Intro: [00:00:00] Stories, labels, Misconceptions NHS remains a blessing Created in 1948 We want it to remain great A podcast where we share our stories Explore solutions in all their glories They say it's broken, but it's not done With your host Val Barrett, Dr. Jeremy Anderson

Val: Welcome to another episode of stories, labels, and misconceptions with me, Val Barrett 

Dr Jeremy: and I'm Dr. Jeremy Anderson. 

Val: We're still doing the health inequality series we're on episode four. Episode one was what is health inequalities?

Val: Episode two is tackling the social determinants of health. And episode three [00:01:00] was who gets left behind. Now this week, is about all the reports still no change. Why knowing isn't enough. So we know for decades, experts have written about health inequalities in the UK. Reports, reviews, government commissions, all say the same thing, that where you live, what you earn, and even the colour of your skin can determine how long you live and how well you're treated when you're sick.

Val: But here's a question. If we know all this, why hasn't it changed? Why hasn't the dial moved? Today, Dr. Jeremy and I are delving into the grown pile of evidence. The political promises and the silence that follows. This is part four of our health inequality series. We're asking what happens when awareness isn't enough.

[00:02:00] Mhm.

Dr Jeremy: It seems we have a tradition in this country of, commissioning reports they get mentioned when released put on a shelf and then we think about it, 10 years later, 

Val: Yeah. 

Dr Jeremy: When another report comes out, that seems to be the pattern.

Val: But today we're going to touch on three. So let's start with what we know. What are some key reports we've seen over the years? So we've got the moment review, which came out in 2010. What did it say and what changed since? Why do these reviews repeat the same thing? Rinse and repeat. I think because nothing's changed. If you're writing reports about health inequalities and you've got the evidence and the government of the day hasn't implemented any of the [00:03:00] recommendations, then nothing's changed. If anything, it's going to get wider as we're going to discover next week. But why, I don't have the answers. I don't work in health, it just seems to me as a person that depends on the NHS, that if you have commissioned, an expert in health inequalities, they come back with evidence, they're not just singing it, they're saying this is the evidence. And the evidence that Mormot produced was similar to the , same evidence to the Black report, to the Acheson report. So why still then people don't feel change? 

Dr Jeremy: We've been talking in this country. Reports have been commissioned for over 40 years. The Marmot report in 2010 [00:04:00] authored by Professor Sir Michael Marmot, commissioned by the Institute of Health Equity. a lot of the findings are what we've been talking about on this podcast people's health follows the social gradient. The lower you are in terms of socioeconomic status, your social position in society, the worse your health. And that's because health is not just about access to a hospital, although that's part of it. It's about inequalities from early childhood. 

Val: Yes. 

Dr Jeremy: How you do in school.

Dr Jeremy: What kind of employment you have 

Val: how you live, the house. How you live.

Dr Jeremy: Where you live. Social determinants like housing, income, education. More important than merely access to healthcare. 

Val: The 2010 one was called fair society, healthy lives. which we still don't have, which is a joke Then they thought they'd bring him back. And he did another review in 2020 called health equity in England, [00:05:00] the moment review 10 years on. And the key objectives was, as you said, best starting life for every child, maximise capabilities and control employment in good work, healthy standard of living, strengthen prevention of ill health. Now, the outcomes were widely praised. . Well done. Report is brilliant. We're not going to enforce it. The same old. So it served as a framework for local authorities and NHS trusts. No national legislation. Was implemented 

Dr Jeremy: right?

Val: It's influence was largely felt at local rather than national level. That's strange. 

Dr Jeremy: I haven't read the Marmot report from 2010, but just the objectives you [00:06:00] listed here. I don't know if that's. Exactly how it was stated in the report but as an objective, it's fairly vague, right? Best start in life for every child. Okay. That isn't something you can just legislate, right? 

Val: Yeah. 

Dr Jeremy: I saw online there's a stat 40 pushups, 10 times less likely to have a heart attack. Okay. 

Val: How many men can do that?

Dr Jeremy: How many men can do that? And it's not like you could just pass a rule. Okay. Everybody, you have to be able to do 40 pushups. Yes, it would be great to get to that point where every man could do that, but you have to go further okay. So if someone can't do a pushup. How do you get to a point where you could do 40 pushups? 

Val: perhaps he will never be able to do it because of disability. As you said, it's easy to say this, but we've got to look at the barriers and the obstacles, you'll get to a, [00:07:00] because you'll have people that can get to a, like that. Yeah. Without any help, any resources. 

Dr Jeremy: Yeah. 

Val: But you'll have that middle group that will just about get there, but need additional help. And then you've got that group that just can't get off the starting blocks. No matter what they do. And those are the ones that, if they can't get off the starting blocks, They're going to get worse where middle at least they have a chance.

Dr Jeremy: Thinking about the third objective fair employment and good work. 

Val: Okay. 

Dr Jeremy: As an objective, it's not like we have perfect control over that, what if the economy goes down the toilet? What if there are no jobs? We don't always have control over those things. So there it's hard to implement some of these things. 

Val: And plus we got zero-hour contracts and then we got this fire. We hire thing that happens as well. [00:08:00] Work is no longer stable. When I was growing up, my friend's dad was retiring and she said he worked at the same place when he left school. I find that hard to believe there's anywhere like that now where you're there for 40, 50 years too many businesses are closing down. People are not earning enough. They're having to do two jobs, three jobs. Yeah. So those, the days have gone where parents just did the one job.

Dr Jeremy: Yeah. I don't think there's anywhere I've seen where people worked the same job their whole career. 

Val: No,

Dr Jeremy: I think that's a bygone era, but also if we think about, this report was written in 2010 what happened in 2010, 

Val: can't remember last week.

Dr Jeremy: We had the financial crash of 2008, 2009. The government brought in austerity around 2010. 

Val: 2010, I was a [00:09:00] baby. 

Dr Jeremy: All of us were too young to remember what happened in 2010. But there were major like economic downturn that, that happened. And so some of these things might've been a good idea if we had the opportunity to do it, but there were choices that were made. There were conditions the government was dealing with that meant a lot of this stuff didn't get enacted. 

Val: Of course it doesn't. 

Dr Jeremy: Yeah. 

Val: It was Labour in 2010, 

Dr Jeremy: When did the Conservatives come in with David Cameron? In fairness, I wasn't living in the country at the time. 

Val: David Cameron. Became prime minister 11th of May, 2010. 

Dr Jeremy: Almost halfway through 2010. 

Val: So what could have happened is it could have got commissioned before Cameron came into power, but it got published under his government.

Dr Jeremy: Cameron came in, austerity came in, the report had been commissioned and published, but [00:10:00] relatively little got acted on because of the situation the government was dealing with

Val: it's so strange. Because in this review, the key policy objective was best start in life for every child. 

Dr Jeremy: Yeah. 

Val: Now, as we know, when Tony Blair's government were in power, they had all these sure starts. In 2010 they were significantly reduced even though this review mentions every child should have the best start and that is what Sure Start was about.

Dr Jeremy: That's a key example of the report saying we should do something, and Sure Start was a way to address that. Then austerity hits. Those things get cut. 

Val: Yeah. And many of them closed. And it's sad because inequalities hasn't gone, isn't it strange that when austerity happens. The [00:11:00] first thing, as we all know, it's a race to the bottom, what can we cut on the ground? But then as we know, with further reports and how health inequalities and data have gone on since then health inequalities has gotten worse for children and adults. So cutting these things, as we spoke before, may in hindsight save money. We know further down the road it's gonna be a bigger cost, 

Dr Jeremy: right? 

Val: When can we have foresight? We need to make cuts or reform. Why? Why is it is got to be at the detriment of the ones that really need the help and support? A child has no control over the family. It's born into where [00:12:00] they live. What mommy or daddy does for a living, no control over whether they're born into poverty. But that shouldn't be the end of that child's story do you see what I mean? 

Dr Jeremy: Yes. 

Val: It shouldn't determine that they stay in poverty for the rest of their life because the government wants to make cuts.

Val: How is that child, when they grow up, going to become a productive member of society? If all they see around them is failure, abandonment, it doesn't make sense. And then they see the rich getting richer. That's not a fairer society. And I think sometimes when people hear that people at the bottom are going to get more, they think things are going to be taken away from them.

Dr Jeremy: Yes.

Val: But the understanding is, a little bit might be taken away. But if it's not taken away [00:13:00] now, a larger chunk is going to be taken away later on down the road because things then have gotten worse. 

Dr Jeremy: I think that's a key point, really, that I talked about before this distinction to be made between equity and equality for some equity helping some people more than others. Has become a bit of a dirty word as if it's masquerading as equality where everyone gets treated equally. And yeah, if you think about it as, these people are getting something and I'm not, that can feel unfair. But I think healthcare is an area where it makes perfect sense to have equity rather than equality, if you get a stent It doesn't mean I need to get a stent, too, if you get a blood transfusion and I don't go around saying I'm not being treated fairly because, someone who needed a blood transfusion got one and I didn't. 

Val: If your house is on fire. And the fire brigade. 

Dr Jeremy: They don't sprinkle water over everybody's [00:14:00] house. You put the resources where they're needed and that just makes sense. With health it's the same thing you give the resources where they're needed. We're talking about equity rather than equality 

Val: okay. Let's quickly. To the 2020 review . Because he came back 10 years later. Yeah. And 10 years later, the Tories are still in power.

Dr Jeremy: Correct.

Val: So let's look at the key findings for 2020. 

Dr Jeremy: Okay. 

Val: So the 2020, review was called health equity in England, the moment review 10 years on, they've asked me again, though. I've made that up. He should have put that in the forward. These people don't listen. 

Dr Jeremy: Yeah. 

Val: So within those 10 years. Guess what happened. Do you think is it might be a trick question. I want you to think [00:15:00] about this. Remember your phD depends on this. 

Dr Jeremy: Okay. 

Val: He comes back. He's already said what he said. It comes back 10 years later, do you think health inequalities lessened or widened?

Dr Jeremy: I think they widened, got worse, right?

Val: Of course it did, 

Dr Jeremy: So we had austerity, cuts. This impacted people's health who suffered more, the rich or the poor, probably the poor, right? These health inequalities got worse. And what I thought was interesting is particularly between North and South of the country.

Val: Different. 

Dr Jeremy: Things were getting worse, but the conservatives were always talking about leveling up the North. 

Val: That didn't really come in or that song wasn't sung till much later. Right now we're on the inequalities tune. Same old song, the dial hasn't moved forward. The dial is moved [00:16:00] back. 

Dr Jeremy: Yeah, 

Val: Within the 10 years. So the 2020, it highlighted that life expectancy had stalled for some. And it even declined for the poorest, while the amount of time people spend in poor health increased. The report emphasises the need for action to address the social determinants of health, including education, occupation, income and community. That's what he said in 2020. And I'm sure professor Marmot is still saying the same thing today.

Dr Jeremy: Of course. 

Val: I think he should just record it. Then when he's asked to go to a committee meeting, he just presses play. 

Dr Jeremy: Yeah. 

Val: Guess when I recorded this, how do you think anything's changed? [00:17:00] No, it hasn't. 

Dr Jeremy: Yeah. What happened in 2020? Covid, right? End of 2019, early 2020. Covid pandemic, right? 

Val: I can't remember. 

Dr Jeremy: So it's just once again, some, there's this report, there's recommendations made, but then something comes along and derails it.

Val: But don't forget, even though we did the review in 2020, things were getting worse before COVID and COVID made it even, worse.

Dr Jeremy: I'm not disagreeing with that at all.

Val: I think the lockdown, 

Dr Jeremy: yeah, 

Val: the lockdown of certain appointments for people with cancer and ongoing chronic illnesses. That was bad. 

Dr Jeremy: The original report in 2010 said, here's these problems. Here are the things you should do to fix it.

Dr Jeremy: And then the financial crash happened and the government came in and said, okay, we're going to do austerity. That's going to fix it. And by 2020, they come along and say no, actually it didn't fix it. It actually made things [00:18:00] worse. Here's some things you need to do. Then COVID happens. 

Val: I do understand that in politics, not everyone can get what they want. Everyone can get a bigger slice of the cake. I get that. But then it's about priorities is where you direct those funds to is where you think at that time, the government of the day believes is more important. Do you see what I mean? Because money's always going to go to health education, housing, but it's where the money goes 

Dr Jeremy: Yeah.

Val: So they thought the easiest thing to do was to cut back on. Sure. Start. Sure. Start. 

Dr Jeremy: Yeah. 

Val: Babies, children, age five and under. 

Dr Jeremy: Yeah. 

Val: It says a lot. [00:19:00] A bunch of people on the front bench. This is the Tory government. We have Cameron Osborne and whoever else. And you had a bunch of people. That are not ever going to be in poverty. Their children are not ever going to be in poverty. I know their families are quite well off, do you think as a psychologist, do you think that makes a difference that the people making these decisions, do you think they need a better understanding of what it's like to live in that position? Do you believe that

Dr Jeremy: as a psychologist, I think the way to change people's behavior. is to give them better information, people make decisions based on the information they have and what they think is important. If they have the wrong information, they make bad decisions.

Dr Jeremy: If people have better information, they understand why [00:20:00] something is relevant and better for them. Then they make better decisions. My wife works in education consulting and once went to Kazakhstan.

Dr Jeremy: She was doing a review of their education system. And so the reason she was going is because, countries compete, to assess their education systems by certain tests kids take when they're about 15 years old. And so they compare the education systems around the world and countries are always wanting to increase their score on these tests.

Dr Jeremy: And She and some other consultants were hired by Kazakhstan to review their system, see what they're doing right and see how they could improve their scores. And what she was saying is what the government there was doing was they were putting all their money into these, elite kind of schools.

Dr Jeremy: Students who showed they were smart would go to a specific school and that school would get all the funding to try to push them to the heights of education and productivity and all this kind of stuff. And, [00:21:00] okay, that was all great. What my wife was pointing out is if you actually want to increase your score you get more bang for your buck.

Dr Jeremy: If you put the money. In places that don't have it. It's cheaper to raise a whole lot of people up. Even if those people don't go on to the super high elite levels just if you're, if your baseline level is higher overall, you get a better score and societal, you get a better outcome.

Dr Jeremy: If we apply that to health put resources where people are suffering most, you can improve their lot in life a great deal with a lot less resources. It's more efficient to do it that way. Then it is to try to pour huge amounts of resources into it.

Val: It's interesting when you mentioned that, And when I asked you the question do you think it matters that they should understand poverty more, [00:22:00] but when you said as long as they've got the information is there

Val: they had it in 2010. In black and white. I'm sure they sat down with the professor. This isn't as we will show next week. This is not the first review or the first report ever to talk about health inequalities. It's like we're shoveling snow and there's an avalance coming.

Dr Jeremy: Yeah. 

Val: And that's health inequalities because they're not taking a hold of it. What happens? They start something good, like sure start, new government comes in and this is where they play politics with people's lives. People's lives are not your political game.

Val: They come in, make cuts. And they cut it people in the neighborhoods. Needed it most 'cause it was targeted. . They're the ones that lose out. Yeah. Not the ones that live in [00:23:00] noting hill.

Dr Jeremy: Exactly. As a psychologist I'm thinking of the concept of ambivalence, leadership is ambivalent getting pulled in different directions you can give them some information. . That's pulling them in one direction. But there's other information, there's other factors that are pulling them in other directions, and that's normal, right?

Dr Jeremy: And, clinically, when people, want to make a change, let's say they want to quit smoking, right? But they also want to keep smoking, because they enjoy smoking, so they're pulled in two directions, to deal with that is actually to get people to focus on both things that are pulling them.

Dr Jeremy: So they feel that conflict. That discomfort. By doing that, people understand what they really value? 

Val: Yeah. 

Dr Jeremy: Yes, it's true. I enjoy smoking. There is something I get out of it, at the end of the day, what I really want

Dr Jeremy: is to, not get lung cancer I think our leaders need to [00:24:00] recognise they're being pulled in different directions, and figure out what we want for the country?

Val: I think as they say advise, ministers, decide. But when you look at the departments one minute, someone's the secretary of state for health, the next minute, the secretary of state for transport, in real life, you are clinical psychologist. Would you go and apply for chief executive of transport?

Dr Jeremy: No

Val: See what I mean? 

Dr Jeremy: Oh yeah. That's the crazy thing about government.

Val: Never there for the long term. They have a reshuffle as if that's going to make some kind of difference. It doesn't makes it worse. There's no in that department at all. Everybody wants to put their stamp on it. And when they talk about taxpayers money, we've got to prove that, we're spending it well, we'll [00:25:00] stop doing these bloody reviews and reports then,

Val: it's like they think by showing the country, look, we're doing another report they're doing something. Do they ever tell the country that after the report is published, they're doing sod all they shelve it and that's it.

Val: It's like pissing money up the bloody wall. These things get me angry. There's only one pot of money and all the money is taxpayers money. But the only time they sing that song, that sad old song taxpayers money is when people in the public sector want a pay rise or it's about people on benefits.

Val: They don't sing that tired old song, taxpayers money. when they're giving themselves a rise. 

Dr Jeremy: Yeah. 

Val: Or they're giving out contracts to their buddies that know sod all [00:26:00] about PPE. They don't sing that song again, but it's still tax payers money. All of it. And it seems like people swallow it. They only make noise when the public sector want a pay rise or people on benefits. I didn't hear much noise. About the PPE, all those millions and billions gone up in smoke. Where was the noise for that? 

Dr Jeremy: No, that got some attention, but nothing really happened did it? 

Val: As Chris Rock, one of my favorite comedians, we have selective outrage.

Val: It's still taxpayers money. Where's the outrage about all the money they spend on paracetamol aspirin and ibuprofen? Did I say it right? 

Dr Jeremy: Close. 

Val: Where's the outrage? 

Dr Jeremy: Yeah. 

Val: Where is it? You want more money in health. [00:27:00] You want your waiting time to get lower. You want your operations, you don't want them to be cancelled.

Val: Get outraged about every penny your government is spending. It shouldn't be dedicated to one group. It doesn't make sense to me. They have a responsibility to every taxpayer. With every pound and pence and shilling and toppence that they spend, 

Dr Jeremy: Yeah. 

Val: Yes. 

Dr Jeremy: No argument 

Val: So Marmot Review. As we said, 2020 life expectancy installed, yes, not a surprise, health inequality had widened. Oh, what a surprise. Austerity measures from 2010 onwards linked to worse outcomes. Local government cuts, especially in deprived areas.

Val: Cuts in areas that need it most. Impacted services that determine health, you're cutting housing, [00:28:00] education, and public health. So the outcomes, these were timed just before the COVID 19 pandemic.

Val: And it had a renewed push for cities like Coventry to adopt equity frameworks. We must check that out and see if that is still going on. There's still no legal duty or central accountability for implementation. These people make me want to cry. Yeah. They really do.

Val: Why have? Something like this, and there's no accountability for implementation, none at all, it makes no sense to me, they're quick to implement when the, government body that looks at MPs pay,

Dr Jeremy: oh, 

Val: But they never say, we don't need to pay rise. I've got nine jobs. They never say that. They never [00:29:00] turn it down. They never say, look, we haven't austerity, we're living in hard times. Our people are going through it. We'll go through it too.

Val: They don't, they take that money. They don't argue with that. They implement that. But they don't implement health reports that will help deprived communities, but they implement their money when it's going to help them. 

Val: They always say we don't set the pay, we don't set the pay. Yeah. But you can refuse it or donate it. You don't have to accept it. 

Dr Jeremy: Yeah. 

Val: Supposing one day you get paid for, what's it called? 

Dr Jeremy: Based on performance, right?

Val: That's it. Yeah. See how quick they implement that healthy inequality Yeah. They've got to 

Dr Jeremy: to do 

Val: you're an MP [00:30:00] for a reason. Everyone has a personal reason. Yeah. Yeah. Why they work in public services, a reason why you were a nurse, the reason why you became a doctor, and to be on the platform where you are an MP. 

Dr Jeremy: Yeah. 

Val: , You want to do good for your country. Your constituents. 

Val: There has to be something needs to be done. Yeah. In order to make them do better, she had the budget the other day. Giving away money like Haribos where is that money in health? How much of it is going to pay for consultants management? How much of that is going to go to red tape? Compared to how much it's going to go directly to the front line. That's what we need to know. 

Dr Jeremy: We're bashing politicians here. You're not going to get any argument. We're pointing one finger at them and fair enough. But I want, if we [00:31:00] switch gears for a second, I think one of the reasons why, there's many reasons why governments, don't have the money to do what they want to do. And I think one of the reasons is taxation and a kind of inability to adequately tax the wealthiest people.

Dr Jeremy: Entities in our society, really wealthy companies generating vast amounts of wealth are, not paying a lot of taxes. These companies are earning huge amounts of money, but not contributing back.

Dr Jeremy: And particularly in, in the tech sector, a lot of these companies have made their fortunes disrupting existing systems. And that means Someone is suffering when your company does well. So when Amazon does well, other companies are not doing well, go out of business.

Val: Yeah, 

Dr Jeremy: They've been replaced by Amazon. 

Val: Let's replace them with AI, 

Dr Jeremy: right? That's a perfect example of something coming in the [00:32:00] future. I don't think it'll come, as quick as everyone thinks, but. I think it is coming where certain entities will have all the wealth.

Dr Jeremy: If a vast number of people who don't have it, And if a government, if they can't tax it and redistribute it then we're in a very strange society where there's just all this wealth concentrated in one area and everyone else suffering. I don't have a solution but we need to find a way to, to adequately tax those that have the wealth.

Val: Is it about taxing our way out? 

Dr Jeremy: Whether it's taxed in the traditional sense or some other redistribution method, I don't know. 

Val: They've got to get people into jobs. 

Dr Jeremy: Yeah, 

Val: They've got to it's simple. It's not simple, but. You shouldn't have country in the we in the G seven country, like the UK, where so [00:33:00] many people are sick that want to work, but need extra support

SWOOSH: Mhm.

Val: The second was the Race Disparity Audit. Done in 2017. Before the 2020 Marmot review.

Val: This was launched by Theresa May, entitled Ethnicity, Facts and Figures. There were significant racial disparities in health. Education, housing, employment, and criminal justice, black women were five times more likely to die in childbirth. Ethnic minority groups were over represented in low paid work, had poorer mental health outcomes.

Dr Jeremy: Yeah, I think that's very relevant for my profession, given I work in mental health. 

Val: And had less access to tailored health care, [00:34:00] and they said Black Caribbean and Pakistani communities were more likely to live in deprived areas. I'm sure that hasn't changed, and this doesn't help me, anyone else I know that's interested in health inequalities, when you see these things written down.

Dr Jeremy: And how does that land for you when you see it written down or read it 

Val: When you see it, this is why I got involved years ago, when you see something like that, whether it's about me as a black woman or just about communities in general, 

Dr Jeremy: Yeah 

Val: see the figures and you realise, It just isn't fair and you want to do something about it, before you see it, you're oblivious to it.

Val: You're trying to get a job, but you realising its hard,

Dr Jeremy: yes.

Val: You're not going crazy because you [00:35:00] haven't seen the figures. No one's telling you, this is why it's harder for you. I live by that rule that you need to help yourself if you're able to, there's a percentage down to government. There's a percentage of it that's down to communities and there's a percentage of it that is down to you. I understand. I have a child with a disability. I understand that some people will always be dependent on certain resources to get through their lives, to make it through the day where there's a carer coming in to do tasks for you, keeping you clean, keeping you fed. But if the government doesn't give that percentage and the community doesn't give that percentage, you can't help yourself, 

Dr Jeremy: right? 

Val: You [00:36:00] can't. You need the bootstraps.

Val: It's all right saying, pull up your bootstraps. You need to give me the boots. The government needs to give me the boots. Community resources are the straps to those boots. I might need help to pull them up a bit. Do you see what I mean?

Val: No one rich or poor has done it on their own they expect somebody in a deprived area, with minimal education, who's probably been grown up in the worst circumstances ever. They leave them. To their own devices. No one millionaires don't do it alone. No one does anything completely on their own. So it's unacceptable to allow those that need the most help the most support to leave them with sod all when you've had everything at your feet. Your life was mapped out for [00:37:00] you. 

Dr Jeremy: The last point you read out about these communities more likely to live in deprived areas.

Val: hmm 

Dr Jeremy: If there's a deprived area why is it deprived? It's deprived. At a systemic level, because funding is allocated is usually based on property values or something so that, areas that are poor have less money.

Dr Jeremy: They become deprived and therefore it's more difficult for communities that are poor to not be poor. Whereas there's another choice to be made where you could say, okay, we're going to pull the money from everywhere and we're going to distribute it evenly, or even we're going to distribute it where it's needed most.

Dr Jeremy: That would help poor communities not be poor anymore. And yes, that would mean that communities that are quite wealthy and are enjoying a very well funded. Or even overfunded sector might lose that. They might not need that.

Val: So for the [00:38:00] outcomes of this audit, made data more visible through the ethnicity, facts and figures website. It changed everything for somebody like me because it was there right in front of me. 

Val: Because then you want to do something about it. If it's just based on my ethnicity, what can we do to make two women who are of different ethnicities have the same service, the same outcome as our white counterparts, because we're not saying a new service needs to be provided.

Val: We need to be treated equally. Listened to, it surprised me it also led to some targeted programs. On school exclusions [00:39:00] and employment. 

Dr Jeremy: Reducing school exclusions.

Val: Hopefully. 

Dr Jeremy: Yeah. That would be the aim of the program. 

Val: Yeah. 

Dr Jeremy: Yeah. 

Val: Some people don't like the targeted approach to employment because it's easy to say. It's the best person for the job. That's so easy to say it is because that tells me that other groups are not as good as the white group. And if somebody of color got the job, it's always, they got it because of their color. It's never they got the job because. They're qualified do you know how insulting that is, to men just like yourselves. have the same PhD, same [00:40:00] grades, same experience and everything.

Val: The only thing that's different is ethnicity. . Say , the black person gets the job. Some people think, they got it 'cause they're black. That person had the same.

Val: Qualifications and experience as you, but they're never given that credit. It never is. And they've got to remember why all these programs came in. Because it showed ethnic minorities weren't getting jobs higher up not because they weren't qualified.

Val: I've never applied for a job I'm not qualified for. That makes no sense to me. I hope no one does. 

Dr Jeremy: I can tell you as someone involved in hiring 30 applicants for this job and it was amazing how many applied who met none of the essential criteria.

Val: You're kidding me. 

Dr Jeremy: Oh, no, not at all. And yeah, we had people who had [00:41:00] absolutely no relevant training or experience. 

Val (2): Huh. 

Dr Jeremy: Someone applied with a blank application. They didn't write anything 

Val: Why? 

Dr Jeremy: I have no idea. Those people don't get the job, right? If you've got 30 people applied for a job, we don't interview 30 people. So if you don't write anything about yourself, we can't evaluate your application. So that person doesn't get an interview. But there's a lot of weirdness in hiring I do recall hearing about this is many years ago when I can't remember if you, I don't know if you remember this or not, but I had heard that there were, there was a low number of people of ethnic backgrounds being hired in finance or trading stocks.

Val: Really? 

Dr Jeremy: Because they would show up for interview and there was an unspoken rule to wear black shoes. Maybe more people of an ethnic background were wearing brown shoes. On that basis, [00:42:00] they were saying this person, they look good on paper, but they just don't quite fit in. So they would get weeded out. 

Val: What about class? Because I remember this guy , he has a YouTube channel, I can't remember his name, talks about stocks, stock markets he's white, working class, never saw anybody that sounded like him. 

Dr Jeremy: Yeah. 

Val: So it's not just colour, it's I 

Dr Jeremy: think that's a huge thing in the UK friends of mine who were born and raised here. Talk about the importance of accent. And the judging that people engage in, if they hear your voice, even if they can't see your skin color, they make assumptions about where you're from, what your parents do, what kind of school you went to and what job you're likely to do now as a Canadian, that's over my head. I don't get it.

Val: When I was growing up, I never saw anyone who read the news or any presenters that had a regional [00:43:00] accent. Now you look in government, you've got. All kinds of Midland accents, Northern accents.

Val: I remember the BBC had a lady on having some BBC news that talked about finance. Sure. It was finance and she had a Northern accent and it was very unheard of, because they seem to like the. That cut glass accent, you don't have you don't have one, let's say, but it's changed.

Val: Slowly, it has changed to think that was a barrier to somebody who's got those qualifications. Yeah. Being a main presenter, talking about the thing that they're qualified for based purely on their accent. And in some cases their gender, so [00:44:00] things have changed. I've got a friend, a very cynical friend said, nothing's changed. I said, no, you're wrong. As much as I stumble across barriers still. Yes. Always say things have gotten better. Yes. It has changed. It has improved.

Dr Jeremy:  While things still need to change, we need to recognise the things that have. That leads to the next point, in 2021, the commission on race and ethnic disparities claimed the UK would no longer had a systemically racist society.

Val: Didn't we talk about this the other day that . You can put all these recommendations and the one that sticks 

Dr Jeremy: is the term racism. Yeah. And I think this is a good example because we're talking about systemic racism.

Dr Jeremy: So just, for people who haven't heard that episode, when we talk about systemic racism, we're not talking about old timey overt racism I [00:45:00] don't like you because of your group membership, you. That's classic old timey racism. Systemic racism is really talking about. It's not saying anybody is personally racist, it's just saying that the system is not aligned to specific ethnic groups needs. That's all it means. And I think we can acknowledge the system isn't aligned perfectly to every group's needs.

Val: Do you think they would react differently if the word Racist was put as class. Because class has nothing to do with colour. 

Dr Jeremy: Or, if you just said systemically unequal, 

Val: do they have to swallow that better? 

Dr Jeremy: I think people like the idea of equality, right? Like a more equal society, 

Val: Some see it as a threat to their status. They feel that when the [00:46:00] government gives more or concentrates on one particular group or targets a service for one particular group. It's taken away from them 

Dr Jeremy: That's perceived that way. 

Val: But it's not taken anything away from them. Sometimes it's to do with the fact they've never had to fight for equality. So they see it as a threat

Val: just like the house burning down, the firemen come to put out your house, next door come out and say what about mine? But it's not your house that's on fire. Do you see what I mean? 

Dr Jeremy: We don't sprinkle water on everyone's house, right? 

Val: Not yet, we 

Dr Jeremy: turn hoses on houses with fire.

Val: And at that time, it's our house was burning down. 

Dr Jeremy: Yeah. 

Val: Be thankful it was never yours. 

Dr Jeremy: Exactly. 

Val: And for a group to have never had to fight. For equality and having to battle [00:47:00] every day for so many barriers, I read a story today in the paper in the Daily Mirror and it's Lord Victor Adebowale. I cannot pronounce his name. I do apologise. He's a life peer, a cross bench, I think. Yeah. He does a lot. He does a lot of work. He's the chairman of the NHS confederation. He was saying, given the story about his mother, who was, I think recently she passed away age 92. And she was a nurse for 45 years in the NHS. But yet she was a nurse and yet she faced a lot of discrimination. When it came to treatment. And this is a woman that knows about health, that knows about the system, knows about the NHS.

Dr Jeremy: Sure. 

Val: And what he was saying was. His mother [00:48:00] is a solid example of a systemic problem. it's important that people like me are not seen as above it all.

Val: So he thinks she even though she lived to 92, some of the years she lived in discomfort and they believe she was undiagnosed with cancer. She wasn't diagnosed. He says, quote, I think she got a black service, not an NHS service. 

Dr Jeremy: He means she got subpar service.

Val: Yeah. 

Dr Jeremy: Yeah. 

Val: She presented in A and E in a poor condition. It was a busy day and there wasn't space for anyone. They had to be a negotiation to get her a space. He said it made him angry because how can you live that long with something and not be diagnosed? It looked like she had lung cancer. She [00:49:00] never smoked, lived a healthy life, It's sad because this wasn't a lady who wasn't okay with the system and her son wasn't as well. I've seen him a couple of times on question time, so there was no language barrier, educated.

Val: So you think if that can happen someday like that, then the issue must have been, as you say, skin colour. 

Dr Jeremy: Well, 

Val: that's their experience. Everyone is entitled to talk about their experiences, whether anybody agrees with it, that's up to you. Everyone's entitled to tell their story of how they were treated.

Dr Jeremy: That's why I was thinking talking about systemic inequality would resonate better because, no one who listens to a story of saying, someone, had cancer that went undiagnosed potentially because. Yeah. Of skin color. No one is [00:50:00] saying, no that's perfectly fair. No one says they want that to happen. 

Val: Yeah. 

Dr Jeremy: What we want is everyone who's got cancer, lung cancer or anything else we want everyone to have, equal access to diagnosis and treatment. We want better outcomes for everybody. And if someone is not getting the outcome that they should want that to stop. Right. 

Val: She passed away in January. 

Dr Jeremy: Yeah. 

Val: Her name was Grace. He told delegates, at the NHS Confederation Expo in Manchester this week. It was not the dignified death we wanted for her. It wasn't the death she deserved. it makes clear the need to address inequality. I'd love to meet him. He's always been a fighter about health and health inequalities

Dr Jeremy: yeah. 

Val: In the NHS, which we will talk about. 

Dr Jeremy (2): [00:51:00] Yes. 

Val: Okay. Another bit of , the outcome was many critics argue the government failed. To act on the data. Is that a surprise to you, Dr. Jeremy? 

Dr Jeremy: Not at all. I think that's the overarching theme of all the reports we're talking about.

Val: Same old song. Same tune. 

Dr Jeremy: Right. 

Val: By a different prime minister. Same old tune. My cynical friend says nothing.

Val: He said, this is how it's supposed to be. This is how they want it to be, but even if he feels that we will never have equality as in 50 50, it shouldn't be this bad. Do you know what I mean? On equal where it looks like we're living in two different countries. 

Dr Jeremy: Yeah that's a really good point. If we could magically snap our fingers and [00:52:00] make society the way we want we probably wouldn't want everyone to have exactly the same outcome, no matter what because that kills incentive.

Dr Jeremy: We don't want someone's hard work rewarded like someone who does nothing we want to incentivize people 

Val: yeah, 

Dr Jeremy: The issue I have, and I think most people have is they don't want that incentive to be so extreme that, we don't want disparity so large, people with, relatively small differences in IQ geography gender or privilege being fabulously wealthy. Super yacht after super yacht. We want people to feel rewarded, but not necessarily entitled to fabulous wealth, 

Val: supposing somebody has invented something everybody uses.

Dr Jeremy: Sure. 

Val: We know there are individuals out there. Haven't been born with a silver spoon, but they have [00:53:00] made something of themselves and become fabulously wealthy. That's not their fault. 

Dr Jeremy: No. 

Val: I can't blame them for issues in deprived areas because that's down to government, how they distribute the wealth. As I was telling my friend we were talking about resources and I said, look, I'm not wealthy. I get good service because of the postcode I live in. That's the bottom line. 

Dr Jeremy: Yeah. 

Val: That's not down to skin color, not down to gender. It's down to the fact of where I live. I am within reach walking distance of three.

Val: Major hospitals, my GP, I go on to the consult online. Get a call the same day to go in I get [00:54:00] phone calls out the blue from my GPS to see how we are doing. I get support from the local authority as a carer. 

Dr Jeremy: Mhm. 

Val: That's down to the postcode. That's down to the people that work in that postcode.

Val: He was saying, no, but you've got too many. I said, the royal Brompton was built and years ago. It's not new. If they were gonna build a new hospital now, it wouldn't be in this borough. 

Dr Jeremy: Yeah. 

Val: So that hospital's old, don't forget when it was built. It specialises in lungs. And the other side of me designated heart attack, and I happened to have a heart attack. 

Dr Jeremy: Yeah. 

Val: Can't, this is my personal experience. In reality, you're not going to have everything on your doorstep.

Val: I'm just fortunate that I have. Okay. I can basically say [00:55:00] I do. 

Dr Jeremy: Yeah. 

Val: What can we do? What can the government do in areas that don't, because we talked about rural areas. There's going to have problems with transport links. People work in zero hours. You can't afford to take time off.

Val: To see the doctors, to get the checkup. Do To see if they have cancer.

Dr Jeremy: I think people do need to be compensated better. And I think that requires changes at the system level. But it requires people who are very wealthy or with a lot of power to give up some of that wealth. And have I ever talked to you about Peter Singer?

Val: No. Why should they give up some of their wealth? 

Val: I I don't have any to give up, but if somebody was working here they might say I've worked hard. I've invented X, Y, Z and it's saved whatever. Why should I give up more of my wealth when I pay X amount of tax?

Dr Jeremy: Peter Singer, I might be getting his argument wrong [00:56:00] but imagine you're walking by a pond see a little girl drowning. 

Val: Yeah. 

Dr Jeremy: What would you do? 

Val: you don't know Some people jump in. Some people freeze. Some might phone someone you don't know. Until it happens. 

Dr Jeremy: Let's 

Val: think we'd be jumping and help. Yeah. 

Dr Jeremy: Assuming you're able bodied and not risking your own life 

Val: you can swim.

Dr Jeremy: If it's just a matter of getting your shoes wet you're grab the little girl and save her life. 

Val: Yeah. 

Dr Jeremy: Let's say, you send 10 pounds to charity. You can save a little girl. 

Val: Okay. 

Dr Jeremy: You can save the life of a little girl.

Val: Okay.

Dr Jeremy: Should you do that? If you give 10 pounds, you save a life. If you don't that person dies. 

Val: Let's say I'm the wealthy person. 

Dr Jeremy: Yeah. 

Val: Paying all my taxes. I have a charity. I also give to charity. Yeah. I get other people to give to charities. [00:57:00] We have to admit there are loads of people out there. Some don't sing about it. When they've passed away, people tell stories about how they got contacted. Like when George Michael died, people said, Oh, they contacted him under condition. They don't say anything. So there were a lot of wealthy people that do a lot of good.

Dr Jeremy: Absolutely. I'm not arguing with that at all, but what I'm, trying to illustrate Singer's position, he would say is even if you weren't wealthy, even if you've just got 10 pounds extra, you're not a wealthy person, but you have 10 pounds. If you spend that on yourself and you get, I don't know, you get a takeaway, right?

Dr Jeremy: You spend a little extra money or you send that and you save a little girl, right? On Singer's view, it's immoral to buy the takeaway when you could be saving a little girl. Singer's view is considered extreme.

Val: Who is he? 

Dr Jeremy: Peter Singer a famous [00:58:00] philosopher of ethics.

Val: From where? Where is he from? He's, 

Dr Jeremy: He's from Australia, I can send you a link if you want to read more about him. What he's arguing is that, any amount of disposable income that you're just spending on frivolously on yourself, when you could be saving the life of a human being, he's arguing, and I'm not saying I agree with this, I think, I'm there's something to be said against it. But he's saying that's actually immoral. That's his claim.

Val: And who has disposable income? Nowadays?

Dr Jeremy: I've got disposable income, if I buy a junkie a little dog toy I spent 10 bucks 

Val: dog. 

Dr Jeremy: Sure, but I don't need to buy a dog toy. He's not going to die without a dog toy. 

Val: But then we can justify everything. Do I need that new top do I need a haircut? Exactly. You didn't need a haircut, but you still did it. We can justify anything. Yeah, 

Dr Jeremy (2): be? 

Val: Bloody end. 

Dr Jeremy: That's a good question. I think Singer would argue [00:59:00] it ends pretty far down that road, but, I don't know, 

Val: Singer needs to sing another tune. Yeah, 

Dr Jeremy: I I think it's an interesting idea, but maybe we're not going to go that far, there is a lot more, fabulously wealthy people could do, and it wouldn't cost them a lot of money. Bill Gates is giving away 90 percent of his fortune. He still has a super yacht, right? 

Val: That's up to Bill Gates. 

Dr Jeremy: Yeah. 

Val: That's his right. His choice. Not everybody's going to be doing that. I don't like what singer song has said. There's no disposable income. You have to save for a rainy day. If you own your home, and something happens to your roof. You're not in social housing, so you have to fix it. You decided to give that disposable little income. Away. 

Dr Jeremy: Yeah. That's a perfectly [01:00:00] reasonable objection.

Val:  There's no such thing now as job security. AI is coming for your job Jeremy.

Dr Jeremy: Why do you think i'm doing podcast? 

Val: Coming for us all my friends, 

Dr Jeremy: AI can do a podcast, but do people want to listen to a podcast from AI?

Val: They don't realize. We could be AI.

Dr Jeremy: I promise we're real human beings. 

Val: Don't know about that. But yeah we could go all crazy about that, but believe me, I'm going to advocate for the wealthy. I'm not wealthy. They do a lot. And then you've got that middle income group that also do a lot.

Val: They give money to charity, because there was a statistics done where I heard that it's not the wealthy, it's that group that have just a little bit more than just about managing. They're always constantly given to charity. 

Dr Jeremy: Yeah. 

Val: There are people that do that. We need to [01:01:00] pressure the government and get them to distribute the money better to be more effective.

Val: Go after. Right now, , they're in court trying to get some of that PPE money. They need to look at savings. And things like that and contracts and everything that goes into tax payers money.

Dr Jeremy: Yeah. I was thinking about this the other day. It may not be simply a matter of taxing that's going to lead to greater equality, there's plenty of other things, like home building. The cost of housing is so expensive and there's not a lot of social housing. If we went on a home building spree not necessarily just government contracts for social housing, but even developers building a lot of houses, if you build houses too quickly, house prices fall a little bit, you wouldn't want it to crash completely, but house prices might go down a bit, right? I have a mortgage, so I don't fully own my house. The bank owns my [01:02:00] house, 

Val: have disposable income and a mortgage. I'm moving in. 

Dr Jeremy: I'm paying a certain amount, right? If my house price goes down, I'm taking a hit 

Val: yeah.

Dr Jeremy: Now, am I willing to take a hit to know people aren't homeless, have a house that younger people can get on the housing ladder, that people need to move from one home to another or find social housing or find themselves in trouble are not destitute. Yeah, I'll take that hit, right? It's not a tax but for the well being of society, I'd be happy to take that hit. 

Val: Okay. I'll hold you to that. 

Dr Jeremy: Okay. Yeah. When house prices go down, if I'm crying you 

Val: can't speak on behalf of your wife. I speak on 

Dr Jeremy: Opinions are my own, they do not reflect my wife or my employer. Or my dog.

Val: Or your dog. Because the next time I see you [01:03:00] I don't want to be seeing you from a hotel room. Oh Val, I'm being kicked out. Okay. Let's move on to the last one. 

Dr Jeremy: Yep.

SWOOSH: Mhm.

Val:  The Health Foundation. Did a report called health equity in England in 2020.

Val: It was produced by the health foundation and that was in collaboration with the moment review team who we know that did. So that's revisiting the Marmot 2010 report with. New data, because that's all we need is new data. And so what did they find? Okay. It reinforced. Oh, I'm sorry. Same old song, same old tune.

Val: It reinforced all of the Marmot 2020 [01:04:00] findings with deeper regional analysis. 

Dr Jeremy: They were looking at the effects of austerity. 

Val: Austerity hit the poorest areas hardest. Those areas saw the biggest drop in health outcomes. They really need a review for that.

Val: Poor housing, low incomes, insecure work. And early years education worsened Blair introduced Sure Start, and we know that Cameron and Osborne took away Sure Start, which was for naught to five years old.

Dr Jeremy: Mhm. 

Val: Things change them because you talked about things. Health inequalities have a better starting line for Children. That's why we had sure start. Every child is perfect, which is why the Tories took away. Sure. Start. Because the work was complete. Perfect. Yeah. And the other finding was healthy life expectancy differed [01:05:00] by up to 19 years between rich and poor.

Dr Jeremy:  Are they talking about lifespan or health span? That is people are healthy, 

Val: healthy life expectancy. 

Dr Jeremy: Someone is alive, but unhealthy on their deathbed. It could mean that, someone could be, 30 years old, but they've got a serious health problem. And they're they're just barely breathing and suffering. 

Val: Yes, I know what you mean. It does say here healthy life expectancy,

Dr Jeremy: healthy life expectancy. I suspect that's code for health span making a distinction between just breathing versus actually living your life. 

Val: Some outcomes were strong evidence used by charities, local government and campaigners. They supported the development of equity based public health models in some cities, for example, greater Manchester and Coventry, 

Dr Jeremy: right? 

Val: But when it comes [01:06:00] to a review or a report, it was not adopted as official national health strategy. So it remained advisory. So I can advise you not to have that extra KFC. But that's just advice. As I say, advise is advise. Dr. Jeremy decides, so it's up to you, whether you want to put that KFC, when you smell it, I'll bring it round to you, you can smell it, it's floating through the air, you'd have to decide. I can tell you all the, Health and healthy eating it's up to you whether you want to eat it. 

Dr Jeremy: Yes. 

Val: So that's it. It's either you do it or you don't. Those are the strategies I don't like, because it's not committed. It's not.

Dr Jeremy: For all these reports, they're saying the same thing. Over years we've got evidence that [01:07:00] social determinants, not just when you go to hospital, but all of the things about income and housing and work and all these things are driving health outcomes. We know the problem it's been the same story for 40 years.

Val: I'll say more, but we know we've known for let's go as far back as 1980. Yeah, to the black. Report? We've known all these reports. All of them have the same theme, just like a stick of rock, as the same thing running through it, health inequalities, social determinants, not just medical care, drive health outcomes. So the problem is not lack of knowledge.

Val: It definitely isn't. It's a lack of political action and structural with reform because they talk about all the time. Reform. They talk about change. They talk about putting [01:08:00] money into the system it needs more. 

Dr Jeremy: There were plenty of recommendations, but then something comes along and those recommendations don't get implemented.

Val: They pick and choose their recommendations, when a government commissions a health report, that's the health and they get someone eminent, like professor Marmot to do it, to produce a report. I don't believe it should be handed back to the government to implement things like this should come out of politicians hands. It's like a political football.

Dr Jeremy:  What do you think about NHS England being abolished? The idea was, these arms length organizations would take it out of the politicians hands and manage things better.

Dr Jeremy: But what it's actually meant is the politicians, you can't really promise anything [01:09:00] because they're not the ones in control. So right now, under Starmer, they've abolished NHS England as one of the, as a kind of arms length, non governmental organization to say, okay, we're going to give it, we're going to give politicians more power to implement changes they're promising.

Val: They've never implemented anything. . Even when NHS England were there. There were still things that the government would choose to do or not do what I'm saying about these reports or any future report that come that comes up and whether NHS England is there or not, our most prized possession in this country, is the NHS.

Val: And I would imagine that the majority of us would want it to stay in its current form, free at the point of use. Is that when the government commissioner report is they are the government is that they, the implementation [01:10:00] of the finders findings of the report are not put in politicians hands. They are politicians.

Val: They play political football with the NHS. It goes on too long. They look at the list of recommendations and pick and choose or don't implement anything 

Dr Jeremy: it sounds like you're looking for some system that, that requires a kind of mandatory. Implementing of the recommendations or policy prescriptions, right? 

Val: There has to be something that's not in their hands, whether we have a Labour or Tory government. A panel of experts.

Val: Just does this. Things aren't getting better. money's been ploughed in. politicians, like their sound bites Once something's out of sight they've moved on to something else.

Val: Yeah. That's what politics is. The next best thing. [01:11:00] One day they jump about this. The next day about that. Nobody singing on Grenfell anymore. No dis singing on PPE anymore. Nobody singing. Do you know what I mean? Once it's out the news, it's out of their minds too.

Val: That's the inquiry, still going on, believe it or not. So yes, when it comes to health, it needs to be taken out of their hands. 

Val: I just, they're there. They've got the money. The department that's got the money. They're the ones that can say, okay, we will commission X report and then just leave it. Stop waking up every Tuesday to announce PMQs on a Wednesday. We're going to commission another report because all that does is delaying tactics.

Val: These things, these findings. They're over 40 years old. [01:12:00] It's rinse and repeat and rinse and repeat. Nothing's changed. The only thing that has changed is that health inequalities is getting worse. Because the population is getting bigger, more children, more families pulled into poverty

Val: so things are getting worse. I don't like it that every time a new government comes in, what the previous government did is scrapped like sure start. They come in and want to do something else. And it doesn't make sense. They want to do something different, but at the expense of what, look at the gaps when they took it away. It's like when COVID happened and that pompous health secretary, Hancock? Said he wanted to decide whether somebody lived or died. Who made him guardian of the galaxy? 

Dr Jeremy: Yeah. 

Val: [01:13:00] Who crowned him king?

Val: He's not even an auxiliary nurse. What gave him that right to think it and then say it, 

Dr Jeremy: it's absurd,

Val: This is how they see themselves. I don't think doctors like making that decision. 

Dr Jeremy: They actively dislike it. 

Val: But it's safer in their hands because when's the last time he put in a shift. He's not medically trained.

Dr Jeremy: It's a committee decision. 

Val: Exactly. 

Dr Jeremy: People who are qualified don't want to make that decision themselves. They don't want to be solely responsible. 

Val: No. It's a multi agency decision, isn't it? 

Dr Jeremy: You want multiple perspectives so that you make sure that you're considering as many factors as possible. 

Val: So we know that inaction, what's not happened since, what changes were implemented, not many.

Val: Have any of the government's promises translated into [01:14:00] better health outcome? I don't know.

Val: So the next episode, what we're going to do is go back to 1980, it probably wasn't even born then. But Excuse me. You are supposed to say some, something to that effect. I agree. Val, 

Dr Jeremy: I think you were just a sparkle in your father's eye.

Val: We'll go back to 19 80. We touched on it a bit today. We mentioned the black report. We're gonna talk about the black report. Acheson report, touch on the Marmot review and get up to date with Lord Darzi, which Dr. Jeremy's more a au fait than I am. 

Dr Jeremy: Okay. 

Val: Yeah. 

Dr Jeremy: Sounds good.

Val: We hope you've enjoyed today. Absolutely. Because we, what we did, we just looked at the one second,

Val: we talked about a few reports going back from 2010. The moment review race disparity audit 2017 and the health foundation health equity in [01:15:00] England 2020. 

Dr Jeremy: Yes. 

Val: Yes. We will do our stories labels and misconceptions. On next week's episode. Yeah.

Val:  Follow us on X Instagram and Facebook. Make comments. What do you think of these reports? 

Dr Jeremy: We'd love to hear what you have to say.

Val: Bye. Go.