David Widgery

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The Great Divide

(June 1987)

From Socialist Worker Review, No. 99, June 1987.
Transcribed by Christian Høgsbjerg.
Marked up by Einde O’Callaghan for the Marxists’ Internet Archive.

AT THE Marxism 86 AIDS meeting, I can remember suggesting, blushingly, that branch treasurers seeking a good investment might consider the London Rubber Company, the near monopoly condom manufacturers.

In less than a year, not only are condoms out of the closet but Tory ministers eulogise them, pop stars toss them instead of kisses to admiring fans, Ian Dury has demonstrated exactly how to afix them on television, and Katherine Hammett has taken to designing clothes with prominent rubber wear pouches.

The point is not whether universal condom use is necessary to contain what remains the highly localised incidence of AIDS (though it certainly would limit other sexually transmitted diseases like cervical carcinoma, gonorrhea, NSU and clamidya which have always made heterosexual sex risky for women).

Nor is it to foster any illusions about the government’s motives for their belated advertising campaign, so clearly devised to give the appearance of action and in sharp contrast to its meanness to those doctors and nurses dealing with the disease.

But it is to observe that when the modern state puts its weight behind an item of health promotion, publicity can have a very real effect.

Contrast the government’s approach to obtaining publicity for the numerically far more important clinical advice given by the doctors commissioned to review and update the findings of the Black Report on inequalities in health. The carefully argued and statistically rigorous document The Great Divide was not launched on Wogan by Edwina Currie or made the subject of keynote speeches by cabinet ministers.

Instead its press launch was cancelled and had to take place in the rear of a guitar shop off New Oxford Street.

Because its findings, far from suggesting that good health is a result of individual enterprise and clean living, show instead that health, good and bad, is deeply connected with living conditions and thus, in a society so deeply stratified as ours, with class. Working class babies are born smaller, and die more often in the first year of life. Working men and women die younger and suffer more illness when they are alive.

The common causes of premature death like heart attack, stroke and lung cancer, are not equally distributed across the board, as one is encouraged to think, but are skewed according to social class.

As a general practitioner one sees the human evidence every day of one’s working life: children whose developmental potential is damaged even before they can walk because of poor diet, over-crowding and under-stimulation; young mothers’ bodies aged by chronic infections, repeated pregnancy and the strain of bringing up young children as well as holding down exhausting manual jobs; the working men dying unnecessarily before they reach retirement age.

For the majority life is not about enjoyed good health but, as a widow put it to me last week, “Well, he worked hard all his life, he got made redundant and then his heart went on him.” Indeed this is why socialists oppose capitalism so bitterly: not because the inequality of class society is somehow aesthetically or sociologically displeasing, but because it kills and maims and distorts the potential of the great majority of those who live under its rule.

No reader of Socialist Worker Review will be shocked then at the damning findings of the Health Education Council’s analysis of the widening health gap between the rich and poor. Nor should we be surprised that the Thatcher government shows little enthusiasm for publicising the recommendations of these reports (“political dynamite in an election year” the new Chairman of the Health Education Authority is said to have remarked) or that Radio One DJs aren’t chirpily introducing its statistics between the traffic jams and the plugs.

But what is interesting, surprising and heartening is the radicalism of these reports’ conclusions.

The medical profession is one of the oldest and most stable of the bourgeois professions. The philosophical outlook of most doctors is either hostile to or incomprehending of Marxism and the BMA has been fairly accurately called the Tory Party at the bedside. But doctors have a scientific education and are relentlessly empirical.

So it was the BMA’s Board of Science not the editorial writer in Socialist Worker who wrote recently:

“The problem as a whole is so great and so entrenched in the structure of society as to be insoluble without significant diversion of public resources”, and that “allowing deprivation to persist on the scale we have described is a national scandal.”

It is Professor Alwyn Smith the epidemiologist not Jane Soap the agitator who argues that

“the damage to health from unemployment can no longer be gainsaid. Britain has not only some of the worst housing in the industrialised world but the general standard of housing is very low in the basic amenities … our national diet has been the subject of sustained criticism for decades. It is particularly poor among those who are generally underprivileged.”

And it is the editors of the British Medical Journal who agree with the authors of these reports that “policies to combat inequalities in health by concentrating on the individual are misguided”.

So perhaps some of the slow and painful lessons of the Thatcher years are being learnt and by people who, in terms of their own class position, ought to be sympathetic to the present government. If there is anyone out there terminally depressed by Marxism Today and the New Statesman, you might consider switching your subscription to the BMJ.

Last updated on 30 October 2019