Health policy in an independent Scotland: tackling inequality is key.

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On 11 November 2013 Dr Kate Wrigley addressed a meeting of the Edinburgh branch of the Radical Independence Campaign. We brainstormed what an independent Scotland could do to improve the health of the people of Scotland.

On 11 November 2013 I attended a meeting of the Edinburgh branch of the Radical Independence Campaign, addressed by Dr Kate Wrigley.

Graph modified from the Equality Trust website showing that health and social problems are worse in unequal countries.  Click on the image to visit the site and learn more.

Graph modified from the Equality Trust website showing that health and social problems are worse in unequal countries. Click on the image to visit the site and learn more.

Not just poverty but inequality explains Scotland’s poor health

Dr Wrigley got us to come up with a number of (ill-) health conditions and discuss whether they were more likely to occur in the relatively poor or the better off.  Unsurprisingly, the vast majority were more prevalent in poor people. She also reminded us of The Spirit Level, which demonstrates the link between societal inequality and poor health, presenting evidence that unequal societies are less healthy for everyone in them. In other words, wealthy people in unequal societies fare worse than people with the same income in relatively equal societies. Inequality is bad for everyone.

For a country of its GDP, Scotland is one of the unhealthiest in the world. As part of the grossly unequal UK, this is not surprising.  (In addition, there is the so-called ‘Glasgow effect‘, which we did not discuss on 11 November.)

Powerlessness and chronic stress

The ill health of poor people is not adequately explained by poor diet, a higher incidence of smoking, poor housing conditions, etc.  While these things do contribute to morbidity (illness) and premature mortality, they are not sufficient to explain the difference between the wealthy and the poor. It is likely that powerlessness and associated chronic stress (high levels of cortisol) play a major role in excess morbidity and mortality. We were reminded of Sir Michael Marmot’s famous study of Whitehall civil servants, in which rank was found to correlate with health and longevity (higher ranks faring better), and this was only partly explained by harmful behaviours.

Next we were divided into two groups to discuss how an independent Scotland might improve Scotland’s health. One group looked at how healthcare provision might be changed and the other looked at how to tackle the major driver of ill-health – inequality.  I joined the latter group.  This is what we came up with:

Ideas for Reducing Inequality – thus Improving Health – in an Independent Scotland

European Citizens' Initiative for an Unconditional Basic Income

Support the European Citizens’ Initiative for an Unconditional Basic Income

* Implement a citizen’s income.

* Implement a living wage (i.e. a legal requirement for employers to pay a decent minimum wage).

* Set maximum wage ratios in all public bodies (of the highest to lowest paid employees) and also use public procurement to favour organisations with low wage ratios.  (The latter would possibly require Scotland not to sign up to international trade treaties.)

* Reduce working hours (this would enable more jobs to be created, so reducing the welfare bill, and it would also improve health directly and increase productivity).

* Strengthen trade unions.

'Transfer pricing' is the biggest tax avoidance scheme of all. The government must insist on companies being more transparent

‘Transfer pricing’ is the biggest tax avoidance scheme of all. The government must insist on companies being more transparent

* Implement fair, redistributive taxation and crack down on tax avoidance and evasion. This could be done by, for example, favouring companies in public procurement that did not use tricks such as transfer pricing.  (This would possibly require Scotland not to sign up to international trade treaties.)

* Nationalise natural monopolies, such as energy companies, the railways and the postal service.

Cartoon illustrating relationships between workers in an employee-owned company.

Employee-ownership: when a company is employee-owned, and people have adapted to the idea of being their own bosses, they are much happier.

* Favouring employee-owned companies in various ways (such as through the tax system and public procurement). They tend to have lower pay ratios and numerous spin-off benefits for their employees and the wider community, as David Erdal makes clear in his book, Beyond the Corporation, Humanity Working.

Our money system guarantees that inequality will get worse

The gap between the very richest and the rest of us has increased continuously over the last thirty years. Did you know that top 10% of population earns on average 6 times more than the bottom 90%? Many factors contribute to this growing gap, but one of the most significant is least understood: the role of money creation by banks.

* Reforming the monetary system. At present private banks create money as debt: more than 97% of the money in circulation is made this way and not by central banks. This inevitably drives the redistribution of money from the poorest 90% of the population to the top 10%. Scotland should issue its own currency and prevent private banks from creating it.

* Improve the quality and availability of social housing. (We could use the passivhaus model, for example.)

* Implement a land value tax.

* Introduce co-operative-run media, such as this Canadian example, and prevent large corporations from controlling major national media. (To understand just how malign our corporate UK media are, have a look at the Media Lens site.)

Decrease the size of local authorities.

* Change the metrics (GDP etc.) that drive economic policy. (Here’s something Bill Wilson and I put together on this topic.)

Most of the above potential policies fly in the face of neoliberal orthodoxy (which I tackle elsewhere in this blog), and so I can’t see any of them being implemented in the UK, but all the suggested policies have an evidence base, as you will discover if you click on the links.

Join the debate

Why not join the debate? Here are some websites on which these and related ideas are aired:

Radical Independence Campaign

National Collective was founded by a small group of artists and writers based in Edinburgh in 2011. Since then it has grown significantly across Scotland with over 1,400 members. It is the non-party movement for artists and creatives who support Scottish independence.  Our organisation was founded with the aims of arguing the positive case for Scottish independence and imagining a better Scotland.

National Collective was founded by a small group of artists and writers based in Edinburgh in 2011. Since then it has grown significantly across Scotland with over 1,400 members.

National Collective

Bella Caledonia

Jimmy Reid Foundation

Scottish Left Review

Finally, I do hope you will vote ‘Yes’ (for independence) in the 2014 referendum and, once we govern ourselves, push for some or all of the above policies to be implemented.

Wishing you health and happiness!

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About biowrite

I am a writer specialising in non-fiction, particularly in assisting people with their biographies.
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