An article in the British Medical Journal poses the question, “Why are we devising regulations that enable consumers to use dangerous products, rather than preventing their release onto the market?” 

(Opinion Piece by Machine Zone Director, Adrian Bailey)

A highlight of the Scottish Alliance for Health ad Social Care’s 2020 Annual Conference was Equality Trust co-founder Professor Richard Wilkinson’s presentation. If you weren’t among the lucky ones to see it, here’s a recording.

Professor Wilkinson is a co-founder of The Equality Trust and author of many books including The Spirit Level, Unhealthy Societies and The Inner Level. The crux of the matter in these and in the above video is that inequality is at the root of many social evils and the huge toll of suffering experienced by citizens, especially those ‘at the bottom’. In the decades since Thatcher and Reagan, in nations driven by neoliberal idology such as  the USA and UK the rich have got much richer and the poor have been ravaged by austerity policies and the outsourcing of industries to countries where wages are low. But Wilkinson is less focused on low incomes than on inequality itself as the main problem. His presentation in the video is affable, conversational, backed with appropriate graphs, diagrams and images.

In the UK there are, compared with more equal countries, far more police, security guards, prisons, video cameras. People are more frightened. Mental and physical health are wrecked for the least fortunate. Life expectancy between the wealthiest and poorest varies by up to twenty years. Watch the video to learn more and then read the books and visit The Equality Trust. And even those with more than adequate wealth and income also suffer from deep mental, emotional and spiritual malaise as a result of an unequal, scared society.

There is one especially memorable moment in Wilkinson’s presentation. It’s an aside and can be easily missed. He ironically apologises for being so impolite as to suggest that inequality and its harms may be political issues. Indeed, here is an allusion to vast swathes of polite society that think ‘political’ is a dirty word, not at all respectable. This is not the same point made about the many who -probably quite sensibly – despair of parliamentary and party politics. Many of us as part of our work have to engage with the machinery of government albeit reluctantly, with our fingers crossed. Pragmatically, aiming to achieve  practical objectives – for instance getting addiction services better resourced or improving local transport – involves trying to influence those with power, national or local governments. But more and more, especially among young people, politics as the influencing of power streams in society, is issue based. Most notably perhaps this is seen in environmental campaigning where the view from below sees politicians merely rearranging the deckchairs on a sinking ship, and mouthing empty platitudes while the band plays on.

There are too, radicals seeking to change the mental and health systems. Not only is more resourcing demanded  but more importantly calling for a revolution in discourses, how we conceptualise and understand health, is called for. This is most impolite and offensive to those large thrid sector organisations that speak and think with the dominant discourses that assume somehow that health is not a political issue. They also disseminate the neoliberal ideology which makes a sick person, a broken person, a poor person, an addict, as ultimately the sole agent of responsibility for their condition. Society, as Margaret Thatcher claimed, does not exist: we are all isolated atoms completely unaffected by the social, cultural and power environments. Get on your bike to find work. Get out into nature and meditate to fix yourself

It’s OK not to feel OK. In fact it’s completely normal! Heal your sick mind with pills, meditation, magnesium and getting back to nature.

The multi-trillion dollars wellness industry  peddles commodoties with an expanding and eager consumer market which ranges from the merely miserable to the sverely ill. Statutory mental health services aren’t designed to attenuate a pervasive cultural malalise, and they face enormous struggles in supporting even those most in need.. Individual workers in these systems are doing their very best to  give of their very best, and we’d all be much worse off without them. But they generally work with people who have already  become ill or whose life requires urgent social support. If inequality is a prime cause of human misery and illness we can’t expect these workers to deal with that (but on a brighter note, let’s celebrate the fact that there are many and growing examples of workers promoting the idea that wellbeing and flourishing rather than illness is an important focus. There are health and social workers set on challenging orthodoxies, pushing for radical change, engaging with service users in many forms of change-activism).

But in an aresa like Glasgow’s Drumchapel the risks of dying from drugs are 18 times higher than for people a mile down the road in wealthier Bearsden. In Pollock life expectancy for men is 54. In areas where years of  chronic illness after the age of 40 are much higher than average, bookmakers, alcohol and junk food outlets cluster and proliferate. How can health possibly not be a political issue?

It’s important to state without the slightest equivocation that at an individual level, the main location of our care for ourselves, our children, our grandparents, there has been a welcome shift to non-clinical ‘therapy’. Getting out into nature can be good (unless, perhaps, you’re an unemployed farm labourer with multiple mental health and addiction issues, and for whom such advice may not be quite appropriate). Social prescibing, cascaded support from Links workers who may map opportunities from the locus of a single individual, here, now, are excellent developments. Meditation, mindfulness, tai chi, celery all have their place. Men’s sheds, recovery cafes, community activities and so on are vitally important for healthy communities. A shoulder to cry on, a problem shared, leisure opportunities, seriously good humour, checking on your neighbour, to sing and know you’ll never walk alone, mutual support groups, community, com-unity: these are not add-ons but bases from which to build health and social care support. To these, before these, must be added the human rights for decent housing and income.

We can choose between the New Statesman or the Spectator, between lager or bitter, but if, to mention one verion of the story, we’ve been shot by an arrow we tend not to wonder where it came from or where it was manufactured. These things are very important but not of most vital urgency. We want help, for the pain to go away, for  measures to prevent sepsis. The original Buddhist parable spoke of the arrow of suffering rather than a real arrow. and how many people wound themselves twice by ‘shooting’ themselves with a second arrow which is to replace the actual pain with ruminations about where the pain came from. No, on a battlefield, you don’t have any thought about the causes of war, or even immediate threats: your sole concern is to get your wounded  child or comrade to safety. If you’re a surgeon or nurse in a field hospital, you may have time to contemplate issues concerning the war, but your only immediate concern will be with this person, here, now, whose life may need saving, whose pain may need balming, whose  hand needs holding.

As community members we can all do unspectacular human things to support each other. It’s good too if  we join with others to call out injustices. It’s very easy to take a view from nowhere of all that’s wrong with health and social care systems. But if we forget for one moment the deep compassion in the shape of human bodies who every second of every day are  salving at least some of the suffering of our fellows, we’d be better stay quiet. If we don’t know, see, understand the nature of such work with all its demands and all its costs, there’s nothing worth saying. If we don’t take for granted that compassion comes with sacrifice, pain, sometimes despair, we don’t know what compassion is.

Many live their lives with quite narrow core moral values. Hard work and selfish concern only for self and family represent these values. They generate condemnation of ‘losers’ who have only themselves to blame for being crushed by austerity, poor physical and mental health, addiction and despair.Well, we live in a democracy and all sectors of society have a voice whatever their differences. Really?

Impolite cover of Amnesty’s Autumn 2021 magazine

None of us are angels (though among the many sectors of democracy are those who not only think they are, but who despise the immoral losers. Some newspapers specialise in targeting such a readership). We all make judgments of others, readily ‘see’ a person as a type. We, apart from the saints, enjoy gossip, enjoy others’ downfall (watching someone fall lower gives us the illusion of having risen higher), and unless we are totally dishonest with ourselves each of us is a breeding ground for the petri dish of a culture of stereotypes and objects to stigmatise (humans, sadly, reduced to objects everywhere we go and think).

Happily, history demonstrates that blanket pessimism is a fairly cheap excuse to retreat into a little sterilised safe place from where to mutter and complain. ‘We need to address inequality’. I’d agree with that, along with many millions of others, each of us differing in  how we’d bring about change. I do think that being ‘anti-stigma’ is a good thing, for me at least, but I’m no authority to issue ten commandments of ‘how to do’anti-stigma’  (and. very impolite of me, I’m irritated by some places that do have authority, or at least have been authorsised to publish the one true dogma). Challenging stigma, inequality, injustice, exploitation so quickly become abstractions ( a little bit like how some organisations have come late to the party and are falling over each other to ‘include’ the voices of lived experience). And for myself I see anti-inequality as more important than anti-stigma, while embracing both.

It’s not a party political thing. For instance a former Conservative leader is one of the most consistent voices against the immorality of gambling industry’s exploitation of the most vulnerable, whereas a former Labour politician now heads the Betting and Gaming Council  and tweets that all calls to examine the industry come from ‘Sunday school prohibitionists’.  There are, incidentally, within this great democracy of ours sectors which it is almost embarrassing to mention.  We’ve come to wearily accept that addiction is not a polite issue in mental health and wellbeing chatter, as if there’s something smelly about it, almost as if its stigmatised. Another embarrassing area where it’s best not to go is among people who believe that gambling is one moral vice among others. (The word ‘moral’, after some extraordinary linguistic gymnastics, seems to have become taboo in some quarters. Nobody likes being harangued by a moralist or a bible-basher, but to agree that child molestation is wrong is to share a moral judgment. Indeed, judging by the amount of violent dramas, preoccupation with serial killers, etc. gloating over the evil wretches beneath us has almost reached the status of a national blood sport. What fun to gloat and slobber over the low life appearing continually upon our screens, and which figures suggest offer the most popular form of entertainment.) There may still exist living human beings holding to the Judaeic, Christian and Islamic prohibition against usury (lending money for profit from interest). Money making, profiting from others,  are, or rather were, seen as wicked.. But in ‘the real world’ look how much gambling, alcohol and financial industries ‘contribute’ to the Treasury. Half of the UK’s ‘industry’ is in the financial sector.  You may recall that what was then the world’s biggest bank made a disastrous gamble (though it was usually defined as an unwise investment decision) which combined with the sub-prime mortgage scam in the USA (whereby spivs got commission selling mortagages to people who obviously couldn’t afford them, resultant debts ‘packaged’ and  sold between banks). Luckily for all of us the government saved the RBS by covering its enormous losses (well, to be accurate, its customers’ money is what was lost).  To claw back that money, the government  initiated an austerity programme (which included withdrawal of central government funding of addiction services), there being no ‘magic money tree’ (apart from the ‘secret magic money tree’ that has resulted in the rich getting much, much richer, and the poor being told to put up, shut up and continue to see their place as natural losers.

Forgive the diatribe. Optimism for today as throughout history is with humans, not figures, with individuals, not data, with communities, not voting boundaries. There are no magic wands. Change is hard. Change is slow. Immense benefits pouring into the future have flowed from the strength and spirit of ordinary people everywhere, Maybe an individual is associated: Rosa Parks refusuing to give up here bus seat to a white man; Keir Hardie, down the mines at the age of seven. But despite Thatcher saying that there is no such thing as society it is the social, the communal that still has the power to challenge the gross immorality of power structures.  This person, here, now, flawed,  sinful (that word  sparks a distant memory of someone or other who had a good understanding of what it is to be fully human, suggested we fully recognise this in ourselves and others, forgive ourselves for being merely human, and  support each other. Can’t remember the guy’s name just now). This very ordinary person, this person radiating compassion (beaneathhwhatever gruff exterior), this person and all like her or him who not only supports us but sustains us towards a life of community that is worth living, a sort of low burning joy, a joy which, ironically, you can’t buy with money no matter how rich you are. (True, the Beatles pleased everyone so no surprise that two singls have very different sentiments: Can’t Buy Me Love  and Give Me Money but that’s a reflection of each of us: we do have fine principles but sometimes give way to our less attractive desires. Anyway, for a good film piece you can’t miss Pink Floyd’s Money). Shock, horror! References to what’s right or what’s wrong. (What’s right or wrong is basically  all that morality refere to).

Perhaps fighting evil is just another way of saying fighting for the good. And when you or I, here, now, each uniquely individual but partly made of  traditions of resilience, mutual support, a focus on those amongst us most in need of help, perhaps a contempt for the rapaciousness of the ‘elite’, when we join in a movement we are as different as drops in a waterfall. We may be this, that or the other by our own or others’ definitions; almost certainly we will argue amongst those who ‘share our cause’, sometimes with a vehemence so strong that we insulate ourselves within the ‘correct’ group while demonising the Incorrects who are isolated in prisons for reforming or, more likely, punishing. The waterfall feeds a stream. Many other streams, some trickles and some torrents, feed a river which for all we know will end in a stagnant estuary upon a polluted sea. So it goes. You keep on trying.

Duggie Wallace, ‘Harrodsburg’ : street photography Kensingtom

In the big scheme of things,  gambling reform is less of an issue than humankind’s insatiable addictions for war and the rape of the planet, the latter almost certainly having taken the species very close to extinction  (and it’s increasingly believed that it’s now too late to prevent this). But even when the facts are against us, human animals never stop working to make things better. There are more optimistic takes on climatic meltdown. There are optimists who believe that inequality can be lessened, even if it can’t be done away with in the immediate future. That’s what we do. Even when we argue amongst ourselves about drugs, gambling, health design, education and so on we’re all  doing our little bit, that little bit the best we can do. If you’re concentrating on peer support give it your heart and soul; if you’ve the (dubious!) privilege of having experience in parliamentary lobbying. do that. It may all be about gambling but it can’t not be also about health inequalities  connected with industrial exploitation (unless, of course, you sinceley believe that all of the many ills we are prey to are down to our own choices, character etc.). There are millions of people just in the UK giving their all to answer urgent social needs.  Millions of volunteers, thousands of small charities and other groups, the single individual  whose care for a neighbour is crucial. (By the way, who is my neighbour?)  Appearing in no accounting books, these millions do what comes naturally,  from an embedded and totally taken for granted belief that we are here to serve and support each other. It would be possible to estimate the ‘economic value’ of such work, but that would represent an unpleasant  reduction of quality (in this case, love)  to terms best restricted  to  the machinery which knows the price of everything and the value of nothing. It could be asked though what it says of GB that the ‘elite’ of the fifth wealthiest  nation in the entire history of human life prefer a kingdom which maintains a very few in obscene wealth while allowing a cruel pittance  for those in greatest need.

Anyway, in the unlikely event that anybody has reached this far (I know I wouldn’t have if I hadn’t written it),  please excuse the rant.  In particular, I beg forgiveness should I have strayed too far from  polite discourse by suggesting that preventing gambling harms is a political issue. I especially beg pardon  from my betters who valiantly maintain the structures of inequality without which The Economy would wither and die. I know my place.

While writing this and revisiting the Beatles, a scene from their film A Hard Day’s Night came to mind. The clip shown here is shot on a train. In the second half of it a rather pompous man, very irritated by the impolite behaviour of his fellow passengers says, ” I fought in the war for your sort”, to which, Ringo with perfect timing quips, “Bet you’re sorry you won.” There are centuries of humour based on social class, usually with them below coming out on top. It’s one way we survive while at the same time having a laugh. Some laughter is nasty but a sense of humour is related to the word human which is related to the humus or soil. It is a basic attribute of human animals. Inequality is no laughing matter but in everyday life humour is one of our greatest resources. Enjoy the clip!