The poor still die young

Medical Matters: Does it matter that the poor die young? Theologians will say we are all our brothers keepers and that we are…

Medical Matters: Does it matter that the poor die young? Theologians will say we are all our brothers keepers and that we are in it together. Doctors will go on about the preventable nature of premature death. Lawyers will want to know if they can pin it on anyone.

The Minister for Finance will point to his poverty industry and probably say "there go the pinko liberals - poverty pimping again".

For opposition politicians, it's simply because not enough money is invested in health. Looking at the same set of figures, Government politicians will point out that more money than ever is being spent on health.

In developed European countries, about 10 per cent of the gross domestic product is spent on health. A significant proportion of this money is spent on the health consequences of poverty. The hospital sector gets most of it, although the positive impact of primary care on health is gradually being appreciated by governments. In the US, the poor are left to their own devices. France is reputed to have the best healthcare system in the world but, as every finance minister knows, it cannot afford it.

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Society is worried about people living longer. Older people know that retiring early, retiring at 65 or indeed retiring at all, is rapidly becoming a pipe dream. The mortality figures are very much against the poor having any retirement or even having the luxury of worrying about it.

Over the past decade we have developed a new kind of poor - the low paid. They are the people who look after our children, clean our schools, hospitals, banks and offices. They are on the minimum wage, no medical card, but have to work for five or six hours in order to pay the doctor and another five or six hours to pay for the subsequent pharmacy bills.

There was a time when the better off feared the poor because they might catch infectious diseases or parasites. People now talk about crime and the poor in the same breath. Sink estates throughout our cities have become synonymous with crime which occasionally leaks out into the better-off communities.

You seldom hear a debate in the media about the negative portrayal of the poor. A poor news day is livened up with breathless reports from the courts on man's inhumanity to man or woman. "Thank God, it's nobody we know," we mutter about the victim. We would never expect to know the perpetrator.

Modern finance ministers see health as a bottomless pit which has a unique ability to generate bad news. Results, if ever, are slow in coming and never before an election. Public opinion becomes contaminated and local politicians start getting it in the neck at the doorstep.

In urban Ireland we have now segregated the poor and the better off, who only meet in well- structured employee/employer relationships. In healthcare, the only time the poor and the better off meet is in Accident and Emergency. A visit to an overcrowded A&E department is certainly mind altering for the better off.

However, access to a bed in a hospital is usually quicker with VHI and BUPA subscription thus depriving us better-off folk of the ignominy of a few days in a hospital corridor.

That the poor die younger matters to theologians, doctors and politicians. But the people that really matter are in our business schools learning about the benefits of competition and enterprise. Those in the banks and counting houses matter even more. Those of us filling out our tax forms and lamenting the amount of tax we pay also matter.

Newspapers, radio and television now have entire supplements and programmes devoted to discussions on business, the making of money and the personalities involved. You never hear them talk about the purposes of money.

You hear discussions about business ethics which seem to be about a "hands in the till" sort of honesty. But wealth generators do not debate or concern themselves with the fact that the poor die young. They may not even know the statistics.

Anyway they have enough on their minds, have little interest in politics, put in long days and pay their taxes.

But there is more to it than keeping your nose to the grindstone. In societies like ours where there is a wide disparity in health status, our overall health is worse than in societies where the health differences between rich and poor are narrower.

If your cleaner dies young, the chances are that you as the employer won't be as far behind as you think. The social justice arguments have clearly not impressed our wealth creators, perhaps self interest will. We are all in it together.

• Dr Tom O'Dowd is professor of general practice at Trinity College Dublin and a practising GP.