Tag Archives: health promotion

Inequality, health & the credit crunch.

“life expectancy here in London falls by one year for every underground station you stop at from Westminster to Canning Town”

(Gordon Brown 2008)

I am looking forward to reading “The Spirit Level: Why More Equal Societies Almost Always Do Better” by Richard Wilkinson and Kate Pickett which was published at the start of March. Wilkinson has a long track record of studying and drawing attention to the effect that inequalities may have on public health.  Most famously, Wilkinson’s work played an important role in the development of the report into health inequalities that came to be known as the Black report. This link has a good account of the history behind the Black report as well as the then government’s rather un-enthusiastic reaction to it’s conclusions. 

Despite the fact that we have long had good evidence suggesting that inequality has a powerful effect upon health I would argue that usually, nothing very much is done about it. Usually the most prominent Public health messsage is of the “take care of yourself” variety i.e. Five portions fruit & veg, don’t smoke, drink too much, get fat etc etc.  Whilst there is nothing wrong in suggesting that people look after themselves the argument has always been that this “look after yourself” message is pushed by Governments in preference to actually doing anything concrete about structural inequalities in society. I wonder what difference our recent economic woes & the credit crunch will make to this argument?

We have seen an awful lot of argument and anger over executive pay and bonuses for bank bosses. Whilst I think it is a bit simplistic to blame everything upon these people, I do think it is good that some light has been shone onto this sort of thing & that debate has been started about greed in society. 

Am I being naive in wondering whether some good might eventually come out of this current crisis? – Wilkinson’s book (above) is one of a few things (or this) I have noticed recently that are trying to discuss this issue. I predict that this forthcoming report by Micheal Marmot into health inequalities  which is due in December will get quite a lot of attention. I suppose we will have to wait and see what difference any of this makes.

In the meantime, I will answer my own question – I suspect it is naive to imagine that anything will change – the economy will eventually pick up, the rich will continue to get rich & the poor become poorer & all this will get forgotten about again? – or will it- what do you think?
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Health Promotion?

I’m getting a bit tired of the emphasis on just promoting physical health – what about mental health? Of course, five portions of fruit and vegetables are important, so is not smoking etc – of course mental health nurses have a role in this, but…


When I became a mental health nurse, it was because I believed that I could help people in distress. I found that I could easily talk to people and communicate on a variety of levels. I developed the ability to enter into someone’s ‘world’ to see it as they did. Indeed, as time passed I found that I had a particular skill in talking to those who were becoming physically aggressive to de-escalate the situation. I can spot side effects and help people who are experiencing these distressing consequences of the medication that we give. I can help a depressed person out of their hole and assist families to understand.


I have got some idea about physical needs, despite a relative lack of training in this area. I am not suggesting that I couldn’t spot the overweight person who smokes 40 a day and drinks alcohol like it is going out of fashion. Rather, what I am saying is my area is essentially concerned with facilitating people to enjoy their life. To give an example – I do not smoke,  yet I will defend the rights of smokers to do so provided that they understand the potential consequences and do not force me to inhale their smoke. We are adults capable of making a decision. Surely my job is to facilitate the making of an informed decision? The Code of Conduct clearly states that we should respect the right of a patient to decline care yet too frequently if a patient declines then ‘no insight’ is recorded in their notes. I firmly believe that the majority of nurses break the Code on this point.


What about Mental Health promotion? WHO have identified that depression will be the number 1 illness in Europe by 2020 but rarely do I see any health promotion on this issue. The ubiquitous health promotion posters tell me to lose weight, stop drinking, stop smoking, lower my cholesterol, go jogging etc etc but I have never seen a poster saying


‘Hey! Go and chill out!’


And I probably never will. Yes I am well aware that many physical promotion has a knock on effect on mental health but surely we should be promoting factors that are primarily aimed at mental health promotion?


The candle that burns twice as brightly lasts half as long. Personally, I want to enjoy my life rather than extend a miserable one.