Traditionally the right has suggested that those in poverty are poor and unhealthy because they make bad choices.
It is true that the poorer you are the more likely you are to smoke, eat unhealthily, drink problematically and exercise less. But the evidence is also very clear that people do not make choices in a vacuum – we, and the choices we make, are inextricably shaped by our circumstances.
In their book Scarcity economist Sendhil Mullainathan and psychologist Eldar Shafir show that a lack of resources reduces ‘mental bandwidth’, making it much harder to make ‘good’ choices.
That lack of ‘bandwidth’ is compounded by environments in which many poorer people live which make ‘good’ choices even harder to make. As a Lambeth councillor I led on work to make our high streets healthier by seeking to widen the choice open to our poorest residents. Payday loan shops, 24-hour off licences, takeaways and betting shops cluster in our poorest fresh food desert neighbourhoods. Can you blame someone, frazzled from multiple shifts and caring responsibilities, returning to that kind of high street and choosing fried chicken and a four pack rather than walking further to buy some fresh vegetables to cook at home?
In any case, wherever and whatever the choices made, scientists find that even when we take account of ‘bad’ lifestyles, poverty and lowly status still harms health.
Michael Marmott’s Whitehall Studies have tracked the health of British civil servants for decades. The studies show a health gradient that descends with income and status from the most powerful mandarin to the lowest paid porter. This means that the lowlier your status and income the higher the levels of disease and early death. This gradient persists even when you statistically remove the effect of poor lifestyle choices like smoking, drinking, poor diet and lack of exercise.
Marmot finds this status syndrome applies even at the top and impacts health more than lifestyle choices. For example Oscar winning actors live, on average, five years longer than mere Oscar nominees despite living very similar lifestyles. People with PHDs live longer than those with a master’s degree who live longer than graduates and so on.
Obviously we cannot all be Oscar-winning PHDs but there are many lessons we can learn about reducing the worst impacts of poverty and the importance of giving people opportunities to fulfil their potential, have real agency and make the best choices.
When I apply this to my own life and those of my poorest constituents this rings true.
As a young bartender with no qualifications living in (then even more deprived) Brixton I was smoking, drinking problematically, eating junk and had no time to exercise. Funnily enough I was also depressed, asthmatic and suffered from regular illnesses.
Since getting my degree and working my way up the career and status ladder I have quit drinking and smoking, moved near a leisure centre and away from the polluted main road. My health and wealth have correlated and never been better. I was fortunate to have the support I needed to begin fulfilling my potential – far too many people do not.
At the moment the ‘poor make poor choices and are responsible for the bad things that follow’ view is one that prevails. I was recently invited to a Department of Health event on how to get poor people, who use A&E services far more than higher status groups, make better choices and go to their GP or pharmacist. Apparently it hadn’t occurred to the government that perhaps the best answer was to lift people out of poverty, as the last Labour government did so successfully, rather than impoverish hundreds of thousands more as this Tory government has done.
A few years back I heard former Number 10 adviser Matthew Taylor talk about how the 1997-2010 government cut poverty in half through reforms like tax credits. His regret was that this laudable effort was ‘left to clever people in the Treasury’ and did not become a truly national enterprise that embraced everyone’s efforts.
We need to renew our commitment to eradicate poverty and give people real control over their lives and environments. Poverty is a blight that stops people from making good choices and fulfilling their potential. The economic and social costs are huge and our failure to eradicate it has helped lead to a period of political extremism.
I cannot think of a better national purpose to bring us together than eradicating poverty. If we achieved it by building healthier, greener, fairer communities and more evenly distributed, our economic base across the country, we would give people, nation and planet a better chance of thriving.