The human cost of difficult times

1. The human cost of difficult times Professor Gareth Williams School of Social Sciences, Cardiff University and Public Health Wales

2. Hard times ‘If I say the word – “Depression” – what does that mean?’ ‘I wouldn’t know, ‘cause I never heard the word before.’ ‘What do you think it means?’ ‘I figure you’re all tensed up or somethin’. That’s the only thing I could think of “depression” meanin’. ‘Ever hear of the time when millions of people weren’t working, in the 1930s – long before you were born...?’ ‘I heard about it. They didn’t have no food and money. Couldn’t keep their children fed and in clothes [...] See, I never heard that word “depression” before. They would all just say “hard times” to me. It is still. People around this neighbourhood still has hard times.’ (Terkel, 1986 [1970]: 211)

3. The conditions of the working class ..How is it possible, under such conditions, for the lower class to be healthy and long lived? What else can be expected than an excessive mortality, an unbroken series of epidemics, a progressive deterioration in the physique of the working population?’ (Engels, 1982 [1892])

5. A Tale of Two Cities In the Calton area of Glasgow life expectancy at birth for men is 54 years, while in Lenzie, a few kilometres away, it is 82. Closing the Gap in a Generation:Commission on the Social Determinants of Health published in 2008

6. Mortality trends: All-cause mortality, males, all ages, Wales, 2001-03 to 2007-09 • National inequality • gap has widened • over time • Local inequality • trends vary Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD(WG) Measuring inequality gaps in Wales

7. Life expectancy, healthy life expectancy and disability-free life expectancy at birth Cardiff Blaenau Gwent Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD/WHS(WG) Measuring inequality gaps in Wales

8. Recession for ever! ‘We’ve always been in recession in Blaenau Gwent…’ (Health & Social Care). ‘I’d say that for a lot of the Welsh valleys they’ve never fully recovered from the closing down of the primary industries in the area, and Blaenau Gwent is no different, we had a huge steelworks site here, they were a big local employer, they’ve closed down’ (Housing)

9. Some Lives! ‘The despoliation of our cities concerns me not just as a Londoner but as a doctor because it generates a great deal of ill-health, depression and family disruption. It is compounded by a reversal… of the century long trend to greater equality of income and the prising open of the already wide gap between rich and poor. The consequences of that economic process are presented in human terms, conveniently out of sight to the politicians, in our surgeries every day. Patients made sick by poverty, living an unhealthy overcrowded existence, which is exhausting them and making them ill’ (David Widgery, Some Lives! A GP’s East End, 1991, 233-34).

10. Michael Marmot’s priorities 1. Giving every child the best start in life2. Enabling all children, young people and adults to maximize their capabilities and have control over their lives3. Creating fair employment and good work for all4. Ensuring a healthy standard of living for all5. Creating and developing sustainable places and communities6. Strengthening the role and impact of ill-health prevention.