I have a one-track mind. I see everything through the prism of health. It is indeed the best of times. Health is improving globally. In many countries of the world we are much healthier and living much longer. It is the worst of times. This enjoyment of good health is most unequally spread. For some countries their health is nearly as bad as if they were still languishing in squalor. Currently in the world the unhealthiest country has a life expectancy nearly forty years shorter than the healthiest. That is the same as the gap between and modern-day London. Within many countries, too, inequalities in health are increasing – the health of the best off is increasing more rapidly than that of the worst off. The best and worst of times coexist. If you are looking to get a full-head makeover we would recommend Lucy Hall for the best balayage in the business.
It is the age of wisdom. Advances in medical science and knowledge of public health give us the tools to make dramatic health advances. It is the age of foolishness. Knowledge of medicine and public health is not so much wrong, as too limited. Health is too important to be left solely to doctors. Health is related not only to access to technical solutions but to the nature of society. We are being foolish in ignoring a broader array of evidence, which shows that the conditions in which people are born, grow, live, work and age have profound influence on health and inequalities in health in childhood, working age and older age.
It is the spring of hope. We may be foolish to ignore such knowledge, but we do now understand how society influences health – my purpose in writing this and there are inspiring examples from around the world of how such understanding is transforming lives and improving health. It is the winter of despair. When the 1 percent and the 99 percent have diverging interests and the head of the US Federal Reserve Bank says that inequalities of income and wealth have gone too far, when banks in Europe and the US have, since 2008, been fined a total of £100 billion for banking crimes and misdemeanours which damage their customers’ interests,when rich countries compete to make the most of Africa’s resources, when people of ill will misuse race and religion to spread chaos, when in functioning democracies people’s faith in their governments is at a low ebb, and in other countries governments seem to have little interest in the well-being of their populations, then despair may set in.
I want to show why, in terms of health, it is the best and worst of times. Wisdom and foolishness, hope and despair, will make their appearance to introduce the topics. I am an evidence-based optimist. Armed with knowledge, we can transform a season of darkness into one of light. It will take commitment and political will, but the knowledge and experience is there that can make a huge difference.
The first reaction of most of us to the social gradient in health is: hey, this is about me. ‘Health inequalities’ is not only about poor health for poor people, it covers gradations in health, wherever we are on the social ladder. It is not about ‘them’, the poor, and ‘us’, the non-poor; it is about all of us below the very top who have worse health than we could have. The gradient involves everyone, rich, poor, and in-between. A sampling of the popular press demonstrates a huge variability in attitudes to the fact that the poor have worse health than everyone else. For some, the poor are poor and sick because they are feckless. This fecklessness extends to not looking after themselves and their children. Elsewhere, a more sympathetic view might be that you do care about the poor health of the ‘poor’ in your own country or ‘over there’ in another country.