I experienced déjà vu listening to radio interviews with Prof John Kennedy on the Irish Cancer Society’s new Strategy Statement 2013-2017: Towards a future without cancer.
The strategy notes that people living in disadvantaged communities have a far greater risk of getting cancer and dying young because they are twice as likely to smoke, eat too much poor-quality food and be physically unfit. “Cancer-related deaths in the lowest occupational classes are double those in the highest occupational class. Lung, stomach, mouth, head and neck, and cervical cancers are all more common in areas of higher unemployment and deprivation.”
The strategy was discussed on several news bulletins and current affairs programmes and, without exception, the interviewers seemed nonplussed by this “new” link between cancer and social disadvantage, asking questions such as: “Is this just an Irish problem?”, and suggesting solutions: “More education is obviously needed by these groups” and “If you could give two pieces of lifestyle advice what would they be?”
Where have the media been for the last half century? Why are TV and radio programmes not discussing the reasons health inequalities, which have been around forever, have not and are not being addressed?
Decades-old reports
Forty years ago, the Lalonde report identified the influence of poverty and education on health and recommended that governments should focus on reducing health inequalities, not just the provision of health services. The Black report, published in the UK in 1980, found widespread health inequalities due to economic inequities.
The WHO report: Closing the Gap in a Generation shows the huge differences in health between and within countries are matters of social justice: “Social injustice is killing people on a grand scale.”
Sir Michael Marmot’s 2010 report, Fair Society, Healthy Lives, found adults with a decent wage and safe and secure employment were significantly less likely to adopt unhealthy lifestyles. In fact, every health outcome report published in the past 50 years has identified the links between education, poverty, joblessness and health inequalities.
It is assumed that providing people with information about tobacco, alcohol and nutrition through schools or the media changes behaviour. If people know the facts they will start looking after themselves, right? Wrong. Research shows that health behaviour is not a simple matter of knowing the facts, and unhealthy lifestyles are not chosen because of ignorance.
Scare tactics don’t work
Experts in the psychology of health behaviour know that using scare tactics: “smoking kills”; exhortation: “please give up smoking for your children’s sake”; or telling people what to do: “my advice is to stop smoking now” does not work. Information, advice and exhortation compete against a barrage of real-life experiences that promote a different message. This is more powerful than information about risky behaviour and cancer.
Those who live in areas of high unemployment and deprivation are more likely to engage in unhealthy behaviours because of feelings of powerlessness over their lives and hopelessness about the future. “There is nothing here for us” is a frequently expressed sentiment. Low educational attainment reduces their sense of control. If they give up smoking, take more exercise and eat more healthily, will their future and that of their children actually be better?
Long term, 20 or 30 years down the road, they are less likely to develop cancer or other chronic health problems.
In the meantime they are still jobless, still looking out their windows at ugly environments. The healthy choice is not the easier choice. Short term, to them it seems more logical to enjoy life now and forget about the future. In contrast, those from higher socioeconomic groups are more optimistic. Investing in the future is routine. They know that investing time and energy in education gives them more control over their lives. For them, the healthy choice is the easier choice.
If anything, health inequalities are getting worse in Ireland. Decades of poorly thought through social welfare policies have resulted in huge numbers of jobless households which, at 22 per cent, is more than twice the EU average. This is why people from lower socio-economic groups have worse health, not because they are ignorant about health matters.
It is time to stop victim-blaming and wasting taxpayers’ money on awareness-raising about cancer risks. No matter what advances are made in cancer treatments, and there are many, poor people will continue to be twice as sick as their better-off peers unless effective solutions are found for joblessness and hopelessness.
Dr Jacky Jones is a former HSE regional manager of health promotion