Any healthcare system will not be able to solve inequalities everywhere.

But that has not stopped policymakers from haring off after entirely the wrong idea in trying to work out what might be done to reduce health inequality.

They are, sadly, blaming health inequality purely and entirely on the wider inequalities of society.

For example, the relationship between health inequality and economic inequality gets reported that they are related is obvious.

The poor have had worse health and shorter lifespans in every society we’ve ever been able to study in sufficient detail.

So that there is a relationship is obvious. And we are all quite willing to believe that at least some of it is because the poor are, well, because they’re poor. They live in the more polluted parts of city, have worse diets, lower access to effective healthcare and so on.

The poor have worse health and shorter lifespans than the rich. To the point that some start blaming the poor for their lifestyle choices: something that might be fair enough given that smoking and heavy drinking are more prevalent among the poor than the rich but not to the extent that some do blame them.

For it should be obvious that health inequality can and does also cause economic inequality.

That man who has an incapacitating stroke at the age of 40 and goes on disability is going to be poorer at 50 than the one who didn’t and remained working.

That heavy drinker who becomes an alcoholic is going to earn less than the one who doesn’t.

I also have no doubt that income inequality leads to some health inequality: I’d be surprised to find rich children suffering from vitamin deficiencies, for example.

Or, let us agree that being poor makes you ill. Being ill kills you. OK, that’s what everyone is saying and to an extent it is true. Now, can we also consider this: being ill makes you poor? It’s a blindingly obvious point; for of course it does.

Yes, sure, there is welfare, no one’s left to die in the streets, but these sorts of severe and chronic diseases are going to lower your earning capacity. Illness will make you poor.

My point is, health and income affect each other in both directions: not only does higher income facilitate better health, but poor health and disabilities can make it harder for someone to succeed in school or to secure and retain a high-paying job.

Which leads us on to the public policy implications of this. For public policy will obviously depend, at least in part, upon the assumptions that are fed into the evidence base used to decide upon it.

And if we decide that health inequality is a very bad thing (it is) and that it is also only caused by economic inequality, then we’ll end up recommending the ending of economic inequality in order to achieve health equality.

Yes, we probably would like to reduce, if not eliminate, health inequality. But we’re not going to be able to do that by enforcing greater economic equality because it’s noting only one part (and whether it’s a larger or smaller half of the problem is still up for debate) of the problem and addressing only one cause of both sorts of inequality.

Just as with that recent finding that 60 per cent of cancers are simply due to a bit of bad luck which does lead to economic inequality.

Overall, we should be proud of the progress made in improving overall health to the extent that life expectancy for the poorest.

Perhaps, just maybe, the poor would prefer a sufficiency of the basics than equality?
So, what should we concentrate on? Is it better that more people live longer, or that people live more equal periods of time?

I also can say that the secret of a long life is to be in a care home. The people in care homes are in care homes because they have lived lives long enough to become senile, eh?

There’s another one thought as well. If everyone stayed where they were born then we would be able to say that this difference in life spans. But people don’t stay in the same place all their lives. Certainly, someone who gets educated, gets rich, doesn’t go back to rural Kapit, does he? No, he ends up in a care home having that longer life span along with the other rich people.

I have long said that I’m not all that worried by inequality, as long as levels (health, income, whatever) are improving. Is there any reason why I should change my mind?

The views expressed are those of the author and do not necessarily reflect the official policy or position of the New Sarawak Tribune.