Column

Your money or your life!

A busy consultant is speaking to two recently admitted patients.

‘As you know, you both have a serious condition. Without treatment you can expect to live for about five years, most of the time with few if any symptoms to worry about. With treatment you are likely to live up to ten years, again with few troubling symptoms until the final stages.

‘Naturally you are entitled to NHS treatment, but you must understand that therapy for your condition is expensive. Given this we’d like you to consider an alternative to treatment.’

Stephanie Lawrence LLB is puzzled. ‘What alternative?’

‘A deal, a commercial transaction. If you agree to decline treatment we’ll pay you half what it would have cost us to treat you.’

Johnny Parsons, the second patient, is incredulous, ‘You mean you’ll give us money for being sick? For dying? Money for our lives?’

The consultant shrugs.

‘We’d rather you weren’t sick. But yes, we’ll give you money in return for an agreement to forgo therapy. That way we have funds available to help other patients and you have a fair life expectancy. It’s your choice. £100,000 for five years of life.’

Stephanie is astonished. She won’t even consider the proposition. But Johnny nods slowly.

‘I’ll do it,’ he says. ‘I’ll take the money. It’s an easy decision for me.’

***

Would you accept the offer? Would £100,000 be enough for you? How about £500,000? Would £1million do it? It would depend on your circumstances, and even a small amount might be enough if you were poor like Johnny.

Though only 30, Johnny is uneducated, unemployed and always broke. Ten more years of a life like this seems less attractive than five years of relative wealth. With money he can travel and paint and learn how to write the stories he’s always dreamed of.

Stephanie chose to decline the consultant’s offer because her life is good already. She doesn’t particularly need the £100,000. She has children, she has a career and status, there’s a lot more she can achieve yet: ten more years of Stephanie’s life is an enticing prospect.

Whether or not you’d take the money, the fact that we can seriously entertain the idea proves that health – understood as ‘not being ill’ – is not a fundamental concept, despite our deep-seated cultural habit of assuming it is.

At bottom, income and health are not separate factors. If they were, we would have to conclude that Johnny’s choice is bad for his health. And yet it seems perfectly sensible for Johnny to opt for a better, though shorter, life. Now Johnny can make a difference – his autonomy immediately expands, so he is healthier in a more basic sense.

The biggest social issue is not that people with low incomes tend to have less health because they get sicker more often. The problem is that people with low incomes tend to have less health simply because they have low incomes.

There’s no getting away from the logic of it. If you want to eradicate inequalities in health then you must eradicate inequalities of opportunity .This means preventing avoidable disease and illness in the least well-off social groups, because as a rule disease and illness restrict opportunity. And it also means preventing avoidable lack of money in the least well-off social groups, because as a rule less money means less opportunity.

It is much more conducive to the political status quo to discuss how to tackle health problems caused by inadequate income than it is to address the central problem: lack of adequate income itself.