Wellbeing, the healthy environment, and the common good

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At the conclusion of their 2013 book The Body Economic, David Stuckler and Sanjay Basu suggest that when we ‘tell our children about the Great Recession, they will judge us not by growth rates or deficit reductions. They will judge us by how well we took care of society’s most vulnerable, and whether we chose to address our community’s most basic health needs: healthcare, housing, and jobs’.

It is a striking prediction, so much so that it is easy to overlook the way in which they have grouped housing and jobs under the heading of ‘basic health needs’, alongside the more obvious ‘healthcare’. But they are surely right to do so. We are so used to compartmentalising aspects of our lives, especially in political discussions, that it is easy to miss the ways in which they are all interconnected.

Without an adequate home, sufficiently warm in winter, clean and in good repair, it is all too easy to fall into bad health. Without a stable, reasonably well paid job, it is all the more difficult to maintain a reasonable standard of mental and physical health. So Stuckler and Basu are right to highlight the health implications of these issues.

We could add others – and indeed the authors treat a range of other issues throughout the book. Poverty, not surprisingly, is associated with a poorer diet, and often with inadequate exercise. It can also lead to higher anxiety levels. Low wage, insecure jobs can be stressful, and if you think it is tough at the top, try living at the bottom of the income ladder for a while. Stuckler and Basu show again and again how the effects of relative poverty can be closely linked to poorer health outcomes – and just how much poorer can be measured in terms of years knocked off life-expectancy – to say nothing of increased suicide rates.

But above all, they show again and again how none of this need be inevitable, almost none of it is a mere accident of nature. According to their wide ranging and detailed empirical studies, it is clear that policy choices make a decisive difference to the health and wellbeing of a given population.

Investment in public services and in social protection programmes are vital not only for widespread health and wellbeing, but help to hasten economic recovery after recessions. Moreover, where cuts in public spending have been implemented in an effort to reduce government deficits, it can backfire, even in terms of costs, because of the risk of rocketing rates of diseases and other health problems.

Perhaps the most significant element we could add to the list, though, is an issue less thoroughly examined in the book: the environment itself. Most obviously, the condition of our environment matters because nothing could be more basic to our health needs than the air we breathe and the water we drink. More subtly, there is the issue of the local environment in which we live.

As Tony Juniper shows in a recent book (What Has Nature Ever Done for Us?) communities that have access to woodlands, meadows, or other green spaces, with all the plants and wildlife that go with them, enjoy better health, mental and physical, than those that don’t. These effects are measurable and empirically verifiable, and Juniper provides a range of striking statistics to back his claims for what he calls the ‘natural health service’.

Yet the issue of health is habitually presented in political debates as being all about hospitals and GPs and nurses and waiting lists. Of course these things matter, but we need to start looking at the issue of health in a broader context. Indeed health matters to your whole life; so we need to look at health in a whole-life context, including the medical side, but starting with our environment itself.

For the Green Party in Northern Ireland, a whole-life approach to health means we must ensure there are green spaces accessible to all and enjoyed by all. We must make sure local government provides simple playing fields near the communities that would use them, rather than just pouring funds into expensive, showpiece sports centres so far away you have to drive to them. We must push for cycling to be taken seriously as a mode of transport – at one stroke you could reduce pollution levels and get people exercising regularly. We must ensure, too, that our children are provided with nutritious food in schools as well as at home, and given a decent education about it into the bargain, rather than being sold ‘fast food’ by omnipresent advertising campaigns and lucrative product placements. We must see to it that older people are actively included in community life, that our neighbourhoods are designed not just with able-bodied, younger people in mind, but with the needs of others taken into account from the off. In short, health and social care is inextricably linked to a full range of other social and equality issues affecting our whole lives in our local communities. To address each in turn, piecemeal, is not sufficient. They are interconnected, and can be fully addressed only in the context of a politics of the common good.

This is not something on offer from the conservative parties who, for thirty years, have been champions of the alleged ‘panacea’ of market competition – at the very heart of which is the notion that what is profitable is fit to survive, what is unprofitable must be left to go to the wall.

Moreover, when these same parties warn us about ‘the deficit’ they are talking only about the amount the government gets and spends – the fiscal deficit. Yet their dogmatic drive to reduce that deficit by way of cuts and freezes in the public sector risks opening up another deficit – a health deficit, whereby the least well-off and the most vulnerable end up paying with their health in a misguided attempt to ‘balance’ the fiscal books.

There are other ways to achieve the latter aim – we’ll set them out in due course – but the problem with a health deficit is that, as Stuckler and Basu show, once it’s opened up, at least for some of us, it can never be healed.

8 February 2015

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