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Mm Yeah. Hi, everyone. So I'm just going to record a video on health inequality in the Mar Review. I did an internship for a charity in the isle of wight. Basically looking at something called The Moment reports and that basically is some of the best data we have looking at health inequality in the UK. Now, why should you care about health inequality? Out of all the inequalities, there are someone having a bigger house, a better car. These are all things which are irritating but they are more stays as simple, someone living a shorter life and a large proportion of that life less long. That isn't good. That's terrible. That's downright systematically in my opinion, a little bit evil. In this talk, I'm going to try my best to be as a political as possible. At no point when I get out a sickle and hammer, I will try not to criticize individual politicians or parties, but there will be some criticism of the effects of things like austerity on things like health inequality. I'm happy to take questions at the end and of course, we have some feedback forms. So what I'm gonna do now is I'm gonna share my screen and I'm going to go through this. I suspect it will take somewhere between 30 to 60 minutes, probably somewhere around the 40 mycosis suspect I've decided what I'm gonna do is I'm gonna put you on presenter mode. So I'm gonna share the screen now. OK? Put this here. Can you see this? Fantastic. OK. And let me check that I've pressed live because I want to do the whole presentation and then find out it's not live because that would be incredibly infuriating. Thank God that didn't happen. OK. So back to the start and I'm going to press go it to sign, gonna put it on to presenter because then you can see in my notes and that way it will be in the recording. And I think in many cases, there are some nice little factoids in there. So if you want to scroll through, you can see them and I'm sure I prefer to see text as well and see what people are talking about. All right. So here we go. One of the things I loved about the moment review is the sheer breadth of the data. But even though there's so much data, it will incredibly vague, crudely. So very, very simply we're talking about chronic conditions which are affected by people's diets, air pollution, family structure stress, all these things that aren't the central pieces of healthcare but are actually in many cases, the Arctics of the health problems we face. OK. So there's the black report, which in many cases was the predecessor. This though that's more of a factory, not particularly important. Everyone agrees e equality is bad. What a lot of people don't always appreciate is that it's getting worse and that it's directly tied to investment in infrastructure for the poorest. So these are basically some quotations I've taken directly from the report you can see here. The main thing from the side is the phrase Fortunate Universalism, which is a way of saying people have different needs and to get to those to overcome those difficulties, people need to be given different levels of support, which is a fairly simple thing. I'm going to go through the review in terms of the main point, I'm gonna look at tables graphs, bar charts and I'm going to not go through every single point because frankly, that was my nly done. It was 100 hours of intern work I did. And honestly, I think that would put you all to sleep and it's not, it, it's quite dry stuff in and of itself even though it is important. So I'm gonna find the main point and explain it to you and then move on and a lot of the graphs and tables are repetitive. So I'm not gonna spend too long on them. I'm simply going to illustrate the point once I've illustrated it in a previous slight effectively. So I'm gonna try keep it as streamlined as I possibly can. Ok. So selfishly, if your neighbor isn't living as long, people who are a bit more Machiavellian may think. Well, I don't really care, but the problem with that is if someone's living less longer, they're not going to be as productive in terms of the economy and they'll be spending a greater proportion of their shorter life, not able to pay tax, disabled, less productive and maybe not paying anything at all. Society has an enlightened sense of self interest, reason to actually deal with health inequality because it's not just a nice thing to do that costs us. It's a terrible thing that we are dealing with that is costing us by not dealing with it. In many cases. As a society, we have a problem. We have a scarcity mindset whereby we look at what's good for the next five years and not think of the cost that's going to occur on us over the next 50. And this all sounds very nice and lovely, but it's a bit vague something I've realized reading this and all the data is you can ow a problem but throwing money at it doesn't make it better. You can, let's say you have Game of Thrones, which is like lightning in a bottle. But then you try and recreate Game of Thrones and it gets to a point where you can throw money at something, but that doesn't make it exist you, you can't buy everything. So simply with money, just cos you spend a lot of money doesn't mean it's going to be affected. And you need to find a way of engaging with communities who generally speaking, have better insight into their problems than some bureaucrats in Whitehall who probably can't even conceive of what poverty is like. Ok. So you can see that generally speaking, there has been a decrease in spending. This is worse in poorer areas. This is arguably the most important slide in the powerpoint, you can see the state pension age there, which is the light green line going across the screen. And you can see the gray dots which are basically life expectancy. But what you can see is people who are in the green dots, sorry, the green dots that is basically people having disability, free life expectancy. And you find that for part of the population, they're spending up to 40% of their life, up to 40% will be disabled effectively before they retire. And that, that that is horrifying cos pragmatically, how do you deal with that economically if there's a way of preventing this, this is beneficial for them, but also society as a whole. And there's a similar pattern, of course, for it. Ok. So for most of society, most of the 20th century, we found that there was an increase in life expectancy, things just kept getting better and better and better. We find that historically, things were getting better for men at our rate, they were getting better for women because of course, there was a sex difference. Sorry, someone from me just sent me a message, let me just check. OK, that's fine. And the gap between the s was closing. That's good. Then around the time of austerity around the time of the credit crunch, we see that that plateaus around the time when the decrease in funding for infrastructure comes about life expectancy. Both two things you should take away from. This. One is you see the greatest inequality between the sexes in the most deprived areas. So when it comes to men and women in the bottom 10% you can see here, the difference is the greatest. Whereas here it's not so much perhaps because generals aren't as prevalent in the wealthy and people are more better educated and they're more obviously mobile. But that that is speculation and extrapolation on my part, I just confess. However, I'm gonna come over in a second and talk about how it's not particularly great for women in poor areas as well though in a slightly different way, this is quite simple. People in Leicester prive areas live longer. I'm not going into anyone's intelligence by over explaining that. Ok, so what you see here is you're comparing men and women nice rich area, let's say in Oxford and here so pretty much all groups are having an increase in their out life expectancy. Except this group here, for some reason, the bottom 10% who happen to be women. I actually find that average life expectancy has decreased. And this could be because people in poor areas are more likely to depend on a provider or depend on welfare. Maybe that they are a single mother. There could be a whole host of reasons. But that is an example of how in poor areas, men have a greater inequality between sexes of life expectancy. And women have actually on average, a decrease in life expectancy, which is actually kind of alarming. So life expectancy, the more deprived you are the fewer years of healthy life you will have. And there's a 12 year difference in terms of healthy lives. And this is the exact opposite of that. You can see that here. Ok. So this is like I need to be sensitive and careful about because you always need to be careful when you talk about ethnicity. What you find is that the quality of life is generally speaking worse on average for people of Arab Bangladeshi. So sorry, Arab Bangladeshi, Pakistani and white Gypsy traveling communities. On average, of course, you can't just point to someone from that group and say it's definitely worse. Everyone's an individual. It's merely a an average is merely an emergent quantity that comes about from looking at groups as a whole. It's not something you can attribute to an individual within that group. But it is something we have to acknowledge to realize that not everyone's coming from the same place and has the same problems we need to enlarge individual problems within communities and problems people face. OK. So a good thing to do is compare to our peers in terms of what is realistic. A good way I find is to look at other countries to see what, what I'm going to do often is I'm going to look at Germany and France because they are in many cases, our peers economically and culturally, they are extraordinarily similar to us. So what we can see here is if we look at improvement of life expectancy. UK is here, Germany is here and France is here, I appreciate the world is very polarized. But one thing I've always found is that we all agree that we should be able to, we should at least be aspiring to beat France. So my conclusion from the slide is that there's a bit more we should be aspiring to do in terms of life expectancy. And I'm sure Britain has it in its to be the cheese eating sur in the monkeys. All right. So what you can see here is it is quarter one and quarter four. This is when it's coldest. Why don't we look here is slower. So cold people more like to catch a cold, more likely to be sick. So that makes sense here. Not so cold because that's the third quarter, autumn, not as bad. The, the reason summer is higher is because people can get heat exhaustion during the summertime. Basically, people get more angry. I spoke to a policeman some time ago and he basically told me that the best thing to stop a riot is actually rain because people get hot and bothered and the rain cools them down. They just don't want to be outside. So that's an interesting fact but not directly relevant. But I think I throw that in there. The second part, I should tell you about these graphs is that until the time of austerity until the credit crunch. You see that generally speaking, they were all going down, the mortality rates are going down because people are living longer and then all of a sudden they come to a screeching halt. And in fact, for women, you see the mortality rate is starting to creep up a bit, which backs up the idea that it's actually, oh, sorry. No apo apologies, apologies. I quadrants, quadrants, of course, of course. Ok. So what we can see is it's actually going up a bit for one in terms of the first quarter, which backs up the idea of it getting worse. Sorry, I just cat got my tongue there for a second. So this looks at avoidable depths and once again, you find that it is worse, it's worse until then. I suppose that's partly because of the point though. That's a bit of an extrapolation. On my part. Now, looking at desks, it's a similar pattern. As you can see this slide here covers something very important because you can see that in poorer areas, you're more likely have problems with injury, injuries and respiratory diseases. But there's a huge increase the people in poorer areas, particularly ma'am with heart attacks. I'm gonna cover something that isn't directly tied to the moment review but is quite interesting. You might have heard of it in med school in the first few years. It is something called the Whitehall research. So basically we looked, they looked at people in different levels. So people high status, middle status, low status and they found that generally speaking, people's general health, mental health, physical performance and disability all showed that it was better of higher grades. Now you could make the argument that's higher grade to begin with. They'll find it higher and easier to get to the top and that's a fair point. But we're gonna look at the detail which might maybe shake that comfort a little bit. Ok. So let's look here. So there's a ton here and you can basically compare high and low hit is heart attack 10 50. Let's look at BM I here over 30 1.54 0.5. And generally speaking, you see the same thing over and over again. There is a definite link between people being of lowest status and people ending up with these health problems. Now, of course, there's always the argument some people make about consequence or causation. But I would personally hypothesize a large amount of it is going to be due to cortisol. If you think of it like this, you know, we were designed to, we see a tiger, we get a shot of Cortisol, we run away, we get a shot of it, we run away effectively. But if we have that whole time, perpetual stress, always thinking something's gonna happen always in a sense of about to half flight or fight. Then of course, that's bad for us. Cos it's increased glucose in the body, increased risk of diabetes, increased stress in the heart, increased mental stress. All these things are not good for us. And the argument being that it's that type of stress that lack of control is bad for you mentally and physically. So that's an interesting piece of data. And it's one of the pieces where I think that's probably something a bit simple enough. You could probably show that to someone in high school and they probably look at it, you know, that that's actually quite interesting, straightforward infant mortality of no surprise to anyone. If you're in the poorest group, babies are more likely to die. So even they probably haven't even said their first word. They are going to be casual in this dynamic we have going on in society. Ok. So looking at good development, this is particularly interesting and I'm gonna hop on this point quite a few times when you look at an unfree school meals versus not on free school meals. That's the indicator of poverty for obvious reasons because uh uh with the exception of a few psychopaths, people generally speak, prioritize giving their progeny food, food as a high as possible. So that's a real measure of poverty if, if they can't afford that and they're on free meals. What you see here is that of course. So we see here, males with free school meals, they are doing the worst in school, compare that to the male counter spots here, that's worse. And we're gonna come back to this point in more detail in other sides. Ok. This slide is interesting cos there's two points. You may think there's one, the second point is in a second. The first point is quite obvious. You see that Children in deprived areas aren't doing, doing as well. Generally speaking as people in richer areas. You can see that if you have the kids without free school meals, but then you look here and something weird happens. So if you are a child who's on free school meals in a rich area, so let's say you're in Oxford and you're getting free school meals and maybe you're in the class of someone who's, I don't know the son of it to see yourself and how everyone else in the dynamic and relationships you develop with the rest of humanity because you can see quite clearly here if you're poor and everyone else. But that difference is much greater if you're the poor kid full of a class, full of rich kids. That's something that honestly, I hadn't thought to mom if you put in front of my face, I used to see this as well with health, with, with uh inequality, the areas with the greatest inequality where you have rich people living next to poor people areas where coincidentally you have the greatest amount of fact in part because you know, you see something quite expensive you can't afford well, you'd want to take it. But another part of it is, I suspect there's no of psychologically, people feel mental of anger and envy, you know how people had quite privileged life by comparison and they feel trapped by what they've had in their own lives, probably in many cases, kept them down. OK. OK. So what we have here is the same graph with women and it stays pretty much the same pattern. I would argue it's not quite as extreme. It is very, very, very, very similar. This graph II wondered whether or not to put it in. It's basically the point. Well aware of that housing costs are very expensive and the general thing we used to think about living and surviving is a lot harder when you to consider the current cost of housing. I wouldn't really read into it any more than that. So the market review basically defines poverty as anyone living with an income, less than 60% of the media income. So that's basically less than 18 K and that's more likely if you're alone parents, if you're unemployed. And of course, if you have Children. So let's have a look at the international Leader board for percentage of Children living in poverty. What we can see is the UK is here, Germany is here. So they're beating us and we're also where's France? Here we go, France is beating us as well. So this is something I would argue we can and need to get better at because the Frenchies are beating us. OK. Aces. So of course, a lot of people will be from families where let's say there's some abuse or maybe there's parental separation. Of course, that's very traumatizing Children to a certain degree, quite often have a lot of robustness. They can bounce back from things. But of course, when there's a lot of different things, adverse childhood experiences, it can be overwhelming. What you tend to find is that in poorer areas you can see in each of these most deprived, generally speaking, each of these things is more likely to happen in Children are more likely to be traumatized by each of these things in poorer environments. And then you think to yourself, so we've got more traumatized Children, becoming more traumatized adults. And then in these more stressful, unfair environments. We have more crime. It, it's just, the data is right there. It's an extrapolation, but it's quite a logical one. I don't think it's particularly partisan to say that you can see to put it very cruelly the origin story of a lot of thieves here right in front of our eyes. It's actually kind of distressing. But you see how a lot of middle class families or upper middle class or even they leave families, they don't have the same sort of economic stress which is causing these things or at least making it more likely to happen. Perhaps I should say to be diplomatic. So something we can be happy about is there has been in recent years, an increase in spending on kids in school last I checked as of 2015, which is relevant to when the market review came out, we were spending 0.8% of GDP. But to put that into context, Iceland is spending 1.8% of GDP. And to put it very simply you can make an argument that for the long term, there is very few, there are very few investments that you can make that are better than education of young. It's more a case of, it's something that takes decades to fully enjoy the benefits of or decades to fully experience the detriment at all. And if you're a politician who's concerned about the next 4 to 8 years, that's not going to be high upon your radar. And the sad thing is it's not something you can truly fix. And that is perhaps one of the detriments of the system we have. And I honestly don't know a way of fixing that as opposed to some sort of citizen's assembly where people come together in a bipartisan fashion. But again, I don't want to get too overtly political. Ok. So we can see that there. So there's effectively comparing dark and light green. You see a big decrease in spending on the Mr of Prive area. I'm sure you're sick of hearing me say this, but it happens over and over again, the people who need the money aren't getting it is the short answer. OK? So of course, I'm all able to remember the goal of getting five AAR to C grade G CSE S. And of course, what you find is that the kids who are in the most deprived areas. So the dark green compared to the kids in the top 10% there is a huge, huge difference, which is a difference of 17% basically 20% right there. So if you wanna get a bit pedantic, talk about privilege. That is one such example of the place you're starting from is 17% further back than the person starting a pie. And that's humbling for me because of course, I went to med school. I see myself on that chart and well, it's not right at the top or even second from the top, it's high enough that I think, you know, I had some advantages that other people didn't have. Ok. This one is interesting because I want you to look back at the previous slide and tell me spot the difference in the interest of time. I'll tell you notice how the dark green one for most deprived at the bottom is for some reason at the top, for some reason for Children on free school meals, they're doing the best here compared to the other kids. Remember what I said earlier, if you look at the kids in the better. So this is your little Oxford kid on free school meals, sitting next to some child of a Duke getting bullied in class. A again, that's a very gross distortion but it probably sticks in the mind. You can imagine this child here in the posh area on free school meals been reminded of where they are in the world and what the world thinks of them and they're doing less. Well, you've got the additional stress of how they see themselves and how their peers see them. Whereas a poor kid surrounded by other poor kids doesn't have that additional stress. So that is, that is interesting and it shows a certain level of robustness in the poverty, I don't think. And there's a whole other layer of that. It's not just what your poverty is. It's your sense of perceived poverty in terms of how others and how yourself are seen internally. And that's, that's something that really stuck with me. There, there's something someone told me once about that, there was someone I knew who was vaguely famous. He and he told me the thing is about getting tormented on social media. It's not that other people think ill of you. It's that eventually you can internalize what they think of you and it affects your sense of self worth and you a try. And that is basically what we have here. That's the concern here. It's not just a case of being the poor area. It's been in a situation where you feel low about yourself and a child not having confidence, of course, isn't going to do as well as they should. And I'm hopping on this point because how people do in school, not having confidence, not getting support, they need that is truly truly detrimental to them and the rest of society. OK. So another one of the slides where I need to choose my words carefully and make sure I'm diplomatic. So of course, we have to acknowledge that there are differences between averages between different groups. Of course, we have to do that. It's not fair if we don't. The comparison we always go with is comparing whites against black. We can see here for your average kid not on school meals. You can see that there is a definite difference between white and black in terms of attaining the V eight, which is basically a level of attainment in high school. It's, it's one of the targets they go for. Interestingly. However, when you look at black kids and white kids on average, you actually find that there is quite a notable difference between the two in terms of free school meals. My point here is merely to illustrate that in making any form of generalization between groups. When you get more data, it always shows that things are more complicated. And if you make a generalization about white kids having it better than black kids, in terms of school and attainment, if you're talking to a kid who basically was on free school meals, it's not gonna go well down with, it's not gonna go down well with them because they had a completely different experience that if you look a bit deeper, you can immediately see. So my only point there, it's a bit like the saying all models are wrong, but some are useful. All of these are far from the complete picture and there's always more data, always more information and it is quite humbling, but it's also important to acknowledge the overall picture so that we can see where people are coming from. OK. So from poorer families, free school meals are more likely and particularly during the time of austerity to get excluded. And the obvious extrapolation that I would make from that is that if they're in a more stressed family, perhaps they needed that infrastructure. It's more likely that the family structure breaks down, more likely to have those adverse childhood events more likely to get excluded. So you can see these things coming together in terms of affecting a child and what lessons they learn about the world and how the world values them or doesn't value them. Ok. Employment rates. So you can see they're going up. This is generally speaking fairly straightforward. OK. All right. So what we have here is there are definite differences between ethnicities. So this is sort of amalgamating ethnic minorities together. And you can see that generally speaking, there is a difference in terms of employment between white people and people of ethnic minorities. And of course, we can think of reasons for that. The one that comes to mind that is quite infamous and famous, it's kind of disputed is the res my idea, the idea that you send off a resume with a foreign signing name and you're less likely to get the job. Now, I do have a piece of data here which is in the bottom left which that paper basically makes the argument. I think it was 9000 C vs, they sent off and they couldn't find a statistically significant difference when they tried a foreign name versus an, a white person name if you like and, or perhaps I should say what would be the correct way of saying it. Uh a stereotypical English name. They couldn't find evidence of that. They did perhaps suggest that maybe it could be more of a class name so it could be something a bit more deep in that. It could be something more evidence. I honestly don't know enough about that to we definitively, but I want to say that that's one argument that is made that when it comes to see these people are biased, implicitly against people because of their names. But I've also heard the argument that the Evans sper isn't that strong. But whatever the reason is, however many reasons there are, there is a definite outcome which is a problem which needs to be addressed. Ok, this is fairly straightforward. So you can see here that people are saying they're feeling more stressed. There's two main reasons basically come into play there. The first one is the number of people coming out and saying they're gay has increased. That doesn't mean there's an increase in the number of gay people. It just means in society we're more willing to talk about. The same is true for mental health problems. People are more likely to say they're feeling stressed, depressed or anxious. And an interesting point there is, well, that's actually a good thing. But I think the general narrative at the moment review is that it's a result of the stressless people have been under and austerity. So it was not good for people's mental health, but you can see how a piece of data requires social interpretation. You can go at it from different angles. So the main point I am administrating here is things can be complex and definitely multifactorial. And you can see how people can weigh in either way to either minimize or en enlarge the implications of the data. OK. So this is a another interesting leaderboard compared to other countries. So compared to the other OECD countries, we find that the change in wages in the UK have decreased roughly over 10 years. And comparing us to once again, France and Germany. So France, they had an increase in Germany, they also had an increase. So one could say this is something that Britain can afford to be doing better at the main point of this study is basically saying it's not just a case of people not having a job and being poor. There are quite a lot of people who are now actually fully employed working all the time, but housing expenses, food expenses, everything is so expensive nowadays that they are effectively working full time. They don't have time to retrain, they have a family and they're basically working the 9 to 5 and they, there, there is no way out and they're trapped in that. So that, that is something that is a gearshift when it, when it first hit me and surprised me, it, it, it, it struck me slightly, ok? And you can see that there's been increase in the amount of poverty rates. Ok. Zero hours contrast. So now of course, this was a more political issue around the time of Ed Miliband. And of course, the amount review is over five years old now, but effectively it started off 10 years ago covering about 200,000 hours of employment and then it went up to 900,000 hours of employment. Of course, if you're a student and you're living with your parents and a student loan, then that's not such a problem because it gives you a bit extra money. But if let's say you're part of the 50% plus people who don't go to university, who's the same age who maybe he's trying to live off working at Subway mcdonald's or what have you, you'll find that it's very hard to make ends meet if you're on a zero hours contract because basically you don't have guaranteed hours and you don't have the stability that you need to maybe support a family. And of course, it's these simple jobs, these straightforward jobs which don't require as much training, which are causing the less problem in terms of zero hours contracts. Automation is also another risk though. I think A I is something that's going to have to be explored in more detail. It's right now, it's somewhere between science fiction and speculation. All it's very fascinating to me, but I think finding someone who's a true authority who can tell you exactly what's gonna happen with that is actually very difficult and will only become obvious with the benefit of Einstein. So here we can see the medium weekly income, sorry, I should say gross weekly earnings and you can see that the 95th percentile it's going up and everyone else it's staying roughly where it is. So the people who don't really need more money are getting a bit more money, which isn't, it's to be expected, but it's not necessarily a solution to the problems we've been talking about. Mhm Another comparison, this is actually probably gonna be the most in slide that I talked to you about because what we have here is we always talk about, oh the 1% they own everything. What, how much do they actually earn? This is pre COVID. So it will have changed a bit in the UK. It was roughly 20% of the wealth in the UK or declared wealth in the UK is owned by the top 1% and in some ways, depending on where you are politically. That sounds not so bad. That could sounds all right. That could sound great if you're thinking you're gonna become one of the top 1%. But where we are in the UK here, this is one of those times where compared to other countries, we're not as terrible as we were. There's definitely been an increase, there's definitely been an increase in inequality, but we are still comparable to a lot of the other countries, even though we're quite high up in the league table, so to speak America. This one is just a tale all on its own. The top 1% in America. I'm not even sure this relates to health inequality for the UK. I'm just saying it cos I was just blown away by it. I II have to say it aloud cos I don't believe it, As I say it, the top 1% own around 40% of the wealth in America. That, that, that's crazy. And II, I'm gonna move on because that's, that, that could be his whole thing. Ok. So once again, poverty is 60% of the median income. So 18 K Ls and of course, we've already covered that. It's more likely if you're a child and you're single, which are reasons that I think are quite intuitive. These next few slides are gonna cover basically how people make ends meet and whether or not they can afford to look after themselves with what they're earning. So if you have a national living wage, you see that the shortfall, it got worse here and then it got worse here and then it got a little better. So it sort of fixed the problem, but it has made it better, at least from this day to day. Ok. Another slide. So what we see here. So in terms of people in impoverished households, we find that Bangladeshi, Harstoni and Black African Caribbean, Black British are the most likely. So there is of course a difference between different groups because all manner of systematic issues and to put it rather bluntly racism. OK. So this is another interesting slide. So this is fairly simple. We have a decrease in spending in infrastructure in welfare here and benefits and everyone else's tax have gone off a bit. That's not too surprising. Uh There's something weird here and when I first saw this, I thought to myself, oh right. So th they colored the barest the wrong way round. This should be light green, this shit. No, no, actually what this means is there has been a decrease in tax for the wealthiest and an increase in benefits. So I don't know, like the, I don't know, maybe these guys could give these guys the money or something but uh to speak a bit more seriously, the argument behind it would be if you want the economy to grow, which is how you get out of recession. The argument would be that you need the people who know how to generate money to have as few restrictions as possible. So they can make income and make jobs and trickle down some of that wealth eventually to some of the peasants. And there is an argument there in the book, I read social mob immobility. So social mobility and its enemies, which I'm going to cover. In the second part. Of this, which is gonna be next week. It basically makes a very plain simple argument that as terrible as social immobility is that you can grow an economy, but it's very hard to grow the economy because every time you try and excel, whether it's in a degree, whether it's at work, whether it's income, whether it's in a race, you are trying to excel and claim some form of a claim by putting others as far behind as you can with us directly or indirectly. So in a sense, the growth is the driver of inequality in a sense. So it's a bit of a damned if you damned if you don't situation. And of course, this is percentage change in the household income. So this here to these people is actually still quite a lot to these people here. So it is something that's quite depressing, but I can't think of the immediate solution unfortunately. So this slide has a twin. We all want to eat healthy. But if you actually tried to, if you're in the bottom of 10% you find yourself spending 75% thereabouts of your disposable income. So get a calculator out on your phone. OK? So 75% and we're gonna go to the next slide. So the bottom 10% would spend 37% of their income on housing, ok? So that's 100 and 12%. Now, I don't have 100% of my own income personally. And it probably cost me quite a lot if I tried to spend that every day. It's one of those ads that is expensive being poor. That if you, and this is a bit of an extrapolation again, that let's say you buy a boot, the boot is cheaper than a boot. That's maybe a bit more. But that boot breaks far faster and you have to basically get it repaired and you have to spend more money replacing it. But it would be cheaper to just pay for the more expensive boot that would last longer in the long run. But because you didn't have the money to do that, you couldn't do that. It, yeah, an example would be like grammar, I paid like 100 quid for that and it's cheaper to make a one out payment, but not everyone's gonna have the free cash to do that even though it saves me like, I don't know, 20 quid or something a year, bit bit of a tangent. But I think it partly expresses the point that it can be rather expensive being important. And these people, these hypothetical people who are eating healthy, who have a roof over their head. Well, they better not want water or Wi Fi or to watch Netflix, I mean, who would want to watch Netflix nowadays anyway. But the point being it's not really realistic, there's literally no way they can do it financially and not end up getting short changes on that the deck isn't stacked against them. It, it's just simply you can't balance that checkbook. It's just not just not gonna happen. This slide should basically be titled. The middle class is shrinking because you can see a very clear pattern. Very, very clear how there is a decrease in housing ownership. At the same time, there's increase in renting, I suppose someone still owns the houses, but it's a smaller and smaller group of people. And there the of course, landlords and owners, yes, this is a slight trickier slide to get your head around. But to put it very simply the greater the difference between the rich and the poor, the greater the social inability, putting it very simply the steeper the money slope, the harder the slope is decline. And this is quite interesting because you find that whereas the UK, the U K's here, America's here. So you find that despite America having its own problems, we're not actually that much better. The Nordic countries tend to do a bit better. Oh, hang on. Sorry, sorry. II, I'll just stick to comparing to America. I'll keep it nice and simple. But generally speaking, this is the type of thing where I'll cover this in part two in more detail. And I think the diagram has there, which is basically a screenshot of a book I read is much better. But basically, it's, as I said that if the Money Hill is steeper people at the top are far more than the people at the bottom. It also follows generally that it's much harder to climb that hill. Probably because the people who are at the top know how much of a for it is and they don't want to be like the people at the bottom. So they try their damnest to hold on to what they've got and to keep the people at the bottom at the bottom. So II won't go any further into that because I'll start reciting the Communist Manifesto if I do. Ok. So tax revenue. So what you can see here compared to a lot of other O ec OECD countries. Let's find Germany again. Here we go. And let's find France. So we are definitely comparable. That's a lot of other countries in our situation that are as developed as we are, have higher taxes, which maybe hints that maybe we could afford to take a bit more from tax and spend it effectively. But of course to do that, it's not that simple. I mean, no one in their right mind is going to win elections saying they're going to increase taxes. It's almost a political deft, but it's something that generally speaking needs to happen if you need better services. And well, that's all there is to it, but no one likes taxes. Ok? So you can see the difference in expenditure, great increase in the poorest areas. You've already cut that add to add nauseum, we can see that there's across the board being a trend increasing the virus and you can see how it's worse for poorer areas. Ok. Air pollution. Again, this is something I cover in more detail in the one next week it affects everything from respiratory health to even potentially people's IQ which a bit more controversial but actually kind of interesting. Basically, you see in these great cities of Britain that generally speaking, the air pollution ends up in places suspiciously are people who are poor. And this is something that I've been told is quite common that they'll put it in areas of minorities or other religious groups that aren't always seen as any positive light. Because in democracy, you need to find a way of making sure it's the smallest minority of people who are punished. So you can get the majority of people to vote for you tyranny of the majority. And that type of stuff which makes a sort of Machiavellian sense, but it's not particularly fair because it means that you'll be persecuting those who haven't really done anything wrong other than being disadvantaged already. And the example of that here is people who are poor, generally speaking, well, generally they're less likely to vote because they feel disenfranchised to begin with and they don't exactly have friends in the media they can rely on to scream outrage to put it very crudely. Being poor equals pollution, which equals further bad health. Ok. This is gonna be incredibly intuitive and I wondered about we're not even getting rid of it, but basically what we have here we have in poorer areas. You have more cigarette buds, more litter. And what I'm going to assume is dog feces. And I'm not entirely sure how they always checked that. I, but let, let, let's just for the sake of not being discussed as assume it's dog feces. II don't know, maybe I be third visited the area or something. I don't know. There is something I'll touch on briefly called the broken window hypothesis, which a lot of you might have heard of. Basically, the idea is that you break a window in a neighborhood and crime is more likely to happen there. So there's no, is that the symptom or the cause? Is it a case that places with that, that are poorer, that have less income that basically spend less money on the police and by extension, other services such as cleaning the neighborhood up are more likely to have crime that goes unchallenged or is it the case that people basically see a broken window? Think? Ah ha I'm a drug dealer now, I will set up shop and I deal with drugs and some people would criticize the broken window hypothesis and say it's, you know, it's, it's two things coming from poor infrastructure spending, not necessarily cause in and of itself. And I'm more of the latter group. But I will acknowledge that the traditional opinion is the broken window is a driver of crime because people feel less pride in their community. And I think the extension of that mentality is something along the lines of people feel when they're in poorer neighborhoods. Something I've noticed that people don't like being associated with a place covered in feces and cigarette butts and they sort of draw more internal. I think it's me, it's my family and this place is terrible and I'm not gonna associate my identity with this and some people, a minority, a small minority of people adopt the mentality and think. Well, what do I care about this place? It's already a dump and that's the argument I think. But again, you can take it many different ways. OK. So this is a slide which when I was practicing these slides, I actually started ranting and I'm gonna try not to do that this time. But basically, this is a slide with a lot of duality. I have a mcdonald's that is a 20 minute bike ride away. And I'm glad for that because it means I have to do some exercise to get there. If there was a mcdonald's, that was five minutes away. I would be as fat as a barrel. And the problem with that is, let's say you're in a poor neighborhood where you have a sense of scarcity. You don't know if you're necessarily going to have the money for the rent next week. You don't know if you're gonna be a house. You don't know if, sorry, you don't know if you're going to have a house or not be a house, you could end up unemployed. And I think this is one of the reasons why some people who are poorer, don't always like it when people talk about what's gonna happen by 2050 because frankly, they're thinking about what's gonna happen by the end of the week or end of the month. They don't have the privilege of thinking as a lot of middle class. People do, like a lot of us will probably be, are thinking in years to decades, you know, becoming a doctor is something that requires a lot of help and support over years and decades in order to get there and we're either aware of it or we're not, but it definitely happens. And just to bring that back to the point, people are in these areas where they don't have the luxury of that. They're going to think more short term, they're going to have more of a scarcity wise that take what they can get in the moment. And it makes more sense. If you're thinking more short term, you're going to be part of a culture that perpetuates a more slightly hedonistic thing of, oh, I'm going to be more like to smoke. I'm going to be more likely to drink. I'm going to be more likely to do what feels good in the moment. And, and that's something that is quite corrupting because the thing is that being a culture, it's very, very hard to not be affected by a medical school. Everyone's working hard to the point where we're trying to gaslight each other to thinking who's working harder in the pre opposite place where finishing your homework or not doing school work. Well, in many cases, that's the exact opposite effect and it has a draining effect. And of course, if I was in that area, I probably wouldn't have gotten to medical school because I would have basically had a more humanistic mindset because I think, oh, that's never gonna happen. It probably wouldn't have, I would have basically gone to mcdonald's because I would have wanted to do something more hedonistic. I would have wanted to be more short term. I wouldn't have thought of it like that obviously. But that would have been the sort of impulse. And the problem is the annoying thing. It, because of how capitalism works, it's supply and demand areas that are more likely to want more mcdonald's, they're going to get more mcdonald's because they can support more mcdonald's. It becomes a vicious cycle and then it becomes, instead of being 20 minutes away, it becomes 10 minutes, five minutes away and it becomes a vicious cycle where even if you're just a regular guy who literally just walks into the area, if you drive through that area. I guarantee, even if you're from another area, I bet you you'll be more likely to get in. Go mcdonald's drive through. So it's a situation where it's not as simple as, oh, evil capitalists. It's a situation perpetually being at the bottom of not having that security. And even though this is a very simple slide in other ways, you can see how it ties on to other things. I've not even talked about the health blacks uh implications of mcdonald's. One thing I regret not doing is putting a link to a kind of funny video. There's a homeless dog who hasn't like eaten for days and they show him a mcdonald's burger and the dogs just sort of looks at goes and basically refuses to eat a bit and runs off. And the, the worst thing is, you know, even though I'm talking about mcdonald's all that much, it's actually making me want one. So II II need to move on to a different slide before I make myself a hypocrite within the hour. Ok. So overcrowding and I'm gonna touch on the next slide as well because what we find is that there's more overcrowding in house of ethnic minorities. So someone emigrates from another country where perhaps maybe they prefer to be poor into the UK and hopefully have the at least dream of being able to work their way up the ladder. You can have a situation of multigenerational families that has positives. Definitely you've got support for the elderly. So they don't feel isolated. You've got care for the Children so the parents can work and status of community. And that has many, many positives. It wasn't always a positive during COVID because of the crowing people together. But there's definitely elements of how many people we have overcrowded in houses, which causes a risk for infection. These next slides are fairly straightforward. So there's been an increase in temporary housing, there's been increased in people who are sleeping. So this one is something that only really makes sense to you if you're a bit more cold hearted and only care about money. Basically, if you look at the start here, you see how the money taken from prevention has gone into crisis. So someone during austerity had a clever idea of thinking, oh, we're spending all this money in prevention. Well, we need money now. So we'll take it out of prevention and then a bit like using a credit card. Now, there's a debt to pay here in crisis. Now, technically speaking, looking at it very crudely, it does still save some money at 200 million which proportionately isn't nearly as much as one might initially think looking at it very crudely and in a moral sense, if you're someone who does not have to live in these areas isn't affected by it. It could seem very machiavellian, it could make a certain sense to you economically. But to people who are morally affected by this, who know people who are affected by this, who've seen this happen to people. It's actually quite disgusting to see looking at an alternative would be this case report here, which is basically the wiggins housing and health approach. This is basically where money was spent better in prevention intelligently so that every pound spent saved 2 lbs in cost of things like care, health and criminal services. Because if people are more likely to have stability, they're less likely to turn to crime. But it's, it's what I said earlier that it's not just enough to throw money at the problem. It's not just enough to take money away from the problem. You have to find a way of spending and not spending money intelligently because quite often in the immediate five years, maybe that's not a problem, but it's gonna cause a problem later down the road. It's not just the cost of spending money, it's the cost of not spending money. And it's all about that sense of having the idea of not just being a bureaucrat in an office, but having that understanding of the local community. I in many cases, a good MP who not only works with Whitehall but is tied to their community, who can work as that connective tissue. That is the solution to many of these things because you need to find a way of people who are standing up in the community who just need the opportunity. But you know that in some ways I'm gonna go off at another rant and frankly, I'm already probably gonna end up eating mcdonald's. I don't want to go any further. Ok. So this is fairly simple. The analogy I'm gonna use here is Weight Watchers. Let's say you want to lose some weight. What you do is you put in a bit of weight, think, oh, I need to lose some weight except we're not really talking about weight. We're talking about life expectancy. So there's been an increase in the gap of life experience. So you think, oh, we need to do something about this. Here's a strategy we're going to do to fix it. Decrease in gap in life expectancy starts to decrease. And if you're very proud of yourself, you lost some weight, you decrease the difference in life expectancy and then you sort of fall back on the way you were and you become even fatter than you were before. The mentality is that you need to diet forever. It's not a holiday, it's a religion, dieting. It, it's something you do forever and you don't ever leave otherwise you'll find yourself in hell. And the same is true with strategies. It needs to become something integral that you can do habitual that always stays that way. So the next slide and this is the one where you think, oh, finally we're getting onto the NHS. You think Well, this is all nice and well, but you know, do we have the money for this? And the counter argument to that is you could actually argue that inequality is costing the NHS money. And of course, you think of diabetes, obesity, you think of smoking, you think of all these things where lifestyle choices, short term hedonism is causing problems in the long term. The cost is projected to be around 12.52 billion. I believe that's a year. So we could generally speaking, reduce our cost for the NHS if we found a way of intelligently spending money in the community having impact. And the problem is it, you know, you can throw money out a window, but that's not gonna do anything. You need to find a way of giving it to the right people who have the right sense of values that they're not just going to waste the money and take the money and run a a all these things are incredibly complicated. But the annoying thing is there are strategies that will work that have worked. So I'm gonna move on to the next slide it to put it very crudely. It's a bit like the Pareto principle. Sorry, the prato ratio. But you find that if you think of an author or a musician, 20% of their produce will yield 80% of their money or, or dating apps, 20% of the guys will get 80% of the likes. And I'm not just being bitter there, that is actual data from him. But the, the point of view, very simple is that success often comes to a minority and the same often is true of disadvantages if we can find a way of implementing and attacking those things intelligently, that could hopefully fix the problem though. It is a very deeply rooted problem. And it's not, basically, it's not labor or conservative, It's something fundamental in human nature and that would be very, very difficult to solve. But it is, it is fixable. This is more of a side topic, but I found it a bit pressing when I read it, Children in cold homes with no heating and of course, they're twice as likely to get respiratory and cardiovascular disease, which of course, something that is entirely preventable when it's a factor of two as well as be more likely to get cold and the flu. So transport if I want to, I can get to work by bike, I can also get to bike by a car though. Frankly, paying for parking and finding parking in NHS. Car park is nothing short of extortion, but maybe that's a whole different topic. If you are, let's say, living in a council house, you need to get to work. What's your problem? You need to be able to get there, you need to be able to widen your radius. So you can find as many jobs as possible. The problem is if you don't have a car, you need public transport. Let's say they decrease funding as has happened for public transport, it becomes harder to find a job because let's say the bus is instead of running every 20 minutes, run every 45 minutes and they're irregular. The chance of people looking at you thinking he doesn't have his own car. I'm not sure I'm gonna want to hire him because there's a good chance he'll be late. The chance of if you get a job, the bus being unreliable and causing friction at work can be more to get let go. These all cause problems. Good transportation is a good way of getting people back on the employment ladder and not having that just makes it easier to fall back down. There is also an argument. It's not as directly impactful to the UK at the moment, but of course, it will have consequences in decades to come, but it's not exactly good for a carbon footprint either. So this is an idea about something that is quite effective. So, what we're talking about are schools with kids who are more likely to get excluded, more likely to be aggressive, get into fights. The solution is, and it is generally speaking, boys who are in this situation though. Of course, that is a bit of a generalization. There is something called football beyond Borders. And the idea is that you use football as a way of teaching people about channeling their aggression in a productive fashion, let off stream steam, be healthy and learn how to see themselves as a man in a positive masculinity sense of the word where they maybe talk about the feelings where they use sport as a way of you can do sport, you can do this football, but you've got to watch your grapes. And the idea is it's sort of like a mentor system where the coach is basically teaching the Children, teaching the young adults to grow into more responsible adults. And it sounds rather pedantic. Oh, what could it possibly do? But it was found to have results. 72% of these participants showed increased behavior at school and basically a lot of them finish school, 95 per percent, 95% of them finish them without getting excluded. So the point here is this is actually incredibly simple. It's a human thing. It's not, there's something that would probably be even that expensive, but it requires someone to stand up, take responsibility and basically clean up their neighborhood, their school and do that bit more. Of course, the counter that as well. People, teachers, they're already expected to do so much more. And that, that is a fair point. And II don't know what to say to that except to say that I don't see any way out of these problems except for people taking more responsibility and being more creative. And come up with more schemes like this. This could be another talk in itself. And I am going to imagine you're all getting sick of hearing me talk at this point. So the Greater Manchester Evaluation basically Coventry and Manchester had a good look at the moment review that I'm talking about here. And they basically said, well, what if we actually try this? And the short answer is the view is quite positive. I find it to be incredibly vague. And I was looking for some nice numbers that I could use. But generally speaking, I found it was a bit of a political document and there is a counter argument to it that basically this came towards the end of austerity. This came basically, things were starting to progress towards the mean where things were already starting to get better. So did it ride the wave or did it make things better? So generally speaking, I couldn't weigh in and say if it definite was the holy grail, it was made out to be ok. So generally speaking recommendations, a lot of these are vague. I'm not gonna read all of them because my throat is getting very, very dry and it's hurting and I'm sure you guys are sick of hearing my voice. But some of them are quite interesting, reduced levels of child poverty by 10 to 10% which is the lowest rate in Europe, which is a competitive thing. It's what is it like? In other European countries. So it's achievable but it would require a lot of work working in prevention, reducing exclusion. So football beyond borders would be an example of that better employment. So that's a bit of ad at zero hours contracts though national living wage, redesigning universal credits, like kind of striving towards being carbon neutral. Generally speaking, that's a good thing. I mean, it doesn't factor as much as one might think in the moment. Review some ways it felt a bit stapled in like it was put on on the end to sound a bit more green. But of course, in the long run, not being carbon neutral is going to have implications, not only for people in poorer countries but also ourselves. So that's something we can benefit from, of course, in the long run. All right. So I did create a mentee quiz here, but given how late it is right now and the time we've taken, we're going to give that one a miss. There is a part two to this which has a bit more from the Mark review and it is basically half more interesting stuff. I thank you all for your time. It's been fantastic talking to you. That is basically what you can type into Google to find the amount reviews less than 200 pages. I promise if you want some very dry bedtime reading, it took me about 100 hours to fully understand it. So while an hour may sound like a lot. I promise you condensing. It took an awful lot of thinking. Ok, so at this point, I'm going to go off present and I really, really hope that I'm still alive because it would drive me crazy if II did a presentation and presented the whole thing and then I had to present it a second time in the evening because, well, never mind. Ok, so thank you all for your time. I'm just gonna have a look, see if there's any questions and if there's anyone watching this video after it's been live. Thank you very much for watching. I hope you have a great evening. I believe there are some feedback forms if you could give me some of those, that would be fantastic. It's been my first time doing this full medal. I have been a bit nervous and it's been a fantastic opportunity. I'm very grateful. I hope you will have a great evening and I hope I get the opportunity to work with some of you at some point. Ok. So I'm gonna stop sharing now. Thank you so much for your time.