Date30 April 2020
Published date30 April 2020
AuthorRachel Perkins,Julie Repper
Subject MatterHealth & social care,Mental health,Social inclusion
Rachel Perkins and Julie Repper
Austerity, inequality and mental health
In February 2010, the Marmot Review into health inequalities in England was published
(Marmot et al.,2010). This report demonstrated that life expectancy for people living in the
poorest neighbourhoods is sevenyears less than that of people living in the richest areas.
They also spendan average of 17 years longer livingwith ill health or disability.
Faced with data of this sort, two responsesare typical:
1. to regard this disadvantage as being of people’s own making their “unhealthy
lifestyles” they just need to stop drinking, smoking, get exercise and lose weight; and
2. to blame the disadvantage on lack of health services and to call for bigger and better
health services.
This is a mistake.
It is undoubtedly the case that stopping smoking, drinking less, losing weight and getting
more exercise are good for people. However,for example, Holt-Lunstad et al. (2010) showed
that social isolation is worse for your chances of survival than obesity, lack of exercise and
alcohol and on a par with smoking, stronger social networks and social integration increase
your likelihood of survival by 50%. This does not mean that there is no role for personal
responsibility,rather that:
[...] personal responsibility should be right at the heart of what we are trying to achieve. But
people’s ability to take personal responsibility is shaped by their circumstances. People cannot
take responsibility if they cannot control what happens. Marmot (2015, p. 51)
Pye (2018) cites the example of a boy brought to A&E several times with stomach pain, but
his investigationswere normal. She concluded that his symptoms resultedfrom poor diet and
recommended healthy eating, drinking plenty of water and doing exercise. However, the
critical question should have been what was preventing the boy from eating well and
If I had asked, I would have found out that Jacob’s mum works 14 hours a day split between two
cleaning jobs. She’s a good cook, but doesn’t have time to buy or prepare meals. Money is a
significant problems, and often the quick, affordable food that her children resort to eating has
low nutritional content. Jacob likes playing outside with his friends after school, but his mum
doesn’t think it is safe, so tells him and his siblings to stay in the [small two bedroom] flat while
she is at work. Pye (2018,p.1)
She goes on to say that:
Jacob’s family’s circumstances are shaping his opportunities to eat healthier food and be more
active. The social, cultural, economic, commercial and environmental factors, the social
determinants of health, shape the conditions in which people are born, grow, live, work and age.
Good physical and mental health care is, of course, important. However, it accounts for as
little as 10% of a population’shealth and well-being (Pye, 2018). Social determinantsof health
are more, much more,important:
DOI 10.1108/MHSI-05-2020-064 VOL. 24 NO. 2 2020, pp. 61-66, ©Emerald Publishing Limited, ISSN 2042-8308 jMENTAL HEALTH AND SOCIAL INCLUSION jPAGE 61

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