On the eve of the general election I find myself increasingly exercised by the issues of justice that are at stake here. This election isn’t just about who we would like to govern our country, it is about how we, as a country, and the people who govern us, treat our fellow-citizens, particularly the most vulnerable in our society: children, the elderly, disabled people, immigrants and asylum seekers, those living in poverty, those with mental health problems… the list could go on.
Over the past three weeks I have spent a lot of time preparing and delivering lectures on child mortality, both in the UK and overseas. While there has been incredible progress over the past 25 years in reducing child mortality, we live in a country in which over 5,000 children and young people die each year, and in a world where over 6 million children die each year before their fifth birthday. One aspect stands out above all others:
there is a consistent inverse relationship between child mortality and socioeconomic status.
The more wealthy you are, the less likely your child is to die. This finding is persistent across time, and geography, and holds true regardless of whether you measure socioeconomic status at an individual or societal level.
What is particularly striking in looking at global child mortality is the association with income inequalities within countries. The five high-income countries with the worst child mortality rates (USA, New Zealand, Portugal, Canada, and the UK) are those with the widest inequalities in income.
Source: Petrou et al., 2006
So where does this take me in deciding who to vote for?
In a recent YouGov poll, the top three important issues facing our country were listed as the economy, health, and immigration. All three have a direct bearing on outcomes for children and are issues of justice.
I tried to sit down before reading the main party manifestos, and consider what I would particularly be looking for in these. I was particularly helped by the House of Bishops’ pastoral letter on the 2015 General Election. This raises some pertinent questions that extend beyond the UK general election. I have also been helped by some valuable commentary in the British Medical Journal, including their interesting infographic.
So what did I come up with?
Here is my list – I recognise that it is somewhat ad-hoc, and contains a mixture of general aspirations and more specific details; that it cannot possibly include everything of import; and that many would disagree with my stance. But it is a start, and has helped me in making up my mind.
Economy
- Tax policies biased in favour of the poor
- Welfare policies that ensure a sustainable quality of life for the most vulnerable
- Ensuring a living wage for all
Health
- No major reorganisation to allow a period of stability
- Commitment to a publicly-funded service
- Shift towards primary care and community services
- Investment in mental health
- Public health policies including plain packaging of cigarettes and minimum pricing on alcohol
Immigration
- Policies that welcome those from other countries, including refugees and asylum seekers
- Adequate care of those in need entering our country
Transport
- Promote increased use of public transport services
- Invest in improving local rail and bus services
Defence
- Reduce overall defence expenditure
- Scrap Trident
- Commit to our armed forces supporting global peace-making initiatives
Foreign Policy
- Increase overseas development aid
Did I find what I want?
Not surprisingly, none of the parties matched up with everything I was looking for, and every party had elements in its manifesto with which I disagree (some far more than others!) But the two that came closest (in my view) to addressing the important issues were Labour and the Green Party. Given that I have failed to be inspired by any of the main party leaders, and given that almost certainly we will end up with a hung parliament and eventually a coalition government, it seems to me to boil down to which of those candidates in my area is most likely to deliver.
So I’ve made up my mind, and if you do get in, Jim Cunningham, perhaps you can look forward to a letter from me asking how you’re going to ensure your party lives up to its promises, and addresses those gaps where you haven’t spoken out.
References
Petrou S, Kupek E, Hockley C, Goldacre M. Social class inequalities in childhood mortality and morbidity in an English population. Paediatr Perinat Epidemiol 2006; 20: 14–23
Sidebotham P, Fraser J, et al. Understanding why children die in high-income countries. Lancet 2014; 384(9946): 915-927.