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In Place of Fear
Narrowing health inequalities

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In Place of Fear, the title of Aneurin Bevan’s book published on the 10th anniversary of the Beveridge Report, is synonymous with all that the welfare state sought to achieve. In 2013, as the principles of Bevan and Beveridge are being killed off, the belief that inequalities should narrow is also under attack.

This paper shows that the 1930s were the last time the population of Britain was as polarised in terms of their health as we are today. Falling life expectancy is being recorded again. First highlighted in Glasgow, it could soon be more widespread as mortality counts during 2012 and 2013 have been rising. Other than when we were at war, the last time actual rises in mortality were reported in Britain was during the depression of the 1930s.

It was not simply the introduction of the NHS in 1948 that halved inequalities in health in Britain between the 1930s and early 1950s. The overall improvement in living standards brought about by the introduction of the welfare state had a significant impact. It is now well known that the strongest correlate to poor health is poverty, and the longer people live in poverty the shorter lives they can expect to live. Geographical inequalities in health tend to fall when social inequalities in income and wealth fall.

What we can now be sure of is that as income and wealth inequalities rise, so too do health inequalities. When it comes to providing a health service, it is harder to provide a good health service in a more economically unequal country. In more unequal countries the rich are more likely to opt out of national health services, and have less interest in the quality of that service. This exacerbates health inequalities further.

This paper suggests that policies 'in place of fear' need not be costly but they need to present a genuine commitment to tackling inequality.