Six in 10 doctors in Scotland plan to vote against independenceBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5072 (Published 13 August 2014) Cite this as: BMJ 2014;349:g5072
All rapid responses
On September 18th in Scotland we will all have our own reasons for voting Yes or No. That’s as it should be. There is no over-arching ideology at work here. There is no unitary path to enlightenment.
For me this journey has always been about wanting to live in a better society and having what I believe to be the best democratic means of achieving that. And I always envisaged the core principle of that society would be a perpetual drive for fairness and equality.
We’ve heard a lot over the last two years about whether the people of Scotland might be better or worse off by a few hundred pounds. But that could happen just by changing your gas and electricity supplier.
In reality the difference in average income between wealthier countries really doesn’t matter at all. What does matter is the level of income inequality within any given country.
In the most equal countries like Finland, Norway or Sweden the rich are 3 to 4 times better off than the poor. In the UK at present the figure is 7 times. The UK is the second most unequal country in Europe. On the OECD table of equality the UK ranks 7th bottom out of 34 countries – more unequal than the supposed “basket cases” like Greece, Iceland, Ireland, Italy and Spain.
At present in the UK the top 0.1% of the population have average incomes in excess of £1 million. The top 1% exceeds an average of £270,000 and the top 10% average nearly £80,000. But the remaining 90% of the population have average incomes of less than £13,000.
The richest 10% in our society have 45% of the total wealth of that society. Meanwhile the bottom 50% has only 13% of total wealth between them, with the bottom 20% effectively having no wealth at all.
Between 1929 and 1979, the top 1%’s share of total wealth fell from 18% to less than 5%. Then Margaret Thatcher came to power and the share of wealth held by the top 1% rose continuously, so that by the time of the “crash” in 2008 the level of inequality was back to the levels not seen since the Great Depression 85 years ago.
But why does any of this matter? It matters because in less equal societies people of all income levels do worse, with the bulk of that burden falling on the poor.
Inequality leads to reduced levels of trust; reduced social cohesion and well-being; and increased social stress.
Women in less equal societies “achieve” less political participation, reduced educational attainment, lower earnings and diminished social status.
There are also increased levels of obesity in unequal societies which, in turn, leads to increased levels of heart disease, diabetes and cancer. Stress, anxiety and depression are more prevalent and there are higher levels of drug and alcohol misuse.
Overall educational attainment falls whilst the levels of teenage pregnancy and marital breakdown rise. In the UK 39% of single parents live in poverty – in Sweden the figure is 18%.
Society becomes more violent, including an increased incidence of rape and murder. According to the UK Government there were 1.94 million violent crimes in the UK in 2011 and how many more went unreported?
Inequality threatens our sustainability by bringing about lower productivity, lower efficiency, lower growth and increased economic instability.
And inequality threatens our democracy. We don’t trust our politicians and we don’t trust our media. We feel disenfranchised and less inclined to vote and as a result we play into the hands of the rich and powerful who seek to mould the system to their own ends and desired outcomes. At the same time we have governments too reluctant to invest in the type of public spending which produces a thriving, dynamic economy; and too weak to engage in the type of redistribution that leads to a better, healthier and fairer society.
How did all this come about? It came about through a change in the “political norm” to a more right wing agenda with associated change in societal attitudes to a more “me-first” culture. Trade unions were aggressively pursued and substantially weakened. Changes were made to taxes and welfare which favoured the rich and damaged the poor.
Reducing inequality needs a re-imagination of our society. I believe we need to take a new direction and the democratic change a Yes vote will deliver could help Scotland achieve the necessary social and economic changes. It is not simply about changing the way in which we are governed, important though that is – it’s about changing ourselves, our communities, our institutions. We need to reclaim the notion that we can be a better society.
David Cameron speaking in 2009 said “among the richest countries it’s the more unequal ones which do worst...per capita GDP is much less important than the size of the gap between the richest and the poorest.”
In 2010 Ed Miliband said “I do believe that this country is too unequal and the gap between rich and poor doesn’t just harm the poor, it harms us all.”
Over the last 20 years the proportion of the UK population who believe that the income gap is too large has averaged about 80%.
But what has Westminster delivered? Reduced public spending, tax cuts for the rich, welfare cuts for the poor and an inequality gap unrivalled since 1931. And yet we in Scotland are asked to believe we are better off continuing with the current arrangements.
A Yes vote is about giving the people of Scotland the power to choose their own path to creating a better, healthier, more sustainable, more equal society. There will be mistakes along the way of course - but they will be our mistakes and the solutions will be ours too.
I believe that with independence we could do so much that Westminster is currently failing to do. For example: – close all tax loop holes and erradicate tax evasion; increase higher rates of tax and create a fairer, more progressive tax system; ensure that the top people in a company or organisation do not earn more than a democratically agreed multiple of the lowest paid; encourage more employee-based involvement and ownership and instead of businesses serving the needs of a few rich proprietors and institutional shareholders they act like communities with responsibilities to those who work in them and the people served by them; move towards a higher paid, higher skilled economy; spend more public money on health, education, transport, public housing, etc.
This is not a call for some Utopia – it’s all readily achievable if there is a political and a societal will. And the best chance of Scotland achieving this, in my view, is by having a government in which we have 100% of the say 100% of the time.
Writing in 1784, in an essay entitled “What Is Enlightenment?” the philosopher Immanuel Kant said “Enlightenment is man’s emergence from self-imposed nonage. Nonage is the inability to use one’s own understanding without another’s guidance. This nonage is self-imposed if its cause lies not in a lack of understanding but in indecision and lack of courage to use one’s own mind without another’s guidance. Dare to know!”
It may have been 230 years ago but I think Kant was daring me to vote Yes.
Competing interests: No competing interests
This article is, quite frankly, a shoddy piece of journalism which does nothing to reverse the BMJ's recently declining reputation as a quality publication.
For a start I wouldn't regard less than two thirds of something as "most".
The BMA debate in Edinburgh on 6 August was not an opportunity to "question Scottish Nationalist and Labour ministers".
The Labour representative was Richard Simpson, MSP, a member of the Scottish Parliament Health and Sports Committee and he was not there representing the Labour Party - he was there on behalf of the Better Together/No Thanks grouping.
The SNP representative was Bob Doris, MSP, Deputy Convener of the same Health and Sports Committee and he was not representing the SNP - he was there on behalf of the Yes campaign.
Neither man is a "minister".
And who is "Andrew Robertson of the UK Labour Party"? I have "Googled" his name under Labour, Scottish Labour and UK Labour and I cam up with nothing.
Now to the BMA survey reported in this article. There are currently over 17,000 working doctors in Scotland ( and thousands of retired ones too). Yet this survey managed only 311 responses - less than 2% of the total number of working doctors.
The response rate for GPs was less than 3% of the total number of Scottish GPs and for hospital doctors the figure was only 1%.
Most political surveys of any quality state a margin of error yet none is stated here. Most political surveys regard a 35 margin of error as good quality. This would have required 1004 responses.
Even if we accept a more generous 5% margin of error a minimum of 376 responses would have been required.
In addition the actual response rate was shockingly poor. Given that the respondents were familiar with the organisation posing the questions a response rate of 20 - 30% would be regarded as reasonable. It doesn't say in the article if respondents were contacted by post or email but if we assume email then a response rate of 40% would be seen as more than adequate and 50% would be good.
By any of these measures a response rate of 14% doesn't come anywhere close to allow us to make any reasonable conclusions. The sample is simply too small and the results are essentially meaningless.
Competing interests: No competing interests
As September 18th approaches, the biggest sovereignty decision in 300 years will be handed to the people of Scotland. While opinion was doomed to be divided on this issue, this article is very interesting as it seeks to explore the reasons behind their vote, exploring their fears or expectations for the future.
The observed divide amongst doctors - 33% to 60% for YES/NO respectively is similar to national polls carried out by Ipsos-MORI in February 2014. While public opinion as a whole has shifted slightly towards YES, the doctors voting intention seems to reflect a more recent poll by Ipsos-MORI of the 20% least deprived areas in Scotland. This begs the question of whether socio-economic status may be influencing the doctors' responses.
It is also interesting to consider the reasons cited for voting no. While the economy remains a major concern and point for consideration, issues surrounding regulation of the medical profession post-independence or need for Scotland-specific laws on abortion and surrogacy seem to have less to do with the question being asked. This is probably more a reflection of negative, 'divorce-oriented' campaigning around the referendum question.
Scotland does not seek, nor need her own laws on abortion. She does not need her own regulatory body. She does not wish to cut back on medical research. She would however like a voice; we are not seeking to change these things, we're seeking the ability to change them if the Scottish people want to change them.
The independence referendum is not about a break up. It's about giving people the opportunity to enact changes that best suit them. Devolution worked for the NHS in Scotland. It worked for free personal care in Scotland. It worked for our pensioners. It worked for our students. Why can't independence work for doctors now?
The SNP are seeking to give Scotland the ability to decide for itself - this does not necessarily mean doing things differently, it means having control. We are not seeking to stop our co-operation; in fact the only side creating barriers to our future co-operation as equal nations is the NO campaign. Why could't we use the GMC (which covers all the devolved health services already)? Why couldn't we have independence and NOT change some laws (we didn't after devolution!)? - The list of questions NOT answered by the UK government grows. If we can't use them it's because barriers have been put in place POST referendum. Without immediate (or indeed any) plans to change medical regulation, research funding or introduce autonomy on medical education, it is difficult to see the relevance of these things to independence.
That being considered, it could be concluded that the result of the BMJ poll may be heavily influenced by misinformation - and reflects a failure of the respective campaigns to clarify the issues at heart.
Come what may, Scotland will always work with its partners on this island to continue shaping the world. Whatever happens, we will continue to be part of this island Britain, and continue to read the BMJ.
Competing interests: No competing interests