by Tim Wilson (ARC NWC Public Advisor) and Professor Rhiannon Corcoran

This strategy can be summed up as – promote equity and upstream public health, embed in all stages of research, include people suffering from inequities.

Equity is a moral ethical issue, it’s about social justice, fairness, human rights, distribution equity, having the prerequisites of health for all 2000.

Inequities are the causes of the causes, they cause inequalities in health, Marmot (2015) example from Calton ward (deprived) were men die on average at 56, a few miles away Lenzie (affluent) men die on average 82 years. In Calton and similar, people have chronic health issues (morbidity) 15 years before affluent areas. These inequities repeated in every town UK.

There are two concepts of liberty, negative liberty, freedom from constraint or interference from state, minimal state, market, individualistic. Positive liberty is the facilitation of all citizens development, flourishing, the state provides equity with a stronger concept of social justice for all, more role for public intervention/services.

We are not all equal, certain people need extra help for health and flourishing. Intersectionality is relevant, certain people experience existence differently because of class, gender, ethnicity, age, disabilities, poverty, lack of security and control, poor housing, overcrowding, poor working conditions – all these stressors overlap and impact on health, particularly mental health. Inequities and poverty are particularly harmful to children.

A report in 2019 estimated that 14.3 million 22% of the population live in poverty – 34% of children live in poverty – 4.5million live at 50% below the poverty line- extreme poverty. Many people have to choose between food or heating, no heating makes you miserable. Look at the real causes do not individualise and medicalise.

According to the Kings Fund 1981 (coinciding with Black Report, later Health Divide) – the Social Determinants of Health (the causes)– social, economic, political and broad environmental issues (SEPE), cause 70-80% of ill health/health. Downstream health services only account for 10-15% of health. So urgent need to tackle causes. One upstream health profession is public and environmental health- e.g., noise nuisance causes much mental distress – but both have been under resourced, ignored in last 11 austerity years – a negative concept of liberty rules, neo liberalism, this has consequences for health see Davies sedated (2021) click here.

Racism, bullying, abuse is detrimental to mental health – abuse is structural see intersectionality above, e.g., comfort cheaper food, food bank food often inflammatory advertising promotes inflammatory food, stressors also cause obesity, more inflammation, this all affects mental health.

The Mental Health Acts are inherently a violation of human rights in two ways – if sectioned assumed to have no capacity (so autonomy curtailed very bad for mental health) and also racism. Black /ethnic minorities more often: diagnosed as schizophrenic, compulsory detained under MHA’s, admitted as offender patients, held by police under s136, transferred to locked wards, more likely to be given physical treatments including electro-shock see Fernando & Keating 2009.

Issues contributing to mental distress: Deliberately targeting the disabled with welfare cuts, local authorities having to cut community provision, libraries, community centres, too much social media time destroys ability to focus attention see Hari 2022, low income curtails participation in the norm see Spirit level and inner level, Wilkinson and Pickett lack of green space and poor air pollution adversely affect mental health – all these issues are SEPE issues.

Poverty is a powerful predictor of mental distress issues – according to John Reid 2010 poverty can drive you mad and one of the main causes of the causes. Relative poverty see Sprit and inner levels is an even stronger predictor of Mental distress.

Citizens must join with people who reject racism, sexism, colonialism and exploitation and must find ways to redistribute social power and to increase social justice. We must all work together to change social and political structures and ideologies in the interests of social justice and the common good. Those interested in some contemporary mental health issues see revision news winter edition 2021.