Theresa May is an unlikely revolutionary. Yet, on the day she entered 10 Downing Street, this was how she defined herself. She spoke of the need to tackle shorter life expectancy of those born poor, the harsher treatment of black people in the criminal justice system, and low educational attainment among white working class boys. Six months later, in a speech entitled The Shared Society, she restated this commitment. [1] The British public had, we were told, voted in the EU referendum for a “quiet revolution” that would “change the way our country works.” There is, of course, the minor detail that this was not the question on the ballot paper so how could she know what type of change voters wanted? But, even if she could know, it’s far from clear how she would address these issues.

The challenges of distilling meaning from the Prime Minister’s words are well known. Her pronouncements on Brexit have been Delphic. All we know is that Brexit means Brexit and it will be red, white, and blue. Each time she seems to be adding detail, it is contradicted within days, or even hours. [2] Her portrayal as “Theresa Maybe” on the cover of The Economist captured the mood. [3] There is also the uncomfortable disconnect between her words and actions. She expresses her intent to tackle problems that, in many cases, were created or exacerbated by governments in which she was a senior member and whose policies continue under her premiership. [4]

Notwithstanding these caveats, it may be possible to distil some meaning from her words by the simple expedient of taking them at face value. Importantly, her focus seems to be not on what she terms the “obvious injustices [that] often receive a lot of attention,” which she implies include social justice and social mobility, but on the people who are “just about managing.” [1] This group has long attracted attention in continental Europe, especially France, from politicians on the right and left, but in the United Kingdom only since 2011, with the publication of Guy Standing’s book The Precariat. [5,6,7] As the Prime Minister notes, their lives are characterised by uncertainty and instability, of employment, work, housing and much else.

There are many reasons why the Prime Minister might wish to address the challenges facing this group. The most obvious is political. As history shows, the precariat is especially susceptible to the false promises of populist politicians, as seemingly confirmed by recent analyses of the factors behind the unexpected election of Donald Trump. [8,9] It could also be that she genuinely believes in promoting social justice, although as noted above, this is difficult to reconcile with her service in governments that pursued austerity over the past seven years, which impacted most on the “just about managing.” Yet, whatever her motivations, there is also a strong public health argument for action to protect the health of this group.

Austerity has been described as an “experiment on the people.” [10] There is now a large volume of research showing the adverse health effects of cuts in areas such as employment, housing benefit, and welfare, as well as evidence of the health benefits of policies such as a minimum wage. [11,12,13,14] However, policies that would protect the health of the precariat would require a redistribution of power, away from the so-called elite, whose incomes have soared in recent years. Their numbers include a handful of families who control most of the media, giving them the ability to frame the national discourse. [15] The beneficiaries would be “hard-working families,” whose interests are traditionally represented by trade unions.

Such a redistribution of power would indeed be revolutionary, especially for the leader of a right-wing party. Yet there are precedents. Theodore Roosevelt, a Republican, took on powerful corporate interests. [16] In the United Kingdom, Macmillan boasted that the massive expansion of council housing was among his greatest achievements. [17]

We should take Theresa May at her word. But she will need help, from academia, civil society, and representatives of employers and unions. Previous governments commissioned seminal reports by groups chaired by Black, Acheson, and Marmot. [18,19,20] It is time for a new one, addressing specifically the distribution of power in society and its consequences for health. This was a core issue in the 2016 Vienna Declaration, supported by health organisations across Europe. [21] That would be a good place to start.

Martin McKee is professor of European Public Health at the London School of Hygiene and Tropical Medicine.

References:

1. May T. The shared society: article by Theresa May. 2017.

2. BBC News. Theresa May bids to reassure business on Brexit ‘cliff-edge’. 2016 (accessed 10th January 2017).

3. The Economist. Theresa Maybe, Britain’s indecisive premier. 2017. (accessed 10th January 2017).

4. Toynbee P. Theresa May’s great deceit: there is little left to share. 2017. (accessed 11th January 2017).

5. Pitrou A. La vie précaire: des familles face à leurs difficultés. Paris: Caisse nationale des allocations familiales; 1978.

6. Paugam S. Le salarié de la précarité.. Paris: PUF. L’orientation scolaire et professionnelle 2002; (31/3): 467.

7. Standing G. The precariat: The new dangerous class. London: A&C Black; 2011.

8. Krugman P. Weimar on the Aegean. 2015. (accessed 10th January 2017).

9. The Economist. Illness as indicator. 2016. (accessed 10th January 2017).

10. McKee M, Karanikolos M, Belcher P, Stuckler D. Austerity: a failed experiment on the people of Europe. Clin Med (Lond) 2012; 12(4): 346-50.

11. Barr B, Taylor-Robinson D, Scott-Samuel A, McKee M, Stuckler D. Suicides associated with the 2008-10 economic recession in England: time trend analysis. BMJ 2012; 345:e5142

12. Reeves A, Clair A, McKee M, Stuckler D. Reductions in the United Kingdom’s Government Housing Benefit and Symptoms of Depression in Low-Income Households. Am J Epidemiol 2016; 84: 421-9.

13. Loopstra R, Reeves A, Taylor-Robinson D, Barr B, McKee M, Stuckler D. Austerity, sanctions, and the rise of food banks in the UK. BMJ 2015; 350: h1775.

14. Reeves A, McKee M, Mackenbach J, Whitehead M, Stuckler D. Introduction of a National Minimum Wage Reduced Depressive Symptoms in Low-Wage Workers: A Quasi-Natural Experiment in the UK. Health Econ 2016.

15. Reeves A, McKee M, Stuckler D. ‘It’s The Sun Wot Won It’: Evidence of media influence on political attitudes and voting from a UK quasi-natural experiment. Soc Sci Res 2016; 56: 44-57.

16. Goodwin DK. The bully pulpit: Theodore Roosevelt, William Howard Taft, and the golden age of journalism. New York: Simon and Schuster; 2014.

17. Macmillan H. Reconstruction: A plea for a national policy. London: Macmillan and Co.; 1933.

18. Black D, Morris J, Smith C, Townsend P. Inequalities in health: report of a Research Working Group. London: DHSS; 1980.

19. Acheson D. Independent Inquiry into Inequalities in Health Report. London: The Stationery Office; 1998.

20. Marmot M, Allen J, Goldblatt P, et al. Fair Society, Healthy Lives. London. The Marmot Review, 2010. 2013.

21. McKee M, Stuckler D, Zeegers Paget D, Dorner T. The Vienna Declaration on Public Health. Eur J Public Health 2016; 26(6): 897-8.