Dr Michael FitzPatrick, co-chair of the trainees committee at the Royal College of Physicians, explains how and why the RCP is helping to reduce inequalities in health
In 1980, the Black Report was published by the (long-since replaced) Department of Health and Social Security. ‘Black’ was Sir Douglas, president of the RCP at the time, who had been asked to chair the expert committee into health inequality: unfair and avoidable differences in health across the population, and between different groups within society.
In certain circles, the Black Report is infamous; not because of what it said, but because of how it was published. Only 260 copies were printed (one of which still sits in the RCP library) and it was introduced to the world on August bank holiday – hardly an attempt to gain significant media coverage.
The reason the government chose to do this – to a report that would go on to have a huge impact, sparking OECD and WHO assessments of health inequalities in 13 countries – is laid out in the secretary of state’s introduction: “I must make it clear that additional expenditure on the scale which could result from the report’s recommendations – the amount involved could be upwards of £2 billion a year – is quite unrealistic in present or any foreseeable economic circumstances, quite apart from any judgement that may be formed of the effectiveness of such expenditure in dealing with the problems identified (my emphasis).”
That is, ‘you might be right but it’s going to cost too much.’ Or perhaps the committee had done its job too well, laying out in stark, non-political terms that the richer you are, the better your health. The 1998 Acheson Report said the same, as did Sir Michael Marmot’s Fair Society, Health Lives in 2010.
Fair Society, Health Lives was another report commissioned by the government, but this time its fate was decided by the general election. If Gordon Brown had won, I think we may have seen a cross-government strategy to reduce health inequality. But he didn’t.
Fast forward to today, and that’s exactly what the RCP is calling for, and why it has convened the Inequalities in Health Alliance. Together with over 130 other organisations, we wrote to the prime minister to ask the government to do three things:
- develop a cross-government strategy to reduce health inequalities
- commence the socio-economic duty, section 1 of the Equality Act 2010
- adopt a ‘child health in all policies’ approach.
You can read more about why we’ve chosen those aims on the IHA webpages, but the bottom line is that we think they’re the things that are going to have the most impact. The RCP also thinks both the ‘national minimum wage’ and the ‘national living wage’ should be at least in line with the real living wage, as calculated by the Resolution Foundation.
As one of the chairs of the RCP trainees committee, I have no doubt that reducing health inequalities is something most doctors want to do during their career. But the problem is, what to do? As the reports I’ve mentioned make clear, these disparities in health are a symptom of a wider societal issue: socioeconomic inequality. How can I, as an individual doctor, do anything about it?
I don’t think there’s a simple answer, but it’s no reason not to act. So alongside this campaigning work, the RCP is supporting doctors and other clinicians to understand and address health inequality in their everyday practice. We’re updating existing online courses and creating new ones. We’re recruiting a clinical fellow to work with students, trainees and new doctors to develop practical advice and guidance. And our advisory group on health inequalities, supported by our policy and campaigns team, is constantly thinking about what more we could be doing.
But, just like the response to the Black report 40 years ago, there are still those who say to physicians and other professions, ‘stay in your lane’. But, as the social media campaign addressing gun control in the USA says: #ThisIsOurLane. We all have a moral duty to tackle inequities in society, particularly when our day job could help to reduce them. We can work to improve equity of access and outcomes to the services in which we work. We can educate ourselves and our colleagues. We can collaborate to advocate for governmental action to address the ‘causes of the causes’ of health and other inequalities.
Whatever you do – or intend to do – your views, thoughts, and ideas matter. The RCP would love to hear from medical students – contact us via firstname.lastname@example.org – and there will be similar organisations that want to hear from other students. You are the future of our professions, and we need to hear your voices.