've never met a successful person who didn't credit his or her success to a whole host of exogenous factors - from schools and parents through great colleagues to sheer good fortune. Moreover we should consider what the alternative to meritocracy might be - presumably this is the 'fraternity' Willis alludes to as the opposite of equality. But isn't that a pretty stagnant society, a sort of land of 'meh'.
So I return to my earlier point. It is poverty that should challenge us not inequality. In the short-term part of the response to poverty is redistribution but over a longer period we need to alter the opportunities available to poor people, to allow them to play the meritocratic game along with everyone else. And these solutions are educational and economic - put bluntly better schools and better jobs. To say, as Willis is saying, that meritocracy is a problem is to deny the poor opportunity. Or rather to replace the chance to be independent, self-reliant and achieving with a sort of commune-like fraternal society.
This is just the intelligent articulation of the problem with community development - the idea that we can 'work with' communities from outside and that growing vegetables on roundabouts is somehow a substitute for education, skills and jobs. This is the world of the cuddly left where hugging the poor and saying 'there, there' is seen as a satisfactory response to the fact that they failed at school and haven't got a job. Or worse still giving them a hug and saying their problems are all the fault of those rich people in Ilkley (or bankers, or big business).
So back to Bradford and its health challenges. To make a difference we have to do a couple of things well - target interventions where they work best and recognise that improving the economic lot of people in Holme Wood or Barkerend is the best way to improve their health. For the targeting it's not about nannying because we know nannying doesn't work. Instead it's about real improvements - warmer homes, fewer chances to trip and fall, more pedestrianised areas, support for self-employment, training in today's skills and better outcomes at school. But this wouldn't suit The Young Foundation because what we're saying to those people is that they have skill, talent - genius even - and that we're going to release it, to allow them to achieve. Not from entitlement but from merit.