The Scottish Parliament has proved itself in areas of health. Certainly there are disagreements and differences in administration and priorities. But whereas the English NHS is undergoing privatisation with clear for-profit motives, the cross-party consensus in Scotland is to deliver health service in the public interest, to keep the health service well-funded and in public hands.
Yet chronic health problems remain almost as severe as before devolution, and powers to change this lie beyond health policy. The great opportunity of a Yes vote is to bring to Scotland the deeper powers – over areas like the economy, jobs, incomes, welfare and other social security – which can begin to alter not the symptoms but the causes of an unhealthy nation.
Despite being one of the richest countries in the world, the unequal division of wealth and economic security in Scotland explains the shocking differences in healthy life expectancy between the richest and poorest parts of the country. Other inequalities matter too, like gender and ethnicity – but often these are linked to material deprivation or social discrimination, creating or exacerbating ill health.
Consider the health of the up to 100,000 children in Scotland who will be plunged into poverty by 2020. Take the Westminster welfare changes, not only certain policies like the bedroom tax, but the overall approach that leaves those with the least facing the greatest impact of austerity. Many thousands have to choose between heating and eating and are frozen out of even a basic living standard by falling wages and too few working hours. Under this government the Red Cross has started handing out food for the first time since World War Two. These are the symptoms of a profoundly unhealthy society, and ill health follows as a sad matter of course.
Preventative care mitigates the impact of social injustice, but poor health is not a disease isolated from deeper conditions of life, or something people are endowed with – like an asset or a liability. To properly address health challenges, we need to integrate powers over health with the powers to rebuild the economy and share the wealth we produce more broadly. The integration of social and economic policies to tackle the injustice in society is a significantly different approach from our Westminster system, which looks unlikely to invest in the social change we need, even if Labour wins in 2015.
We need powers over welfare, work and wages, held by a government willing not just to attend to the effects of social inequalities, but to work against the divisions in society. It will be up to socialists in Scottish Labour and beyond to champion social justice, and work for an independent government in 2016 that tackles the causes of ill-health in society: creating the work that gives people the security and living we all deserve; and ensuring that social security means more than sanctioned welfare, but is genuine support for all to attain a healthy living standard. A Yes vote is a means to this end, bringing to Scotland the powers we need to eradicate the causes of ill-health in our society.
Cailean Gallagher is a researcher for Yes Scotland, and a member of the Campaign for Socialism
This article first appeared in Healthier Scotland – The Journal Published by Socialist Health Association Scotland March 2014