Statistics from Altmetric.com
Dear politicians in rich countries,
I write to issue a challenge to you: are any of you brave enough to really tackle health inequities both in your own country and between your country and the poorer countries of the world?
But I can hear some of you saying “yes but we already have a strategy, a committee or a policy within our health ministry to deal with inequity”. I know that, but nearly always they miss the mark. They consider behavioural risk factors, look at poverty reduction strategies or at increasing access to healthcare services. Yet the evidence indicates that the reasons inequities continue to exist is because of excess wealth and a world trading system that continues to perpetuate inequities. Oh dear! Have you stopped reading? Are you wondering why a professor of public health might be bothered about world trade rather than curing disease. Well it is because I'm convinced that unless we can tackle the issue of excess wealth and create a fair trading system then the future will not be very healthy.
So often when we consider health inequities we assume that poverty or the poor are the problem. The number of poor people is growing in your country and the gaps between them and the most wealthy is increasing, unless you are from one of the very few countries where this is not the case. Globally 800 million people in the world are malnourished and 30 million die from hunger each year. I know you don't have to bother about winning their votes but don't you care about them none the less? It is true that as a national politician you have less power than in the past. Transnational corporations are becoming ever more powerful. Walmart, owned by the Walton family in the United States has an estimated wealth of $27 billion, which is higher than the GDP of Bangladesh with its population of 120 billion.
So, you say, what has all this got to do with health? A lot. The position of transnational corporations is maintained because everywhere national governments bend over backwards to accommodate them and the impositions of international financial institutions such as the World Bank and International Monetary Fund. The Structural Adjustment Policies or neo-liberal policies of the past years have cut vital health and education services. Privatisation of services, reduction of welfare, withdrawal of regulations all have health consequences and in nearly all cases have increased inequities in health.
What can you do? You could be brave enough to start the tide turning against the madness and inequity of neo-liberalism or economic fundamentalism as others call it. You could decide to reinforce the role of government in intervening to redress the inequities of the market. Instead of concentrating on welfare cheats you could use the public service to ensure that companies pay the tax they should. You could lead a public debate about the desirability of higher progressive taxation and encourage people to see the payment of tax as a fine duty of citizens who are making an investment in their own and their children's future. You could make taxation avoidance socially undesirable. You could suggest a tax on financial transactions and invest the income in exciting community development projects to help poor communities. You could support this by telling your electors about the evidence that shows that countries that have more equal wealth distribution are healthier than those that don't. You could argue that the same is true for the world as a whole. You could make equity futures more important that financial futures. There are so many things you could do.
But first you have to put the pursuit of equity at the centre of your policy objectives and you have to believe that the sorts of inequities I list above are obscene. If you do this you won't have problems convincing people that excess wealth and the systems that produce it have to be tackled. You might find you gain votes, that people respect you, that the catastrophic decline in trust of politicians over the past decades is reversed. Perhaps even the voters in those all important marginal seats might vote for you. Then your dream of being remembered for the good you do will come true as your reforms pass into history and you are remembered as one of those who made the world a healthier and more equitable place.
Good Luck. Our health depends on your actions.