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Health, Wealth and Poverty
By Charles Webster,
Margaret Whitehead
et al
Published by the Medical Practitioners' Union and the Socialist Health Association,
1993, £2 Reviewed by John Dale
F YOU ARE short of money,
it is easy to understand why
poverty and ill-health go together. But why are the wealthiest so much healthier than even those in 'good jobs who can afford basic needs?
Some of the answers are in Health, Wealth and Poverty, a pamphlet bringing together six papers presented to a conference last November, published jointly by the Medical Practitioner's Union and the Socialist Health Association.
The biggest cause of early death in the UK is heart disease. At one time this was thought of as a businessman's problem. Now it is far more common among working class people. A study of 17,000 Whitehall civil servants showed the risk of dying from heart disease amongst middle management is twice that of the top civil servants. Clerical workers have three times the risk and manual workers, messengers, porters, cleaners etc, have four times the risk of the most senior grades.
The first paper in Health, Wealth and Poverty, by Dr Charles Webster, shows how those in power have ignored or covered up such inequality for years. In 1933, for example, the Chief Medical Officer wrote that there was "no available evidence of any general increase in physical impairment, in sickness or in mortality, as a result of the economic depression or unemployment"
This flew in the face of health statistics that had been available since 1911. However, it suited the National government of the
Book Reviews
Inequality, as well as poverty, damages health.
1930s, with its policy of benefit cuts, to push the idea that class differences in health were due to the biological or moral defects of the poorest in society.
Margaret Whitehead's paper includes the results of some interesting international studies. In Canada there is a gap of over six years in life expectancy between the richest 20% of men and the poorest 20% and nearly three years between the richest and poorest women. If the number of years spent without disability is calculated, the difference grows to over 14 years for men and over seven years for women.
Throughout Europe, she concludes, "the mounting scientific evidence... all points to a better health status for those who earn more, know more, or have more power".
The paper Income and Health, by Richard Wilkinson, reaches important conclusions, although the statistics are a bit heavy. The Whitehall civil servants study, mentioned above, is analysed further. Is the difference between top civil servants and the rest simply because they are better at following a 'healthy lifestyle"?
Wilkinson points out that all the known risk factors for heart disease, smoking, diet, high blood pressure etc, explain less than
a quarter of the difference between the civil service grades.
Comparing different developed capitalist countries, he shows that average life expectancy is closely related to the distribution of wealth. Where inequality is greatest, life expectancy is lowest, regardless of the average income per head.
In Britain, for example, average life expectancy fell by about a year between 1969 and 1986. The share of income of the poorest half of the population fell from 31% to 28% in the same period.
The Department of Social Security has produced figures showing that 98% of the poorest fifth of households have a TV, 80% have a washing machine and 42% have a car. What these figures don't show are the problems caused by trying to pay for a TV license, repair an ageing second-hand washer or being caught with bald tyres you can't replace. Wilkinson argues that this stress, causing anxiety, depression and insecurity, is the main reason for the health gap between rich and poor in the advanced capitalist countries.
Although some of the statistics in Health, Wealth and Poverty are quite technical, at £2 it is worth buying for facts to prove that inequality, as well as poverty, damages health.
Reviews • 31
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JOIN MILITANT LABOUR TODAY Capitalism, in Britain, Culture and Decline 1750-1990 By WD Rubinstein Published by Routledge, 1993, £25hb Reviewed by Andrew Price N OUR ECONOMIC analysis of world capitalism, Militant has explained the reasons for the massive economic boom from roughly 1950-1975 and how the system has since moved to periodic slumps and booms. Within the general crisis of world capitalism, however, there are special features of the crisis of British capitalism, which has witnessed the massive decline of Britain as an industrial nation. The recent book by WD Rubinstein, an Australian academic, is a contribution to this debate on the decline of British capitalism. However I cannot conclude that he has helped us understand the process any more clearly. Rubinstein devotes the largest part of his work to a strong attack on what he calls the cultural critique'. This argument traces the massive growth of British industry post-1760 leading to the establishment of Britain by 1850 as the workshop of the world. But this period of industrial hegemony was shortlived. After 1870 came the economic decline of Britain, a process that has continued to the present day. The "cultural critique' advanced by a number of economic historians attributes Britain's economic decline to an 'anti-business' and 'anti-industrial' culture among people in power in Britain. I would like to join Militant Labour Name Address.
32 • Reviews Rather than seriously examine the actual historical relationship between the development of capitalist economy and the institutions of the state (government, law, the education system, civil servants, police, the army etc Rubinstein attacks supporters of the "cultural critique with the argument that Britain was never really an industrial nation and therefore has not suffered a process of industrial decline. In nearly all of his arguments he is wrong. For example, a British Conservative writing in 1826, quoted in Trotsky's Where is Britain Going?, argues: "The prospects which are now opening to England almost exceed the boundaries of thought, and can be measured by no standard found in history... The manufacturing industry of England may be fairly computed as four times greater than that of all the other continents taken collectively, and sixteen such continents as Europe could not manufacture as much cotton as England does". So much for Rubinstein's claim that Britain was not the workshop of the world.
Rubinstein's arguments range from the unusual to the questionable to the downright ridiculous. Thus having produced an array of statistical data on Britain's industrial decline, he claims that it is not really a question of the rapid decline of British capitalism rather than the rapid growth of German and US capitalism! In defending the decision of the British ruling class to invest in services rather than manufacturing industry, Rubinstein shows that more people Telephone Return to: 3/13 Hepscott Road, London E9 5HB Or phone 081 985 7578 use Heathrow airport than any other airport in the world. Finally, he attacks those who maintain the superiority of manufacturing over a service economy in the following terms: "It is difficult to believe that there is not some underlying sexual undertone to the preference for manufacturing rather than services"!
Rubinstein fails to draw a distinction between making money and creating wealth. The British ruling class has been very skilful in the former, but have shown little facility for the latter. Early in the lifetime of the present Tory government, for example, the very minimal exchange controls introduced by the previous Labour government were lifted. Since then billions of pounds that could have been invested in manufacturing industry has flowed abroad. This has made the ruling class richer as has their colossal investment in banking and insurance. But British manufacturing continues its remorseless downward march. These actions graphically indicate the absolute decline of British capitalism, and the ruling class's pessimism for the future. Ironically they have less faith in the future of capitalism than have the leadership of the Labour Party. But despite considerable scholarship and research, this vital point is lost on Rubinstein. Those looking for an introduction to the complex but vital questions raised in this book are better advised to start with Trotsky's Where is Britain Going?, which retains today all the vitality and relevance as when it was first published.
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