Daniella Radice on health inequality in Bristol

Daniella Radice, Assistant Mayor for Public Health at Bristol City Council writes about health inequality in Bristol. This is part of a series of blogs, where key players in Bristol’s health sector write about a health related subject of their choice. If you want to contribute, email [email protected].

Being asked to write an article on health inequalities for health professionals is a little daunting for a non-health professional but health is a political issue. The timing of this piece is particularly appropriate, as Bristol City Council has just become a full member of Bristol Health Partners, joining the city’s NHS organisations and universities. It is vital that all politicians are aware of the wider determinants of health and how we can influence them so I am going to use this article to pose a series of questions.

When I stood for Mayor in 2012 I said: “Health means so much more than the absence of disease. It’s about being safe, fulfilled, having a decent place to live, access to meaningful employment, thus every chapter in this manifesto is about the health of Bristolians.”

I have read The Spirit Level: Why More Equal Societies Almost Always Do Better, which analyses the relationships between poor health and inequality and was very impressed by it, as well as the follow up research by the Joseph Rowntree Foundation.

Reduction in overall inequalities as suggested by The Spirit Level will involve higher taxes for the wealthy, as much as raising the standard of living through policies such as the Living Wage. We are working on the Living Wage in Bristol but do not have our own tax-raising powers – yet. (I do not call a capped-increase-council tax, tax raising).

So, therefore, what can we do as a city?

On Friday I was at a council enquiry day on skills and employment for south Bristol. The inequalities in employment and education statistics are congruent with health inequality patterns across the city. The million-dollar questions to me are:

• Given limited resources, would putting more of our resources into supporting people economically or through skills training lead to better health outcomes in the long term than direct health interventions?
• Or perhaps we should not see them as distinct, and should any intervention or policy aim to do both explicitly?
• And what would be better for Bristol?
• And what are the interventions for economic and skills development that really work, presumably we can discount the ones that have been tried in the past?

Perhaps this research has already been done – if so, please could someone send me the links?

I read a really interesting book called Poor Economics recently – lent to me by a friend – about development policy, where controlled experiments were done on various interventions, some health-related, some social. Two examples that stick in my mind were:

• In one case, a set of children were given worming tablets for a couple of years, and their outcomes were followed up. Many years later, those that had had the treatment were significantly more economically successful than those that had not been treated.
• In another case, a local village council system had quotas of women members imposed on them, these villages ended up spending more resources on children and water (perhaps unsurprisingly), but also, even after the imposed quotas had been removed, women continued to play a more active role in those village councils.

Advocating for controlled experiments in interventions is ethically difficult, but if we really want to know what works – let’s do some controlled experiments (and please send me the links via Twitter @GreenDaniella if this is happening already).

So, what can we do as a Council? While reading up for this article I was struck by the recent work of the World Health Organisation on the social determinants of health but also their Health in All policies. Recent work in Finland has been successful in reducing obesity and I think we should be following their lead. The integration of public health into the Council is already starting us on that road. I would like to see formal health assessments of policies and decisions, and the health impacts being given proper weight, I am particularly thinking of planning. And of course, our full membership of Bristol Health Partners opens up wider opportunities to influence health across our city and throughout our local health system.