H e a T l t h Fabi anRev iew I e - Fabian Society · FabianReviewSpring2008 3 Fabian Review isthequarterly journaloftheFabianSociety [email protected] Editor TomHampson

FabianReviewSpring 2008www.fabians.org.uk

The quarterly magazine of the Fabian Society Volume 120 no 1 £4.95

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The Brown government risks beingwritten off before its first anniversary.The greatest frustration for Laboursupporters is just how winnable thenext election could still be were bothgovernment and party to demonstratea strategy and appetite to win it.Frustration one: there is no great

mystery about the Prime Minister’score vision, though voters could beforgiven for not knowing that. The ar-gument that links policy together –that Britain should compete on highvalue skills, not low wages, by un-locking the talent of all to ‘race to thetop’ in the global economy – is true,but too technocratic. This must betranslated into a public political argu-ment about what Labour wants tochange about Britain, around which awinning electoral coalition can be re-built. That should involve mobilisingprogressive support for the cause ofending child poverty while showinghow the argument that every child de-serves a decent start and the chance tofulfill their potential can resonateacross Middle England too.

The challenge is not just one ofcommunication but political strategytoo. Gordon Brown recognised lastspring that ‘more of the same’ could

not defeat the call of ‘time for change’next time. He was right. But will vot-ers be able to point to even three keypoints of ‘change’ if asked at the endof his first year as Prime Minister inJune?Frustration two: the party’s internal

debate is badly stuck. The left worriesthat countering southern discomfortwould cost Labour’s soul. The Blairiteright flank worries about appeasingGuardian-reading liberals. Labourwon’t recover by debating which vot-ers it doesn’t want.There is no real chance of any lead-

ership challenge, nor should there be.Those who lacked the support to putup a candidate when there was a va-cancy last year should shut upwhen itcomes to stoking media speculationabout somethingwhich is not going tohappen.But we need a more outward-look-

ing and open debate about Labour’score mission. Few – if any – of JohnHutton’s Cabinet colleagues agreedwith the content and tone withwhich he celebrated ‘huge salaries’and people who ‘climb without lim-its’ at the top. Yet only Hazel Blears,concerned about ‘social apartheid’between rich and poor, offered any

corrective. Those in the Cabinet’sBrownite centre who know why nar-rowing the gap matters have shiedaway from getting out in front of thePrime Minister – perhaps sometimesstill acting more as advisers thanMinisters. They should realise that ifonly a ‘No Turning Back’ Blairism isarticulated, the call for ‘change’ willbe lost by default.Frustration three: why is Labour’s

instinct still to cautiously hoard politi-cal capital? What for? Caution waspartly a successful New Labour strat-egy of quiet advance, partly too, aneurotic under-confidence whichcould not recognise when argumentswere being won.Eleven years in, the calculus of risk

must change. Whether the LabourGovernment has two or seven yearsleft in office, its central mission mustbe to embed and Tory-proof a progres-sive Labour legacy against future po-litical change.That means ditching tactical trian-

gulation, still too often the defaultmode of this Government. Cleavingthe tactics of 1997 to the politics of2008 suggests a failure to understandNew Labour’s success in convertingthe Conservatives to

REVIEW OF THE SPRING

The Prime Minister is ‘Best at his Brownest’ and should return to thestrategy which won him the leadership last year

Gordon, hear the call for change

Fabian Review Spring 2008 1

AdrianTeal

cont’d

progressive aspirations and language.It amounts to an offer to fight the gen-eral election on David Cameron’sterms. The Conservative leader wantsvoters to think there is little differencebetween the parties. That electionwould simply become a referendum

on the incumbents, not a choice be-tween alternative governments.Labour must offer that clear choice.So what needs to change? Get the

Downing Street machine in place, butcancel Number 10’s subscription to PRWeek. Leave Hillary Clinton’s pollster

Mark Penn in Washington. Then makea fairer Britain the defining mission:take risks for the cause of child poverty;make clear what climate change de-mands of us all; go for electoral reformand a written constitution. If not now,when? Sunder Katwala

2 Fabian Review Spring 2008

THE REVIEW Email your views to: [email protected]

In the last Fabian Review, the ForeignSecretary told TomHampson that he re-jected our call for a full public inquiryinto the Iraq war. This gained consider-able media coverage and FabianGeneral Secretary Sunder Katwalawrote to the Prime Minister, arguingthat Labour’s ability to reach out andwork with those outside party politics“will depend on acknowledging andlearning the lessons of Iraq”. GordonBrown replied in a lengthy letter thatthere would be a full inquiry after all:“There is a need to learn all possible les-sons from themilitary action in Iraq andits aftermath."

At the beginning of April the Secretaryof State for Communities and LocalGovernment told the Fabians that noone faith or ethnic group should domi-nate a townor city to the exclusion of allothers. Launching the Fabian Housingand Community Policy Network,Hazel Blears said that "There is nothingwrong with enclaves of particulargroups – every city benefits from itsChina Towns, Little Italies, or as inLondon, Bangla Town, KangarooValley, or Little Korea." However, sheargued that “No neighbourhoodshould be dominated by one group in

ways which make members of othergroups feel alienated, insecure or un-safe." You can read Hazel Blears’ fullspeech at http://fabians.org.uk/events/speeches/blears-housing-speech.

Over recent weeks the Fabians havebeen building a coalition and campaignto make the case for inheritance tax.Alongside our Fabian pamphlet,How toDefend Inheritance Tax (supported by theTUC and which Fabian members willreceive in their mailing with this issueof the Fabian Review) we also ran a de-bate at the House of Commons withBrendan Barber, General Secretary ofthe TUC, Martin Narey, Director ofBarnardos, and pamphlet author StuartWhite. On 15 April the Fabians sent aletter to the Guardian, signed by MPs,trade unionists, policymakers, academ-ics and writers, defending the principleof inheritance tax against political at-tacks. We will continue to work withother organisations on fair taxation.Youcan read the letter on our website athttp://fabians.org.uk/publications/publications-news.

Foreign Secretary David Miliband pre-dicted that a ‘civilian surge’ would re-shape global politics. He spoke at the

beginning of our NewYear Conference– the biggest UK public conference onglobal politics. Over 700 people de-bated with 50 leading speakers – on is-sues including how George Bush’sdeparture could lead to change inglobal politics, what the rise of Asiameans, Britain’s role in Europe and thelessons of Iraq. We finished the daywith the other Miliband – Ed – seekingdelegates’ ideas for the next Labourparty manifesto which included a pro-posal for a ‘poppies for medicine’ cam-paign to licence poppy production inAfghanistan, to deal with a worldwidemorphine shortage and improve locallivelihoods. You can read full write upsof the conference at http://fabians.org.uk/events /events-news/newyearconference-08.

The Fabians held a major series of fiveseminars on narrowing health inequal-ities between November 2007 andMarch 2008, including sessions led byhealth ministers Dawn Primarolo, BenBradshaw and Ivan Lewis, and emi-nent academics Julian Le Grand andSir Michael Marmot. The FabianHealth Inequalities Forum seminarscontinued the work of the FabianCommission on Life Chances andChild Poverty, explored the major bar-riers to narrowing inequalities across arange of key health policy areas, andsought to suggest directions for the fu-ture strategy on health inequality thatwe need. The Forum was kindly sup-ported by Sanofi Aventis and you canread full reports on all five seminars athttp://fabians.org.uk/events/events/health-inequalities-forum.

Gordon Browntold the Fabianshe wanted anIraq inquiryafter all

Inheritance taxwas in need ofsome friends

Hazel Blearssaid it is badfor communitieswhen oneethnicitydominates

Fabians changethe worldone step at atime

Ben Bradshawwanted to makehealth moreequal


Fabian Review is the quarterlyjournal of the Fabian Society

[email protected]

EditorTom Hampson

Books EditorHannah Jameson

Fabian Review, like all publicationsof the Fabian Society, representsnot the collective view of theSociety, but only the views of theindividual writers. Theresponsibility of the Society islimited to approving its publicationsas worthy of consideration withinthe Labour movement.

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General SecretarySunder KatwalaResearch DirectorTim HortonEditorial DirectorTom HampsonEvents DirectorJemima OlchawskiResearch FellowLouise BamfieldResearch FellowJames GregoryHead of CommunicationsRachael JolleyEditorial andMarketing ManagerHannah JamesonEvents ManagerTim GoreEvents ManagerRosie ClaytonEvents ManagerFatima HassanEvents AssistantEd WallisFinance OfficerMargaret McGillenLocal Societies OfficerDeborah StoateMembership OfficerGiles Wright

FABIAN REVIEW

Cover storyLive longer under LabourHannah Jameson

The Fabian InterviewDawn PrimaroloInterview by Tom Hampson

How Labour can winwith the NHSDr Neil Goulbourne

A shot in the arm forhealth equalityMary Creagh MP

8 policies for ahealthier nationAnne Campbell, Bryan Jones,Dr Howard Stoate, Chuka Umunna,Sunder Katwala, Tim Horton, Dr PhilipJames, Tom Hampson and Louise Bamfield

The Fabian EssayReducing inequalities inhealth: a policy choiceMichael Marmot

Books58 countries falling apartDavid Mepham

War and peaceUsama Hasan

Stress ballsStewart Lansley

When the personalbecomes politicalSeema Malhotra

The Fabian SocietyNoticeboardFabian BookshelfListings

Live longerWhat do people thinkof the NHS, and howshould it change?

Cover story, p4

Win with the NHSCan championing apreventive NHS offeran electoral boost?

Neil Goulbourne p10

Feeling betterWhich policies wouldmake a big differenceto the nation’s health

8 policies, p14

Big differencesHow can we reducehealth inequalities

Essay, p19

Falling apartHow can we help thebottom billion?

Books, p26

MM Arrrgh!Should school placesbe dependent onhaving the MMR jab?

Mary Creagh, p12

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7

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26

27

28

29

QUESTIONS WE’RE ASKING

HampsteadTown

Belsize

Swiss Cottage

Frognaland

Fitzjohns

ortune Green

WestHampstead

Kilburn

10

12

14

19

3032

Life expectancy is up but the gap remainsSee Sir Michael Marmot p19

As the NHS hits 60, we ask the big questions:

� What should the NHS do next?� How can the health service tell its story of supporting parents?� Is there the public appetite for a local, more preventive NHS?

As Hannah Jameson shows here, our YouGov poll suggests that people love the NHS for all its

flaws, that there is a real appetite for a health service that prevents illness rather than treats it and

that after 11 years of Labour government, people may not want nanny, but they do want a state

that provides them with good support and information.


1. A preventive health service.We’re for it – but we’re not quitesure what it is.The public recognise that we need a wellness rather than asickness service – an NHS that is able to put into practicethe old adage that ‘prevention is better than cure’. 52 percent of respondents to our survey agreed that the NHSshould concentrate more on preventing disease and pro-tecting good health. But how successful have governmentand the health service been at translating positive re-sponses to preventative health into realistic expectations?Honest politicians acknowledge that taking preventative

health seriously is unlikely to mean local health care provi-sion stays concentrated in hospitals. But in the cut and thrustof electoral politics it has been all too easy for Labour to pointto the huge programme to build new hospitals, the 85,000new nurses, the 32,000 additional doctors as if the hospitalwas at the heart of our vision for the newNHS.

The New Labour story on health has been thoroughly ab-sorbed by the public. But Labour has become a victim of itsown success. When asked what funding priorities should bein the future, 66 per cent said theywantedmore hospital doc-tors and nurses. When asked whether any new money fornursing should be spent on nurses for schools or in hospitals,86 per cent said hospitals. This suggests the means havebegun to obscure the ends.The challenge for government revealed by this survey is

clear. In order to improve public health we need a preventa-tive health service. But building on the public’s tentativerecognition of this will mean presenting a vision of what thatservice will look like that is more appealing than the districtgeneral hospital version that currently occupies the publicimagination. It will mean taking on the assumption thatschools or high street clinics are less part of the health servicethan hospitals, and finding ways to channel the enthusiasmfor hospitals towards primary care instead – towards GPsand polyclinics. There are promising signs for preventativehealth; people are for it, but government ministers andLabourMPsmust be brave and explainwhat it is, rather thanhiding behind their district general hospital.

2. I � the NHSNHS spending in 2007/8 was triple the level in 1997, yetour survey shows that there is still considerable supportfor further spending – especially on the left. 51 per cent ofLabour identifying respondents said government shouldcontinue to increase levels of funding, and increase taxesif necessary to pay for it. The naked argument Labourmade in their first term for increasing taxation to fund theNHS still resonates today.

But what is more remarkable is the support for current lev-els of funding amongst Conservative identifying respon-dents. Only 7 per cent agreed that the NHS should receiveless funding and that taxes should be cut. It shows the extentto which the small state conservatives, who have tradition-ally argued for less public service provision and conse-quently lower levels of taxation, have been isolated inmainstream debate.Arguments for private provision of healthcare – until re-

cently made by the Conservatives – also seem to have lost


The National Health Service focuses on both prevent-ing and treating illness. Looking to the future do youthink the balance is right? Which of the following isclosest to your view?

The NHS should concentrate more on preventing 52disease and protecting good health.

The NHS has the right balance between treatment 31and prevention/protection.

The NHS should focus more on treatment and 9less on prevention/protection.

Don’t know. 8

There will always be some limit to the money that theNHS can spend. Which two or three of these do youthink should be the NHS’s greatest priorities?

More hosital doctors and nurses? 66Finding new ways to deliver healthcare locally 41More GPs 31Specialist cancer care 29Better access to free fitness programmes 26Paying for expensive new drug treatments 23Building new hospital buildings 12Campaigns to reduce obesity 12Greater privacy in hospital 11Support for local pharmacies 8None of these 1Don’t know 4

If there were a limited amount of new money for extranurses and a choice had to be made would you preferto see more new nurses in schools or more new nursesin hospitals?

More new nurses in schools 10

More new nurses in hospitals 86

Don’t know 4

Which of these statements comes closest to your viewregarding the funding of the NHS?

Total Lab% Con% LD%

The government should continue 38 51 21 43to increase the levels of funding,and increase taxes if necessaryto pay for it.

The NHS receives enough money 50 40 67 42and should use it better

The NHS could provide a 4 2 7 3reasonable service with less money,so it should receive less and taxesshould be cutDon’t know 8 7 5 13


POLLING

ground. Not only are Conservative identifiers committed topublic funding of the NHS, but the majority agree that it isthe commitment of the NHS to free treatment for everyonethat means it is one of our great national symbols.

But is there a downside to this broad base of support? TheNHS turns 60 this year and, as our survey shows, has estab-lished itself as a national institution. Is there a risk that affec-tion for the NHS will limit its ability to evolve to meet 21stcentury health challenges, fixing it as a nostalgic tribute to abygone era? The NHS was a radical initiative 60 years ago,and its advocates had to struggle hard to argue that itsmodelof general hospitals and GPs’ surgeries was the best way toimprove the nation’s health. This survey suggests that a sim-ilar battle may need to be fought today to win the case for anew model of the NHS fit for the task of improving the na-tion’s health again.

3. From the nanny state to theparents’ supporterFear of being labelled the ‘nanny state’ has long dominatedBritish politics. But our survey suggests thatmany people arecomfortable with high levels of government intervention.Younger people in particular aremoreprepared to accept that

governments have a legitimate role in improving the public’shealth. 51 per cent of all 18-34 year olds agreed that it isrightly the government’s role to try to reduce levels of obesityand ensure people make health choices, 15 per cent morethan respondents in the over 55 category.

Overall, our survey showed that people wanted govern-ment interventions to help them to improve their health,whether that was providing free entry to swimming poolsand leisure centres or introducing traffic light labelling onfood. They consistently want more information, advice andsupport – an enabling state that makes it easier for them tomake the right choices. But younger people were more likelyto accept an even greater role for government than older re-spondents, for example by limiting the amount of salt in foodby law and adding fluoride to the national water supply.According to the Wanless review, a sustainable NHS that

maximises life expectancy and health status will require citi-zens to be fully engaged inmaintaining their ownhealth.Oursurvey suggests that individuals and families accept respon-sibility for their own health, and that increasingly they recog-nise that government has a clear role to play in providinggood information, making healthy choices easier, and settingthe framework within which we make decisions about ourhealth. They don’t need a nanny, but they do need sensiblegovernment support.

This poll was made possible by the gener-ous support of the Royal PharmaceuticalSociety of Great Britain. You can read thefull poll online at www.fabians.org.uk

MANIFESTO HEALTH POLICIES

Make swimming pools and leisure centres free

One of Labour’s most popular polices in 1997 was making admission to our great museums free. Visitornumbers increased and voters saw it for what it was – a measure from a government confident in its supportfor education and culture. In 2008 we should do the same for swimming pools and leisure centres.Swimming is free in Oxford, Manchester and Bristol if you’re under 16 and Ken Livingstone has supportedLondon Boroughs who have experimented with free access. But why only young people and why notnationwide? This was by far the most popular policy with our poll respondents and allowing free entry wouldclearly show that this government understands the new role it should be taking on health – supportive,preventive and egalitarian. HJ

Which of these statements comes closer to your view?

18-34% 35-54% 55+%

Given the importance of diet and 51 41 36lifestyle on your health, it is rightlythe government’s role to try to reducelevels of obesity and ensure peoplemake healthy choicesWe already have too much of a 43 56 62nanny state - people should makechoices about their own lives andtheir health without interference

Don’t know 6 3 2

The NHS is sixty years old this year. Which of the fol-lowing best describes your attitude to it?

Total Lab% Con% LD%

Whatever problems the NHS may 70 80 56 79have, its commitment to freetreatment for everyone means it isstill one of our great national symbolsThe NHS was a good idea for its 25 15 39 13time but we now need a differentway of running modern healthcareprovisionThe NHS was a bad idea from 1 1 3 3the start; it should be abolishedand replaced with somethingcompletely differentDon’t know 3 4 2 5


THE FABIAN INTERVIEW

What storyCAN Labourtell about health?

Tom Hampsonmeets with afrustratedminister andtests out someelectionslogans

If you were Dawn Primarolo, what wouldyou do? How would you describe whatthis government is up to on health? In thisdoggedly persistent administration insearch of a narrative, with its strongrecord of improvements in public healthand investment but with – as Sir MichaelMarmot shows on p17 – still shocking lev-els of inequalities in health outcomes,would you be able to describe your visionof the future of health policy?There’s an election manifesto to write,

so let’s try out some possibilities.First up is ‘The parents’ friend’. The

government has recognised for some timethat if it gets this right, it could be one ofits strongest cards with the electorate.During Labour’s time in power there hasbeen a big change in the way health serv-ices work, and they are much more re-sponsive to the patient as ‘consumer’ thanthey used to be.But we are still lacking the sense that thestate is ‘on your side’ if, say, you’re liv-ing in damp housing conditionswhich are affecting your health orwhen you’re shopping at the su-permarket, choosing your enter-tainment, using public servicesor seeking information and sup-port (as our poll shows peoplewant). Supporting parentsneedn’t just be about better in-formation about, say, healthyeating, it can also be about sup-port against pester power,against large corporations seek-ing to exploit your children,and against pollution. AsPrimarolo says, “Public healthhas moved from being about


the great crusades for clean water and decent livingconditions to today when the greatest threats to ourhealth and wellbeing are the products of our modernliving.”But making the link between these quality of life ar-

guments and a political argument is not easy. Not leastbecause it means workingright across government.Primarolo knows this:“What distinguishes usfrom the Tories is that theyopposed us on the decenthomes standards, they op-posed us on health trainersand complained about it,they opposed us on ourtraffic light system for foodlabelling and looking at thewhole question of the rela-tionship between super-markets and the consumer.So they don’t understandthe complexities and the

wider public health agenda – that is about health lead-ing but other government departments having a roletoo.”Primarolo knows the power of advertisers and big

corporations here. Getting them to change how theyoperate could make a real difference in improving thefood that children eat and to tackle childhood obesityand improve levels of health. But again, the politics istough. When it comes to negotiating with business, thishasn’t been a government that has ever walked with abig stick.Could one way to make the political narrative work

be to publicly take the battle to advertisers and super-markets? “I think yes, of course we have to - we haveto take the arguments to them. The idea that the onlypeople who have a duty on alcohol is the Governmentis clearly nonsense. So then it’s about saying, to thefood producers, to the manufacturers, to the advertis-ers: “where’s your responsibility to make sure thatwe’re reducing harm to health?” There are some biglevers there: labelling, advertising, access. I do notthink it is acceptable that some in our society think theycan put their hands up and say ‘this is not my respon-sibility, it’s the Department of Health’s’, when a conse-quence of what they are doing is harming health.”As can often be true with this government in this

frustrating year, ministers sound annoyed at their pow-erlessness, especially over the things that matter mostto them. “We know we can’t do this by ourselves. Howcan we compensate for food manufacturers if theywon’t properly label what is in their products so peoplecan’t make the judgements about whether it’s healthyfor them to eat it or not? And that means saying to themanufacturers you’ve got a responsibility here and ifyou don’t step up to the plate we will point out thatyou aren’t stepping up to the plate…”This doesn’t seem like much of a threat, and

Primarolo surely agrees. What’s more, the frustration

across public health is that real change is so slow –amongst food manufacturers, supermarkets, employersas well as with individual members of the public. InBoris Johnson’s campaign he called some ofLivingstone’s more coercive measures ‘cattle prod poli-cies’. “That doesn’t say much for what he thinks aboutthe population…” says the minister. “If I always needto try and persuade and cajole people to come to thehealth table and say “this is what my organisation cando to reduce health harm”, then we haven’t quite madeit, we will be trapped in the ‘it’s just a nanny state’mindset. It’s about being on their side, it’s about work-ing with them, and realising it’s a partnership. You can-not tell people what to do. You cannot force them,because they won’t do it.”Primarolo says that she is often asked by parents to

do things which aren’t strictly in the Department ofHealth’s gift, such as food labelling or safety on theroads: “They say they would love their child to walk toschool but are concerned for their safety. Or [they say]‘I want them to be able to play unstructured play out-side’ but either there aren’t the facilities or again there’sthe safety issue. Solving those issues is not the respon-sibility of the department of health. But we can encour-age it.”So unless the Government finds its way around the

political obstacles of coercion and nanny stateism(maybe by taking up some of our eight policy propos-als on p14) it might find it hard to make a convincingpublic case for being the ‘parent’s friend’. This is partlybecause people have lost some trust in the state – theold submissive doctor-patient relationship is nowlargely gone, and people are building their own under-standing of their health.People want a more preventative health service and if

the government was able to describe a clear vision of a‘preventative NHS’, they would win enthusiasm and,with any luck, votes. But again there are problems inmaking the public argument – and this might explainwhy this Government has so far failed to paint that pic-ture. Our polling backs up the idea that people’s judg-ments about particular policies are driven by viewsabout the fairness of the policy itself rather than thefairness of the outcome of that policy. This means thatwhile people say they want preventive health, theyoften say they don’t want any of the policies that mightlead to it: “I could be on the television defending thegovernment from people who are saying ‘our cancerrates are too high’. But I could then be on the televisionlater saying that we need to cut down smoking and thisis what the government is doing to take forward initia-tives to dissuade people from smoking. And as soon asI start talking about how to prevent smoking they say‘oh no, that’s my individual choice’. So what we’re hav-ing to explain is that these are related. Our cancer ratesand our level of smoking are related. Our hospital ad-missions and our liver disease and cardio-vascular dis-ease is related to alcohol consumption.”While, as Primarolo says, “there are those – the Tories

– who say it’s all about personal behaviour, it’s allabout individual choices and that is so simplistic as to

THE FABIAN INTERVIEW

It’s about saying, tothe food producers,

to themanufacturers, to

the advertisers:“where’s your

responsibility tomake sure thatwe’re reducing

harm to health?”


be laughable,” it is also true that this is a very fine bal-ance. Do we just bow to the whim of public opinion ordo we really try to move opinion and thereby changebehaviour. One example that the Government rightlybrags about is the smoking ban, where something thathad seemed laughably American only a few years ago

became – in a very shortperiod – accepted andcommonplace. This hap-pened because legislationwas used to actuallydrive opinion rather thanjust to react to it. As ourpoll suggests, the pub-lic’s appetite for carefulnanny statism can bestronger than we think.So, if it carefully

chooses policies thatmake a clear case for pre-ventative health – re-spondents to our pollparticularly liked freeswimming pool access –

maybe the Government can make its public case well.But swimming pools or smoke-free zones do not makean election-winning narrative.Labour MPs know from their own constituencies that

this narrative that connects ends together with means isbadly lacking on the ground. While people want morelocal services, they don’t like it when they see it – theyfeel defensive of their local hospitals. “Big hospitals ab-solutely have to be reorganised. We’re in the process.The reason they have to be is that people are saying: ‘Iwant to get out of hospital as fast as I can and I want togo home as soon as I can, but I might need the supportat home so I want nurse services there. And whereverpossible I’d rather have day surgery and I want all thetreatment to be as close to where I live as possible be-cause that cuts down the amount I have to travel andthat’s good for the environment and it’s convenient forme.’ But it’s when we start to make the big changeswithout explaining and showing and beginning to de-liver the new services that people get unsettled and sayno, no, no!”But frustration isn’t necessarily a bad driver. And

Primarolo has a reputation for getting things done.She’s clearly thinking of creative solutions to joining upgovernment better. One more plausible narrative mightbe the line ‘It’s not just the NHS, stupid’. The obesitystrategy is already working across a number of govern-ment departments – not just the Department of Healthor the NHS.This means Primarolo spends much of her time asking

the DCMS what they are bringing to the table on adver-tising, on sport, and on encouraging activity, workingwith the Department for Schools as the lead departmentfor the health and wellbeing of children, to theDepartment for Trasnport about cycling and exercise andso on. As she says, “Public health cannot be solved by theDepartment of Health. It’s everybody’s responsibility.”

And intriguingly, she is clearly very interested in theidea of a new ministerial post that focuses on publichealth across government, maybe even from outside ofthe Department of Health, maybe in the Cabinet Office.She asks whether a new minister could be the best wayforward because “I’m increasingly across in every de-partment. And where does the public health ministerreally sit? I’m increasingly in meetings with three orfour other ministers so that we can talk about our jointdepartmental issues.”The politics of health has always been prone to overly

simplistic stories. For Labour in the 1990s the story wasclearly one of Tory underinvestment and this morphedeasily into a bright new Labour Government that val-ued our hospitals, that was driving down waiting listsand investing in hard-pressed staff. Eleven years on,though, Cameron’s narrative of waste – an NHS stuffedfull of bureaucrats and losing money hand-over-fist –seems to be increasingly attractive to the public. Thefact is, though, that public health has always been morecomplex than that.But in an election battle between hope and fear,

maybe fear will win out. Rather thanPrimarolo’s preventive, local vision of “the health

service in leading, as a sort of steward, if you like, ofour health and wellbeing”, maybe we will run on ourold friend ‘The NHS isn’t safe in the Tories’ hands’.“The Tories just don’t get it”, says Primarolo. “They

actually see the health service in terms of buildings andthey see it frozen in time. The Tories are not responsiveto change, whether that be clinical change – listening towhat clinicians and healthprofessionals are sayingabout how best toprovide healthcare – or tochange in ourcommunitiesabout peo-ple’s percep-tion. So theysee it still as ani n s t i t u t i o n ,rather than as aliving part of ourlives, integrated in ourlives. We know the Toriesaren’t committed to theinvestment, whateverthey say.”

She is clearly veryinterested in the

idea of a newministerial post that

focuses on publichealth across

government, maybeeven from outside of

the Department ofHealth, maybe in

the Cabinet Office


The disappearance of Labour’s impressiveand long-unassailable poll lead onhealth is frustrating for theGovernment. It would prefer that vot-ers focused on the extra £50bn a yearinvestment, on the 100,000 more staff,on Britain’s biggest ever hospitalbuilding programme, on the dramaticfall in waiting times for treatment andimprovements in performance acrossthe country.But instead the public sees the clo-

sure of local hospitals and what themedia is calling ‘cuts’. Rather thancrediting Labour with securing the fu-ture of a valuable public service,many recall the introduction of theprivate sector, through the private fi-

nance initiative, and stand-alone,profit-making treatment centres. Andthe targets that have transformed per-formance in many areas of the NHSare regarded as unwarranted andcounterproductive interference withthe decisions of trusted nurses anddoctors.So Labour has a problem. And it is

increasingly clear that the solutionmust lie with NHS staff themselvesand in successfully reconfiguring thehealth service so that it works to pre-vent illness as much as to treat it.Cuts, privatisation and the under-

mining of professionals – the public’sview of the NHS under Labour could-n’t be further from its own. It soundsworryingly like the Tories’ record ofthe mid 1990s. Yet today’sConservatives, having successfullydivorced themselves from their recordin government, are now making aconvincing bid to become the party ofthe NHS. Having promised to matchLabour’s spending plans, they haveneutralised the issue of funding thatformed the main dividing line be-tween the parties for years.

Furthermore, rather than picking afight with health workers as Labourhas tended to (the spat with GPs overopening hours being the most recentexample) the Tories have promised tohand back power to staff on theground. Although sharply at oddswith their record in power, this mes-sage appeals both to clinicians whoare tired of relentless change and to apublic that still trusts health profes-sionals above politicians.If Labour now finds itself wonder-

ing how to recapture the initiative andregain health as an electoral asset, thesolution may be close at hand. It iscommonly acknowledged that the

How Labourcan win withthe NHS

Dr NeilGoulbourneConvenorof theLabour GPNetwork

Not only is prevention ofillness more powerful thantreatment after its onset, itis also the most effective

way of reducing thegrowing inequalities in

health that shame the UK

HOW LABOUR CAN WIN ON HEALTH


focus of the NHS needs to shift if it isto meet the challenges of the yearsahead. The crippled health service ofthe 1990s struggled (and often failed)to treat the sick. Having largelydragged its performance into the 21stcentury, a system designed to dealwith illness must now face the grow-ing challenge of preventing it.Not only is prevention of illness

more powerful than treatment after itsonset, it is also the most effective wayof reducing the growing inequalitiesin health that shame the UK. Inherentin the notion of an NHS focused onwellness is the need to intervene inpeople’s choices, to reduce smoking,obesity and physical inactivity. Thetwo-pronged attack formed by the re-cent ban on smoking in public andmajor investment in services that helppeople to stop smoking are examplesof the way ahead. But to move thisagenda still further the NHS musttreat patients as individuals – ratherthan as statistics. Only then will theygive it license to step into the territoryof prevention. For the NHS to becomethis type of ‘wellness service’, it needs

to value quality of care over quantityalone.Crucially, making that shift – to pre-

vention not just cure, and to quality aswell as quantity –means developing afresh approach to NHS staff. TheGovernment needs to find ways toshow that it doesn’t just see staff asbarriers to reform – but instead seesthem as valued resources, and as part-ners with whom it can develop thenew NHS.There are some hopeful signs. GPs

can now commission new servicesthemselves and more targets arebeing set locally rather than inWhitehall. But the political messagehas not been clear enough. Without asharper political focus on supportingand empowering staff, theGovernment will fail to convincethose staff and the public that any-thing has changed.At a time when the Right is once

more finding an audience for the mes-sage that the State should stop med-dling in society, Labour must recreatea coalition with the public sector to ef-fect progressive change and to ensure

that it presents a united and success-ful public face.Labour can still regain its position

as the party of the NHS and win thepraise it deserves for saving it, but itwill only do so if it can first recommititself to be the party of theNHS’s staff.If we cannot convince those workingin the NHS that only Labour embod-ies their ideals, we will struggle toconvince the wider public. We notonly need the electoral support of thatvast phalanx of NHS staff, we alsoneed them to act as ambassadors forLabour’s achievements, rather thanthe disgruntled critics they presentlytend to be.

Labour can still regain itsposition as the party of theNHS and win the praise it

deserves for saving it, but itwill only do so if it can first

recommit itself to be theparty of the NHS’s staffPA

Photos


Health inequalities between rich and poorare proving hard to eradicate. Figuresreleased inMarch by theDepartment ofHealth show the life expectancy gap be-tween men in the poorest areas ofEngland and the average man is 2 percent wider than it was ten years ago.People born in Wakefield are morelikely to die of cancer and heart disease,and have a shorter lifespan, than thosein Kensington and Chelsea. Men whoearn the least – those in the bottom fifth

of the income scale – are 70 per centmore likely todie of cancer than those inthe top fifth. For women the differenceis 41 per cent.There are also major health inequali-

ties between the sexes. Men dieyounger than women because they areless robust as babies, more prone to ac-cidental and suicidal injury as adultsand, as older men, less likely to go totheir GP until their health problemshave become serious.Men’s cancers arethe poor cousins of breast cancer, men’sdiets, drinking and cigarette use are ig-noredby the lifestyle pages. Looking se-riously at men’s health, includingaccident and suicide prevention, is vitalif we are to plug the health inequalitygap between the sexes.But health inequalities start before

birth and persist in early life. Dealingwith the recent slide in rates at whichchildren are vaccinated would make abig difference to health inequality.Vaccination has been hugely success-

ful in eradicating many childhood dis-eases in the UK. One hundred yearsago, thousands of children died orwereleft disabled by measles, mumps, andrubella (German measles). Mass vacci-nation programmes had all but eradi-cated these diseases in the 1980s and1990s. Sadly however, the success of the

vaccination programme has bred indif-ference; as the horrors of vaccine-pre-ventable disease faded from the publicmind, they were replaced by un-founded tabloid claims of the MMRvaccine causing autism. The result?Childhood vaccination rates are as lowas 11 per cent in inner London, andcases of measles, mumps, and rubellaare rising sharply. Figures released inMarch show that cases of whoopingcough – which can be fatal to babies –have nearly trebled since 2003.Labour should imitate the successful

US model, introduced by PresidentClinton to ensure that no low-incomechild was left unvaccinated. There, chil-dren can only start school after proof ofvaccination has been supplied by par-ents (except on religious or medicalgrounds). In the absence of vaccina-tions, catch-up jabs are offered to chil-dren before they start school. Theresponsibility for ensuring children arevaccinated by the age of five should fallto Local Education Authorities, whohave access to 99 per cent of childrenthrough school, rather than health visi-tors or GPs where access can be spo-radic, temporary or non-existent. MMRcatch-up sessions for five-year-olds arestandard in some parts of the country,but we need to ensure national targetsare met if we are to offer every childhealthy start.We should extend the range of child-

hood vaccinations to include chickenpox (which can lead to a form ofmeningitis), and rotavirus (wintervomiting disease). We should also in-clude under-two’s in the annual fluvaccination programme. It is thelargest vaccine-preventable disease in

A shot in the armfor health equality

Children who have not been

given their MMR jabs should

not be allowed to start

school, argues

Mary Creagh MP

Mary Creaghis the LabourMember ofParliament forWakefield, DenbyDale andKirkburton

After a single rogue study on the links between the combined measles,mumps and rubella vaccine and autism and – perhaps rather moreimportantly – the media’s glee at whipping up fears, vaccination droppedsharply in the UK from 92 per cent in 1996 to 84 per cent in 2002. By2003 it was as low as 61 per cent in some parts of London.

With ‘herd immunity’ so compromised, it’s not surprising that children fellill. Even in 2006, incidents of measles were 13 times their 1998 levels.Mumps cases were a full 37 times higher. In 2006 the first British child in15 years died of measles and in London two children had to have kidneytransplants and their health was permanently compromised.TH

the UK. The virus is more virulent inchildren under two, who should there-fore be our first priority. Children arealso more likely to pass the virus on torelatives, carers or friends. Vaccinatingthem would mean less flu in societyoverall. Such a programme wouldbring the added benefits of scaling upthe public health community’s abilityto provide mass flu vaccination whichwould be vital in fighting any futureflu pandemic.Labour has much to be proud of in

ten years of health policy. An end tohospital waiting lists by the end of thisyear, greater access to GPs, earlier de-tection and better survival rates forheart disease and cancer. There havebeen great strides in public health too,with landmark legislation such as theban on smoking in public places, the‘five a day’ fruit and veg message, andfree fruit in schools. The Healthy Startschemehas seen amove away from for-mula milk towards vouchers for thoseon low incomes to purchase fruit andveg, and free vitamin drops for babiesand toddlers. Labour listened to theFabian Society’s arguments about sup-port before birth and all pregnantwomen will receive £120 in the seventhmonth of pregnancy, to encourage themto eat healthily and help ensure theirbaby is not born underweight.The Government is also beginning to

give serious attention to the child obe-sity problem, with a focus on nutritious

schoolmeals, the reintroductionof cookery lessons and a ban onjunk food vending machines inschools. And – after pressurefrom children’s food campaign-ers – there is a limited ban onjunk food TV advertising to chil-dren.We must not be afraid of setting

out the need for government inter-vention in public health. Toryhealth spokesmanAndrewLansleywants to see more money spent onpublic health (although he hasn’tsaid how the Tories would pay forit while ‘sharing the proceeds ofgrowth’) but he is implacably op-posed to clearer food labelling andtighter controls on TV junk food ad-vertising aimed at children. Labourshould end the consultations on foodlabelling andplace a duty on foodman-ufacturers to use the Food StandardsAgency’s traffic light system. Wealso need a 9pm watershedon junk food advertising.Prevention is key. As

we celebrate the 60thbirthday of the NHS wemust recognise that forthe health service to be assuccessful in the decades tocome, we must dramatically shiftmoney from hospital treatment to com-munity prevention. We know thatchronic poor health and poor mentalhealth are key factors preventingpeople

fromworking and reaching their poten-tial. Closing the health gap betweenrich and poor is an imperative for thatto happen.

In 2007 Gordon Brown askedMary Creagh to Chair aManifesto Group on PublicHealth, looking at how MPs’experience on public healthpolicy can be integratedinto Labour’s next electionmanifesto.

MANIFESTO HEALTH POLICIES

Link benefits to vaccinations

Another way to increase levels of vaccination wouldbe to link child benefit to immunisation andvaccination procedures (with exemptions only onclinical grounds).

The great advantage of linking vaccination to auniversal benefit such as child benefit is that you would not be targeting any specific group, but ensuring fullcoverage. It would also help make the clear argument that this was being done for the public good ratherthan for this benefit of individuals.

The effect of such a combination of rights and responsibilities, not least to what the medical profession calls‘herd immunity’, would be great.At a stroke a major indicator and cause of inequalities would be removed.

Sir Sandy Macara

POLLAlthough the medical experts have said there is no foundation for a concern

about the mumps measles and rubella (MMR) vaccine, over the last five years

the rate at which parents vaccinate their children has fallen significantly. Should

the government do more to raise the number of children who are immunised?

Yes – immunisation only works if everyone is covered 63

No – whatever the experts say, it’s up to families to make this choice 31

Don’t know 7


8POLICIES FOR A

HEALTHIER NATION


Given the rising number of obese adults, an initia-tive to hand out free pedometers to everyone couldpay enormous dividends in reducing future NHScare costs. If this initiative were to run alongside aneducation programme with, maybe, local incentivesfor those users whose activity increases the most, itcould lead to a significant improvement in thehealth of the population.Pedometer users are usually given a target, of say

10,000 steps a day, which they can do by walking orrunning and this is a good motivation to increase ac-tivity. Healthy activity is a necessary means of reducing

obesity and pedometers are a very cheap way of en-couraging people to take more exercise. When the

whole family is involved, then the interventionsmay be even more effective. The Government has already shown that using pe-

dometers to promote and incentivise healthy activ-ity works. In January 2007 Caroline Flint (then aHealth Minister) launched an initiative to hand outpedometers to children in 250 primary schools. Anearlier government pilot project called Schools onthe Move showed a dramatic increase in activity bychildren at the end of a 23 week programme. Thismeasure would be a cheap way of immediately rais-ing fitness levels and would provide this govern-ment with an eye-catching example of how our NHScould work as much as a prevention service as atreatment service.

Give everyone a free pedometer

Anne CampbellChair of the Fabian Society

1

Making the principles of the NHS part of the fabricof British society is the Labour Party’s greatest his-toric achievement. We should not take it for granted,as the US election again sees the world’s wealthiestnation debate whether it can provide universalhealth coverage. The 60th anniversary of the NHS should be a time to

strengthen the core principle of universal access tohealth services, free at the point of use. We should re-open the argument about whether patients should becharged for prescriptions, or whether prescriptionsshould be scrapped as Labour has done in Wales.Prescription charges do raise money: around £1bil-

lion a year, which is about 1 per cent of the total NHSbudget (though administration would cost less with-out charges). But charging affects health outcomes. The King’s

Fund health think tank has argued for the abolition ofprescription charges because of the evidence – inter-

nationally and in Britain – that they lead to some pa-tients failing to take medicines prescribed to them.(This can also lead to more expensive treatment later). The King’s Fund makes a strong health argument.

The Labour Party should make this a political issuetoo. All major parties claim equal allegiance to the prin-

ciples of the NHS and the Opposition pledges tomatch Labour’s increases in health funding, despitebackbench grumbling. Let us test this. David Cameron has pledged to

‘share the proceeds of the growth’, which for himmeans putting tax cuts ahead of investment in publicservices. Labour should share the proceeds of growthvia a more popular route: a manifesto pledge to re-duce prescription charges year on year in the nextParliament, seeking to abolish them entirely as re-sources allow. This could kick start the ‘popularequality’ agenda Labour needs.

Free prescriptions for all

Sunder Katwala and Tim HortonGeneral Secretary and Research Director of the Fabian Society

2


Rather

POLICIES

Watch any important football match these days on TV,and you’ll see dozens of references to alcohol over theninety minutes. Carlsberg, who sponsor Liverpool,have become the most popular drinks brand in thecountry. Their Merseyside neighbours Everton aresponsored by Chang Beer. Carling not only sponsorsthe Carling Cup, but Rangers too. You see drinksfirms’ logos on teams’ shirts; drinks adverts on hoard-ings beside the pitch; drinks commercials at half time;bottles of champagne for the man of the match. Thelist is endless. Why do we allow this? Britain’s alcohol advertising

rules specify that adverts must not link alcohol with‘daring’ or ‘toughness’ or suggest that it may enhance‘physical performance’. They also say that adverts foralcohol should not appeal strongly to people under18. And yet it seems that the regulators and theGovernment see nothing wrong it seems in allowingour leading football teams and most successful sports-men – with their millions of young fans – to be closelyassociated with alcohol products.

In a bid to assuage critics of the industry’s market-ing strategies the Portman Group has recently agreedto ban the use of drinks firms’ logos on children’sreplica strips. This is an extremely hollow gesture. But does this really matter? Well, the fact is that

young people are drinking more than ever. Since 1990the alcohol consumption by 11 to 15-year-olds inEngland has doubled. Alcohol misuse is also having agrowing impact on young people’s health. Teenagersas young as 13 are being admitted to hospital for alco-hol-related treatment. And, for the first time, liver spe-cialists are now seeing patients in their 20s and 30swith end-stage alcoholic liver disease.We need a more radical measure that will prevent

alcohol companies from associating themselveswith the excitement and glamour of professionalsport and using it to boost their sales among theyoung in particular. A complete ban on alcohol ad-vertising or sponsorship within sport is the onlyway of achieving this. It is a step that the public willsurely welcome.

Ban alcohol advertisingand sponsorship in sport

Dr Howard Stoate3

It is often said that there is too much emphasis ontreatment and not enough on prevention when itcomes to tackling poor health. One in six people suffers from a mental health prob-

lem at any one time, so the Government’s announce-ment last October that spending on psychologicaltherapies is to increase from £5m to £170m by 2010 isto be welcomed. But the focus needs to shift to reduc-ing the pressures and strains people find heaped uponthem in the modern world which help create thesemental health problems in the first place.

Numerous studies have shown that blame for ourpoor mental health can partly be attributed to ourlong working hours culture. It is not a panacea for theresolution of these issues but I’d like to see the com-plete implementation of the EU working time direc-tive setting a limit on the working week of 48 hours sothat the 3.2 million people working in excess of thosehours every week can lead less stressful lives and per-haps find the time to exercise, keep fit and healthy,which would prevent the onset of other health relatedproblems.

Reduce the long workinghours culture in the UK

Chuka Umunna Labour’s Prospective Parliamentary Candidate for Streatham

4


We know that changing your diet makes a big difference.International evidence shows rapid improvements indeath rates and levels of disability if people improvewhat they eat. We also know that health education on itsown fails. It is crucial that wherever possible we ensurethat only high-quality food is available in public placesThis means biting the bullet and limiting the density of

fast food in town centres in the same way as we alreadydo for places that sell alcohol. We should also restrictfood and beverage sales within defined zones nearschools at specific times of days during school terms. We must think creatively about how to ensure there is

a better range of food commonly available to people. InFinland, the Government has engaged business to en-sure that employers are routinely providing good food –

indeed fruit and vegetables must be included within theprice of all dishes in their canteens and catering systems.(People often don’t buy fruit and veg if they’re sold sep-arately). We should do the same and ensure that this alsohappens in publicly supported organisations – in partic-ular we must eliminate fast food sales from all hospitals,schools, universities, and publicly-funded buildings.While we’re at it we could give preference to locally-sourced supplies.Finally, while it is a good thing that traffic light-style

labelling has become much more common in supermar-kets, we should also label all meals in restaurants, cafesand in office canteens with FSA nutritional profiles. Thisneedn’t necessarily mean regulation – we should start bypublicly identifying the worst offenders.

Fewer fast food outlets intown centres

Dr Philip JamesHon. Professor of Nutrition, London School of Hygiene and Tropical Medicine

6

Much of the recent debate about health inequalities inBritain has focused squarely on what the NHS itselfdoes to tackle them. Far too little attention has beengiven, however, to the role of local councils in reduc-ing health inequalities. If we are serious about reducing health inequalities

then we have to give councils back their publichealth role: only by doing this will we bring publichealth back into the political mainstream at locallevel and ensure it gets the priority that it undoubt-edly requires. We ignore the contribution of local councils at our

peril. After all, it is councils that have the responsibil-ity for planning and maintaining our communities,for managing our leisure services and co-ordinatingour transport system. In other words they are respon-sible for virtually all the basic infrastructure thatshapes our everyday lives. In fact the responsibility for public health did once

rest with councils. During the nineteenth century itwas our civic leaders who made some of the singlebiggest contributions to raising life expectancy thatwe’ve seen in this country by building the sewers andthe water supply networks that remain in our townsto this day. But this changed in the mid 1970s when this re-

sponsibility was transferred to local health boards – adecision that robbed councils of generations of accu-mulated public health expertise.Today, local authorities are mindful of the impor-

tance of tackling health inequalities, but it is an issuethat comes well down their list of priorities. For ex-ample, it is little wonder that thousands of homes getbuilt every year with barely a second thought given asto how the people who are going to live in them willlive healthy lives. Give local authorities the responsi-bility and we will see a marked improvement inhealth inequalities.

Let local councils makehealth more equal

Bryan Jones5


Anyone who has shopped with small children knows theproblem. Go to the crisps aisle in Sainsburys, ASDA, orTesco and the provocations to pester power are shameless.High on the top shelves are peanuts, pretzels and the kindof dry biscuits for cheese that frankly only those over 60would buy. And on the bottom shelves, Monster Munch,multipacks of Wotsits, and Disney-themed ‘corn snacks’.You can’t avoid it – even in the check out queue (the one

place in the store where even the most strategically cun-ning parent has no choice but to be stationary) the massiverange of sweets is placed so low down that an adult whowanted a Mars bar would have to ask a nearby child tohelp. This is no accident. Supermarkets now employ talented

professionals to ensure they maximise the exposure thatindividual brands get to their target audience. They putfreshly baked bread near the entrance to draw you in, andplace umbrellas near the exit just in case. They put dipsnext to the nachos and buns next to the burgers. They putTransformers magazines at shin level for young people

and top shelf magazines on the, well the top shelf. If theycould ask you your race and class at the door and directyou to the relevant aisle, they probably would. Clearly grown ups can fend for themselves, but chil-

dren are a different matter. The number of overweightchildren in the UK has risen steadily over the past 20 yearsand around a quarter of young people are overweight orobese, with many gaining weight from an early age.Obesity is associated with many illnesses and is directlylinked to lower life expectancy. The link between child obesity and pester power is an

obvious one and this is an area where Labour can easilyplay the parent’s friend. Preventative health means asking– and then telling – supermarkets to put products aimedat children on shelves where it is adults who make thechoice. It means local councils’ planning departments en-suring new supermarkets are built with crèches so singleparents don’t have to drag children around the entirestore. In the cause of public health, Labour must stand upfor harassed mothers in Morrisons.

Make supermarkets putjunk food out ofchildren’s reach

Tom HampsonEditorial Director of the Fabian Sociaty

7

Cycling offers multiple benefits both to the individual cy-clist and wider society, from improved health and well-being through increased physical activity, to the widerenvironmental benefits of reduced car use, traffic conges-tion and carbon emissions. Growing recognition of thesebenefits has seen increased investment in a range of na-tional and local initiatives over recent years to create theconditions in which more people are cycling more safelyand more often. Along with a free pedometer, giving all children a free

bike at the beginning of Year 5, when most pupils areabout 10 years old, would provide the boost needed to re-ally bring about behavioural and lifestyle change for thecurrent and next generations of young people. Givingevery 10 year old the chance to cycle in the last years of

primary school would complement wider cycling strate-gies, incentivising local authorities to invest in safe schoolcycling routes and encouraging schools to provide cycletraining, which is currently not compulsory. At this age, afree bike would also coincide with level 2 training ofBikeability, the modern form of the old style cycle profi-ciency tests, which gives children the opportunity to un-dertake quality cycle training to ride safely on roads.Of course, choice and flexibility within the scheme

would be essential – there is no point in handing out na-tional-prescription bikes for children who already havethem, or cannot store them. A free bike would thereforebe one of a number of alternatives ways of spending avoucher, which could also be used to buy cycling acces-sories, other sports equipment, or a short course of out-door activities.

A free bike for yourtenth birthday

Louise BamfieldSenior Research Fellow at the Fabian Society

8

POLICIES


Here’s an unsurprising statement:poor people have poor health. Asone simple illustration, Guatemalais poor and life expectancy for men,there, is 66.2. By contrast the UK isrich (GDP per head in the UK, atreal exchange rates, is $33,200; inGuatemala, under $4,600) and hasa male life expectancy of 76.7. An 11year difference in life expectancy isenormous.If you want to see a life ex-

pectancy difference of 11 yearsand don’t want to enlarge yourcarbon footprint, or lose yourbags at Heathrow, get on yourbike. I live and work in theLondon Borough of Camden and,more or less happily, can cyclefrom Hampstead in the north ofthe borough to St Pancras andSomers Town in the south in 30minutes. In that time I have cov-ered a life expectancy gap of 11years. If I were being trite I mightsay that Hampstead is the UK andSomers Town is Guatemala, yetthey are only 8 Km apart ratherthan 8,000. I started by saying that poor

people have poor health. But are

REDUCING INEQUALITIES IN HEALTH: A POLICY CHOICE Michael Marmot

is Professor ofEpidemiology andPublic Health at UCL

Highgate

HampsteadTown

GospelOak Kentish

Town

Haverstock

Camden Townwit Primrose Hill

Cantelowes

St Pancras and

SomersTown

Regent’sPark

Bloomsbury

King’sCross

Holborn and

Belsize

Swiss Cottage

Frognaland

Fitzjohns

Fortune Green

WestHampstead

Kilburn

Covent Garden

Life expectancy, males (in years)

77.5 to 79.775.5 to 77.573.5 to 75.571.5 to 73.569.5 to 71.5

Figure 1 Map of male life expectancy in Camden

Source: London Health Observatory

THE FABIAN ESSAYPOLICIES

Sir Michael Marmot ischairing the WHO’s

Commission on SocialDeterminants of

Health which willreport this spring.

Here he argues thatto reduce inequality,government must be

much more joined up

the people of Somers Town andSt Pancras poor? Forty per centof the global population arepoor: they live on $2 a day orless; and in Guatemala 32% ofthe population do. By this definition no one in

Somers Town is poor, althoughthey are certainly a good dealless well off than the people ofHampstead. Yet their expecta-tion of life is a staggering 11years shorter than people upthe hill in Hampstead. What isgoing on?Before answering the ques-

tion of what is going on and,more importantly, what we cando about it, it is crucial torecognise that the statementabout poverty and poor health

is, at best, a partial picture. The map in Figure 1 showsfine gradations of life expectancy within the borough ofCamden. It is not simply that people in the poorestareas have poor health and everyone else is fine. Thereis a social gradient in health.My colleagues and I first showed this social gradient

in health in the Whitehall studies of British civil ser-vants. In Whitehall, among office workers, none ofwhom is poor in the global sense, all of whom had stable

jobs with low risk of unemploy-ment, there was a social gradientin health: people second from thetop had worse health and shorterexpectation of life than people atthe top of the hierarchy. Thosethird from the top had worsehealth than those second from thetop; and so on all the way to thebottom. (Figure 2)

Poverty and inequalityThe stark truth is that health in-equalities represent the major pub-lic health issue facing the UK andmost other countries. But the so-cial gradient should change thedebate. No one is in favour ofpoverty. If the poor have poorhealth as a result of their poverty,that provides yet one more reasonto deal with poverty. Surely all po-litical parties would sign up tothat. The social gradient, however,

has two key implications. First byfocussing only on the poorest, one misses people sec-ond from the bottom who have worse health than thoseabove them. In fact one misses almost everyone withhealth disadvantage due to social position because weall have worse health than those above us in the socialhierarchy. The social gradient means that we are all in-volved in this issue. It is not “them”, the poor, and“us”, the non-poor, but all of us. This leads to the sec-ond implication. The social gradient in health tells usthat health inequalities result from the unequal distri-bution of resources in society not only from an unfor-tunate few who are poor. The “poor” of Somers Townand St. Pancras are at one end of a continuous distri-bution. They are not qualitatively different from resi-dents of Kentish Town. They simply have a bit less ofwhat is good for health and/or a bit more of what isbad. I’ll come to that in a moment.This changes the political debate. Eradicate poverty?

A noble aim. I, and most others, applaud. Eradicate in-equality? The nay sayers are now varied and numer-ous: impossible, or undesirable, or both.

The magnitude of the social gradientin health variesIt is, of course, true that all societies have hierarchieswhich correspond to unequal distribution of resources.No one has succeeded in abolishing social inequalities.This does not for one moment mean that we should


THE FABIAN ESSAY

Wilkinson’sconclusions –that inequality

affects thehealth of thenon-poor as

well as the poor– have been

hotly debated.But there seemslittle doubt thatthe degree of

inequality doesmatter for health

* These Figures come from Tackling Health Inequalities: 2007 Status Report on the Programme for Action.DH 2008. The production of this report was overseenby the government’s Scientific Reference Group on Health Inequalities which I chair.

40-65yrs 65-89yrs 70-89yrs

80

70

60

50

40

30

20

10

0

Admin Prof/Exec Clerical Other

Figure 2 Whitehall gradient – absolute difference in mortality by grade and age

Source: Marmot MG, Shipley MJ (1996) . Do socioeconomic differences in mortality persist afterretirement? 25-year follow-up of civil servants from the first Whitehall study. BMJ,313(7066):1177–1180.


THE FABIAN ESSAY

therefore ignore health inequalities. The magnitude ofhealth inequalities varies within a society over timeand varies across societies. If the social gradient inhealth is not fixed it is a reasonable question to askwhat we can do to change it.The most intrusive question, then, is whether the de-

gree of inequality in society matters. Richard Wilkinsonhas argued powerfully that it does; that the greater thedegree of income inequality the worse the overallhealth of society and the higher the rates of crime andsocial disorders. Wilkinson’s conclu-sions – that inequality affects thehealth of the non-poor as well as thepoor – have been hotly debated. Butthere seems little doubt that the de-gree of inequality does matter forhealth.Income matters but not for the rea-

sons it does in Guatemala where thepoor lack clean water, adequate nutri-tion, reasonable shelter and qualitymedical care. As the American econo-mist Robert Fogel says in describingthe US scene: there are now more ra-dios in the US than there are ears. Thepoor own automobiles and areplagued by obesity rather than calorieshortage. Material deprivation, in the$2 a day sense, is over in the US as it isin Britain. To see that, look at infantmortality rates. Infant mortality is ex-quisitely sensitive to material depriva-tion. In Guatemala the poorest 20%have infant mortality of 58/1000 live

births. In England the most disadvantaged group, sin-gle mothers who have neverworked or are long-term unem-ployed, have infant mortality of10/1000 live births. For those as-signed to the “low” socioeconomicclassification – routine and manual– the infant mortality is now5.6/1000 live births.* Fogel says thatthe next great challenge is egalitari-anism of quality of social and psy-chological resources. He uses theterm ‘spiritual; I use the rather moreresearchy ‘psycho-social’ – by whichI mean the degree of control peoplehave over their own lives and theiropportunities for full social partici-pation – but we are talking aboutthe same thing.Increasing income inequality,

the incomes of the rich growingmore rapidly than those of thepoor, means that some have morecompared to others: relative in-come inequality grows even as ab-

solute standards of living improve.Economist/philosopher Amartya Sen provides insightinto how income matters. Relative income is important,he says, because it translates into absolute differencesin people’s capabilities to lead a flourishing life. What are we all saying: spiritual? Control over your

life? Capability to lead a flourishing life? Being a socialparticipant? A dispassionate observer might ask if theseshould be in the realm of policy. Of course it should.Being relatively poor means that a flourishing life is

7171

72 62 63

59

5449

44

50

24

45

40

35

30

25

20

25

10

5

0

Poverty rates post tax and transfers Poverty reduction by income redistribution

Finl

and

Nor

way

Swed

en

Belg

ium

Ger

man

y

Net

herla

nds

Italy

Spai

n

Cana

da UK US

Figure 3 Poverty pre and post tax and benefits

Source: Lundberg et al 2007 citing Fritzell and Ritakallio 2004. Data from Luxembourg Income Study

Table 1: Male life expectancy: Glasgow, Washington DC, and selectedcountries

Place Life expectancy at birth, (male)

Scotland, Glasgow (Calton)b 53.9Indiaa 62.3United States, Washington D.C. (black)c 62.5Pakistana 64.3Lithuaniaa 66.9Philippinesa 68.9Polanda 71.0Mexicoa 73.1Koreaa 74.3United Statesa 75.2Cubaa 75.8United Kingdoma 76.7Japan 78.7Scotland, Greater Glasgow (Lenzie)b 79.5United States, Montgomery Country (white)c 79.5Iceland 79.9

a Country data: 2005 data from Human Development Report (UNDP 2007) b pooled data 1998 – 2002: Hanlon P, Walsh D, Whyte B (2006) c pooled data from 1997 – 2001: Murray et al. (2006)


THE FABIAN ESSAY

less open to you. You have less control over your life,fewer opportunities to be a full social participant, andhealth suffers as a result.

Policy mattersFigure 3 shows the impact of policy on poverty. It usesa relative definition of poverty, as we do in the UK –below 60% of median income. It shows that before taxesand transfers poverty levels in the UK are higher thanin the US and a little higher than in Sweden. Taxes andbenefits reduce poverty levels in the UK by 50%. This isbetter than in the US but pales by comparison withSweden, Norway and Finland where government pol-icy reduces poverty levels by more than 70%. Absolutedeprivation may be finished in the UK but relativepoverty affects what people are able to do in society. Wehave a choice. Do we want a society with higher levelsof poverty such as the US or one with lower levels suchas in the Nordic countries. It gives different meaning tochoosing health.Parenthetically, the US has lower life expectancy and

worse health than we do. In fact, in terms of life ex-pectancy up to age 65 the US ranks 33 globally for menand 36 for women. I would not be so scientificallycrude as simply to attribute the comparatively poorhealth in the US to their miserly approach to the rela-tively poor and disadvantaged. What one can say withconfidence is that their approach does not appear to bebenefitting them much, as illustrated by Table 1. Interms of health, the poorer parts of Glasgow andWashington DC are worse places to live than manycountries at much lower levels of income. To accentuatethe point that social inequalities in health are not onlyabout money, 80% of India’s population live on $2 aday, yet average life expectancy is better than in thepoorest part of Glasgow.The nature of tax and benefits also matter. Regularly,

the Office of National Statistics produces a splendid re-port on the effects of government fiscal policy on dis-tribution of income. It has three major messages. First,income tax and transfers are strongly progressive: theyredistribute income to the benefit of those worse off.Second, consumption taxes are clearly regressive.Consumption taxes have the advantage that they maybe “green” or discourage smoking and drinking butthey are regressive and hurt the incomes of those lowerdown the income scale, relative to those higher up.Third, distribution in kind – for example health careand education – has progressive effect. Governmentscan do a great deal. Witness the present government’scommitment to reduction in child poverty. As a result600,000 fewer children are in poverty.

More than health care I am guessing, now, but I suspect that most of us whowork in the health sector in the UK have a strong, evenpassionate, commitment to a national health servicefree at the point of use. The NHS is a representation ofsocial capital. It is there for everybody. To the extent

that there remain differences inaccess and use, in different so-cioeconomic or ethnic groups,these should be ironed out.But differences in health care

are not the main reasons for theoccurrence of social inequalitiesin health. Health inequalitiesarise because of differences inthe causes of illness. Armedwith that insight, it is then com-mon to focus on individual be-haviours: smoking, obesity andalcohol. I chair the Commissionon Social Determinants ofHealth set up by the WorldHealth Organisation. We usethe phrase: “the causes of thecauses”. Smoking and obesityare potent causes of illness andmake important contributionsto generating inequalities inhealth. But why are there in-equalities in smoking and obe-

sity? What are the causes of these causes? Our answeris, along the lines of the above discussion, that thecauses of the causes lie in the circumstances in whichpeople are born, grow, live, work and age – the socialdeterminants of health.This implies that action to reduce health inequalities,

while involving the health sector, must involve thewhole of government. I have already given the exampleof policy on taxes and benefits. Two more examplesmake the point.We know that the higher the education of parents the

greater is the literacy of young people. Literacy mat-ters, of course, for life chances including: income, thetype of job, and whether you live in Somers Town orHampstead. These, in turn, will contribute to health in-equalities. The data show that there is a gradient in thelink between your parents’ education and your own lit-eracy competence. But the steepness of the gradientvaries. The impact of parents’ education is muchstronger in the UK than it is in Sweden or, not shown,in Japan. We are failing our children. Some of that maybe to do with the quality of schools but it starts withfamily environment, and early pre-school child devel-opment, which is affected by the circumstances inwhich the parents live and work. Surely it should be amajor policy aim to try and break the link between par-ents’ circumstances and the literacy levels of their off-spring.The other example comes from work. Occupational

diseases, in the sense of exposure to chemical and phys-ical hazards, remain a concern. But the major contribu-tion of work to health is in the diseases that we don’tusually classify as occupational: mental illness, muscu-loskeletal disorders, heart disease. Here, there is abun-dant evidence that the psychosocial work environmentmatters. We have shown strong effects on illness risk of

The NHS is arepresentation

of socialcapital. It is

there foreverybody. Tothe extent that

there remaindifferences in

access and use,in different

socioeconomicor ethnic

groups, theseshould be

ironed out.


Fabians: setting the health agenda

The Fabian Society celebrates the 60th anniversary ofthe NHS, having being the first to call for its creationand having consistently set the political and policyagenda on health.

� 1911 The Fabian tract A National Medical Servicemakes the first call for free universal healthcare,building on Beatrice Webb’s 1909 Minority Reporton the Poor Law.

� 1968 Leading Fabians Richard Titmuss, Brian Abel-Smith and Peter Townsend – who have set much ofthe post-war health policy agenda in their work atthe LSE – challenge the government to link health,welfare and poverty policy in their Socialism andAffluence Fabian lectures and book.

� 2000 The Fabian Tax Commission’s call forhypothecating extra taxation to increase healthspending sets the agenda for the government’s £8billion increase in health spending by increasingnational insurance in the 2001 budget.

� 2002 Howard Stoate’s All’s Well That Starts Wellmakes an influential call for a national obesitystrategy. Several ideas such as cookery lessons inschools are adopted. Others – like banning pre-watershed advertising – remain on the campaigningagenda. In 2006 Stoate’s follow-up pamphletChallenging the Citadel sets out a strategy to makethe shift to public health possible.

� 2006 The Fabian Life Chances Commissionanalysis of inequalities at birth leads to GordonBrown reforming child benefit so that it is paid fromthe 29th week of pregnancy.

� 2007 Louise Bamfield’s Born Unequal continues thepush for better support for pregnant mothers, withgovernment responding with the new MaternitySupport Grant to improve nutrition in pregnancy.

� 2008 The Fabian health inequalities forum, with SirMichael Marmot and others, and this special FabianReview set out new ideas as we seek to shape thenext decade agenda with new ideas for the nextmanifesto. The Fabians are also looking tocommission a new Fabian Ideas pamphlet on health.

three types of occupational ex-posure: jobs characterised byhigh demand, low control andlittle support at work; imbal-ance between efforts and re-wards; low organisationaljustice at work. Singly and to-gether these make a major con-tribution to preventable illnessin working age populations.These are in addition to thehealth hazards of unemploy-ment and insecure employ-ment. These psychosocial riskscan all be influenced by man-agement policy. We do notsimply have to accept them asan inevitable part of a complexwork scene.

Who cares about health inequalities?We all care about health. The Commission on SocialDeterminants of Health argues, following WHO, thathealth inequalities that are avoidable are inequitable, un-fair. Putting them right is a matter of social justice. But min-isters of education, transport, industry, finance might arguethat health is not their business. Health is for the Secretaryof State for Health. It is for him but, given the social deter-minants of health, health inequalities are also for the wholeof government. Ministers in other departments should carebecause improvement in health and reductions in health in-equalities are clear signs of social progress. We know thingshave got better in Britain, generally, because the health of allsocial groups has been improving. There remains a contin-uing significant challenge: now, to make progress in reduc-ing health inequalities.

1. Marmot M, Status Syndrome, Bloomsbury London 20042. Tackling Health Inequalities: 2007 Status Report on the Programme

for Action.DH 2008.3. CSDH Interim Statement (2007) Achieving Health Equity: from root

causes to fair outcomes, Commission on Social Determinants ofHealth http://www.who.int/social_determinants/resources/interim_statement/en/index.html

4. Image from: WWW.CAMDENPCT.NHS.UK/YOUR_HEALTH/LIFE EX-PECTANCY.HTM Data from London Health Observatory:www.lho.org.uk/DataAndMethods/PCTIndicators.htm

5. Marmot MG, Shipley MJ (1996). Do socioeconomic differences inmortality persist after retirement? 25-year follow-up of civil servantsfrom the first Whitehall study. BMJ, 313(7066):1177–1180.

6. Lundberg O, Yngwe MA, Stjarne MK, Bjork L, Fritzell J (2007) TheNordic Experience: Welfare States and Public Health (NEWS) Reportfor CSDH, Stockholm, Centre for Health Equity Studies (CHESS)

7. Fritzell, J. & Ritakallio, V-M. (2004) Societal Shifts and ChangedPatterns of Poverty. LIS Working Paper Series, no. 393. Luxembourg& Syracuse, NY.

8. UNDP (2007). Human development report 2007/2008.FightingClimate Change: Human solidarity in a divided world. New York,NY, United Nations Development Programme.

9. Hanlon P, Walsh D, Whyte B (2006). Let Glasgow flourish.Glasgow, Glasgow Centre for Population Health.

10. Murray CJL et al. (2006). Eight Americas: investigating mortality dis-parities across races, counties, and race-counties in the UnitedStates. PLoS Medicine, 3:1513–1525.

The Commissionon Social

Determinants ofHealth argues,

following WHO,that health

inequalities thatare avoidable

are inequitable,unfair. Putting

them right is amatter of social

justice


BOOKS Books Editor:Hannah Jameson

Paul Collier is a controversial figure,particularly amongst some develop-ment non-governmental organisations(NGOs), and he clearly enjoys beingprovocative. Don’t look to NGOs tohelp solve the problem of globalpoverty, he suggests in the first chapter;they are more interested in moralisingand keeping their messages simplethan in developing a credible policyagenda that would benefit the world’spoor. They generate ‘developmentbuzz’, but are ‘at times a headless heart’. While some development NGOs will

bristle with indignation at this, Collier istoo credible a figure to be ignored.Currently the Head of the Centre for theStudy of African Economies at OxfordUniversity, formerly a Director ofResearch at the World Bank and adviserto the British Government’sCommission on Africa, he deserves tobe taken seriously. NGOs should en-gage with Collier’s argument and re-spond to his criticisms by developingthe very policy agenda he claims theylack. Providing a measured critique ofCollier’s latest book would be a goodplace to start.The Bottom Billion is well written, un-

derpinned by a mass of economicanalysis, and makes a powerful argu-ment for re-conceptualising our ap-proach to development. At a timewhen the development debate has be-come unhealthily polarised betweenchampions of aid like Jeffrey Sachs andits harsh critics such as William Easterly,Collier offers a more nuanced and so-phisticated narrative that recognises therole of aid but also the need for a much

wider range of policy instruments to re-duce poverty.Collier’s core thesis is a simple one.

The problem is not the five billion peo-ple who live in what are still called de-veloping countries. Many of thesepeople, he suggests, have already madeor begun the transition out of acutepoverty thanks to economic growth.This contrasts with the situation ofaround a billion people (largely but notexclusively African) who live in 58countries that are ‘falling behind, andoften falling apart’. This is where Collierargues that the focus of global develop-ment efforts should now be. Is Collier’s proposed framework use-

ful? Well, yes and no. It seems unhelp-ful to suggest that there is not adevelopment problem in countries out-side the bottom billion, or, to be morespecific, not a development problemthat the world’s richer countries shouldspend much time worrying about. 80per cent of the world’s poor may live incountries that are developing, ‘often atamazing speed’, but it is a big leap tosuggest that the elimination of acutepoverty is a done deal. Look at India.Despite high rates of economic growthfor over a decade, the country’s povertylevels remain stubbornly high, includ-ing shocking levels of maternal andchild mortality. One explanation is the persistence of

entrenched inequalities, including thecaste system, that prevent poor familiesfrom improving their income, health,education and nutritional status. Whatis true of India applies more widely.Economic growth is vital for develop-

ment, but it must be complemented bya greater focus on rights and justice.Collier says relatively little about these. Where he is on stronger ground is in

his suggestion that the ‘bottom billion’countries present formidable and gen-uinely new development challenges.The international policies that mighthelp these countries make progress indevelopment go far wider than the tra-ditional aid, debt relief and tradeagenda. No amount of development as-sistance will make much difference tothe long-suffering people of Somalia un-less there is real movement towards apolitical resolution of the conflict andthe development of some functioningpolitical and administrative institutions. Collier’s argument is that the coun-

tries of the bottom billion remaincaught in a series of development traps.He focuses on four in particular: con-flict, natural resource wealth, geogra-phy, and bad governance.Seventy three per cent of the people

in the societies of the bottom billionhave recently been through a civil waror are still in one. Even where theyemerge from civil war, there is around afifty per cent chance that they will slipback into violence within five years.These conflicts are hugely destructiveand a major barrier to countries liftingthemselves out of poverty. The conflicttrap is unlikely to be overcome withoutgreater international support for con-flict prevention, resolution and peace-building.He highlights next a natural resource

trap - a tendency for abundant naturalresource wealth to fuel corruption andpatronage rather than foster growthand development. Through initiativeslike Publish What You Pay (a campaignpressing extractive industries to publishtheir resource payments to nationalgovernments), NGOs have been on thiscase for some years. But Collier is rightthat there is more to do to help the poor-est countries manage their resources ef-fectively, so that large-scale oil or gasreserves become a blessing not a curse.A third trap is to be landlocked and

bordered by ‘bad neighbours’ (30 percent of Africa’s population is estimatedto be in this category). Collier suggeststhat these conditions can be a major im-pediment to countries trading their wayout of poverty. Addressing this obstacleis complex, although greater invest-ment in transport infrastructure can

In The Bottom Billion, Paul Collier makes an

incomplete case for tackling poverty,

says David Mepham

58 countries falling apart


play a role. This is an issue that manyNGOs have neglected. Lastly, Collier focuses on the conse-

quences of bad governance, particu-larly in smaller countries. Threequarters of the population of the bottombillion live in countries that are or havebeen failing states. It is extraordinarilydifficult to break free from this trap: heestimates the chances of any one coun-try doing so each year at just 1.6 percent. Collier makes a number of pro-posals, worthy of further study. ForNGOs, more thinking is needed on howto provide assistance to poor people liv-ing in dysfunctional polities and how tosupport those elements of civil societytrying to rebuild state institutions andestablish basic services.While these four traps do present real

obstacles to development in the poorestcountries, they are not the only ones. Itwould be possible to construct a muchlonger list of development traps. Twoin particular are worth flagging here. Firstly, there is what might be called

the ‘late developer trap’. Stimulatingeconomic activity is challengingenough for the countries of the bottombillion, but the existence of a highlycompetitive low-cost producer likeChina makes it harder still for thesecountries to diversify their economies

and shift into value-added exports.Tailored support may be required to as-sist diversification strategies in thesecountries and to help meet the chal-lenge that China represents.Secondly, there is the impact of cli-

mate change. Collier acknowledgesthat geography can shape developmentoptions, but he says relatively littleabout the extent to which the world’sricher countries are primarily responsi-ble for climate change and how thisdamages the development prospects ofthe world’s poor. Collier argues that de-velopment traps are rooted largely inthe countries themselves and that exter-nal support is needed to assist countriesto break free of them. But the issue ofclimate change shows that wealthiercountries are also part of the problemand need to put their own house inorder. Collier ends his book with a rallying

cry that would not look out of place in aNGO campaign pamphlet. ‘Within thesocieties of the bottom billion there is anintense struggle between brave peoplewho are trying to achieve change andpowerful groups who opposethem…To date, we have largely beenbystanders. But our support can be de-cisive’. He is right. Development is amore political and less technocratic

process than NGOs and governmentshave often been prepared to acknowl-edge. In the countries of the bottom bil-lion and more broadly in thedeveloping world, progress in reducingpoverty requires greater support for re-formist elements in the countries con-cerned, those who are pushing for moreaccountable government, action againstcorruption, and greater attention to theneeds of the poor. Though both sideswill be loath to admit it, on this issueand many others, mainstream develop-ment NGOs and Professor Paul Collierare not so far apart.

The BottomBillionPaul Collier

£16.99OUP

David Mepham was the principalauthor of a recent Save the Childrenreport on child mortality: SavingChildren’s Lives – Why EquityMatters

BOOKS


BOOKS

“People of the Book” (Ahl al-Kitab) isthe Koranic term for religious com-munities outside that of theProphet, whose message is re-garded as merely the final form ofIslam – submission to God alone.People of the Book are those whocling to scriptures and prophets re-vealed or sent by God prior toMuhammad. The term has prima-rily been applied to Jews andChristians, although it also partlyincluded Zoroastrians in earlyIslam, and there was even the sug-gestion in later Islamic history thatHindus could perhaps be coveredby this term, given their scripturesthat also speak of Divine realitiesand higher truths. This Koranic de-scription of people of other faiths isone of respect as well as responsi-bility: the respect allowed a domi-nant Islamic civilisation to includenon-Muslim subjects with immensegenerosity overall; the responsibil-ity is upon all people of faith to betrue to God’s wordKarabell eloquently narrates the

millennium-and-a-half-long stories

of complex coexistence amongstJew, Christian and Muslim: Muslimtolerance in periods of unques-tioned dominance but some harshtreatment when People of the Bookwere seen as a threat: Medina,Damascus, Baghdad, Andalusiaand the Ottoman empire provideample examples. One of Karabell’sloudest messages is that it is oftenthe conflicts only that are remem-bered, on all sides, whilst the glori-ous accomplishments ofco-operation are forgotten and dis-appear like a mirage – this collec-tive amnesia must be reversed if weare serious about peace betweenfaiths in our world.Memorable and fascinating en-

counters during this history includethe summoning of the Nestorianpatriarch Timothy I to the palace ofAl-Mahdi in Baghdad, c. 780 CE, todebate theology with the caliphhimself. Half a century later, theepisode is repeated with the Greekorthodox bishop Abu Qurra andCaliph Al-Ma’mun but thenNicephorus, Emperor ofByzantium, and Harun al-Rashidexchange insults by correspon-dence. The Christian Cordoba mar-tyrs give their lives to proclaim thesuperiority of their faith amidst theAbrahamic glory of Andalusia thatproduces both Averroes andMaimonides. The latter, who re-mains a towering medieval Jewishthinker, theologian and philoso-pher, also serves as personal physi-cian to none other than Saladinhimself, the Muslim hero of theCrusades. Meanwhile, the TurkicKhazar tribe of modern-day Russiachooses monotheism and convertsto Judaism, at least partly in orderto avoid being caught in direct con-flict between neighbouring, com-peting Christian and Muslimempires. Such rich encounters aresadly unthinkable in parts oftoday’s world that are characterisedby polarisation and mutual igno-rance and hatred.The Ottoman millet system of self-

governing faith communities is fas-cinating, though complex andproblematic – echoes of it may havebeen heard by some in “that recentlecture” by the Archbishop ofCanterbury. The legacy of colonial-

ism and the fall of the Islamic em-pires is clear: Muslims “met thechallenges of dominance; they arestill struggling with the challengesof defeat.” (p. 197)Karabell continues throughout

history to bring us up to date withthe situation today, influenced by amyriad of historical influences. TheIslamic reformist and nationalistmovements over the last two cen-turies are every bit as complex andinteresting as the phenomenon ofZionism. Modern nation states inthe Middle East have their own pe-culiar dynamics with religiouscolouring, whether Egypt, Israel orJordan: the Jewish state, like almostevery Muslim country, has funda-mentalist-secularist tensions. It isan obvious mistake, although manyfall into it, to reduce conflicts in theMiddle East to simple faith-basedcrusades or jihads. The book ends with a provocative

chapter entitled, “Is Dubai theFuture?” to which my answerwould be: perhaps, but with muchless materialism. There needs to bedeeper philosophical and theologi-cal contact also, as there was forcenturies. The phrase “Islam andthe West” in the title is itself prob-lematic, given the rich religious,philosophical, political and culturalinteractions that the author master-fully describes, but the author issurely right in his conclusions: “Ifconflict is what we want to see,there is conflict. But if peace iswhat we are looking for, then peaceis there to be found … Peace iswoven into our collective past; it isthere to be seen in our messy pres-ent; and it will be there in ourshared future.” (pp. 285, 291)

Usama Hasan is Director of the CityCircle, London.

People of the Book: The ForgottenHistory of Islamand the WestZacharyKarabell

£9.99John Murray

Warandpeace

In a narrative spanning

14 centuries,

Usama Hasan finds a

new understanding of

Islam and the West


BOOKS

This is a provocative book but one thatpromises more than it delivers. James’scentral contention is that the move fromwhat he terms ‘unselfish’ to ‘selfish cap-italism’ in English-speaking nations hasled to a surge in the level of mental ill-ness since the 1970s. He attributes thistrend to the spread of ‘relative material-ism’ (or the ‘affluenza virus’ that was thesubject of his previous book) and its ob-session with money, possessions andfame. James attempts to prove that the ad-

vent of selfish capitalism has brought arise in emotional distress by drawing ontwo data sources. The first is a set ofsample surveys of levels of emotionaldistress at different points over the last30-40 years in the US and the UK. Theseshow much higher levels of contempo-rary distress than in the past.

The problem is that the upward trendin distress levels could as easily be ex-plained by the growth of what might becalled the ‘stress industry’, the expan-sion of the counselling and psycho-ther-apy professions and along with themthe lifting of the stigma and prejudice as-sociated in the past with the admissionof depression and anxiety. This willhave led to an increase in the numbersof people saying yes when asked if theysuffer from emotional distress in self-defining surveys and may well accountfor most of its rise. James of course ispart of this industry himself, both as apractising clinical psychologist and as acampaigner and polemicist. Moreover to accept the thesis we

would have to believe that Britons expe-rienced much less emotional upheavalin the immediate post-war decades,that, for example, women often trappedin unhappy marriages and lacking thegreater economic independence and ed-ucational and professional opportuni-ties they enjoy today were muchhappier then their counterparts today? The second set of data is drawn from

a study by the World HealthOrganisation into the level of distressacross a number of nations. This seemsto show that distress is sharply higher inAnglo-Saxon developed nations thanelsewhere with the US at the top of thetable. The conclusion from this data isless easily dismissed but again there arequestions about James’s interpretation. First there is the somewhat funda-

mental problem that the UK, Australiaand Canada are not part of the WHOstudy. To include these countries in thecomparison James draws on other andby his own admission, non-comparable,data. Moreover some of the differencesbetween nations can be explained bycultural differences. That Spain, Italy

and France have relatively lower rates ofdeclared distress may be due in part tothe continuing, if declining, influence ofCatholicism in maintaining familystructures and social coherence as muchas their adoption of a more unselfishmodel of capitalism. There is also theawkward issue of China’s relatively lowlevel of reported distress alongside itsown transition to consumer capitalism,a snag dismissed as due to the rot notyet having set in.While James’s fundamental case is

unproven that does not mean all is rightwith the model of consumer capitalismthat he targets. The rise of mass afflu-ence once offered the prospect, perhapsnaively, of more leisure, more choiceover lifestyles and an end to both ab-solute and relative poverty. Instead,Anglo-Saxon capitalism has become in-creasingly dependent on rampant con-sumerism despite the growing evidenceof the weak link between well being andmaterial living standards. The rise of affluence has brought im-

proved living standards for all alongwith wider opportunities in work andeducation for the majority and fewwould opt to return to the limitedlifestyle options available to earlier gen-erations. But affluence has also broughtthe commercial exploitation of children,the over-rewarding of business and Cityexecutives, the idolising of the super-rich and a return of levels of wealth andincome inequality not seen since beforethe Second World War. To date the po-tential offered by rising material wealthto bring greater equality and well-beinghas yet to be harnessed. It is this para-dox of prosperity that is one of the mostintractable challenges facing Britaintoday.

The SelfishCapitalistOliver James

£9.99John Murray

Stewart Lansley is the author of RichBritain, The Rise and Rise of the Super-Rich. His book Londongrad will bepublished in September.

Stressballs

Stewart Lansley is

unconvinced by Oliver

James’ ‘selfish capitalist’

FABIAN QUIZFor the first time in history Asia will contain three large, economi-cally powerful countries, all with interests and ambitions that rangeacross the whole region, and the world. Rivals: How the powerstruggle between China, India and Japan will shape our nextdecade, by Bill Emmott will explore the legacies of history, thelikely future trajectories of China, Japan and India, and the poten-tial collisions which will shape the 21st century.

To win a copy of the book, answer the following question:

Q: Who was the Secretary of State for Health when the NHS wasfounded in 1948?

Please send you answers on a postcard, postmarked no later than15th February 2008 to 11, Dartmouth Street, London, SW1H 9BN.Or, email your answer to [email protected].


We should be in a golden age ofwomen’s participation in public lifein Britain. Great progress has beenmade – and our democratic systemsare transformed as a result. There isno doubt that the LabourGovernment has a strong record oninclusion and representation in poli-tics, and has invested considerableresources to boost engagement inpublic life. Our equality bodies andinstitutions are being revolutionised,with the new Equality and HumanRights Commission and theGovernment Office for Equalities. Yet less than 20 per cent of MPs

are women. Indeed, as the ElectoralReform Society showed, the major-ity of constituencies have neverelected a woman, and in fact just 291women have ever been elected inthe history of the Commons. Under30 per cent of local councillors arewomen in England, and women

make up just over a third of publicappointments. This matters – we know that if rep-

resentatives are not as diverse as thepopulations they represent it can re-duce the quality of debate and re-duce legitimacy. We need to make areal step change and that means fo-cussing not just on how our systemsneed to change in terms of proce-dures and processes, but taking a re-newed look at the lives of women,and on what they want.This is why the Female Futures pro-

gramme, run by the Fabian Women’sNetwork, has been exploring the ex-perience of women today. What en-courages women to take a step intopublic life, and what happens to themwhen they do? Women of all ages,backgrounds and levels of engage-ment have participated in round tablediscussions with female MPs at theHouse of Commons. We have partici-pants in their fifties who are consider-ing public life for the first time andsome in their twenties who have al-ready been elected as councillors. TheMPs have been open and frank abouttheir personal experiences. It has been clear from these discus-

sions that there is a real lack ofawareness about the public roles thatwomen could consider. Althoughwomen are now taking part in farmore community activity – justunder 50 per cent of magistrates and54 per cent of school governors arewomen – a common experience isthat women take a next step whensomeone actually asks them if theywant to take on a role, and sharestheir own experience of doing it. The answer to engaging women is

as much about recognising the reality

of women’s lives as it is about sys-temic change – our discussions havenot just been about process and pro-cedure. Almost straight away, theytake on a personal perspective, focus-ing on how women juggle much inlife, and the challenges they face inmaking a public commitment. And itis clear that roles could sometimes bemore challenging than some of ourparticipants had expected – thatprogress was much slower. There is also a gap between what

women expect from taking part inpublic life, and what the experienceis really like. Involvement in publiclife can come at a high personalcost. It is not unusual for council-lors, for example, to do case worklate into the evening and overweekends. What’s more, asking for help or ad-

vice when you are older can be a dif-ficult thing to do. Within the FabianWomen’s Network, even womenwho have achieved senior positionsin their fields say that if they had hadroutes through which to ask for ad-vice and mentoring, they would haveachieved their positions far earlierand with much less struggle. This isone reason they are so keen to be partof a process that means they can sup-port younger women today.This is a year of important anniver-

saries. Ninety years ago, in 1918,women won the battle for the voteand were finally able to stand for theHouse of Commons. In 1928 menand women over 21 were granted theright to vote in the Equal FranchiseAct, and in 1958 women were al-lowed to become members of theHouse of Lords. What’s more, thisyear also marks the 100th anniver-sary of the founding of the firstFabian Women’s Group. Parliament now has more women

than ever before, though the recordof individual political parties ishighly uneven – 76 per cent of femaleMPs are Labour. And women can cel-ebrate progress the world over. Over40 nations have now had a femalePrime Minister or President in thelast fifty years, with Hilary Clintontantalising the world with the firstserious prospect of the USA joiningthe club. What better year in which toput a marker down to make thegolden era of women in public lifebecome a reality?

When the personalbecomes political

We need to take a radical

new aproach to get more

women into public life – and

Labour has to take the lead,

says Seema Malhotra

Seema Malhotrais Director of theFabian Women’sNetwork


These pages are your forum and we’re open to your ideas.Please email Tom Hampson, Editorial Director of the FabianSociety at [email protected].

EASTERN REGIONAL CONFERENCESaturday 18 October. 10.30 at the Alex Wood Labour Hall, Cambridge

‘The Child Poverty Challenge – the Politics of Equality’

£10 including lunch and all refreshments.Details from Deborah Stoate

ANNUAL HOUSE OFCOMMONS TEATuesday 1 July 2.00, Committee Room 10followed by Tea in the Members Dining Room at 4.00

‘Is Meritocracy Enough? The New Politics of Class’

Tea afterwards in the Members Dining Room. Price: £16Tickets from Deborah Stoate at the Fabian Society

Speakers include:

David Lammy MPMinister for Skills,

Dr Stella CreasyPPC for Walthamstow.

For further details and tickets, contact Deborah Stoate at the Fabian Societyor on [email protected]

Alan Thake (1927–2008)

Alan was a founder member of Havering FabianSociety, which flourished due to his enthusiasmand good humour. He and Eirlys, his wife,would meet speakers and provide refreshmentsbefore meetings. He was also involved withNational Fabians, including acting as scrutineer.Alan was a dedicated member of the localLabour Party and expended much shoe leatherin his canvassing and leafleting.

Educated at Brentwood school, Alan taught insecondary & primary fields and became Headof three schools. An active member of theHumanists and an enthusiast for Essex Cricket,theatre, Bach & Jazz and especially theEuropean Union, for which he’d served as anEducation Officer. His service in Japanprofoundly changed his views regards nuclearweapons. A recent meeting of local Fabianswith former MEP, Carole Tongue, on the 50thanniversary of the EU, was a fitting epitaph.Alan leaves a widow and many friends who willmiss him deeply.DAVID BALDOCK & DAVID MARSHALL.

Fabian Women’s Network

Over 300 women turned out to hear guest speakersEd Miliband MP, Boni Sones and Dianne Hayter asthe Fabian Women’s Network celebrated its threeyear anniversary. The Network Reception on Feb19th saw a packed room at the Jolly St ErminsHotel in Westminster, with MPs including MegMunn, Vera Baird and Fiona MacTaggart braving aseries of three line whips to join in part of theevening. Highlights from the evening included BoniSones reading extracts from her recent bookWomen in Parliament:The New Suffragettescontributing to a lively and humorous celebration ofthe lives of women in politics, past and present.

NOTICEBOARD


FABIANBOOKSHELF

What should we be reading?Advertise your latest book, pamphlet or publication on our bookshelf. For more information contact Hannah Jameson020 7227 4911 [email protected]

Email [email protected], or call 020 7367 4150 to buy your copy

EARTH INC.BY MICHAEL BOLLEN

“A FUNNY, CHARMING, INVENTIVECOMIC NOVEL. MICHAEL BOLLEN’SWARMTH, SHARP WIT AND EYE FORSATIRICAL DETAIL REMINDED ME OFDOUGLAS ADAMS. QUITE POSSIBLY THEBEST WORK OF FICTION SINCE THE BIBLE”Stephen Merchant, The Office, Extras

It’s 2052, corporations have taken over theworld and George just wants to go to bed. But a conspiracy of killer robots, cyber-terrorists,a mad scientist and the END OF THE WORLDprevent this from happening. Again and againand again . . .

POLITICS & PARANOIABY ROBIN RAMSAY, editor of Lobster

“LOBSTER IS ONE OF THE MOST IMPORTANT MAGAZINES TO BELAUNCHED IN THE POSTWAR PERIOD IN BRITAIN”Paul Foot

“JOURNALISM AT ITS BEST: CURIOUS,ANALYTICAL, RELIABLE, WRY AND INDISPENSABLE”JOHN PILGER

A fascinating collection of essays from one of theUK’s top experts on espionage, conspiracy theories and the abuse of power.

Available from www.picnic-publishing.co.uk

ISBN: 978 0556105 3 0 352pp paperback £9.99

ISBN: 978 0556105 4 7288pp paperback £9.99

Marjorie Tait (1920–2007)

Well known to generations ofFabians, initially as our accountant,Marjorie’s background wassomewhat non-Fabian. Her parentshad been tenant farmers in Sussex,sending her to Horsham Girls school.From there, she joined the CivilService, initially working for the WarOffice in Enfield. She thentransferred to Chessington where shemet Reg and settled, in 1953, intoone of the happiest of marriages, firstin Dorking and later Betchworth.After her retirement from the civil serv-ice, she became the Fabian keeperof the books – in every sense. Notsimply writing the most orderly andprecise cashbooks (so clearly set outthat our auditor liked to send his jun-iors down to work on them to seeperfect double-entry book-keeping inpractice) but refusing errant General

Secretaries’ attempts to overspendand once, when the finances wereparticularly dire, reporting directly tothe Treasurer that “something must bedone”. Her two-days a week inDartmouth Street were alwaysaccompanied by a packet of JaffaCakes, which she shared round dur-ing an afternoon tea-break, ensuringgossip and intelligence got passedon. She shared an office with theLocal Societies’ Secretary, so felt verymuch part of the Fabian team, ratherthan simply a bean-counter. Whenshe retired from the Society, she re-turned each year as Chief Scrutineer– from 1988 until 2003 – attendingeach AGM to certify the results andrenew old friendships. Her belovedReg died in 1989 but, until quite re-cently, she continued to attend meet-ings, and to her garden, in her usualdiligent and quiet way. DIANNE HAYTER (FORMER GENERAL SECRETARY)

Fabian Fortune FundWINNERS: Mick Cornish: £100, Giles Bridge: £100

Half the income from the Fabian Fortune Fund goesto support our research programme. Forms availablefrom Giles Wright, [email protected]

FABIAN SOCIETY

Join the FabianSocietyAt the heart of Britain’s progressive movement, providing ideas and arguments for a more equal society.

� Keep informed. Receive the Fabian Review � Stay in touch. With the very best thinking with our quarterly Ideas pamphlets� Take part. Receive invitations to seminars, events, receptions and lectures throughout the year.

Join for six months for just £9.95 – and receive a free copy of the highly influential Fabian book‘Narrowing the Gap’, the final report of the Fabian Life Chances and Child Poverty Commission, along with the latest Fabian pamphlet and Fabian Review

From equality to foreign policy, the future of democracy to the environment, the Fabian agenda isfocused on the most important challenges for the next generation of progressive politics. Join today andhelp us to set the agenda.

Join online: www.fabians.org.uk Join by telephone: 020 7227 4900 Find out more: [email protected]

THE FABIAN SOCIETY


BATHRegular meetings – new memberswelcome.�Details and information from PaulThomas on 01761 438924 [email protected]

BIRMINGHAMAll meetings at 7.00 in theBirmingham and Midland Institute,Margaret Street, Birmingham.30 May. Neena Gill MEP on‘Presenting a Positive Vision ofEurope@11 July. Liam Byrne MP, Minsietr ofState for Borders and Immigrationand Minister for the W Midlands on‘Representing the Region - a newVision of Regional Leadership’Both at 7.00 in the Birmingham andMidland Institute, Margaret StreetBirmingham.�For details and information contact Andrew Coulson on 0121 414 4966 [email protected] or Rosa Birch on 0121 426 4505 [email protected]

BOURNEMOUTH & DISTRICTAll meetings at The Friends MeetingHouse, Wharncliffe Rd, Boscombe,Bournemouth at 7.30. 30 May. Sharon Carr-Brown PPC forBournemouth West on ‘Does theNHS need an Independent Board?’Michael Bunney. PPC for NorthDorset on ‘How Can We Reclaim theElectorate for Labour?’Both at 7.30�Contact Ian Taylor on 01202 396634for details.

BRIGHTON & HOVEMeetings 8.00 at Friends MeetingHouse, Ship Street, Brighton�Details from Maire McQueeney on01273 607910 [email protected]

BRISTOLSociety re-forming� For details contact Dave Johnsonon [email protected]

CANTERBURYNew Society forming. �Please contact Ian Leslie on 01227 265570 or 07973 681 451 oremail [email protected]

CARDIFF�Details of all meetings from SteveTarbet on 02920 591 458 [email protected]

CENTRAL LONDONRegular meetings at 7.30 in the ColeRoom, 11 Dartmouth Street, London SW1A 9BN�Details from Ian Leslie on 01227 265570 or 07973 681451

CHELMSFORD AND MID ESSEXNew Society forming, for details ofmembership and future events�Please contact Barrie Wickerson on01277 824452 [email protected]

CHESHIRENew Society forming in Northwich area. �Contact Mandy Griffiths [email protected]

CHISWICK & WEST LONDON29 May. Melanie Smallman of SERA.8.00 in the Committee Room,Chiswick Town Hall.June 26. Sir Nicholas Monck on the‘Better Government Initiative’ at8.00pm in the Committee Room ofChiswick Town Hall,HeathfieldTerrace,London W4 4JERegular meetings at Chiswick Town Hall�Details from Monty Bogard on 0208 994 1780, [email protected]

CITY OF LONDON�For details contact Richard Briggson [email protected]

COLCHESTER�Details from John Wood on 01206212100 or [email protected]

CORNWALLHelston area. New Society forming.�For details contact Maria Tierney [email protected]

DARTFORD & GRAVESHAM 30 July. Dr Ian Gibson MP on‘Winning a 4th term’. 8.00 at ‘TheChequers’, South darenth, dartford,Kent. �Details from Deborah Stoate [email protected]

DERBYRegular monthly meetings. �Details from Rosemary Key on01332 573169

DONCASTER AND DISTRICTNew Society forming�For details and information contactKevin Rodgers on 07962 019168email [email protected]

EAST LOTHIAN�Details of all meetings from NoelFoy on 01620 824386 [email protected]

FINCHLEYIf you’re interested in joining thisnew Society, please contact BrianWatkins on 0208 346 6922 [email protected]

GLASGOWNow holding regular meetings.�Contact Martin Hutchinson [email protected]

GLOUCESTERCongratulations on the 50th Seasonof Gloucester Fabian SocietyRegular meetings at TGWU, 1Pullman Court, Great Western Rd,Gloucester. �Details from Roy Ansley on 01452713094 [email protected]

HARROWRegular monthly meetings�Details from June Solomon on 0208 428 2623. Fabians from otherareas where there are no local FabianSocieties are very welcome to join us.

HAVERING �Details of all meetings from DavidMarshall [email protected]

HERTFORDSHIRERegular meetings. �Details from Robin Cherney [email protected]

HUDDERSFIELD AREANew Society forming. �Contact Jo Coles at

[email protected] if you areinterested

ISLINGTON21 May. Joe Harris (GeneralSecretary, National PensionersConvention) on’100 Years of the OldAge Pension’. And AGM25 June. Debate on Nuclear Power8.00 at Islington Town Hall.�Contact Pat Haynes on 0207 2493679

MANCHESTER�Details from Graham Whitham on079176 44435 [email protected] a blog athttp://gtrmancfabians.blogspot.com

MIDDLESBOROUGHNew Society hoping to getestablished. �Please contact Andrew Maloney on07757 952784 or [email protected] fordetails

NEWHAM�For details of meetings, contactAnita Pollack on 0208 471 1637 [email protected]

NORFOLKNew Society needs new members,�Contact Tod Sullivan [email protected]

NORTH EAST WALES�Further details from Joe Wilson on01978 352820

NORTHUMBRIA AREANew Society forming and would likenew members. �For details contact Pat Hobson [email protected]

PETERBOROUGHMeetings at 8.00 at the RamadaHotel, Thorpe Meadows,Peterborough.�Details from Brian Keegan on 01733265769, [email protected]

PORTSMOUTHRegular monthly meetings.�Details from June Clarkson on02392 874293 [email protected]

READING & DISTRICTFor details of all meetings,�Contact Tony Skuse on 0118 9785829 email [email protected]

SHEFFIELDRegular meetings on the 4thThursday of the month, 7.30 at theQuaker Meeting Room, 10 St JamesStreet, Sheffield S1�Details and information from RobMurray on 0114 2558341or TonyEllingham on 0114 274 5814 [email protected]

SHROPSHIRENew Society forming needsenthusiastic new members.�Contact Bob O’Brien on 07970850196 email [email protected]

SOUTH EAST LONDONMeet at 8.00 at 105 Court Lane,Dulwich London SE21 7EE For details of all future meetings,please visit our website athttp://mysite.wanadoo-members.co.uk/selfs/9 April. Ellie Levenson on ‘Feminismin the 21st Century.

8.00 at 105 Court Lane, Dulwich SE21 Regular meetings.�Contact Duncan Bowie [email protected] oron 020 8693 2709

SOUTHAMPTON AREA �For details of venues and allmeetings, contact Frank Billett on 023 8077 9536

SOUTH TYNESIDE�For information about this Societyplease contact Paul Freeman on 0191 5367 633 or [email protected]

SUFFOLKFull programme of meetingsplanned.�For details contact Sally Cook [email protected]

SURREYRegular meetings at GuildfordCathedral Education Centre �Details from Maureen Swage on 01252 733481 [email protected] July.Annual Garden Party 3.00.Dr Howard Stoate on ‘Whither theNHS’�Details and tickets from MaureenSwage on 01252 733481 [email protected]

TONBRIDGE AND TUNBRIDGE WELLS9 May. Tom Flynn on’ Trade Unionsin the 21st Century’All meetings at 8.00 at 71a St Johns Rd. �Details from John Champneys on 01892 523429

TYNEMOUTHMonthly supper meetings.�Details from Brian Flood on 0191 258 3949

WATERSHEDA new Local Society in the Rugbyarea, details from Mike Howkinsemail [email protected] or J DavidMorgan on 07789 485621 [email protected] meetings at 7.30 at the IndianCentre, Edward Street Rugby CV21 2EZ. �For further information contactDavid Morgan on 01788 553277 email [email protected]

WEST DURHAMThe West Durham Fabian Societywelcomes new members from allareas of the North East not servedby other Fabian Societies. It has aregular programme of speakersfrom the public, community andvoluntary sectors. It meets normally on the last Saturday ofalternate months at the JoinersArms, Hunwick between 12.15 and 2.00pm – light lunch £2.00�Contact the Secretary Cllr ProfessorAlan Townsend, 62A Low Willington,Crook, Durham DL15 OBG, tel, 01388 746479 [email protected]

WEST WALESRegular meetings at SwanseaGuildhall�Details from Roger Warren Evanson [email protected]

WIMBLEDONNew Society forming. �Please contact Andy Ray on 07944 454161 if you areinterested

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Documents

H e a T l t h Fabi anRev iew I e - Fabian Society · FabianReviewSpring2008 3 Fabian Review isthequarterly journaloftheFabianSociety [email protected] Editor TomHampson