Government budgets should reflect the health of countries, communities, and the planet, says Siddhartha Mehta

Ten years after his landmark report into social inequality, Michael Marmot has found that inequality has got worse and is having a detrimental effect on the population’s health. The Marmot 10-year review shows that life expectancy has stalled, avoidable deaths have increased, and the number of children living in poverty have increased. The health consequences are amplified if you are from a poorer background, from an ethnic minority, disabled and/or a woman. Most significantly, Marmot’s review finds that there is no biological reason to why life expectancy is stalling and why social and health inequalities are widening, pointing squarely to social and economic conditions. This is also reflected in the recent State of Child Health 2020 report which shows that child poverty is having a detrimental effect on children’s health and wellbeing.

Other recent public health studies have come to similar conclusions from studying the effects of income insecurity, indebtedness, welfare reform, sovereign debt restructuring, austerity, the effects of central bank interest rates, the loosening of labour laws and falling union membership. All these factors lead to an increase in morbidity or mortality from suicide or chronic diseases or a significant decrease in self-rated health or reduction in access and rights to health and social care. 

This is not news to health workers. Everyday we see the effects of poverty on health outcomes for children. We make our best efforts to help protect vulnerable people from homelessness, or to help ease the hardship faced by overworked and underpaid parents trying to make ends meet for their families. But we also see our efforts to prevent these issues constantly fail. When the number of people needing our help keeps growing, while the problems they face continue to compound one another, it stretches our ability as individuals to help all those in need. 

We are constantly looking for solutions—but have we properly identified the problem? This question kept coming up for me in my own experience as a public health worker. Why did our prevention strategies fail to make change? Why are policies that can benefit the health of people and the planet so difficult to implement? When we have the evidence that connects the practices of extraction, exploitation and injustices to people’s health, why do we let them continue? 

The realisation for me was that we are providing sticking plaster solutions focusing on individual or local-level interventions when we should also be advocating for change at the political and economic level. As health workers we have a responsibility to demand better for the people in our care. Our knowledge and experience should make us recognise the urgent need to make decisions centred around justice and fairness as this is the only way we can achieve health equity. 

One of the things we can do as health workers is to recognise the outdated norms and measures that determine how the government decides on its national budget. This policy process has consequences for what is funded and how policies and investments are valued, resulting in metrics like gross domestic product (GDP) becoming the primary reference points for making social and economic choices. Such norms and measures lead to inadequate solutions with severe and long-lasting consequences that further entrench poverty, inequality, and environmental pollution.

What if the government budget used the measures presented in the Marmot report as an indicator of how well it was doing? What if Treasury officials made decisions about funding and investment based on ensuring a good life for all and a sustainable environment for future generations? What if on budget day the main announcement weren’t GDP figures, but the number of people free from chronic disease, the growth in forest cover, or improvement of river water quality?

This is not a radical idea. The OECD has also called for change in the way governments make budgets, calling for measures that reflect the health of countries, communities, and the planet. New Zealand has taken the first step to implement a wellbeing budget and Bhutan now measures its gross national happiness. These are just some of the first steps we should consider if we are to address the root causes of health and social inequalities. 

To make this change happen we need to collect our voices and energies as health workers and call for change. If we are to solve our most pressing issues as health workers, we need to join movements that are calling for change in how we organise our social and economic conditions. 

Now is the time to focus our efforts collectively on working towards structural changes that tackle the roots of these problems. Otherwise so much of the good work we do will amount to nothing more than just more plasters. 

You can add your voice here alongside the other health workers who are also calling for a health centred budget.

Siddhartha Mehta has a background in public health and public interest campaigning. He has been a civil servant in the Public Health system of New Zealand working in the Health Improvement team to improve the built and food environment of Auckland. He was also a Union Delegate at the Public Service Association, working on structural racism and pay equity issues. Siddhartha has been a campaigner with Generation Zero, a youth-led climate change advocacy group where he worked on the successful Zero Carbon Act campaign, a national climate law framework. At Medact, Siddhartha is leading our work on advocating for a fair, just and inclusive economic system.

Twitter: @SJ_Mehta

Competing interests: None declared