Push and pull
Back on health again I’m afraid! This week’s coverage by the media of a national study into health inequalities made for interesting reading. Again, we seem to lapse quickly into intellectually lazy shorthand about ‘deprived areas’. People and families are deprived, not areas; there are a whole bunch of factors that cause people left behind by society to become more concentrated in certain parts of our towns and cities. This does not mean that rural areas are without those who need society’s help.
When it comes to health services the very phrase ‘free at the point of delivery’ rings down the years from the age of Nye Bevan and William Beveridge and sums up what we think of as a universal service. I understand the perception that some people in rural communties can be very well empowered and use this to pull heavily on the NHS’ universal services. It is understandable that at times when resources are in retreat those managing the NHS feel they must push resources towards the most needy and identify urban areas for this approach. However, the very people they need to reach in order to promote better health within rural areas are often isolated and disempowered. The result is that disadvantaged people in rural areas suffer twice, they do not pull as hard on the NHS as some of their more vocal village neighbours but they also do not benefit from the NHS pushing services towards them on their behalf.
A bit of evening up is called for, but pity the politician who openly says that the vocal rural middle classes must expect less. Even if it is in order to enable the NHS to put extra resources into reaching out to those rural people whose health and life expectancy is more akin to the sink estates so seized upon by the national media.
Jeremy Leggett 12 February 2010