The Future of Nottingham - Health Inequalities

Brian Davey

This is extracted from an article on "Green Nottingham" on the Nottingham Social Forum wiki. The rest of the article can be found on http://www.esf2004.net/wakka/GreenNottingham

What might a Green Nottingham look like and how does this relate to todays problems in Nottingham - the inequalities, the crime, the educational crisis, the city elites own strategy for Nottingham? This article is an attempt at an overview within a green equalitarian perspective which can hopefully help the Nottingham Social Forum start to develop one (or more) overview pictures of Nottingham that is not distorted by vested interest.

Life expectancy inequalities

Let's start with a recent Evening Post article - on Friday 30th April the Post ran a story about life expectancy being 10 years greater for residents in places like Wollaton compared to Sneinton and St Anns. Why is this? If you read the Evening Post article, and the local health experts quoted in it, you will certainly notice that poverty in St Anns and the Meadows is cited by the experts as a major influence on life expectancy. And you will pick up the strong impression that, because of their poverty and relatively poor education, St Anns residents are smoking too much, not exercising enough, and not eating the right kind of diet. So you might get the impression that poverty translates to poor health through the behaviours of poor people which are are health damaging. There is no doubt there is some truth in this. Poor people are more likely to smoke and this reduces life expectancy. However, there are good reasons to believe that there is a lot more to it than that. According to Richard Wilkinson, currently Professor of Social Epidemiology at Nottingham University, the "mortality gradient" (inequality in life expectancy between rich and poor) is not explained in terms of behavioural risk factors-or for that matter any other known risk factors. The mortality gradiant is as steep among non smokers as among smokers, and as steep among diseases not related to smoking as it is among those that are related to smoking. With heart disease, where health related behaviour is often thought to be particularly important, the major known risk factors (including non behavioural ones) explain no more than 20% of the social gradient in death rates?( From the article "Health, Redistribution and Growth" in "Paying for Inequality. The Economic Cost of Social Injustice" Eds Andrew Glyn and David Miliband, IPPR 1994).

The psycho-social effects of inequality on health

So in what ways does economic inequality feed into the difference in death rates if you can't blame it on the behaviour of the poor people? The answer is given in another, more recent article by Wilkinson and Marmot in the British Medical Journal. They argue that people die younger because being poorer means lower social status and this undermines people psychologically in a variety of ways. The problems are because of the psychosocial effects of relative deprivation involving control over life, insecurity, anxiety, social isolation, socially hazardous environments, bullying, and depression . Evidence shows that these factors influence health and that their prevalence is affected by the socioeconomic structure and by people's position within this.

For example consider consumption. Wilkinson and Marmot write about the psychosocial importance of consumption as follows: "Within a society, health is correlated with income. However, over and above satisfying basic needs, consumption serves social, psychosocial, and symbolic purposes. It expresses identity. Self image is enhanced by possessions. Shopping provides "retail therapy." Wealth is a marker for social status, success, and respectability, just as poverty is stigmatising.? (http://bmj.bmjjournals.com/cgi/content/full/322/7296/1233)

Humiliating poor people - the city centre shopping paradise

At which we should perhaps pause and reflect hat a major aspect of the city councils strategy for Nottingham, as well as that of the Greater Nottingham Partnership, is to promote Nottingham as a regional shopping centre. At the moment there are even plans being considered to more than double the size of the Broadmarsh Centre. Shopping by day, party by night. It's spend, spend, spend in the future of Nottingham - but what does that do psychologically to those people who cannot afford to join in the party? Perhaps this quote, again from the BMJ article of Wilkinson and Marmot provide us with some clues. They summarise the evidence of many studies:

"At the ecological level greater income equality has been shown, internationally and among the 50 states of the United States, to be strongly associated with increased trust. Greater equality is also associated with "helpfulness" and group membership, while greater inequality is linked with hostility. A meta-analysis of 34 studies shows that there is a strong relation between greater income inequality and increased homicide. More inequality is also associated with increased racism and discrimination against women. Other studies show a close relation between a more egalitarian social ethos and closer community relations. All these are unambiguous signs that inequality has psychosocial effects. Indeed, there seems to be a "culture of inequality" which is more aggressive, less connected, more violent, and less trusting. People with less egalitarian values have repeatedly been shown to be more racist, classist, and sexist."( I have removed the references from the article but these can be reconvered by going to the BMJ article itself, which is on the web.)

http://bmj.com/cgi/content/full/324/7343/978:

See also http://bmj.bmjjournals.com/cgi/content/full/324/7343/978

Income inequality in Nottingham

In this respect we should note that, according to figures on the city council's web site for 1998, in the Manvers Ward 49.6% of the households had an annual income below £10,000 and 22.9% under £5,000. The figures are not much better in Strelley, Radford, Lenton and Aspley. By contrast only 20.6% of Mapperley households had an income of less than £10,000 and 8.2% less than £5,000. There are not disimilar figures in Wollaton, Abbey, Sherwood and Park wards. Nottingham is a highly unequal city and becoming more so. In the City centre shops the poor have their noses rubbed in the difference.

http://www.nottinghamcity.gov.uk/coun/department/chief_execs/policy/povertyprofile/03.htm#l

Social Trust disintegrates as inequality rises - hell on the low income estates

So what's happening in Nottingham's low income estates? Now lets turn to agenda item in City Council's Executive Board of 20th April ? referring to a "Amendments to Procedures dealing with anti social behaviour". The agenda item is another step to tighten up on the "neighbours from hell" problem in a number of Nottingham council estates. It is a further tightening up of the policy involving anti social behaviour orders, which are a major plank in the city's attempt to get some control on the misery, crime and sheer hell on Nottingham's sink estates. The City has a problem, and the council knows it, that they are trying to deal with a colleaction of policies that are summed up by the slogan of "Respect for Nottingham." Specifically the proposal here is evict people from council houses where there is evidence of serious crimes emanating from particular houses ? dealing drugs or stolen goods, possession of illegal guns and so on....end of extract

This article on the wiki continues with a brief discussion of the city's policies to raise community self esteem; the consequences of the decline of manufacturing employment; the limits of strategies to raise standards in Nottingham's schools,;the 2 universities perceived as engines of development; retail centred growth; the growth of indebtness in Nottingham; environmental sustainability and the decline of environment as a priority in Nottingham; the consequences of the Greenhouse effect and oil and gas depletion for local economic and social structure and policy; alternatives to growth focused policies; new sources of manual employment and a green vision for Nottingham's future....See http://www.esf2004.net/wakka/GreenNottingham