Interviewing Sir Michael Marmot for ScotlandCan last week, I was struck by a comment he made about the priorities governments and nations make. Looking back over the last decade, Sir Michael noted that he “almost didn’t care” about growth in the economy. People were getting sicker and health inequalities were widening. If GDP was going up, “so what?”
He “almost” didn’t care –because, of course, economic growth is hardly irrelevant. But the question he posed was whether economic growth should be the main arbiter of a nation’s progress. Sir Michael’s view is that the key “social accountant” should be health and health inequality. When it comes to the hierarchy of interests, he puts that top – on the basis that decent schooling, good childcare, a well-funded NHS, and a stronger economy all flow from that.
Sir Michael also noted how, in Scotland, we now have a plethora of Ministers in the Scottish cabinet with numerous disparate titles – from health, to education, to housing, to sport, to communities and so on. While he “didn’t want to put them out of a job”, he did suggest they might all want to work to the same over-arching priority – to boost health and reduce health inequalities.
A similar point is made in a new book released this month entitled “Saving Sick Britain: Why we need the Health Society” by Martin Yuille and Bill Ollier at Manchester University. Writing in Progress last week, they – like Marmot – argue that the needs of health should “underpin all of public policy”. A “Health Society” they state, rest on three classes of need: vital needs, like nutrition and housing; social needs like transport, and what they described as agency needs, such as having a voice. To do this, they add, there needs to be institutional change (with government focussing on prevention), community change, and technological change.
So, as regards institutional change, here is an idea for the Scottish Government. The office of the First Minister sets the strategic direction for the Government. Rather than making health just one of several portfolios, the next Scottish Government could decide to make it clear it is the priority, by making the First Minister the First Minister for Health and Health Inequalities. This would make it the “accountant” by which all the other departments would be measured by.
Such a measure would be a world first, showing Scotland was a nation prepared to lead where others follow. It would also show how Scottish devolution allows us to set a fresh and radically different course.