Reducing Health Inequality debate – 24th November 2016


Alison Thewliss (Glasgow Central) (SNP): I am proud to participate in this debate, and I am glad that the Chair of the Health Select Committee, the hon. Member for Totnes (Dr Wollaston) has brought it before the House today. This debate is an important one, in which I have a considerable interest.

The issue of health inequalities was one of the first that I got interested in as a teenager. Sitting in my modern studies class in Lanarkshire, I could not understand why any Government would allow people in less well-off areas to disproportionately suffer ill health and die prematurely. I was frustrated when I read about the Black report and the inverse care law. I was angry then, and I am angry now that the political decisions taken here are the root cause of that mortality and morbidity that still blights too many lives in our country today. It is unacceptable that male life expectancy in parts of Glasgow should vary by 15 years, between the ages of about 66 and 81. In the case of women, the gap is 11 years. I got interested in politics because I wanted to change that: I wanted to understand why it was, and I wanted to know what I could do to help.

I joined the SNP when I was at school. I know that today’s debate has not been too party-political, but I think it is important to put this on the record, because it is important to me. I joined the SNP because I could see that the health of Scotland’s people in particular was not a priority at Westminster. When I was at school there was no Scottish Parliament, and there was no way in which we could deal with the issue ourselves.​
The hon. Member for Stockton North (Alex Cunningham) mentioned the Black report. The way in which that report was greeted was quite telling, as is the fact that we are still discussing many of the issues now. The Marmot report has not yet been implemented, and the obesity strategy is still not as strong as it could be. It has not been possible to tackle the underlying causes of health inequality, but I believe that if the Scottish Parliament had all the powers of a normal Parliament, we would be able to deal with them more adequately than they have been dealt with in the past. [Interruption.] Some members may disagree with me, but that is what I believe. It is past health inequality that we are dealing now, because there is a time lag.

Alex Cunningham (Stockton North) (Lab): I do not disagree with the hon. Lady, but I think she must have misinterpreted my action. It was my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) who mentioned the Black report, and I was indicating him. No offence was meant.

Alison Thewliss: My apologies. I had to nip out to the loo earlier, and I must have got my wires crossed. I thank both Members for raising those issues. It is important for us to think about the context of the debate and where we are going.

I have been reading the report to which the hon. Member for Glasgow East (Natalie McGarry) referred. I pay credit to the in-depth work and dedication of the Glasgow Centre for Population Health. Its director, Dr Carol Tannahill, along with Bruce Whyte and David Walsh, lead much of that work. Along with their team of researchers, they have laid out the history of health inequality in Glasgow and in Scotland more widely. They have done a huge amount of research, and have come up with not only history, but some solutions.

In 2007, when I was first elected as a Glasgow councillor, the centre’s most recent report was “Let Glasgow Flourish”, but since then it has carried out a great deal of research on Glasgow’s “excess mortality”. It is interesting to note that that excess mortality applies across different causes of death, and across ages, genders and social strata, although it is most pronounced in members of the working-age population living in the poorest neighbourhoods, where the impact of alcohol, drugs and suicide, particularly among men, is stark. In comparison with Manchester and Liverpool, Glasgow experienced an extra 4,500 deaths between 2003 and 2007. In Scotland overall, there were an extra 5,000 deaths in each year between 2010 and 2012.

I shall not repeat what was said by the hon. Member for Glasgow East, but it is important to note that Governments knew that that was happening. The impact of their policies was known. Urban change, particularly in Glasgow, was taking place in a noticeably different way from the way in which it was happening in Liverpool and Manchester. It had a disproportionate effect on the population, and we still see the lag of that today. One of the reports produced by the Glasgow Centre for Population Health quotes from a 1971 Scottish Office report called “The Glasgow Crisis”, which noted that

“Glasgow is in a socially…economically dangerous position.”

However, nothing was done at the time. The urban regeneration in Glasgow took place in the shopping centres in the middle of the town, but did not touch the areas that needed it most.​
Poverty and health inequality are incredibly difficult to turn around. They cannot be fixed by a sugar tax or any other individual health measure; a wide-ranging approach is required from all levels of government. Glasgow has worked incredibly hard, and has established a poverty leadership panel to examine some of the issues. The Scottish Government have invested heavily, and have set up a ministerial taskforce on health inequality. However, we must keep working harder and working together if we are to achieve a result.

Clyde Gateway is an urban regeneration company in my constituency. Members may wonder whether an urban regeneration company, which builds things and fixes the ground conditions, should be interested in health, but the company has been working for eight years in Glasgow and Rutherglen, and has learnt lessons from previous regeneration efforts. So far, it has managed to lower the claimant count for out-of-work benefits from 39% to 28% and the claimant count for jobseeker’s allowance from 8.6% to 4.8%. That is pretty remarkable in itself, but the company cannot go any further until it starts to tackle the underlying health issues that are keeping people out of work. It is therefore working closely in partnership with local organisations and local people. It is crucial that local people are part of the process and are not having things done to them, as was the case before. They are now part of the solution and the community is a part of what is happening.

Clyde Gateway recently signalled its intention to seek a means of tackling health inequalities. It wants to work to improve diet and cancer screening, which are both factors in the area’s ill health. There is a lot of worrying evidence that people in areas of deprivation are not taking up the screenings to which they are entitled. Those screenings include tests for cancer and free eye tests, which can also be an indicator of other conditions. I spoke to the RNIB yesterday about early intervention and the importance of people going for their eye tests. Clyde Gateway also wants to grow jobs in health and social care in the local community to make people working in the industry part of the community as well, rather than having staff coming in from other areas to “do” health to people.

I wholeheartedly agree with the notion that public health ought to be everybody’s business. It is not just for public health officials to do on their own, because the roots of health inequalities are to be found in income inequalities. So in Scotland we are tackling some of the underlying causes. The living wage uptake in Scotland now far exceeds the uptake in other parts of the country. We are supporting families and helping to improve the physical and social environment and housing. We have invested heavily in housing, because much of the ill health was coming from housing that was damp and substandard. Housing was making people ill and was not being tackled.

We have increased free school meals and continued commitments such as free prescriptions, concessionary travel and free personal care. The hon. Member for Bradford South (Judith Cummins) talked earlier about tooth-brushing and the rates of tooth decay. In the mid-1990s, when I was starting secondary school, just under 40% of children in primary 1 in Scotland—those just entering school—had no dental cavities. That figure ​is now just under 70%, which is pretty good and marks quite a shift, but we need to go a lot further. Initiatives such as Childsmile, through which all children in Scotland regularly get free toothbrushes and toothpaste, are helpful.

As the hon. Members for Totnes (Dr Wollaston) and for Congleton (Fiona Bruce) mentioned, a lot of work is being done on minimum unit pricing to reduce alcohol consumption and deal with many of the issues that lead to people buying low-price cheap alcohol, which is killing them. We have reduced smoking rates, too, by bringing in the smoking ban first, and we are doing a lot of work to encourage active living and healthy eating, and investing to improve mental health services.

As chair of the all-party group on infant feeding and inequalities, I want to take this opportunity to speak about breastfeeding and the impact it can have on health inequalities. James P. Grant, executive director of UNICEF during the 1980s, said that

“exclusive breastfeeding goes a long way towards cancelling out the health difference between being born into poverty or being born into affluence. It is almost as if breastfeeding takes the infant out of poverty for those few vital months in order to give the child a fairer start in life and compensate for the injustices of the world into which it was born.”

That is quite a statement.

Sadly, there is a huge inequality in breastfeeding, particularly in the UK. Women in areas of greater deprivation are far less likely to breastfeed. They are then also often paying for expensive formula milk, which will put strain on their family budget.

I was once told by a Labour councillor in Glasgow that in his experience there was an inverse perverse stigma: if a woman breastfed, it made her look as though she was too poor and could not afford the formula. The cost is a big issue, however, as I highlighted in my ten-minute rule Bill last week.

Families are being penalised for a societal problem: the UK just does not provide enough support, via midwives, health visitors, peer supporters and local networks, to ensure that mums are able to breastfeed for as long as they want to. Some of the economic agenda is having an impact on those important services, and coverage is fraying, as volunteer services find it harder to cope. It is seen as difficult, and there is so much blame and shame for mums, whatever they do and however they feed their children.

Many younger women have never seen anyone breastfeed. There is also interesting evidence from Sally Etheridge that the longer that BME women who have come to the UK from other countries stay here, the lower their breastfeeding rates become as they begin to assimilate into our bottle-feeding culture. I believe that there is a lot we can do to improve this situation and encourage the Government in that regard. I met the Minister earlier this week and am glad that she is listening and keen to address the breastfeeding rates across the country.

The series on breastfeeding from The Lancet and the UNICEF report on preventing disease and saving resources point out that the NHS could save significant amounts of money by investing in breastfeeding services. They reckon that there would be 3,285 fewer hospital admissions for gastrointestinal issues and 5,916 fewer admissions for respiratory tract infections, which could save £10 million across the country. That is no mean feat. There would also be connected reductions in obesity and sudden ​infant death syndrome, as well as a reduction in breast and ovarian cancer in the mum. Breastfeeding is a significant public health intervention, as the UNICEF call to action has illustrated.

I should like to summarise a few of the suggestions in the Glasgow Centre for Population Health report, as it is the purpose of our debate today not only to look at the problems. Health interventions on smoking, alcohol and so on have helped, but the report has found that the main means of resolving health inequality is not a health intervention but a wealth redistribution. A widening gap in income has been perpetuated by different Governments over many years. Fair and progressive taxation and fair wages would make a huge difference to the gap. Ensuring that all people have a sufficient income is critical, yet this Government continue to slash social security spending, which is making people not only poor but ill.

An NHS Health Scotland report published this month said that a quarter of lone parents in Scotland rated their health as either fair, bad or very bad. Those parents have to look after children. If their health is fair, bad or very bad, they will not be able to be effective parents. The impact of food banks on health is also clear. If people cannot afford to put food on the table, they have to resort to going to a food bank to get canned meals. They do not get fresh food and vegetables; they get something out of a can that they might not even be able to heat. That will have an impact not only on their physical health but on their mental health.

The GCPH report looks at the cost of living and at how we as a society can support people to live with dignity and live a life in which they have choices. Having choices in life should not be a luxury. If someone does not have any control over what happens to them in life, it will have a huge impact on them and their family for years to come. The report also recommends affordable, warm and appropriate housing. As the hon. Member for Hackney South and Shoreditch (Meg Hillier) said, not having somewhere affordable and warm to live can have a huge impact on people. We need to learn from past mistakes and look more widely at the policies we pursue and the things that we in this House think are important, because they can have long-lasting effects, as we have seen in Glasgow.

Most significant to all of this is the adoption of the World Health Organisation’s principle of including health in all policies. This must run through absolutely everything that the Government do, because of the impact on health. Yesterday, the Chancellor failed to address health spending; indeed, he failed to address the question of health at all. He is failing the people of this country by not acknowledging the significance of health to everything else that the Government wish to achieve.