Being poor is bad for your health and being ill is bad for your wealth

Babbling on about health inequality has become the latest obsession of the sort of Labour politician who rises to being a council leader or perhaps the shouty sort of backbench MP. This obsession leads to this sort of nonsense:

‘Shocking’ health inequality and poverty go hand-in-hand, meeting told

So says Susan Hinchcliffe, leader of Bradford Council as she comments on a report showing that people living in Ilkley - one of the wealthiest places in the North of England - live 21 years longer than people in Tong, one of the UK's most deprived communities. That both these places are in the Bradford metropolitan district is a quirk of political geography.

What's nonsense here is, of course, the idea that we should be shocked that poor people have less good health outcomes than rich people. This fact has been pretty much common knowledge since people first started thinking about health. So the solution isn't to, in some way, redirect resources from Ilkley to Tong (at a guess the per capita spending on healthcare in Tong is significantly higher already) but rather to reduce the poverty.

The second common misunderstanding here is that there is something about the place that means people are healthier - or for that matter richer. While place has some impact on health (air quality, for example) most health outcomes are entirely unrelated to where people are born or where they live. People in Tong are less healthy because they are poorer. And they live in these places because they have the affordable housing that poor people need.

And for some of the people in Tong, the reason they are poor is because they have poor health. Illness and disability can and does lead directly to reduced income. We can probably all think of someone we know who, because of their health, dropped out of a career or because of their disability never embarked on one. It's probably true that we could do more to reduce this effect but it's also true that we can only really resolve the poverty not the inequality.

So Bradford's "shocking" health inequality is entirely a consequence of Bradford's income inequality. And we don't fix this by making people in Ilkley poorer (or less healthy) but rather by making people in Tong richer. Indeed, we should stop using geography as a measure - especially given the degree to which otherwise intelligent people completely fail to grasp what local area statistics tell us - and should focus on people who are poor wherever they live.

Nationally we spend something like £6 billion on public health and a further £6 billion on various activities dubbed 'prevention'. If we were serious about improving health outcomes - and reducing that health inequality contingent on geographical concentrations of wealth or poverty - then we would shift most of this spending away from nannying people about booze, fags and burgers and spend it instead on programmes to reduce poverty. But I guess that doesn't fit the script.

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