Intended for healthcare professionals

Letters Getting evidence into practice

Causes rather than effects

BMJ 2011; 342 doi: (Published 07 June 2011) Cite this as: BMJ 2011;342:d3354

Mind the gap ...

"My mother's got no money, my mother's got no money", sings eight
year old Courtney from Bradford in an opening clip from the powerful - but
heartbreaking - BBC documentary 'Poor Kids' broadcast last week. [1] The
programme opened with the disturbing fact that the gap between rich and
poor in the UK is wider now than at any time since the Second World War.
There are now 3.5 million children living in poverty in the UK - which has
one of the worst child poverty rates in the developed world.

But it is the gap that matters, the gap between rich and poor: the
bigger the gap the greater trouble that that society ends up in ... in
terms of lower life expectancy, more violence, crime, drug addiction,
mental illness, and even levels of obesity are worse in more unequal
societies. [2]

The evidence suggests that more economic growth will not make us a
happier, healthier society and that there no relationship between levels
of income per head and greater social well being. The evidence suggests
that if we halved inequality,

* Murder rates could halve
* Mental illness could reduce by two thirds
* Obesity could halve
* Imprisonment could reduce by 80%
* Teen births could reduce by 80%
* Levels of trust could increase by 85% [3]

And the evidence also suggests that everyone in society - not just
the poor - would be better off - including the well-off, like lawyers,
bankers, GPs (health-bankers) and the rest ...

[1] 'Poor kids' BBC One Tuesday 7 Jun 2011 22:35. Director Jezza
Neumann on the lack of hope for the children he spoke to: "I believe so
many of the children we met while making the film could go on to great
things in life, if given the right chances." The real future prospect for
these 'poor kids' is teenage pregnancy, heroin and crack addiction, crime,
prison and an earlier death than their rich compatriots. What a waste!

[2] The Spirit Level by Richard Wilkinson and Kate Pickett.
Groundbreaking analysis showing that greater economic equality-not greater
wealth-is the mark of the most successful societies, and offering new ways
to achieve it.

[3] The Equality Trust. Why Equality? Introduction to the Evidence.

Competing interests: No competing interests

15 June 2011
Mark Struthers
GP and prison doctor