Michael Marmot is back with another iteration of his insistence that it’s economic inequality which causes health inequality in the UK. The problem with the insistence being that our evidence shows that it’s not true. We’ve had declining inequality this past decade and yet also rising health inequality and rising inequality of lifespans. Reality appears to disagree with the national expert on the subject.
Reality wins in such circumstances.
Marmot’s basic point is that it is economic inequality which causes health inequality. At least in part this is going to be true. Those eating 4 squares a day in dry and warm housing are going to do better than those starving on yesterday’s crusts under t’sweet paper in middle of t’t motorway. The question is though, how much is this true in a country where we’ve 5,000 rough sleepers out of 65 million people? Given that absolute deprivation isn’t happening to any statistical importance how much of the effects of it are we going to see in population numbers?
He goes further and insists that it’s relative poverty which causes health problems. My having three more pairs of trainers than you makes you ill. A tough thing to prove really.[perfectpullquote align=”full” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Higher taxes on the rich could reduce UK health inequality, says expert[/perfectpullquote]
Hmm. So, we’re to take our economic advice from a doctor, are we?[perfectpullquote align=”full” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Higher taxation for the rich may need to be considered if the UK is to tackle the decline in life expectancy in parts of the UK and the widening gap in health inequalities, according to Sir Michael Marmot, the country’s leading authority on the issues.[/perfectpullquote]
Our problem is that Marmot really is the national expert. And he’s wrong. One sense in which he’s wrong is that he doesn’t take account of an entirely obvious point.
OK, let us accept, arguendo, that economic inequality produces health inequality. But it’s also obviously true that health inequality produces economic inequality. That congestive heart failure coming on at the age of 40. Sure, the NHS might keep you going and all that but it’s going to lead to you being poorer than you would have been at age 60, isn’t it? And Marmot’s numbers entirely ignore, reject even, this point. Meaning that we can’t trust his numbers nor logic.
However, we’ve another rather important problem here. Reality disagrees with the knighted professor.[perfectpullquote align=”full” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Ten years on from his seminal review for the Labour government of health inequality in England in 2010, Marmot will publish a review of what has been achieved and the current state of the nation with the Health Foundation. The evidence is expected to show that initial progress faltered and then stopped under the pressure of austerity, Marmot told the Guardian in an interview.[/perfectpullquote]
Note Marmot’s point. It’s inequality which causes these problems. Not the general level of incomes, but the inequity in them. He recommends more taxation in order to reduce such inequity in post-tax, post-benefit incomes to correct it.[perfectpullquote align=”full” bordertop=”false” cite=”” link=”” color=”” class=”” size=””] But, said Marmot, a change in approach by central government is also needed. And he thinks there is now public support for some reform of taxation. He cited Dutch historian Rutger Bregman, who caused a sensation at Davos by challenging billionaires who he said could solve inequalities by paying more tax. It was “taxes, taxes, taxes, and all the rest is bulls**t in my opinion”, Bregman said. “In the US, the majority of the population think that rich people should pay more tax,” Marmot told the Guardian. “The argument that having a higher marginal rate of tax at some higher level of income I think is very strong. “The evidence suggests very rich people when their marginal rate at the top gets high enough they stop paying themselves so much – they reinvest in their companies. It’s why [American politician] Alexandria Ocasio-Cortez recommended a 70% marginal rate above incomes of $10m. “I think the economists who’ve looked at this suggest you don’t get a drop in productivity or innovation at those top levels so thinking about more progressive taxation schemes that would be good for everybody. Even in the United States, this is no longer on the left fringe.” [/perfectpullquote]
Reduce inequality and she’ll be fine.
Well, OK, it’s a view. How useful a view is it? Well, actually, it’s a view worth stercore*.From the Office for National Statistics:
For those who prefer text:[perfectpullquote align=”full” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]When looking at the change in inequality over the last 10 years, income inequality, as measured by the Gini coefficient, has shown a downward trend across all three measures of income. There has been no statistically significant change in the Gini for any of the income measures in the last year.[/perfectpullquote]
Marmot is complaining that health inequality is rising. Income inequality has been falling over the same period. Therefore his insistence that income inequality causes the rise in health inequality is entire and total coeli*, isn’t it?
And thus, obviously enough, reducing income inequality through higher taxation isn’t going to reduce health inequality, is it?