Why political parties need to address health inequalities before the elections
The NHS is one of the key issues which will decide how the electorate votes in the UK general election this July. [1] Political parties are signalling that they share this concern with pledges for reducing waiting times, improving healthcare through technology and innovation, and increasing workforce and capacity. In parallel, major public health charities, [2] expert bodies, [3] and patient associations [4] stress that a genuine interest in the NHS and people’s health requires addressing the social determinants of health and health inequalities. It is vital that politicians understand and address the fact that social and economic factors drive health, and the unequal distribution of these factors leads to health inequalities.
It is understandable that some political campaigners may fear that emphasising inequalities might create tensions, alienate voters or polarise the electorate. However, examples of a younger generation of politicians, like Alexandra Ocasio-Cortez in the US or Jacinda Arden in New Zealand, show that addressing inequalities not only can bring significant political gains but can also lead to policy change with tangible socioeconomic benefits. The idea that greater equity benefits everyone’s health is neither novel nor abstract; an extensive body of scientific literature from the early 1990s until today supports this argument. [5-9] By focusing on good health for everyone before the elections, political parties can signal their commitment to equitable policies that will bring sustainable change instead of short-lived ‘success’. There is an opportunity to rebuild trust between politicians and voters by reflecting the public’s desire for good health for all and support for those who are marginalised within society.
There is a growing consensus among prominent public health advocates that addressing health inequalities requires a national, long-term, cross-government action and cross-party agreement to put health at the heart of all policies. [10-12] It calls for system thinking and the engagement of multiple actors. Parties need to consider these voices and demonstrate with actions before the elections whether they are willing and able to undertake such an endeavour. It is crucial that they do this now – while trying to connect with voters – by abstaining from toxic rhetoric and creating spaces for deep democratic dialogue.
Rather than simply reaching a majority, deep democracy is about reaching a point where all voices are heard and the different knowledges they carry are all considered important. [13] This means opening up to individuals and communities who have been systematically and continually harmed by racial, gender and socioeconomic hierarchies, and a co-produced strategy to achieve health equity. To build credibility and mobilise a broader electorate, parties need to demonstrate these principles now, not wait to do so if and when they come to power.
Years of austerity, anti-immigrant xenophobic discourse, polarisation around Brexit, followed by the Covid-19 pandemic and the cost-of-living crisis have left society with an open wound and have disproportionately impacted racialised communities living in socioeconomically disadvantaged areas. [14] Evidence shows that there won’t be a recovery unless we put in the necessary effort and resources, and unless we do this equitably [15] to restore the unequal damages. Unfortunately, we don’t have the luxury to wait for parties to get settled in their new positions –whichever these may be – to start the discussion about reducing (health) inequalities. The discussion has been going on for too long now, and it’s time for the parties to explicitly commit to a common, healthier future.
References
1. Ipsos. Labour lead on economy and public services as Conservative share falls to record low. 2024 [cited 2024 Jun 5].
Available from: https://www.ipsos.com/en-uk/labour-lead-economy-and-public-services-conservative-share-falls-record-low
2. The King’s Fund. Tackling the biggest risk factors affecting people’s health. [cited 2024 Jun 5].
Available from: https://www.kingsfund.org.uk/insight-and-analysis/briefings/tackling-risk-factors-affecting-peoples-health
3. NHS Race and Health Observatory. Manifesto for Race and Health. Unification for better health. [cited 2024 Jun 5].
Available from: https://www.nhsrho.org/wp-content/uploads/2024/05/NHS-Race-and-Health-Observatory-Manifesto.pdf#page=3.57
4. The Patients Association. The Patients Association general election manifesto. Patients can’t wait. [cited 2024 Jun 5].
Available from: https://www.patients-association.org.uk/Handlers/Download.ashx?IDMF=9bbf580e-aaf6-40c3-8cc6-b0ec37fbb9c8
5. Wilkinson RG. Income distribution and mortality: a ‘natural’ experiment. Sociology of Health & Illness. 1990;12(4):391–412.
6. Wilkinson R, Pickett K. The spirit level. Why equality is better for everyone. Bloomsbury Press; 2010.
7. Wilkinson R, Pickett K. The inner level: How more equal societies reduce stress, restore sanity and improve everyone’s well-being. Penguin; 2019.
8. Bambra C. The U-Shaped Curve of Health Inequalities Over the 20th and 21st Centuries. International Journal of Social Determinants of Health and Health Services. 2024.
9. Bennett NC, Norman P, Albani V, Kingston A, Bambra C. The impact of the English national health inequalities strategy on inequalities in mortality at age 65: a time-trend analysis. European Journal of Public Health. 2024.
10. Hiam L, Klaber B, Sowemimo A, Marmot M. NHS and the whole of society must act on social determinants of health for a healthier future. bmj. 2024;385.
11. NHS Confederation. Building the health of the nation: priorities for a new government. [cited 2024 Jun 5].
Available from: https://www.nhsconfed.org/publications/building-health-nation-priorities-new-government
12. The Patients Association. [cited 2024 Jun 5]. Health must be at the heart of all government policies.
Available from: https://www.patients-association.org.uk/blog/health-at-the-heart-of-government
13. Mindell A. The leader as martial artist. Deep Democracy Exchange; 2014.
14. Bambra C, Lynch J, Smith KE. The unequal pandemic: COVID-19 and health inequalities. Policy Press; 2021.
15. Institute of Health Equity. Build Back Fairer: The COVID-19 Marmot Review. [cited 2024 Jun 5]
Available from: https://www.instituteofhealthequity.org/resources-reports/build-back-fairer-the-covid-19-marmot-review