Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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- D Mistry (29 July 2001)
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Direct relation between socioeconomic circumstances and school performance..
- Richard Watson (30 July 2001)
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Increasing taxes; look at the whole picture
- Kate Smith (30 July 2001)
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the medical paradox
- Seth Jenkinson (30 August 2001)
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D Mistry, SHO Huddersfield Royal Infirmary
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Dear Editor, I was interested to read the editorial by Professor G. Watt regarding ‘policies to tackle social exclusion’1. In it, he writes that poor reading skills, unmanageable and aggressive behaviour at school and drug misuse, (amongst other things), are correlates/consequences of child poverty. He argues that policies to tackle the causes of child poverty rather than targeting the ‘problem groups’ should be encouraged. To do this, he suggests increased public spending and implicit in this, the need to persuade ‘relatively affluent groups that social inclusion is worth paying for’. However, I do not think that increased spending alone is the answer to this problem. Indeed, increased resources would improve the situation but relative poverty would still remain and so too the ascribed ‘consequences’. Instead, I think that it is attitudes that we need to change. The increasing mentality of today’s society is that somebody else (schools/hospitals/government) is always responsible when things go wrong. People seem to feel that rectifying these mistakes or problems is the responsibility of these establishments. Although this may be true in some circumstances, the role of the individual, the parent, the family and the community in taking responsibility for themselves has been forgotten. In response to the recent riots in Bradford, Burnley and Oldham, the government has decreed that there shall be “Zero Tolerance” to violence, whatever the provocation, from whichever party. This highlights the point that each individual/community should be responsible for it’s actions. We should not be tempted to ascribe such actions solely to economic deprivation. Increasing resources may go some way to improving the situation for those in lower socio-economic groups. However, resources alone will not eradicate educational and behavioural problems in children. This can only happen when the onus is put back onto the individual and community, as their future is in their own hands. Yours sincerely, Dr D. Mistry
dipanmistry@hotmail.com Competing interests: none 1. Watt G. Policies to tackle social exclusion. BMJ 2001:323;175-6. |
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Richard Watson, GP 11 Craigallian Avenue, Glasgow, G72 8DQ
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Professor Watt writes: "The inverse relation between school performance and socioeconomic circumstances is not confined to a minority of problem schools and areas but is a continuous relation that is observed across society." I agree wholeheartedly with what I take to be the sentiment of this and ,especially, with the plea for vastly more resources for education and health across the board and not just on a few headline grabbing projects. Surely, however, as socioeconomic circumstances improve so does school performance and so the relation is direct and not "inverse"? |
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Kate Smith, GP associate Riverside Centre for Health
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I applaud Professor Graham Watt's motivation and his suggestion that tackling poverty and social exclusion needs to involve the whole of society.(1) However , in order to be taken seriously by government , we as doctors need to recognise the role of other disciplines in developing policy as well as in implementing it. In particular I think Professor Watt has forgotten to mention the importance of wealth creation in preventing poverty and in creating taxpayers. Let us take an example from my own practice on Merseyside. Some of my patients have jobs in small factories. Many of those factories are struggling to stay in business in a very competitive global market. If they fail, I will have several more unemployed patients both adding to those on the poverty line and subtracting from the pool of taxpayers. Increasing taxes may hinder these factories. As doctors we have little insight into the wealth creation side of the equation . Our discipline operates mainly on the spending side . Taxes would not be available for us to spend if the wealth was not created in the first place . It is not enough simply to copy the levels of taxation in other countries where the whole situation may not be comparable to Britain . The government needs to listen to the wealth creators, doctors, the socially excluded and others in order to achieve the correct balance for Britain. Kate Smith GP, Riverside Centre for Health, Park St, Liverpool L8 6QP 1. Watt G. Policies to tackle social exclusion. BMJ 2001:323:175-6 (28 July). |
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Seth Jenkinson, GP Mixenden, Halifax, W Yorks Mixenden Stones Surgery
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Dear Graham Watt, No-one seems to pick up on, I think it was Wilkinson's depth charge observation, that the so-called diseases of affluence are in fact the diseases of poor people in affluent societies. My bailing (baling) the Titanic letter (BMJ 2001;323:402) produced about a dozen responses (as well as your one liner, thanks)including two from Oz and an ancient college mate from Maesteg, and they all picked up on my "despair" but not on the observation, which you also clearly make in your editorial that medical activity widens inequalities because it is the already affluent and more healthy who are able to act upon the insights of modern medicine. If the depth charge observation actually explodes and it becomes clear that the main driver of ill-health in affluent societies is indeed inequality, then we have to stop allocating resources to a medical system that is making matters worse and spend instead on education, job security, environmental improvements, healthy food policies and even a new striker for Bradford City which would probably produce more health gain than a new scanner in the local hospital. A bit like Cuba? It's a mean old scene. Thanks for the intellectual stimulation Seth Jenkinson |
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