I sometimes wish we could have articles in the accountancy press of the sort that are published in magazines like the British Medical Journal. Last week a GP called Iona Heath had a stunning article in that journal under the title 'Let's get tough on the causes of health inequality. As Dr Heath noted:
The UK government has a clearly stated commitment to tackling health inequalities, while perversely allowing disparities in wealth to widen. The problem is that health inequality is directly related to socioeconomic inequality and cannot be separated from its underlying cause or solved independently. It is convenient for governments to believe that this can be done but the medical profession should not collude with them.
As she then noted, in the 1840s two profoundly important reports were written in London. One was on the need for improved sanitation. As Dr Heath notes:
the results were enormously beneficial, saved many lives and redressed health inequalities to some extent.
Most public health physicians think sanitation has done more for health than pharmaceutical products ever have.
The other report was Engels "The Condition of the Working Class in England". As Dr Heath notes of this:
Engels was primarily concerned with social justice and his work and influence led eventually to profound social upheaval and change in many countries, with enduring benefits for the poorest people.
Now I'm no Marxist. I have no idea if Dr Heath is. I don't really care to be honest. My point is this. Her claim is right if we consider the UK alone. We have reasonable working hours, protection for employees, the end of child labour, maternity and paternity leave, paid holidays and so many other benefits precisely because of a belief in social justice. Whatever the rights and wrongs of communism (and as it manifested itself it was clearly wrong) this distinct and separate social concern has delivered more good than sanitation. The benefit for health is therefore greater than that of both sanitation and pharmacy. But we are at risk of forgetting this. As Dr Heath says:
The UK remains a markedly unequal society, ranked 21st out of 27 in the European Union in terms of the proportion of the population living in relative poverty.
This creates health inequality. That is known to be true. In that case, whatever her motives Dr Heath is write to say:
Doctors have a clear responsibility to pursue political answers alongside technical ones and to seek out and draw public attention to injustice as a cause of ill health. ... Doctors have a responsibility for advocacy - to speak out on behalf of the powerless.
I think that true of accountants as well. So why aren't more doing so? Can it really be true that most accountants just don't care?
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There are several political points here:
1) Those of us who are passionate about social justice are going to be classified as structuralists–Marxists. That does not mean we support or agree with the communist regeims of the last 100 years or so.
2) Dr Heath is spot on when she says that health inequality as about socio-economic inequality, and that is a political problem. Although, the social policies since the late 1970s in the UK are about removing responsibility from the State to the individual for all their curent and future care and needs. These agressive Neo-liberal policies demonstrate a total lack of responsibility by the UK governments of the last 28 years.
3) I remember reading about the most contensious Cabinate meeting when Thatcher was PM, which was based around whether the NHS should be privatised. We know the outcome, but the reason for maintaining the NHS was becaused it served the middle classes well. This is exactly the oppisit reason the NHS was conceived for.
4) I re-read “The Condition of the Working Class in England” by Engles at Christmas, and I believe that if he were still alive he would be appaled at the socio-economic divide in the UK. Nothing has changed in relative termes. One of the areas of Manchester that Engles based his research on was Hulme, it was aweful in 1840 and it is still aweful in 2007.
Of course everybody knows that income and health inequality are related…..but the message is somewhat diminished when propagated by those whose earn huge rewards from working with poor and underpriveledged sections of our community. Rather than bang on to others in equally comfortable positions it would be better to involve people in her own community….raise awareness/do some old fashioned consiousness raising and help to show others how to activate and negotiate systems which exclude them from having their own authentic voice heard and acted on. It is ok to speak out on behalf of others but another to claim to represent them without informing gaining consent. There is a need to give up some of the power and control held by well meaning people.
Dr Iona Heath is a GP.
Maybe ytou don’t understand the demands of being a GP. I do. I’m married to one.
But the fault in your argument is obvious when you say: “There is a need to give up some of the power and control held by well meaning people”.
Who would they give it up to? Ill meaning people? Or the wealthy?
Richard
I have to say as a structuralist, and one of those people that try to stand up for my kindred that finding a GOOD GP is very hard, but when you do find one, hang on to them for all your might.
I know that Gp’s have been critised for being “general practitioners”, but good health service practioners, what ever their role, are worth their weight in gold. Thats not bribed with gold in referance as Bevan did.
Health care along with education, or schooling for the less well of, is soley down to cultural capital, that is the ability of the parents to provide the best for their children. This is nothing more than a good old fashioned class argument, something that the British seem to have convieantly forgotten.