Discussing Richards paper

1
Discussing Richards paper

• Dr Richard Mitchell
• Research Unit in Health, Behaviour and Change
• University of Edinburgh

2
What should a discussant do?

• The press release says A lively debate on health
  inequalities will take place
• Id like to be lively, but not to pick a fight ?
• Reflect a little and set up some items for
  discussion
• The ideas in general
• Some areas of dispute
• Who, and how, does relative inequality kill
• A quick rant about social capital
• Policy, the important issue

3
Richards ideas in general

• A rare and good thing combines theory, empirical
  evidence from many disciplines to form a coherent
  thesis (which continues to develop)
• A bit like Marx
• probably got a lot right
• useful as a structure for thinking and analysis
• influential (which means it matters)
• strangely divisive neo-materialist vs. relative
  inequality, one thing or the other

4
Some areas of dispute

• No one really believes its one thing OR the
  other
• BUT, a lot of what he says (about inequality as a
  driver of poor health) is disputed
• national level correlations depend on the
  countries included and the timeframe of the study
• animal evidence (Sapolskys baboons)
• evidence that / how stress is a killer (Macleod
  Davey Smith, and Singh-Manoux)
• social capital

5
Who does relative inequality kill?

• I think that the influence of relative
  inequality on mortality rates varies markedly by
  age and cause of death
• Compared an index of relative inequality with an
  index of poverty to explain geographical
  variation in age and cause specific mortality
• Relative inequality didnt seem to be related to
  inequalities in the big killers like heart
  disease
• Relative inequality was related to inequalities
  in mortality from social causes like suicide
  and accidents violence

6
Why Im not keen on social capital

• Its been used in policy without much evidence or
  research behind it
• this is supposed to be the age of evidence-based
  public health medicine
• It deflects political attention from what really
  matters wealth and opportunity
• be nice to each other, make friends, youll be
  fine
• those close knit (poverty stricken) communities
  have social capital to see them through

7
Public health policy

• If, in the spirit of neo-materialism, you give
  every child access to a computer and every family
  a car, deal with air pollution and provide a
  physically safe environment, is the problem
  solved? (We believe not) Marmot M, Wilkinson RG,
  2001
• Maybe not, but it sure would help!
• Would it help to a much greater extent than
  fostering social capital and respect?

8
Things to discuss

• Are Richard and Aretha Franklin right? Is it all
  about R.E.S.P.E.C.T?
• Does Richards hypothesis really work for the
  big killers? (and if so, how?)
• Is there enough evidence for the relative
  inequality thesis to be a useful basis for policy
  to help Britains big public health problems?
• What would the difference be between a
  relative-inequality based policy to tackle
  societal ills and a policy based on
  neo-materialist ideas?
• Arent we all talking about redistribution?