Wednesday, 1 June 2011

“The biggest disease of them all is the growing income inequality”

Eeva Mielonen examines consequences of income inequality to healthcare.

The Future of Healthcare in Europe conference, jointly organised by the Finnish Institute and UCL on May 13, discussed current issues in healthcare provision. I am interested in the future of public services in general, and I was surprised how thought-provoking and inspiring many of the contributions at the conference were.

Two weeks afterwards, I’m still reflecting on Professor Sir Michael Marmot’s speech about the importance of fair policy-making. For him the word ‘fair’ is not just a quick cover-up for bad policies. He suggested that the word is used too easily nowadays, in a way that in fact makes a mockery of its true meaning. He pointed out that there should be more reflection on the policies drafted and their consequences.

Marmot spoke very convincingly on behalf of a fairer society. He said that, if we want a healthier society, we have to understand that a healthy way of living requires a minimum wage that makes healthy choices possible. In a way that sounds very ‘Nordic’ to my ears. He even spoke of the unfair taxation in the UK: “At the moment people on the top end of the earning scale are paying 35% in tax, on the other end of the scale, the poorest people pay 38% in tax. Is this fair?"” More progressive taxation could be one of the instruments for funding a more equitable and efficient healthcare system.

The nature of the problems in healthcare seems to be more political, social and economic than medical, and so are the remedies. Applying stronger progressive taxation and openly discussing the cuts in public services, instead of concealing them, could well be part of the solution.

In Finland the problem in healthcare provision seems to be poor access. In the UK, in comparison, access to healthcare is good, and as Marmot said, this is a major societal achievement. But in both countries inequality in healthcare is a growing problem. Government social and economic policies have an impact on the overall health of the people. 

I quite often find that in Finland we want to believe that it is still 1988 and that we live in a welfare state with a broad set of measures preventing the polarisation of society. In fact, we are moving at increasing speed towards a harsher society, where economic differences are accompanied by social problems, and where good health is a luxury for those who can afford it. At the conference it also became evident that the Finnish healthcare system needs reform. Questions that should be asked include: Who is healthcare for? How can we fund it? What are the consequences of having a weak healthcare system?

We are at the crossroads and we had better not take the wrong turning: Or we could end up living in an unequal society where the money in your pocket dictates the state of your health. Based on the conference we might already live in this kind of society. 

Eeva Mielonen
The Finnish Institute in London


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