The Good Society

 I was at an event last year where I was asked to list three books that have most influenced my thinking. One of those was The Spirit Level (2009) by Professor Richard Wilkinson and Professor Kate Pickett. 

The Spirit Level sounded the alarm on the corrosive effects of economic injustice. At a time when only a few academics were exploring this issue, it provided a comprehensive analysis linking the negative effects of inequality to a wide range of social ills. It revolutionised the way we looked at, measured and understood the impacts of inequality. Fifteen years on, its warnings ring truer than ever, exacerbated by years of austerity. The authors have published a report, "The Spirit Level at 15, " which highlights many of these issues.

Kate Pickett has also written a new book, The Good Society, which takes her analysis to the present day.

She starts with a (long) definition of a good society. Essentially, a society where everyone's physical and mental health is as good as it could be, by focusing on levelling inequality. Prevention before cure and ensuring the wellbeing of future generations. If those are not your priorities, you will struggle with this book. She argues that society is not improving because a few people are becoming fabulously rich. Tackling poverty and inequality benefits our society as a whole.

This is a book of two halves, not just because I read it on a long train journey to a football match! The first half outlines the blueprints for a good society, focusing on health, care, education, the environment, and justice. The second half explains how to build a good society.

As you would expect, almost every argument is referenced with evidence, and often illustrated with real-world examples. For example, in the city I was born in, Liverpool, half of the children born in 2009 and 2010 had been referred to children’s services by the time they were five. Many of her facts come from well-resourced, government-commissioned reports, with comprehensive recommendations that are repeatedly scuppered by another election, and put on a shelf to gather dust. A story we know only too well in Scotland, with the Christie Commission being just one pertinent example of this theme. Like The Spirit Level, it draws on international examples to show that another world is possible. 

Her solutions are not simply about income, vital though that is, but about engagement. She suggests participatory budgeting,  citizen assemblies and the strengthening of trade unions, alongside a National Institute for Social Change, for “ongoing proper assessment of the effectiveness of proposed social policies, their cost effectiveness”, so that the “then government could act on those things”. Where I part company with her is on the establishment of 'National' services for everything, unless they are limited to frameworks.

In interviews, Pickett has been critical of the incoming Labour government, "Given their mandate for change, I think they could and should have been bolder and faster.” New reviews are fine "unless they sit on the shelf, gathering dust, like so many other government reviews." It would be hard to disagree with that. Jonathan Portes has criticised the book as a "whistle-stop tour of the greatest hits of progressive social policy." Yes, there could be more depth, but that would make the book unreadable and just another report gathering dust on the shelf. The purpose of a book like this is to educate and inspire. On some of his specific criticisms, such as the evidence on Universal Basic Income, he has a point.

It is inevitable that a follow-up book will not be as influential as the original. However, it is important that the case for tackling inequality is refreshed. And this book does just that.

Putting the local into reducing health inequalities

While national strategies are essential in reducing health inequalities, we need to emphasise local action. 

This week the Scottish Government statistics division published its long-term monitoring of health inequalities. Spoiler alert, it doesn’t make happy reading. Male Healthy Life Expectancy at birth was 46.8 years for those living in the most deprived areas, 23.7 years lower than those living in the least deprived areas (70.4 years), and it’s getting worse. For women, the gap was almost identical at 23.6 years. Moreover, in 2020 the premature mortality rate in the most deprived areas was four times higher than the rate in the least deprived areas.

So, what is the Scottish Government doing about it? Well, there was a public health ‘review’ in 2015. There are many glossy documents and websites that say they are ‘working towards’ reducing health inequalities, ‘defining’ their priorities, and a lot of similar guff. What’s missing is any sense of urgency to actually implement these plans.

Let me give just one small example. The Scottish Government rightly says that Fair Work is an important tool in reducing health inequalities, and procurement is an important lever. Last year, SHA Scotland spotted that NHS Education for Scotland (a health quango) had awarded a contract to Amazon. Given Amazon’s notorious employment practices, they wondered how they passed the Scottish Government’s Fair Work criteria that are supposed to be applied to the evaluation of contract bids. So, they sent off an FoI request and were told that the Fair Work Criteria wasn’t applied to this contract. Here we have a government health quango who couldn’t even be bothered to apply the policy. It is no wonder that there is a considerable gap between rhetoric and policy delivery.

Important though national action is, many of the services and actions required to reduce health inequalities need to happen locally. No serious plan to tackle health inequalities in Scotland can ignore the pivotal role of local government. Councils make a vital contribution to weaving the social fabric of their areas and seeking to create and sustain healthy places for people to be born, grow, live, work and age. 

I drafted a paper that SHA Scotland launched this week, which sets out some of the ways that local government can make a difference. Planning, public spaces, leisure and cultural services all make up the vital social infrastructure that promotes wellbeing in our communities. This helps tackle poor mental health through stronger social cohesion and social support. They can also create sustainable communities tackling air pollution and food poverty. However, this cannot be achieved while the Scottish Government cuts councils' funding by nearly a billion pounds. Fair funding for local government is crucial to tackling health inequalities. In addition, centralising services in Edinburgh, as with the proposed National Care Service, is also the opposite of what is needed to reform social care.

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Local action on health inequalities requires councils to lead the way with a community health strategy that puts reducing health inequalities at the heart of everything they do. When we focus on the social determinants of health, we see that local government services are health services. Without local government, adults and children would die sooner, live in worse conditions, lead lives that made them ill more often, and experience less emotional, mental and physical wellbeing than they do now.

The Scottish Government should set the framework for reducing health inequalities and take appropriate actions at the national level. That doesn’t mean micromanaging from Edinburgh. They must also ensure that the local government is funded fairly, not just pass on Tory austerity to councils while protecting their budgets. Local communities understand what needs to be done in their area, and they need the leadership and resources to do it.

Austerity is killing us

Two reports published today show that the increase in life expectancy in Scotland has now stalled and that health inequalities have worsened.

One report compares life expectancy trends in Scotland to those seen internationally. The other report explores the relationship between stalling mortality improvements and socioeconomic inequalities.

The international comparative report shows that 2012-2016 life expectancies in Scotland increased by 2.5 weeks/year for females and 4.5 weeks/year for males, the smallest gains of any period since the early 1970s. The best estimate of when mortality rates changed to a slower rate of improvement in Scotland was the year to 2012 for males and the year to 2014 for females.  Among the UK countries Scotland has the lowest life expectancy, with a life expectancy 2 years lower for women, and 2.5 years lower for men than in England.

Of the 24 high-income countries for which data was available, nearly all had smaller life expectancy gains in 2012-2016 than in the immediately preceding period. Denmark is notable for having maintained mean life expectancy gains of around 10 weeks/year among females across the period 1997-2016, and even greater gains among males.

The second report concludes that as mortality improvements in Scotland stalled in 2012-2017, socioeconomic gradients in mortality became steeper. With increased mortality rates over this period in the most socioeconomically deprived fifth of the population.

This table shows what we already know and what additional information this reports gives us.

Dr Gerry McCartney, Head of the Public Health Observatory at NHS Health Scotland, said:

“What we see here is a worrying trend. Life expectancy not only gives an indication of how long people are likely to live, but also serves as a ‘warning light’ for the public’s health. In addition, the fact that socioeconomic position now plays a bigger role in how long you live than it did before is cause for concern.”

The question is why these figures are going in the wrong direction, bucking a long standing trend since the Second World War. Gerry suggests that austerity is the strongest factor:

 “There are likely to be a number of factors at play. The strongest candidates are recent policies that address recent economic setbacks which have reduced spending on benefits, squeezed incomes and trapped people in poverty – these may all have contributed. Cuts to council budgets and pressures on key local services, such as social care, could also have had an impact. There have been some severe flu outbreaks in recent years which will have increased demands on services too.”

He suggests three key actions:

• Protecting budgets that determine our health, like social care, housing, benefits etc. And ensuring they are provided according to need.
• Reducing poverty for all groups and protecting the most vulnerable.
• Maximise the take up of the flu vaccine.

While pension funds may regard these figures as having something of a silver lining, they are bad news for almost everyone else. Governments and policy makers should be taking particular notice, and develop appropriate responses. Austerity isn’t just damaging the economy, it is literally killing us.

Inequality: moving from analysis to action

The causes of poverty and inequality are well understood, we now need to have the difficult conversations about taking action.


All this week, BBC Scotland have been running a series of features under the heading Unequal Scotland. They have looked at education, health, life expectancy and income. This fairly describes inequality and the impact it has, not just on those most impacted, but also the economy and everyone in Scotland.


As Douglas Fraser explains, this issue is being given a lot of attention by those in power, including heads of government, central bankers, the International Monetary Fund, even the Davos gathering of the economic elite. Nicola Sturgeon has put the tackling of inequality alongside economic growth as her twin priorities. Even a Tory Prime Minister has targeted her political message at those "struggling to get by".


Describing inequality is something we are very good at doing. Taking real action is more tricky, primarily because it involves some difficult conversations with those of us who are not in poverty.


A good example of this is highlighted by Gideon Calder from Swansea University. His research asks, is it okay for parents to pass wealth down to their children? So the kids gain a house when mum dies, for example. And before that, get everyday benefits just because their parents are relatively well-off? He concludes that we are not willing to have this conversation because the 'family' is sacrosanct.


The First Minister's poverty tsar touched on a similar point with her call for increased taxes, not least by addressing inheritance tax. She also picked on tax increases for the richest and the need for a progressive council tax - something the Scottish Government has ducked yet again. She said: "When people say they want a really wonderful NHS they don't say I want to pay more taxes for it. Well, I'm afraid you cannot have a really wonderful NHS unless you are willing to pay more taxes for it."


However, her most telling comment was that she was not convinced governments would raise taxes to the levels needed. She said: "You [governments] can always go further but you'll always have your eye on the next election and what people can expect". This goes to what I call Scandamerica, the idea that we can have Nordic levels of public services without most of us, not just the very rich, having to pay more taxes. Remembering that we now have the powers to address this in Scotland.


The Scottish Government is currently consulting over what a Scottish social security system should look like. This is important because some 37% of benefits will be devolved to Scotland, when you exclude pensions. However, as Govan Law Centre and others have highlighted, the consultation is almost entirely about process, not about adequacy of benefits, a crucial element of any strategy for tackling income inequality.


This theme is also covered by the tax lawyer Jolyon Maugham QC who points out that this year we’ll collect around £170bn of income tax, but forego through reliefs about £30bn of income tax - almost £500 a year for every man, woman and child in the UK. He says these reliefs go  overwhelmingly to those who need it least, the inevitable consequence of two deliberate policy choices: to distribute that £30bn through the tax system and to fail to monitor what good it does.


Tackling these reliefs would include some difficult conversations on issues like ISA's and tax relief on pension contributions, which are valued by middle income groups. Perhaps his most striking statistic is that the highest earning 15,000 taxpayers, almost 0.05% of all taxpayers, netted 5.5% of total deductions and reliefs. Most will have seen six figure reductions to their income tax bills.


This isn't just a parochial issue for us in Scotland and the U.K. As Thomas Piketty argues in the Guardian this week, Trump’s victory is primarily due to the explosion in economic and geographic inequality in the United States over several decades and the inability of successive governments to deal with this. Fiona Buchanan from Christian Aid makes a similar point in relation to the developing world, also highlighting the issue of gender justice.


There are some serious attempts at developing a consensus around some solutions. The IPPR's Economic Justice Commission is one such initiative. Their background paper makes the point that for all the rhetoric about a strong economy, it isn't an economy that works for all. Half of all UK households have seen no meaningful improvement in their incomes for more than a decade. The JRF's 'Talking about Poverty' project also points the way to a better understanding of the solutions.


So, hats off to the BBC for doing what a good public service broadcaster should do - educating us on probably the most important issue of our time. However, we need to move on to some, often uncomfortable solutions. Tackling inequality is in all our interests, because more equal societies do better on every count. This means we all have to contribute to the solutions, and yes, it will cost us.

Household income and inequality

As a new Oxfam report has highlighted, the richest 1% of Britain’s population owns almost more than 20 times the total wealth of the poorest 20%. Or put another way, 634,000 of the wealthiest people are worth 20 times as much as the poorest 13 million. This makes Britain one of the most unequal countries in the developed world.

This 'us and them' society is illustrated by a story in today's Guardian. The disgraced former owner of BHS, Dominic Chappell, owes more than £500,000 to the taxman on the profits he made. HMRC has started legal proceedings to recover the money. However, Chappell has put the business that owes the tax, Swiss Rock Limited, into liquidation, meaning he could walk away without paying the bill. Truly, only the 'little people' pay taxes.

We also have some more detailed data on disposable income, helpfully analysed by SPICe in their latest briefing. Disposable income per person in Scotland is currently £17,905. This is just below the UK figure of £17,965. Scotland has the 5th highest GDHI per person of all UK regions. Between 2013 and 2014 Scottish GDHI per person grew by 0.2% in cash terms. This is lower than the increase across the whole of the UK (0.5%).

Taking a longer time frame is interesting. Between 1997 and 2014 Scottish GDHI per person increased by 28% (£3,740) in real terms with the UK seeing a 27% (£3,830) increase over the same period. The gap between Scottish and UK GDHI per person has decreased from a peak of 8.6% in 2000 to 5.1% in 2014. This is one statistic that we can't put down to the oil price crash.

Unsurprisingly, London has the highest disparity between the highest and lowest GDHI per person in the UK. Scotland in comparison is a more equal society, at least in terms of disposable income. However, there are significant inequalities within Scotland. Aberdeen and Aberdeenshire has the highest level in disposable household income at £20,547, followed closely by Edinburgh. Glasgow City is the lowest at £14,757. East and North Ayrshire saw the largest increase in GDHI per person last year while East and West Dunbartonshire saw the largest decrease.

The GDHI figure is broken down into primary income ( wages, assets etc) and secondary (benefits, pensions and gifts). Scotland has the sixth highest level of primary income of the U.K. regions and accounts for 7.8% of all primary income in the UK, but 8.3% of total UK population. Only London, south-east and east of England outperform their population share. Scotland has the highest proportion of income from wages of total income and the second lowest proportion of rental income and self-employment. Since 2008 all types of primary income have decreased in real terms in Scotland, but financial assets have declined the fastest, probably due to low interest rates.

Scotland accounted for 8.4% of the total income from benefits which is almost exactly the same as Scotland’s population share of the UK (8.3%) and are fourth from bottom in this 'dependency' league table. Interestingly it is areas like, Lochaber, Skye and South Ayrshire that have the highest secondary incomes. This is probably due to pension income and reminds us where the bulk of the welfare budget is actually spent.

So, this data shows that income inequality in the UK remains a huge issue for concern. Scotland is a more equal country, but still has big geographical differences. The question for policy makers is how should these disparities be tackled. Unequal countries do worse on almost every count, so we should focus on progressive taxation and stronger public services to bridge the gap.