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The gap generation
8997 EDITORIAL
The gap
generation
the one hand gladly accept the gifts brought progress of medical science, and apply them
"We
must on
to us
by the
for the benefit of patients; and on the other ... we must be the natural advocates of the disadvantaged"-Sir Douglas
Black, 1984
way.
Gaps revealed
report in The Times last week, the 1996 edition of Social Trends (the publication in which the Government’s Central Statistical Office keeps a weather eye on British society) "will make comforting reading for a Prime Minister who declared he wanted a nation ’at ease with itself". Possibly-but only if he is a very selective reader. Whilst Mr Major may be cheered by the increasing proportion of young people above school-leaving age who are in full-time education, and equally by the growing popularity of opera or the fall in lead emissions from road vehicles, it will be hard to find comfort in the widening gap between rich and poor in terms of real household disposable income. It will be harder still to ignore the confirmation provided by the Longitudinal Study of the Office of Population Censuses and Surveys (published as an article in Social Trends) that mortality rates are inversely related to social class. The study also confirms the significantly raised mortality levels of unemployed men by comparison with all men of
According
discredit the conclusions. The findings of the Longitudinal Study cannot be brushed aside in this to
to a
working age. During the 3-year gestation of his report on inequalities in health, released in 1980, Sir Douglas Black became convinced that the main determinants of health and disease lie outside the realm of direct medical competence, so long as one takes a very narrow view of medicine. Black’s thesis, however, was that medicine must not be narrowly conceived, and that care of the individual and concern for the population should be synthesised by medical practitioners. His committee was established in 1977 by the Labour government then in power to assess the apparently widening class differences in mortality since World War II. His findings were delivered to the Conservative government of
Margaret Thatcher ministers; nor were
and were not well received by those of subsequent studies into the adverse effects of unemployment on health. Moreover, the politicians could justifiably point to measurement difficulties and other sources of bias
February 3,
1996
in other sections of Social Trends contain lessons for health educators, whose messages seem to be getting across haphazardly. The over-65s have taken to high-fibre cereals more than the under-24s, and they also eat more fresh fruit. However, the beneficial cardiovascular effects of the antioxidants in the latter may be outweighed by the propensity of older people to use solid cooking fats, reach for the salt pot while cooking, and drink whole milk. Cigarette smoking continues to decrease in both sexes but the health warnings are less likely to be heeded by young people: those in the 20-24 age group are most likely to smoke. Social successes have their downside too. Developed nations point proudly to the staggering changes in life expectancy since the beginning of the century-eg, in the USA, a man born in 1900 could expect to live to 48 whereas a man born in 1990 could expect to live to 72. In the UK, the number of people aged 80 and over more than doubled between 1961 and 1994 to 2.3 million. The
implications for health care are immense. Black, in the latest issue of the Journal of the Royal College of Physicians of London, returns to the subject of equity when he ponders the Department of Health’s report on variations in health released last October. While commending many aspects of that report, he regrets that the topic has become so polarised politically, worries that the new NHS market culture may leave equity at the mercy of short-term economic gain, and is quietly optimistic that the "mercantile shackles on idealism might be loosened". Overall, however, his unflinching conclusion is that a "radical cure demands nothing less than a renewed dedication to the welfare state". We agree. Whatever the outcome of the reviews of welfare provision that most countries are now undertaking, the principle of equity, achieved via taxation of the better-off, must be retained.
The Lancet
275
The gap
generation
the one hand gladly accept the gifts brought progress of medical science, and apply them
"We
must on
to us
by the
for the benefit of patients; and on the other ... we must be the natural advocates of the disadvantaged"-Sir Douglas
Black, 1984
way.
Gaps revealed
report in The Times last week, the 1996 edition of Social Trends (the publication in which the Government’s Central Statistical Office keeps a weather eye on British society) "will make comforting reading for a Prime Minister who declared he wanted a nation ’at ease with itself". Possibly-but only if he is a very selective reader. Whilst Mr Major may be cheered by the increasing proportion of young people above school-leaving age who are in full-time education, and equally by the growing popularity of opera or the fall in lead emissions from road vehicles, it will be hard to find comfort in the widening gap between rich and poor in terms of real household disposable income. It will be harder still to ignore the confirmation provided by the Longitudinal Study of the Office of Population Censuses and Surveys (published as an article in Social Trends) that mortality rates are inversely related to social class. The study also confirms the significantly raised mortality levels of unemployed men by comparison with all men of
According
discredit the conclusions. The findings of the Longitudinal Study cannot be brushed aside in this to
to a
working age. During the 3-year gestation of his report on inequalities in health, released in 1980, Sir Douglas Black became convinced that the main determinants of health and disease lie outside the realm of direct medical competence, so long as one takes a very narrow view of medicine. Black’s thesis, however, was that medicine must not be narrowly conceived, and that care of the individual and concern for the population should be synthesised by medical practitioners. His committee was established in 1977 by the Labour government then in power to assess the apparently widening class differences in mortality since World War II. His findings were delivered to the Conservative government of
Margaret Thatcher ministers; nor were
and were not well received by those of subsequent studies into the adverse effects of unemployment on health. Moreover, the politicians could justifiably point to measurement difficulties and other sources of bias
February 3,
1996
in other sections of Social Trends contain lessons for health educators, whose messages seem to be getting across haphazardly. The over-65s have taken to high-fibre cereals more than the under-24s, and they also eat more fresh fruit. However, the beneficial cardiovascular effects of the antioxidants in the latter may be outweighed by the propensity of older people to use solid cooking fats, reach for the salt pot while cooking, and drink whole milk. Cigarette smoking continues to decrease in both sexes but the health warnings are less likely to be heeded by young people: those in the 20-24 age group are most likely to smoke. Social successes have their downside too. Developed nations point proudly to the staggering changes in life expectancy since the beginning of the century-eg, in the USA, a man born in 1900 could expect to live to 48 whereas a man born in 1990 could expect to live to 72. In the UK, the number of people aged 80 and over more than doubled between 1961 and 1994 to 2.3 million. The
implications for health care are immense. Black, in the latest issue of the Journal of the Royal College of Physicians of London, returns to the subject of equity when he ponders the Department of Health’s report on variations in health released last October. While commending many aspects of that report, he regrets that the topic has become so polarised politically, worries that the new NHS market culture may leave equity at the mercy of short-term economic gain, and is quietly optimistic that the "mercantile shackles on idealism might be loosened". Overall, however, his unflinching conclusion is that a "radical cure demands nothing less than a renewed dedication to the welfare state". We agree. Whatever the outcome of the reviews of welfare provision that most countries are now undertaking, the principle of equity, achieved via taxation of the better-off, must be retained.
The Lancet
275