1. Higher Pupil Conference April 2008 Wealth and Health Presented by Heather Fulton

2. Areas of the course that can be examined are limited Causes of inequalities in wealth and health Consequences of inequalities in wealth and health Government strategies to deal with these inequalities Success of these strategies Extent of wealth and health inequalities The extent to which the founding principles of the NHS are being met Collectivist v Individualist v Third Way debate

3. In 2007 the 2 questions in the Social Issues section were Causes of inequalities in wealth and health Consequences of inequalities in wealth and health Government strategies to deal with these inequalities Success of these strategies Extent of wealth and health inequalities The extent to which the founding principles of the NHS are being met Collectivist v Individualist v Third Way debate

4. This workshop will therefore concentrate on Causes of inequalities in wealth and health Government strategies to deal with these inequalities Success of these strategies

5. Causes of inequalities in wealth and health Unemployment & Low Income Government policies age gender Glass ceiling Career breaks Types of job race Economic policies which encourage or restrict growth Burden of taxation Employment lawLevel of benefits Spending on health Health education Poor educationTrade cycle Illness & disability Lone parents race gender Social class and health Pension levels Complexity of the benefits system Means- testing Illness and age Health provision Discrimination and harassment education Habits and health

6. Government Strategies to overcome inequalities in Wealth and Health Wealth inequalities have an enormous impact on health inequalities Therefore a major Government strategy to overcome health inequalities is to tackle wealth inequalities.

7. Government strategies to tackle Wealth and Health inequalities Social Inclusion reconnecting people with work educationhealth community

8. Government strategies to tackle Health inequalities A major theme of the strategies of successive Labour Governments since 1997 is to promote more individual responsibility for health and wealth through. EDUCATION Individual responsibility for health is promoted through education in schools, GP surgeries, clinics and hospitals and through advertising campaigns. Individual responsibility for wealth is encouraged through persuading people to get off welfare and into work.

9. Government strategies to tackle Health inequalities Anti - smoking Obesity and exercise Alcohol abuse Smoking bans in Scotland in England Make more use of private sector GP practices to provide more education and preventative services Reduce waiting lists Measures to tackle wealth inequalities Healthy Living Centres To promote good health in disadvantaged areas Health promoting schools – encourage healthy eating and exercise “Working together for a healthier Scotland” Campaigns on TV in press and through NHS Laws NHS Sure Start Help children and carers overcome social exclusion

10. Government strategies to tackle Wealth inequalities Welfare to Work Programme to tackle unemployment Low Income As above but also equal opportunity laws Gender and Race Pension Credit Winter Fuel Allowance Employment Equality (Age) Regulations 2006 New Deal, NMW etc to improve family income Uprating Child Benefit Sure Start programme New Deal National Minimum Wage Working Tax Credit Jobcentre Plus Children Old Age

11. Extent of success of current government policies to end wealth and health inequalities The main government policies get more people back into work reduce and eventually eliminate the number of children living in poverty reduce the number of elderly people living in poverty reduce the differences in health caused by social class increase the the proportion of GDP spent on health in the UK and bring it up to the level of our European neighbours. reduce waiting lists and waiting times Modernise the NHS.

12. Extent of success of current government policies to end wealth and health inequalities TARGET – to get more people back into work SUCCESS In February 2008 5.2% were unemployed - down from 7.2% in 1997 29.4 million people in work – highest number on record Claimant count was 794,000 – lowest in 32 years HOWEVER Unemployment rate up from 4.7% in 2004 Is lower unemployment more to do with a strong economy and not government policies? Two-fifths of those getting work are out-of-work again within six months.

13. Extent of success of current government policies to end wealth and health inequalities TARGET – reduce number of people on low pay SUCCESS The proportion of workers aged 22+ who are low paid (£7 an hour in 2007) fell between 2002 to 2005 The pay gap between low paid men and low paid women has narrowed. HOWEVER The proportion of low paid workers has not fallen between 2005 and 2008 There is still a substantial gap between low paid men and low paid women 50% of children living on a low income are in households where at least one adult is working

14. Extent of success of current government policies to end wealth and health inequalities TARGET – reduce and eliminate children living in poverty SUCCESS The number of children in low income households fell from 4.4 million in 1999 to 3.8 million in 2006 HOWEVER The number of children in poverty is still 3.8 million The government target was to reduce child poverty by 25% by 2006. They are 500,000 short of their target 50% of children living on a low income are in households where at least one adult is working

15. Extent of success of current government policies to end wealth and health inequalities TARGET – reduce the number of elderly people living in poverty SUCCESS The proportion of pensioners living in low income households fell from 29% in 1997 to 17% in 2006. Among single pensioners, the rate has halved over the period, from 40% to 20%. HOWEVER 17% of pensioners still live in poverty a third of pensioner households entitled to Pension Credit are not claiming it.

16. Extent of success of current government policies to end wealth and health inequalities TARGET – reduce the differences in health caused by social class SUCCESS There is some evidence to show that mortality rates from cancer and heart disease are falling. HOWEVER The reduction in mortality rates from heart disease and cancer is across all social classes There is no evidence to suggest any progress in reducing health inequalities caused by social class in areas such as infant death and low birthweight

17. Extent of success of current government policies to end wealth and health inequalities TARGET – increase the the proportion of GDP spent on health in the UK SUCCESS The government has raised spending on health to 9% of GDP which is similar to our European neighbours. HOWEVER Much of the extra spending went on increases in pay and other cost pressures such as the cost of drugs. Therefore the extra money available for extra patient services is only 2.4%.

18. Extent of success of current government policies to end wealth and health inequalities TARGET – reduce waiting lists and waiting times SUCCESS Since 2000, the waiting lists have been shortened significantly and waiting times of more than 12 months have been eliminated. HOWEVER Some of the improvement has been the result of the way in which waiting times are calculated. For example counting the waiting time for each stage in a diagnosis and treatment not the overall wait time.

19. Extent of success of current government policies to end wealth and health inequalities TARGET – Modernise the NHS SUCCESS In 1997, the average age of NHS buildings was older than the NHS (ie over 50 years old). In 2005, less than 25% are that old. By 2005, the NHS had 68 new hospitals built or being built out of the planned target of 100 new hospitals HOWEVER Critics argue that PFI will cost the NHS more in the medium to long term which will cut services in the future and that many of these new hospitals reduce bed numbers and deliver poor quality buildings which will cost more.

20. Extent of success of current government policies to end wealth and health inequalities TARGET – Reduce ill-health by banning smoking in public places SUCCESS Researchers found a 17% drop in the number of people admitted for heart attacks in the year since the ban came into force, compared with an average 3% reduction a year over the previous decade. The reduction was most marked among non-smokers, with a 20% fall, compared with a 14% drop among smokers. Other research published by the British Medical Journal, found a 39% reduction in second-hand smoke exposure among primary school children in Scotland, and a 49% reduction among adult non-smokers The number of all heart attack admissions in 9 Scottish hospitals fell by more than 550, from 3,235 in the year to March 2006, to 2,684 in the year to March 2007. Among non-smokers, the reduction was from 1,630 to 1,306.

21. Summary Causes of inequalities in wealth and health Government policies Unemployment and low income Age – old people and children Gender and race Wealth inequalities have an enormous impact on health inequalities Government strategies to reduce inequalities The government has had mixed success in meeting its targets but overall it is more positive than negative. Legislation eg NMW or Smoking Bans Directing resources towards the old and children Advertising campaigns and health promoting schools and NHS Welfare to work Emphasis on people taking individual responsibility through education and incentives Social inclusion