Doing something about inequalities in health

Posted by Jean Adams

I was at a meeting in Edinburgh at the end of last year on inequalities in health. It was one of those events full of eminent (and emeritus) professors where I felt slightly out of my intellectual depth. I didn't trust myself to say much. But I tried to listen well.

We need to pro-actively engage with the media - like CJ Cregg did everyday

One of the things about health inequalities is that we all sort of know what the solution is. When I told my dad I was going to do a PhD on why poorer people tend to die younger than richer people, he said "well isn't it just because they don't have as much money?". This confused me. What I was interested in was the physiology - how does poverty "get under the skin?". I don't think the money thing had even crossed my mind.

Now, ten years later, I increasingly agree with my dad. Who cares about the physiology? Sure we could know more about the detailed biological processes going on, but what difference would it make to what we might do about inequalities? The solution remains that to change health inequalities to any substantial extent, we have to change the social structure. Reduce income inequalities, redistribute wealth.

You don't need to be a professor to work that out.

The problem seems to be that we (who? the academic community?) think any sort of drastic wealth redistribution is unattainable, or maybe just too difficult to attain. So we think of other little things we might be able to do to alleviate the problem, rather than tackle the cause. You know, target cancer screening programmes better, that sort of thing.

What would it take to get wealth redistribution? Political will. What would it take to get political will? Public pressure. What would it take to get public pressure? Media agitation. Just like everything else.

One of the things that I was slightly surprised we ended up talking about in Edinburgh was engaging with the media. Sure, I like a bit of science communication. But it's not something that has come up in any of my previous conversations about health inequalities. In fact in previous discussions about science communication, the conversation has rather stopped dead whenever I’ve mentioned inequalities.

The phenomenon of inequalities in health is not inherently media friendly. There are no breakthroughs to report on. No big shiny gadgets to take pictures of. Poorer people get sicker more and die younger. As one participant at the Edinburgh meeting pointed out, if there's a report documenting the extent of inequalities it might get a bit of coverage, but it will be presented as if this is some big, new finding. The coverage won’t go much beyond the data to explore what the cause or solution might be. Then there will likely be a few years of editorial 'fatigue' when it feels like that story has been done recently. Once everyone's forgotten, a new report might spark more interest, but again the coverage will be superficial. And the cycle will repeat.

Other participants described instances of reporters looking for a human angle on inequalities stories traipsing off to the most deprived parts of Glasgow and asking the people they met there why their health was so rubbish.

Mainstream media coverage doesn’t have to be like this. But it will be unless those of us within the public health academic and practice communities interested in inequalities in health get a bit more media-savvy. We need to pro-actively generate informed media debate ourselves. One fairly easy approach is to pitch articles to online outlets such as Comment is Free and newspaper blogs that are desperate for informed and timely content on policy issues.

We also need to be ready to publicly comment on anything to do with inequalities even before we are asked. One researcher, very experienced in media work, described how they prepare written commentary on new reports and statements on inequalities issues the day before they are released. It is fairly easy to guess in advance what the content of any new report will be and so respond appropriately – with final tweaks made on the day once they’ve had a chance to read the details. By staying a step ahead of events, it is possible to guide journalists and debate away from simple reporting to more in-depth consideration of what could be done to alleviate the problem.

Which is obviously all rather more easily said than done. We are, after all, full-time researchers, not part-time journalists. But maybe we could hold each others’ hands a bit and take it step by step and see how it goes? It seems we might have much more to gain, than to lose, from trying.

So who wants in with me on a Comment is Free post on what we need to do about health inequalities in the UK today? Ready to be pitched to coincide with the next big report.