Thursday, 9 July 2015

Why public health should be about poverty not booze, fags and burgers


Area deprivation in 2010, as measured by the Index of Multiple Deprivation, was by far the strongest predictor of mortality across all models, with higher deprivation linked to higher standardised mortality rates in 2011-12. To put the effects into context, using QOF year 8 models, a change in the Index of Multiple Deprivation from the median (17.25) to the 90th centile (44.88) would correspond to an all-cause standardised mortality rate increase from the median to the 82nd centile. For the condition-specific standardised mortality rate models the effect was weaker, and a change in Index of Multiple Deprivation from the median to the 90th centile would correspond to a condition-specific standardised mortality rate increase from the median to the 73rd centile.

OK the research is about how primary care affects mortality (not very much) but the results demonstrate clearly that the big deal is deprivation - or if you'd prefer, poverty. Reduce levels of poverty and you increase health outcomes across the board. This is nothing to do with the evils of booze, fags and burgers but to do with a whole complex of issues relating to being poor. Things like cold and damp housing, unemployment, mental health issues, inadequate diet and lower levels of educational attainment. Plus greater exposure (and lower resistance) to contagious diseases.

This suggests that, if the purpose of public health campaigns is to reduce mortality rates (and ill health in general) the money currently spent on what we term 'public health' is misplaced and would be better invested in economic development, education and skills training.



Curmudgeon said...

And better-off people (on average) drink more booze than the poor yet have a much lower level of alcohol-related mortality and health problems.

Anonymous said...

Dear Cllr Cooke

Your quote isn't about people, it's about livestock.

All 'public' officials treat real people as if they were livestock. Yet it is real people who provide the where with all that these 'public' officials eat, drink, sleep and have jobs so that they can 'model' anything and everything about the 'livestock'.

It's about time we kicked 'public' officials out of their well-paid, well-pensioned jobs and let them discover a truly value added life in the real world: i.e. from their perspective, join the 'livestock'.

In this country almost all poverty is government induced.


Anonymous said...

Well said. I'm not old yet I remember fondly that once upon a time "public health" referred to issues affecting the health of the society as a whole which could only be dealt with collectively eg industrial air pollution. To call poking one's government nose into the lifestyle choices of individuals is a convenient way of shifting the 'blame' for the ills of poverty from government to the individual. Smoking is a prime example. If the poor continue to smoke, in spite of every government fag tax hike making it increasingly difficult for them, then it's because life's bloody miserable when you permanently have to watch every penny and the money that would be saved from not smoking merely makes life less miserable and the misery involved in quitting outweighs that. Tackle poverty and you give people hope which then gives them the will to positively care for their own health. Once upon a time politicians seemed to recognize this.