This is my last article in this series about health. I started by addressing the needs of health services,

then continued with an exploration of how to move towards healthier communities so that more people might expect more years of healthy life. I began with shelter, exploring housing, then, food, education, and the environment.

Finally, I want to address the issue of inequality

In Scotland, in 2008, life expectancy figures revealed that men living in one part of Glasgow could expect to live 28 years more than those in another part. This was publicised as the plight of “Shettleston man”, named after the area with the poorest male life expectancy.

Twenty eight years of difference in two areas a mere 15 minutes away from each other.
Shocking? Of course. This wasn’t the full story. The number and severity of illnesses suffered by the men in poor Shettleston, were far greater than those living in the more affluent, Lenzie.
Since 2008, that picture has changed somewhat, partly because that dramatic figure was a result of high numbers of drug deaths. Ten years later the figures still show huge differences between the richest and the poorest parts of Glasgow. One area has a male life expectancy of 82, whilst in another it’s 66 – still a difference of 16 years.

This huge inequality in health experience and in life expectancy are closely linked to other inequalities, from income, employment, and housing to education.
For many years Richard Wilkinson and his partner, Kate Pickett have produced research evidence for inequality itself being one of the most significant factor in the production of these shocking statistics. It’s not just poverty, it’s inequality.
They’ve recently published more findings which explore the links between mental health, wellbeing and inequality.

What they demonstrate is some of the potential mechanisms of the links between inequality and illness, through the psychological impacts which are part of the daily lives of the poorest communities.
We don’t live in isolation.
We can’t just exhort people to eat more healthily, smoke and drink less, and move more and expect the population to suddenly become healthier. We have to address the conditions in which people live. Unless we tackle inequality it’s going to be hard to bring better health to the majority of the population.
Many reports have shown how inequality around the world is on the increase. This article, in The New Yorker neatly summarises the findings of the French economist Thomas Piketty on this issue.

The famous “elephant graph” (so called because of its shape) shows what’s happened over the last four decades.

Is this inevitable?
Surely not. It wasn’t always the case, and it’s actually changing. If we want to change it in a different direction we’ll need to get to grips with ways in which the richest manage to grab and hoard their wealth.

A recent story reported that, in the US, Amazon, despite making a profit of $11.2 billion, they’ll not only be paying zero Federal tax, but will actually receive a tax rebate of $126 million

It’s not only the richest corporations who work hardest to pay as little tax as they can. Individuals do too. The CEO Ineos, the UK’s richest man, is moving to Monaco to save £4 billion in tax. His two wealthiest executives are following suit.

The “Panama Papers”, leaked from the offshore law firm, Mossad Fonesca, revealed, amongst other things

“the myriad ways in which the rich can exploit secretive offshore tax regimes. Twelve national leaders are among 143 politicians, their families and close associates from around the world known to have been using offshore tax havens. A $2bn trail leads all the way to Vladimir Putin. The Russian president’s best friend – a cellist called Sergei Roldugin – is at the centre of a scheme in which money from Russian state banks is hidden offshore. Some of it ends up in a ski resort where in 2013 Putin’s daughter Katerina got married. Among national leaders with offshore wealth are Nawaz Sharif, Pakistan’s prime minister; Ayad Allawi, ex-interim prime minister and former vice-president of Iraq; Petro Poroshenko, president of Ukraine; Alaa Mubarak, son of Egypt’s former president; and the prime minister of Iceland, Sigmundur Davíð Gunnlaugsson.”

The “Paradise Papers” are another big data leak related to a separate company showed many, many, similar examples

“Key revelations include:
Millions of pounds from the Queen’s private estate has been invested in a Cayman Islands fund – and some of her money went to a retailer accused of exploiting poor families and vulnerable people.
Prince Charles’s estate made a big profit on a stake in his friend’s offshore firm.
Extensive offshore dealings by Donald Trump’s cabinet members, advisers and donors, including substantial payments from a firm co-owned by Vladimir Putin’s son-in-law to the shipping group of the US commerce secretary, Wilbur Ross.
Twitter and Facebook received hundreds of millions of dollars in investments that can be traced back to Russian state financial institutions.
The tax-avoiding Cayman Islands trust managed by the Canadian prime minister Justin Trudeau’s chief moneyman.
The Formula One champion Lewis Hamilton avoided taxes on a £17m jet using an Isle of Man scheme.
Oxford and Cambridge and top US universities invested offshore, with some of the money going into fossil fuel industries.
A previously unknown $450m offshore trust that has sheltered the wealth of Lord Ashcroft.
The man managing Angola’s sovereign wealth fund invested it in projects he stood to profit from.
Apple secretly moved parts of its empire to Jersey after a row over its tax affairs.
How the sportswear giant Nike stays one step ahead of the taxman.
The huge tax refunds given by the Isle of Man to the owners of private jets.
Offshore cash helped fund Steve Bannon’s attacks on Hillary Clinton.
The secret loan and alliance used by the London-listed multinational Glencore in its efforts to secure lucrative mining rights in the Democratic Republic of the Congo.
A former UK minister who defended tax avoidance has a Bahamas trust fund.
The complex offshore webs used by two Russian billionaires to buy stakes in Arsenal and Everton football clubs.
Stars of the BBC hit sitcom Mrs Brown’s Boys used a web of offshore companies to avoid tax.
British celebrities including Gary Lineker used an arrangement that let them avoid tax when selling homes in Barbados.
Prominent Brexit campaigners have put money offshore.
The Dukes of Westminster pumped millions into secretive offshore firms.
A tax haven lobby group boasted of “superb penetration” at the top of the UK government before a G8 summit that was expected to bring in greater offshore transparency.
The law firm at the centre of the Paradise Papers leak was criticised for “persistent failures” on terrorist financing and money laundering rules.
Seven Republican super-donors keep money in tax havens.
A top Democratic donor built up a vast $8bn private wealth fund in Bermuda.
The schemes used to avoid tax on UK property deals.
The celebrities, from Harvey Weinstein to Shakira, with offshore interests.
How a private equity firm tried to extract £890m from a struggling care home operator by making it take out a costly loan.
Trump’s close ally Robert Kraft, the New England Patriots owner, is the longtime owner of an offshore firm.
One of the world’s biggest touts used an offshore firm to avoid tax on profits from reselling Adele and Ed Sheeran tickets.”

It’s only the wealthiest individuals and companies which go to such lengths to contribute less of their wealth to the societies in which they made their gains.

Meanwhile, at the other end of the scale, there is a growing evidence that increasing minimum wages is a great way to make positive impacts on populations.

A 2011 national study showed that low-skilled workers reported fewer unmet medical needs in states with higher minimum-wage rates. In high-wage states, workers were better able to pay for the care they needed. In low-wage states, workers skipped medical appointments

“Studies have linked higher minimum wages to decreases in low birth-weight babies, lower rates of teen alcohol consumption and declines in teen births. A 2016 study published in the American Journal of Public Health found that between roughly 2,800 and 5,500 premature deaths that occurred in New York City from 2008 to 2012 could have been prevented if the city’s minimum wage had been $15 an hour during that time, instead of a little over $7 an hour.”

None of these issues can be tackled in isolation. They need co-operation and collaboration. That should encourage us, because these are two of the greatest strengths of the human species.