INTRO RAP: [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 an episode of stories, labels, and misconceptions. We've Val Barrett 

Dr Jeremy: I'm Dr. Jeremy Anderson. 

Val: And this week we are continuing our health inequality series. And as we said, last week, we talked about three reports. We went over the Marmot review 

Dr Jeremy: and the Black report and the [00:01:00] Acheson report.

Dr Jeremy: No, 

Val: Okay. We quickly spoke about the moment review 2010 2020. We went over the race disparity audit 2017. And finally, we went over the health foundations, health equity in England, 2020. This week, we're going to dive a bit deeper into the black report, the acres report. The moment review again, and up to date, the Lord Darzi.

SWOOSH: Mhm.

Val: For those that don't know, this country loves a report.

Val: We love to write about things we already know. It seems strange, but we do. We haven't gone as far back as The Beverage Report.

Val: Everything links. And the reason why we're starting with the black report is because a lot of the reports today, [00:02:00] especially the Acheson report, Marmot review, and Lord Darzi one connect to the black report, the black report commissioned in 1980.

Val: under the Labour government, released under the Thatcher government. Found strong evidence that health outcomes were closely linked to class and income. 

Dr Jeremy: Okay. 

Val: He called for major risk redistribution Of wealth and policy changes, which we know were ignored. The recommendations, the amount was upwards of 2 billion a year. What I wanted to do was find out what the price would be today, because we know that nothing out of the black report [00:03:00] was implemented. If we don't deal with the issue at hand, it's just going to get wider. We know that because it did. 

Dr Jeremy: We know it did. Yeah.

Val: One of the findings was class and income yeah. Mortality and morbidity rates were far worse for working class people. 

Dr Jeremy: Mortality is when you die and morbidity is when you're sick.

Val: Okay. And they said these inequalities, as you said yourself, weren't just about the NHS. Yes. We know they're about the social determinants of health, but in 1980, I don't think he used that phrase

Dr Jeremy: yeah. These phrases evolve over time.

Val: He mentioned housing, jobs, education and access to transport Some recommendations were major redistributive policies [00:04:00] to reduce poverty. 

Dr Jeremy: Yes. 

Val: Cross department collaboration, which I would assume was already going on, we talked about departments working with their own budgets, but then when one department may cut back, they don't realise that. Eventually the effect of that is it will move to another department will pick up that budget because something has gotten worse. Can you give me an example? 

Dr Jeremy: The example we've talked about on the podcast is underfunding social care people get at home.

Dr Jeremy: And that means that people who are in hospital are not able to get discharged because they have no one to look after them at home. So this costs the NHS in terms of hospital stays a huge amount of money, way more money than it would to fund someone to look after someone and keep them well at home.

Val: Yeah. We talked about, people not taking care of at home in social care. The cost goes on to the NHS, [00:05:00] goes on to A& E, people are going into A& E more, if you're elderly, you're likely to stay in a bed more.

Dr Jeremy: And even budgets unrelated to health, directly maintaining public housing.

Val: Yeah, 

Dr Jeremy: if you don't maintain it and get a bunch of damp and mold that ends up causing health problems costing systems that are not related. They're not the same budget. But if you paid for one, you would pay a lot less than the other. 

Val: Yeah. And in fact, one of the key recommendations were investment in housing and early years.

Dr Jeremy: Of course.

Val: As we talked about the crucial part of children of age, especially naught to five, is why when the labor government came in 97. They created these sure starts. 

Dr Jeremy: Yeah, because there's a window of opportunity to make children's lives better. The things you do early on have knock on effects. 

Val: Of course. 

Dr Jeremy: What you're hoping for with [00:06:00] these preventative measures and interventions is if you do something small now, the knock on effects will be large later.

Val: In 2010 when Cameron and Osborne took away the sure starts. So we have today more children than ever before living in poverty. 

Dr Jeremy: Yeah, that was a key theme from last week's episode, these reports get written, the recommendations get made, and It seems like a good idea, but then something happens and the government says we've got other priorities So we're gonna cut this really good thing because of austerity or the stock market crash or whatever 

Val: the conservative government only produced 260 copies the black report because they never commissioned it. At the end of the day, they wanted it swept away, put in a cupboard of other reports and reviews that have been done. 

Dr Jeremy: This was the Thatcher [00:07:00] government in 1980. There was no email it was whoever got a hard copy of the report. 

Val: We managed without emails.

Dr Jeremy: I can't believe that. 

Val: Yes. Strange, but true. No internet. 

Dr Jeremy: Val, where were you when you got your first email account? Let's just make sure the listeners know that we're both very old. I was in my second year of university when I got my first email it was my third year university. And I remember being told I needed to get this. And I remember asking why do I need this? And they're like, , you just need to do it. I'm like why do I, why are you making me do something? I don't want it. I don't want to, I don't need what do I need this for?

Val: Still using drums. 

Dr Jeremy: Yeah. Smoke signals.

Val: What year did they come out? If you told me the year. 

Dr Jeremy: Clearly I'm a late adopter I think it was about 1995. It was the mid nineties. Oh my 

Val: My son was born. 

Dr Jeremy: Yeah. 

Val: Oh my God.

Val: The Thatcher government dismissed the recommendations as too [00:08:00] expensive and politically unpalatable.

Dr Jeremy: Yeah. 

Val: What does that mean? 

Dr Jeremy: Politically unpalatable means, it's not in keeping with their ideology. If the recommendation is saying something that is anti, if it was a conservative government and it's anti conservative recommendations, then that's unpalatable to them.

Dr Jeremy: If it was a labour government and they were making very kind of conservative recommendations, that would be unpalatable to a labour government 

Val: I don't know, because if you're going to ask an expert to do a report on health inequalities, they can't adapt it to please whichever government is around at that time. It is what it is, the recommendations are what they are. And at the end of the day, they are bound to

Dr Jeremy: no, but they're not bound, right? It was commissioned, by a labour government. 

Val: Yeah. 

Dr Jeremy: So the new [00:09:00] government comes in and we don't like it now. Yes, it's an expert writing it, but the issue is the governments are not bound. If they want to ignore it, they can ignore it. 

Val: the author of the report, they're more focused on their findings. Their findings is not going to be balanced in any way favourable towards any particular political party. It's not. Whatever the findings are, that is what the findings are. He can't make them up to please Thatcher. He couldn't make them up to please them. 

Dr Jeremy: People might argue the author is biased, but let's say this is completely unbiased. He's purely presenting the facts

Val: yeah, I would like to start off with that they're not biased. I wouldn't like to think that any expert is. Whether commissioned by conservatives or labour I hope it's different from being a government advisor but to commission a [00:10:00] report based on the people of the country has got to be factual.

Dr Jeremy: Yeah 

Val: Whoever does it. the recommendations for action, the black report proposed a range of social policy measures to tackle inequalities, including increasing child benefits. Improving housing, working conditions, better access to education and preventative health services. Yeah. Don't forget, this is 1980. 

Dr Jeremy: Yeah. 

Val: despite its significant findings, the report was met with resistance

Dr Jeremy: take for example some labour protections for workers. I wasn't in this country in 1980, but I don't recall the Thatcher government being famous for being pro worker.

Val: No, 

Dr Jeremy: I don't think so. Anything pro union or pro worker would have been politically unpalatable to the government of the day, 

Val: course. 

Dr Jeremy: [00:11:00] Yeah. 

Val: But the black report remains a landmark document in the study of health inequalities and its findings continue to be debated and analyzed. Which is why, when we then move on to Sir Donald Acheson report of 1998, this was called the inquiry into inequalities in health. And this was commissioned under Tony Blair's Labour government.

SWOOSH: Mhm.

Val: Guess who was on the advisory group for that report? 

Dr Jeremy: No idea. 

Val: Lord Mormot. Lord Mormot 

Dr Jeremy: Okay, 

Val: Professor Marmot 

Dr Jeremy: Okay. 

Val: So he was there, everything has a link. The key findings, what did they do? They reinforced the black report, health is shaped more [00:12:00] by social and economic conditions The medical care alone, we know that the black report stated that gave special attention to early childhood, maternal health, nutrition and income security. Don't forget, this was the start of sure start. 

Dr Jeremy: Yeah. 

Val: So they did action some recommendations. They did action early starts. They looked at early childhood. And I know loads of women that use sure start. 

Dr Jeremy: Sure. This is not rocket science, if people are better taken care of, they're healthier. Not a huge surprise right? 

Val: There was a consistent emphasis on the need to tackle the social and economic determinants of health inequalities, as well as a commitment to employing cross cutting government policies to tackle health inequality. Most [00:13:00] importantly, by 2004 national targets to reduce health inequalities. Like what the black report said? So they're still saying the same thing. 

Dr Jeremy: Yeah. 

Val: Yeah. I remember when Blair's government came and they loved a target A & E how many hours, how was this has be done in four hours. They've got to measure it somehow, they produce all of those targets, lots of loads of them.

Val: As the 1988 Exum Acheson report. Was formally titled independent inquiry into inequalities in health independence. That's astonishing. The fact that they put independent. Do you know what I mean? 

Dr Jeremy: Yeah. 

Val: Okay. And it did investigate the persistent and widening gap in health between different social classes [00:14:00] in the UK. Groups like ethnic minorities, genders, and the report offer 39 recommendations across various policy areas, emphasising the need for a broad approach to tackle these inequalities. 

Dr Jeremy: Okay. I think again, it's, as you say, it's linked to the black report. It's saying many of the same things. 

Val: Yes. 

Dr Jeremy: Reinforcing the findings. they can set targets, but the targets don't get met.

Val: And the thing is, when the black report was done in 1980. We know after that report, health inequalities, got wider.

Val: It was there before it isn't going anywhere until they actually they have to action it. Nobody seems to think, okay, we have to do this imagine a world where it was implemented. How would things be today? At least we would have [00:15:00] been shoveling snow , before the avalanche. Yeah. Do what I mean? 

Dr Jeremy: Yeah, if we had implemented a bunch of preventative measures, hopefully we would have seen a healthier society.

Dr Jeremy: By preventing health problems in the first place and making people generally more healthy, like this country would look more like Sweden or Japan, in terms of health outcomes, then other effects maybe geopolitically, right? We're seeing in the U. S. A distaste for foreign intervention, not just starting new wars but even foreign aid where we're going to see hundreds of thousands, if not millions of Africans in dying in the next little while, because of the absolute abolishing of USAID.

Dr Jeremy: These are political decisions. And when you think about politicians, they're not acting because they, in their party, that's just really what they care about. What they care about is what, where they think the electorate's at. They won't [00:16:00] do something that they think the electorate won't like, or they'll do something they think that people will vote for. So I think there is a, there's a public appetite for saying, enough with messing around and trying to deal with these really expensive foreign issues. Take care of us. 

Val: Yeah. 

Dr Jeremy: If people had been taken care of a bit better decades ago, there would be less of a stingy attitude towards helping people around the world. I think all these things depend on what came before if things had been different, the world could have been radically different than it is now. In some ways predictable, in some ways less predictable.

Val: Do you know between the Black Report and the Acheson Report, there was another report?

Dr Jeremy: Yes, there's another report.

Val: The conservative government didn't act on anything. What Douglas Black [00:17:00] said a group of professionals who work independently to the government, which was led by Margaret Whitehead. They did a report called the health divide report. In 1987

Val: the findings concluded that the gap between health standards and social class had widened since the black report of 1980.

Val: That's all it does. As you say, didn't take rocket scientist. It doesn't take how many doctors probably with PhDs and degrees between them all even know that, nothing is acted on the likelihood is it's going to get worse. It's not going to stay the same. It's not going to get less. It's going to get worse. And that's what it did. Thank you. And then came the Acheson report. After the Akerson report. 

Dr Jeremy: Is the Marmot [00:18:00] review. 

Val: Yeah. Let me tell you some of the recommendations. For the Acheson report health impact assessments for all public policies, which I've done myself and a colleague did for the sickle cell society. many moons ago. 

Dr Jeremy: Yeah. 

Val: More investment in early years, education, housing and income support.

Val: Tackling gender and racial disparities. there was sure start early education, but change wasn't underfunded as there was no legal duty to implement recommendation. God, you just want to weep. As soon as I saw that, I just wanted to weep. What's the bloody point? You've seen the black report, sod all got done seven years later, the health divide report. They're telling you it's got worse. Donald? [00:19:00] Acheson to do an independent inquiry into inequalities in health.

Dr Jeremy: Yeah, 

Val: because we know inequalities got wider and there was no legal duty to implement recommendations. So it's like you do it or you don't. at least with Thatcher's government, they said sod off. We ain't doing nothing Blair's government, no legal duty. What's the point? Really and truly when it comes to health. And as we know, health crosses everything, education, housing it crosses everything. 

Dr Jeremy: Yeah. 

Val: Why wouldn't you make this a legal requirement? Makes no sense to me. 

Dr Jeremy: Let's game this out. A report comes out the author is unbiased. They're just dealing with the facts. They're saying this is the plan. This is going to make things better politicians. You should implement [00:20:00] these changes. And this will make our society better. Okay. 

Val: Yeah. 

Dr Jeremy: So we know that making societal level changes at a minimum, it's going to take 10 years at a minimum, to make social and cultural changes at a minimum. To see the benefits you need 10 years, right?

Val: Health inequalities, isn't going anywhere. 

Dr Jeremy: Health inequalities,

Dr Jeremy: it might take 20 years. Or more so why is the government of the day going to implement something? If they're facing election in three or four years, 

Val: that's the thing, isn't it? 

Dr Jeremy: They need to do something now. 

Val: What are the quick wins they can do within three or four years? And this is why I don't like 10 year plan. This is why I keep saying when it comes to the NHS, this precious thing that we have, that we all cherish, that we all.

Val: We'll need [00:21:00] one, day and we want it to work when we access it. It should be taken out of politicians hands. If it was, we wouldn't have all these things. Oh, we're only in government for three years that gets abandoned. New government comes in or we don't like these mamby pamby sure starts. And the only people that suffer. Is a community. 

Dr Jeremy: Yes. And that's another, problem with making these reports, or 10 year plans legally binding. If you had a new government come in, they're legally required to continue the plan or the aims of the. Previous government. Now we're hamstring. We're putting the people who've been elected to do something, there's political will to do something, but now they're bound to do the old thing when they've been elected to do the new thing.[00:22:00] 

Val: This is why it's got to be out of their hands. Because every time each party will have their manifesto, we're doing this for the NHS, the government before didn't want that. It's like shoveling snow and the avalanche is coming. Nothing's moving. The dial ain't moving. 

Dr Jeremy: Yeah. 

Val: The only thing that's moving is that government keep talking, reports keep getting commissioned. They keep writing. , No legal requirement when they look at reforms? Cuts it's the communities that need these services the most, whether it's DWP, good housing sure start, all these things get cut. More families are living in poverty. Using food banks. There's more billionaires and more food banks. Those two things shouldn't [00:23:00] be together. It makes no sense that a country in the G7 has more food banks. Some countries, I don't care about rockets. Putting money man on the moon. I really don't, the amount of money that costs compared to trying to keep the man on the ground fed, keeping the man on the ground with a roof over his head is more important than this space race. Giving money to India, who is doing space programs, makes no sense to me. And then what happens is, we don't have money for this. There's cuts, but they find money to support a war. 

Dr Jeremy: Yeah. 

Val: No wonder people are fed up. Do these people actually read the room?

Val: do they know how people feel? Do they know how people are really living? We're in height of summer now and we're sweltering as we're [00:24:00] recording this 

Dr Jeremy: yeah.

Val: As we blink winter is upon us. 

Dr Jeremy: Yeah. 

Val: And you can bet this government is not ready for the flu intake because it's a surprise. It's Oh my God, it's winter. Really? 

Dr Jeremy: And so

Dr Jeremy: Val, maybe if we just step back a little bit and think abstractly, really what we're talking about is the conflict between.

Dr Jeremy: Yeah. The facts on the grounds, like what we know about what's happening in the system, what needs to be done. And then there's the political will, right? That is, it's this kind of group decision making that we have, or we decide what needs to get done. And often the political decision making is a matter of ideology.

Dr Jeremy: And I think, I don't know what you think about this, but I think ideology. Is a kind of stand in for the facts that is when we don't really know how something is. We have an opinion and a [00:25:00] framework for how we think things ought to be before we've got the facts. If we had the facts. 

Val: Yeah. 

Dr Jeremy: We could change. And I think the thing that we're coming up against here is, we're going over these reports that are going back 40, 50 years. And they're all saying the same thing. The facts are still there. It doesn't matter what the government is.

Dr Jeremy: The facts are the facts, but we're dealing with is a political ideology that won't implement the changes that are being recommended. 

Val: It's frustrating I don't work in NHS. I'm not a politician, but for somebody that lives in the community, my son relies on the NHS. I rely on the NHS.

Val: From my point of view, you've got the report. Bloody go and do it. It just makes things easier and better if we have a society where people are well, where people are educated, people are able. To go [00:26:00] out to work because they think by cutting the DWP bill, all that's going to do is starve people. They're going to force people out to work. They like to wake up and use soundbites. Yes. We know the welfare bill is a lot of money. And we know it can't stay , in the current form that it's in.

Val: We know that, but it's how you do it if they are not working side by side with health and those social determinants of health. Not a lot is going to change that people fall into that bracket at DWP. If anything, more people are going to be reliant on disability, on sickness benefit, if they don't get a grasp of the NHS, they don't sort out social care. That's where they're going to end up. 

Dr Jeremy: Yeah.

Val: And it's just one great big box [00:27:00] of poverty. I don't want their handprints. Their DNA all over the NHS anymore, sick and tired of changes I don't care what you call it. Just make it better. We wait until the avalanche arrives and then blame the elderly. We call them bed blockers.

Dr Jeremy: Yeah. 

Val: Because it's your fault you're blocking our beds. 

Dr Jeremy: Let me ask you this, Val we're maybe getting a little off track here, but would you say, are you just thinking about this for a moment? Are you frustrated with democracy? 

Val: I'm frustrated 

Dr Jeremy: because having politicians thinking about, what are people voting for?

Dr Jeremy: What will my constituents vote for? That is the system of government we've decided these are the people who should be making the decisions. 

Val: Oh yeah. 

Dr Jeremy: The system we've got is leading you to say, Oh, I just want to take it out of their hands. I don't want them making the [00:28:00] decisions.

Val: The reason why I'm looking at the NHS is because they use it as a political football. They have all these reports we've known, as you said, for 40, , 50 years. We know health inequalities is getting wider. I keep saying that avalanche is here and it's gaining momentum yet there's no legal requirement to implement any of the recommendations.

Val: They're not working in the best interest of the people because they have the facts and figures. Supposing you as a psychologist, you a patient comes to you and they've got X, Y, Z, and you're thinking to yourself I don't want to do that. I want to do something else. But it isn't for you to decide what he needs. If this [00:29:00] person has come with a particular illness that's what your focus should be. It's all about your interest. Oh, but you can say I've got an interest in obesity. No, this person before you has something else your job. Is to work with them on the issue at hand.

Dr Jeremy: Yeah, 

Val: that's the fact they see the report. The facts are there. 

Dr Jeremy: Yes. 

Val: They're there for everybody to see. They can't hide 

Dr Jeremy: yeah. 

Val: But they decide to implement a few palatable ones, they can swallow. And poo the other ones because of the cost. But if you don't do something today, It's going to cost you a lot more tomorrow. They look at things now, what's it going to cost now? This is a budget I've got now not [00:30:00] thinking well, three years down the road, this thing that you've said no to. It's going to triple in cost in three years time. 

Dr Jeremy: Yeah. 

Val: Would a business work, like that? 

Dr Jeremy: I think successful businesses are nimble and will change according to what's needed. The ones who don't adapt. Get left behind, wonder if I think maybe this conflict is coming from the fact that we value different things, right? So you and I sit here and we here are the facts. This is why there's inequality in society.

Dr Jeremy: This is what you should do. Because we value equality. We want things to be more equal. We don't want some people to have all of it. And some people to have none 

Val: right? 

Dr Jeremy: Maybe the difference, at least for some people, maybe the politicians, maybe certain groups of people, like maybe they just plain don't value equality in the way that you and I do, right?

Dr Jeremy: The idea that, [00:31:00] we should be giving workers benefits. So they have, better health outcomes, that makes sense to you and me. Because we value people , having better health because we think they should, but what if you don't care? What if you don't value equality,

Dr Jeremy: what if you think businesses need to make as much money as possible and forget the workers. We're trying to make it easy for business owners. That's our focus. That's what we value. 

Val: But going back to the reports. This is what I don't understand

Dr Jeremy: sure.

Val: Even though there was no legal duty to implement the recommendations of the Acheson report, they commissioned the Marmot review, 2010 fair society, healthy lives. We touched on that last week, as we know health inequalities

Dr Jeremy: yeah. 

Val: Widened. 

Dr Jeremy: Yeah. 

Val: Really? Of course. Of course it did. So he then states, there's a clear link, as we know, [00:32:00] between income, education, work and life expectancy. And it also said what you said before. Health isn't just about access to care, it's shaped by the conditions in which people are born, grow, live, work and age.

Val: He outlines six key policy objectives. One, give every child the best start in life. Sure. Start Would have done that to enable all children, young people and adults to maximize their capabilities, create fair employment four ensure a healthy standard of living for all five, create healthy places and communities, six, strengthen ill health prevention. What happened after that? 

Dr Jeremy: They cut all these things. Remember? 

Val: What happened after the first Marmot review? 

Dr Jeremy: [00:33:00] So there was the crash of 2009. The economy plummeted. Conservatives came in, austerity started. 

Val: That's it. Austerity,

Dr Jeremy: yep. 

Val: Austerity. I don't think anyone could have predicted that even though he said, give every child the best start in life, the black report said that Acheson report stated that, and I'm sure other reports did too. What are the first things they did? Let's cut sure start 

Dr Jeremy: Yeah. 

Val: They'll be fine. They're kids.

Dr Jeremy: Certain cuts that apparently needed to be made and they chose to make those cuts. 

Val: I'm not disputing cuts need to be made, what people dispute is where these cuts are made.

Dr Jeremy: Which comes down to values. What do you think is important? If you don't think equality is important. You'll cut Sure Start and any other thing that's directed at trying to improve equality, right? [00:34:00] It goes to where your values are. And , I think when, even though they keep commissioning these reports, to look into equality. 

Val: Yeah, 

Dr Jeremy: I don't think people truly value it. 

Val: The report. Sorry. 

Dr Jeremy: No, 

Dr Jeremy: I think if you're commissioning a report to look into inequalities the assumption is you value equality, right? The point is to make more equality. But if you truly don't value equality. If that isn't important to you, then the then the report is just window dressing. The report is just something you do to stall or pretend you're doing something. The truth is you don't care about that. What you really care about is what you're willing to fund and keep funding, even when things are tough. 

Val: Yeah. So after that Marmot review in 2010, they thought, . [00:35:00] Let's give the man a break for 10 years. So the Marmot review 10 years on, was commissioned by the health foundation. Now the key findings, life expectancy stalled for the first time in 100 years for the poorest women. It actually declined. The North South health divide grew sharper. Remember, I was telling you before in this country, there is a big difference between the North and the South and that's with everything, transport, health access, blah, blah, blah, austerity, deep cuts to housing, people living in damp, mould, welfare had made inequality worse. So I'm going to give you another quiz, Dr. Jeremy. 

Dr Jeremy: Okay. 

Val: Get your quiz hat on. 

Dr Jeremy: Okay. 

Val: What happened? Okay. The recent report dropped just before [00:36:00] this is 2020. You reminded me. Yeah. This last week.

Dr Jeremy: What happened in 2020? 

Val: Yeah. 

Dr Jeremy: What were we doing in 2020 when this happened? 

Val: I was drinking loads of gin, yeah. That's a clue. 

Dr Jeremy: Yeah. So this little thing called COVID happened. We started to notice it in about December, 2019 and into the winter and spring of early 2020. That's when lockdown happened. 

Val: Isn't that awful? Every time Professor Mormot does a review. 

Dr Jeremy: something terrible happens, I don't know 

Val: what the universe is telling us. Once again, no legal force, no real accountability, soon swallowed. By the pandemic crisis, that is what happened to that gone in the bin. 

Dr Jeremy: Yeah. 

Val: Sad. Nothing's [00:37:00] changed. 

Dr Jeremy: Yeah. 

Val: So let's look at the shared themes across all these reports. We know health inequality is driven by social inequality. You can't fix health with hospitals alone. You need policy change in housing. Education, welfare, and employment. The UK needs cross government action, not just NHS interventions. The key thing is cross government work. I know they have these cross party committees and things like that, but , I don't know how well that works. But something, obviously it needs to change, needs to get better because one thing's for sure. Health inequalities it's going to get bad.

Dr Jeremy: but what I'm actually concerned about is that, the systems of government the democracy we [00:38:00] have.

Dr Jeremy: It's not working very well as you've said, these reports keep getting issued. They don't get enacted. There's no legal force. There's stuff is not getting better. It's getting worse. And I think just my general sense is that there's a dissatisfaction the appeal of someone like the orange goblin in the white house is he says, I alone can solve this problem. I will just make decisions and get something done. Forget democracy just let me decide. I'll handle it.

Val: We don't want that here. 

Dr Jeremy: No, no one should have that 

Val: much power. No way. 

Dr Jeremy: Absolutely. I'm in agreement with you Val. When people get frustrated things aren't getting done. People get frustrated with democracy in general. And really what needs to happen is we really just need to re examine what is really important. What do we really value democracy can work as long as people value the right things. When people start telling you the wrong things, then they get fed up. 

Val: People are [00:39:00] fed up with politicians 

Dr Jeremy: because they value the wrong things. 

Val: Fed up with these politicians. Notice people like Nigel Farage and Reform, want a lot of council seats. 

Dr Jeremy: That's a protest, right?

Val: Still a vote. 

Dr Jeremy: Yeah. 

Val: It should be telling the government something. Look, you're wrong 

Dr Jeremy: yeah. 

Val: You've got people that may have voted labour all their lives, it doesn't mean I'm going to vote for you another time. And I think they take certain groups of people's votes for granted. I remember when they lost a lot of Jewish votes. Because of what happened under Corbyn, I don't know about the black vote. People are free to vote where they want to. We know historically when my parents came here and Jewish people came here, we went to labour. But people are changing because they're watching what's going on. [00:40:00] They're seeing a crisis of the boats, cuts where it's really affecting a lot of people. They feel as their politicians don't understand their needs. They're not doing what they said they would do. Right now we have a leader that does more U turns than I've done in my car.

Dr Jeremy: No, but if you think about why a leader who makes a U turn who changes his mind, why is that a problem? If you just think about following a leader, right? You want to follow them in a straight line. Ideally you want them to know where they're going and be going in the right direction. If you have someone who's always. Zigzagging and you feel like we're going this way, but it's a waste of time because now we're going the other way. Nobody likes that. So I think in order for a leader to stand firm, they need to actually take some care and have a clear idea of where they were going in the [00:41:00] first place. Don't step up and lead if you don't know where you're going. 

Val: But doesn't that tell you that just because you're brilliant in one job doesn't mean you're going to be brilliant in other jobs. Not everyone can lead. Do you remember at school you were always more fearful of the deputy head. Not the head. Much like John Prescott. Yes. And Tony Blair. It was a good role. Yes. But it doesn't mean the deputy head would've made a good head. 

Dr Jeremy: Yes.

Val: Two completely different roles? 

Dr Jeremy: In Canada, we call that the vice principal. The head of a school is called a principal. The deputy would be the vice principal the vice principal was always the disciplinarian the scary person who you got sent to. 

Val: Why does a certain group of people believe. They can do any job. Why is that? 

Dr Jeremy: Yeah. 

Val: The only time I really looked at him and thought, blimey, he's [00:42:00] really good. Is when the riots happened and he went into action. Cause he ran the DPP and that was him at his best, but then suddenly thinks he can be a leader of a party, the prime minister. I'd be terrible I'd give everybody money. Bankrupt the place

SWOOSH: Mhm.

Val: Why did inequalities get worse?

Dr Jeremy: Inequalities got worse because the programs to address those were cut, 

Dr Jeremy: and times were bad. So it's not surprising that things got worse because times were 

Dr Jeremy: bad and those issues weren't being addressed, 

Val: but also we talked about political short term ism.

Val: Governments change but health inequality requires what?  long term investment 

Dr Jeremy: Yeah,

Val: political gain in 10 year plans when elections come every four years [00:43:00] another reason it should be taken out of politicians hands. Then you have austerity measures that deepened inequalities.

Val: You got lack of accountability, no legal duty to act on any of these reports. Then you have structural racism and classism black Asian and working class communities often marginalised in policy making. Then you have blaming individuals, policies often focusing on telling people to eat better or exercise more rather than addressing systemic barriers that people face.

Val: And that word I hate, bed blockers and hard to reach. The onus is on us, so we're going to end today and next week we focus on Lord [00:44:00] Darzi book. Is it Darcy? I keep saying Darcy. 

Dr Jeremy: I would say Darcy as opposed to Darcy. 

Val: I'm thinking of Jane Austen.

Dr Jeremy: Yeah. 

Val: I keep thinking of Darzi. I don't know why. 

Dr Jeremy: It's spelled with a Z. I would say Darzi 

Val:  Sometimes when you see how a word is spelled. 

Dr Jeremy: Yeah. 

Val: That letter is not necessarily pronounced. 

Dr Jeremy: You see what I mean? More so in the UK. You guys. 

Val: Is it? 

Dr Jeremy: Like Leicester and Worcester.

Dr Jeremy: As a Canadian, you come here and you're like Smithwick. Because I don't know that you're not supposed to pronounce those letters. You have to grow up here to know that, right? 

Val: Oh, that is so funny. We must talk about that. 

Dr Jeremy: Yeah. 

Val: Next week we will focus on Lord Darzi Report. And what's his name, the secretary of state for health West Streeting 

Dr Jeremy: Yeah. And 

Val: I do actually like, I do a [00:45:00] bit of West.

Val: Yeah. I do. Yeah. I think he's 

Dr Jeremy: got good ideas. The right thing. 

Val: Number 10 for West. 

Dr Jeremy: Yeah. 

Val: But yeah, I do like West. We'll focus on that and we'll get up to date and see what this government, this new health Secretary, what changes he's going to make within NHS and social care.

Dr Jeremy: Okay. 

Val: So I'd like to say thanks for listening. Thank you. We'll do our story labels and misconceptions for next week, . 

Dr Jeremy: Okay. 

Val: Buy from me, Val Barrett.

Dr Jeremy: I'm Dr. 

Val: Jeremy Anderson, please follow us on our socials, share this out it really helps. Have a good day.

Val: Bye.

[00:46:00] You