I was going to begin with a question, and it should not have been, “Where the heck is my card?” [Laughter.] As well as the question, I have a speech, but I begin by asking, “Can a society be too tolerant?” That is members’ starter for 10. Is Scotland too tolerant? Whatever the colour of our political rosettes, whatever our habits and hobbies outside the Parliament and whatever we had for breakfast, are we too tolerant?
Tolerance is not a bad thing. It is a good thing. It is the mark of any civilisation that is worth the name, but at what point does it lapse into complacency, dereliction, or even fatalism and the acceptance of the unacceptable? I am talking about an indifference to the suffering of others—what Nye Bevan called “social blindness”.
NHS Health Scotland has produced a graphic—I am waving it about now—that takes us on a journey eastwards along the Argyle line from Jordanhill to Bridgeton. Each stop of the train represents a drop in life expectancy of 1.7 years for men and 1.2 years for women. Some people call that the Glasgow effect, but the effects of inequality can be felt in all corners of Scotland and across all social classes, for inequality diminishes us all.
But then, some are more unequal than others. In William McIlvanney’s 1975 novel “Docherty”, he wrote:
“Everyone ... had failed in the same way. It was a penal colony for those who had committed poverty, a vice which was usually hereditary.”
Harry Burns’s name will probably come up in other speeches this afternoon, but I want to be the first to make Burns’s ears burn. His and Michael Marmot’s evidence to us on the Health and Sport Committee was impassioned and compelling. It was some of the most powerful that we have heard in this Parliament in 16 years.
Our former chief medical officer was evangelical about the early years. He told the committee about his daughter’s gap year, teaching in Spain. Each morning, the five and six-year-olds queued up when the bell went and each one would give her, the teacher, a kiss and a cuddle before going into class. No apples changed hands but it is fair to say that, in that context, we do not always show our children such love and care. Perhaps we should, if we want the next generation to be compassionate, imaginative, resourceful, spirited and happy—to be masters of circumstance and not its servants, and to be resilient when things do not go their way and purposeful when they do.
“You’re not going to be able to fix this”, Sir Harry told us, pointing his surgeon’s finger. Sir Michael joined in, asking us what sort of society we thought we were running. That is a good question. For more than 40 years, health inequalities have been driven by a growing disparity in income, power and wealth. Not one of the successive Governments in Edinburgh and London—ours, the SNP’s and that of the Conservatives and the Lib Dems—has dealt with that successfully.
The Institute of Health and Wellbeing outlined three key domains: employment, earnings and education. That hat trick of factors is outwith the Health and Sport Committee’s remit, hence this afternoon’s debate and the committee’s desire to draw others into the discussion.
We knew that the topic would be difficult when we began to consider an inquiry in 2012. Sir Harry Burns told us:
“The issue is much more complex than you think”,
and added that the story of health inequalities was
“bedevilled by people who knew the answer”.—[Official Report, Health and Sport Committee, 22 January 2013; c 3156.]
We will not add to that bedevilment. We do not have an answer, but we have lots of questions.
Why do more equal societies enjoy better health outcomes? How important is community and quality of housing? Are the latest teenage pregnancy figures a sign of progress? What emphasis should we give to lifestyle drift, the inverse care law or proportionate universalism? When do a family’s stress levels become intolerable? Is a zero-hours, poorly paid, low-skilled job better than no job at all? Where does the molecular biology of a hug come into all this? Do not panic, Presiding Officer. We will leave Sir Harry to explain that one to you.
Sir Michael Marmot told us that
“a health service for the poor is a poor health service”.—[Official Report, Health and Sport Committee, 13 May 2014; c 5370.]
As Campbell Christie told us, the allocation of funds is important but cash alone cannot resolve this. Through good times—times of plenty—and through austerity, we have not resolved these issues. We need leadership, and to have the right policies in place and the courage to see them through, beyond a single term of government—beyond even the lifetime of this Administration and the next one, because, in the words of a 2008 report:
“Social injustice is killing people on a grand scale.”
Some would say that that is overblown and overstated, but not according to the World Health Organization’s commission on social determinants of health. Sir Michael chaired that commission and his stance certainly has not softened. It is a political choice, he told us, that the worst-off should suffer more. Poverty is not down to people shirking, he said. It is because, he said in a stage whisper, people “are not paid enough”.
There were some hints of hope. Sir Harry enthused about the early years collaborative, the family nurse partnership and the positive parenting plan. If a policy is shown to work and make a difference to people’s lives, we should pursue it. If not, we move on. If that sounds easy, members obviously have not been listening.
Sir Michael cited the example of Sweden, where leadership at a local level has been encouraged. Targeted services could make a difference but tackling health inequalities has to be “a corporate issue”, at the heart of local and national government. He talked about breaking down barriers in Norway to the extent that its Minister of Foreign Affairs could declare, “I’m the Minister for Health.” That principle is important. With no slight to Shona Robison, or to the previous cabinet secretary, I say that responsibility for this issue should extend to all her Cabinet colleagues—to each and every portfolio.
Ours was a lengthy inquiry. The committee learned that inequality is complex and multifarious but far from inevitable, and that it is of concern to everyone. I cannot conceive of a single committee in this place that it does not impact upon. It is on that Parliament-wide basis that we want members to take part today.
In a recent Scottish Government debate on tackling inequalities, I said that aspirations were fine, but that we must first win the argument, which is one that was ably articulated by Sir Harry and Sir Michael, and by many others who are not of the knighted realm. Earlier this month, the actor Michael Sheen told a St David’s day rally:
“We only say we’ve crossed the finish line when the last of us does. Because no one is alone. And there is such a thing as society.”
Of course, it is not just luvvies who say that; it is popes, presidents, economists and even trade unionists. I finish by quoting a clarion voice—a compassionate voice. It is more than 40 years since Jimmy Reid gave his rectorial address at the University of Glasgow, which was described by The New York Times as the greatest speech since the Gettysburg address. Harry Burns was a medical student there at the time—Glasgow, not Gettysburg—and I have heard him say that the comparison was rather over the top, as it flattered Abe Lincoln.