Capitalism, health and wellbeing with Rob Noonan podcast

Transcript

Capitalism, health and wellbeing with Rob Noonan

---

Thomas Felix Creighton (TFC): Hello, welcome to the Emerald Podcast Series. My name is Thomas, and my guest today is Rob Noonan, the reader in Health and Education at the University of Bolton here in the UK. He's also the author of the book, Capitalism, Health and Wellbeing: Rethinking Economic Growth for a Healthier, Sustainable Future, I hope you enjoy this episode…

…It's a real pleasure to have you! I've been spending the morning reading your book Capitalism, Health and Wellbeing. And just first of all, can you tell us a bit about it? 

Rob Noonan (RN): Yes, so, one of the drivers to write this book is that I've taught in higher education now for about a decade and across many subject areas ranging from public health to sport science to psychology. And often the material and the discussions that I have with the students tend to relate to some of the societal challenges that we face from health inequalities, obesity, mental health, to physical inactivity. And one of the challenges that I've had is signposting students to one or perhaps a couple of books that links all these challenges together, and essentially gives them a clearer sense of what's really happening, and more importantly, why it's happening. So, I wrote the book for that particular reason to fill this gap. But the second reason relates to the work that I do as a researcher. So, a lot of the work that I do tends to focus on behavior and on the environmental determinants of health. And what I mean by that is how the environment shapes health behaviors, and how these health behaviors then influence people's health. And during this time, I've become a strong believer, and arguably an advocate, for tackling the social determinants of health. And what this means is that social determinants of health, in many respects, relate to our health being the product of the places in which we're born. We grow, we live, and we like to age. But despite the evidence supporting the social determinants, it continues to remain largely absent from the public, and also the political debate. In recent years, in recent decades, we've seen lots of evidence and lots of news stories, and so on, life expectancy stalled, obesity and physical inactivity levels rise, and we see more and more people taking prescription medication to deal with the psychological suffering. And what this tells us is that something's not quite right, it tells us something's not right with society, and tells us that it's not an individual level problem. It's a societal one. It's down to structural factors. So, I wrote the book for that purpose to spark a curiosity and a conversation for how a healthier, more sustainable future is possible. 

TFC: And you mentioned in the book how we've had this laser focus on GDP. 

RN: Yes, so as a society, we obsess about growing the economy, baking a bigger cake, essentially. And rarely do we actually think about the societal costs of doing so. So, the pursuit of economic growth, as I argue in the book, has become a much higher priority than protecting improving the nation's health. And a question or a couple of questions that are posed in the book is, what if the economy grows because more people are consuming poor-quality food and obesity levels go? You could also argue, what if the economy grows because more people are buying bigger vehicles driving them more often, leading to inactivity levels going off, air pollution going up, congestion going up, and also more people dying on the roads. And then you could also argue the economy might grow because more people are suffering psychologically, they turn to alcohol or turn into drugs or perhaps even resorting to taking their own life. So, the message there is, the economy might grow. But what good is this if society gets sicker? That's the first point. And then the second point relating to the GDP aspect, Thomas, is that something else that's rarely discussed, is how this growth is achieved, and what impact it has on our lives. So, what we have to think about it for the economy to grow. This means that productivity levels need to rise which means the consumption levels need to rise. But if you dig a bit further, dig a bit deeper, this means the goods have to be manufactured faster, it means the services have to be delivered faster, it means that the goods and services that are consumed have to be consumed more often. So, this means then that work is about working faster or working longer. And they don't just have to do this to boost productivity, it is the crux of it, they have to do so. So, is the money to meet the ever rising consumption patterns. So essentially, they need to live their lives faster, and that has costs on their health and on the environment. So, here's the point, one of the easiest ways to feel less stressed for a lot of people, not all, but a lot of people is to slow down. But slowing down isn't an option. And the ultimate goal is to grow the economy. In fact, you could argue that there is a cancer to the capitalist system that we've currently got. 

TFC: Absolutely. I mean, I'm thinking of a small businessman I know who described his life as ‘constant running faster and faster and faster, in order to stand still’.

RN: Yes, mostly people call that the hedonic treadmill, running on that particular point. Economic historians have detailed this very clearly and very comprehensively. They've argued that economic growth does have costs and these costs show in the fact that you have increased levels of deprivation, which also increased rates of disease and increased rates of death. And a lot of the discussion, a lot of the content that they've talked about relates to the Victorian era, when you're seeing that, you know, infectious disease has gone through the roof, you have airborne diseases and waterborne diseases, people die of cholera, you know, in the late 1800s. And what was needed back then was regulation. There was neither an awful lot of investment from the governments to tackle, what you could argue is the social determinants of health as talked about in the book. These particular economic historians talk about the four Ds, Disruption, Deprivation, Disease and Death. And what they say is, if this particular process is not rectified by the state, the government, so instead of implementing the policies, that would limit the disruption or lessen the insecurity and the harmful effects. In recent years, in recent decades, if you think about the UK, in particular, they've tended to do the opposite. And, and the message in the book is, the governments are locked in a vicious cycle of spending huge sums, huge sums of public money, that harms in many respects, their pursuit of growth in their own policies. And, you know, listeners will see that, and not just on the evidence that's in the book but also just out there. The news headlines around weakened welfare states that means public services are not tackling the externalities of economic activity. And what I mean by ‘externalities of economic activity’ is… let me give you an example, one of the greatest achievements of in public health, and certainly the last couple of centuries, has been the separation of human waste human feces from water, that led to huge improvements I mentioned before, and brought down, you know, the rates of cholera and some of the other waterborne diseases. But we've seen in recent years, by virtue of not being tough on regulation, what happens, you know, where some of this waste is now going into some of our waterways, hundreds of thousands of times every year. And these are the very places that young people play in and swim in. And you know, in recent times, governments have actually even voted in favor of allowing this for time to come. So, that's just one of the examples of what happens where there's not strong regulation. I haven't mentioned it yet, but we often think about some of the benefits of free market capitalism. The advocates and the proponents of it'll talk about freedom and choice. But often what's missing in that particular discussion is freedom for whom. Freedom for whom is very important, because freedom for one person doesn't necessarily mean freedom for the other. So, in the example I provide there, you give companies freedom to just do whatever they want, so that they can increase profit margins and make their shareholders even wealthier, that could have drastic effects on communities and individuals. The example provided there related to water, you know, so many examples that we could provide around the market and advertising and very poor-quality foods, and some of the other types of emissions that we see in society. So, there's lots of examples where we have been able to mitigate some of the costs of capitalism, which we seen after the Second World War, but in recent years, then regulations that are needed haven't always been implemented.

TFC: Absolutely. After the end of the Second World War, we have [the implementation of] the Beveridge report, taking us forward… and more recently, we've had austerity.

RN: Yes, most definitely yet. Well, that's one of the things that are talked about in the book, it's the kind of elephant in the room. And you could argue in the fact that one of the reports that came out in recent years by the British Medical Association, who had consulted with a range of different doctors and physicians from around the UK, and the title of the report was called ‘The Country's Getting Sicker’. And they thought about how some of these changes that would seem by virtue of a status it contributed to population health worsen at a drastic scale, there's been lots of reports that have come out at the start of the year, authored by Sir Michael Marmot. And some of the work that's done through the Institutes of Health Equity, where they demonstrated that not only had health inequalities widened, but life expectancy has stalled, and in some parts of the country has actually gone backwards, certainly for people living in the most deprived parts of the country. But that report that I mentioned, by the British Medical Association, talked about how we can see cuts to public services and where poverty and a broken safety net, have contributed. These are the social determinants that I mentioned at the start of our talk today, you know, what we tend to see is the government's tendency to favor a - what I often call a - sticking plaster approach to rectify some of the social and health costs of growing the economy, and favor these particular approaches, I argue, because they align with short term electoral cycles, and are closely aligned with the profit motive for these particular decisions. The costs I've just alluded to, and, you know, one of the things that we see in society at the moment, has been issues around young people's mental health, which is arguably been exacerbated with the COVID 19 pandemic, and you know, more isolation and more remote work and so on for young people. But at a time, when young people's mental health crisis levels, a lot of the preventative services have been curtailed, you think about youth clubs, you know, they don't just provide a safe space for young people. But the provide a sense of belonging, and these types of preventative services, you know, there's a lot of evidence to support the value of them.

TFC: And you mentioned in your book, the importance of, you know, belonging, of community of togetherness…

RN: Most definitely, some of these are the preventative measures as well, around Sure Start Centres. So, there's been a substantial amount of research that's been done, they were implemented by the Labour government. And some of the research that's been done has been to the benefit of reducing health inequalities. So again, there's evidence to support the benefits of these types of programmes. But again, they've been caught. If you look at leisure centers, again, they are in many respects hope to the community, we know that we have a huge issue with physical activity in our country. And arguably, in many of the developed world. One of the reports that came out by the World Health Organization recently evidenced this, but again, at the time, when we have some of these public health crises, a lot of the preventative measures that can support people being active, whether that's green space, whether that's making our communities walk more walkable, whether that's investments in some of our, you know, leisure centers that in many respects support people from vulnerable backgrounds, and, you know, in sort of the deprived communities, we don't necessarily put much support and investments into them, particularly as you know, you could argue the some of these leisure facilities have a huge public health benefit, but again, they're not part of the statutory fund. And if there's cuts to be made, it's often to these particular services.

TFC: Oh, absolutely. I live in a small town, and the swimming pool was closed a few years ago. And previously, all the young kids would then happily play there. They've got their community, they've got their groups, where is now where can they go? It's a small town, there's not a huge number of options for them except sit on the sofa, play video games, hang around to the bus stop…

RN: Most definitely. Yeah! So then, what you tend to see is the data starts to come out and start to say, well, actually the healthy young pupils deteriorating, their physical health deteriorating because they spend the more time being inactive. Incidentally, their mental health is deteriorating, because they're spending more time alone, isolated. You may start to see more kinds of antisocial behavior, you might start to see more crime on the streets. And you know, it’s very rarely that the we then actually see discussions around the fact that will tell you why we're seeing these issues in society, we're seeing them now because it's a domino effect, because we've caught services or taken from one area. And now we're having to treat that particular problem and in society, another example that can provide this, one of the public health challenges that the country has at the moment around loneliness and isolation, certainly in older people. And in 2018, the government's introduced, this may come as a surprise for look for some listeners, they introduced their very own loneliness minister, and implemented a strategy around loneliness. And we know that from some of the evidence around community facilities that are beneficial, not just for communities, but at the individual level, and giving people a safe space to go things like libraries, libraries, don't just give people access to books and digital resources, gives them the opportunity to go somewhere, you know, and actually meet people and get like a sense of belonging, cut down isolation, and so on. And there's evidence to support the benefit the social value. 

TFC: Absolutely. I mean, I was surprised to see a sign in the library recently saying, ‘please talk, if you're reading a book, talk to your neighbor about it’. 

RN: Yeah. But again, you know, if there's this form and cuts to be made, you often tend to find, as we've seen, that that attends it tends to be in these particular areas. 

TFC: Very interesting, and we've been focusing mainly on the UK, but your book also has a global perspective. 

RN: Yeah, it does. I think that, you know, as I touched upon some of the factors, most of the issues that are talked about, do tend to be in relation to high income countries, because a lot of the issues that they face from a health perspective is down to their stage of economic development. So, there are some points in terms of issues to do with crime in some of the other countries where I'm talking about some of what happens when poverty is high, and people tend to crime and so on. But you could also there are still striking parallels with our country, in particular. And I think that then particular points that are mentioned, certainly around poverty, relate to jobs, because when we think about people's income, and we're thinking about poverty, it's often in the context of people's wages. But actually, people's income is the product of wage and number of hours worked. And a conversation with a friend the other day was around the fact that there's so many people in our society – in  one of the richest nations around – who live hand to mouth, essentially, every day they tread water to get by, and they remain poor. They rely on food charity, some of the excellent work that's done by the Joseph Rowntree Foundation, some of the reports they've published in recent years, evidence, almost roughly 70% of people who are classified as living in relative poverty, live in a household with at least one work and member and some of the evidence around the consequences, the health consequences of absolute material deprivation, did they go back to the Victorian era, did they go back centuries ago, wouldn't have known what the impacts are when, people don't have enough money to be able to survive. If you think about the book that was written in the 1840s by Friedrich Engels, it was called The Condition of the Working Class in England. And what he talks about in this book, his argument is, you know, the living and working conditions brought on by the capitalist system back then resulted in in health inequalities. And these health inequalities sent the English working class prematurely to their graves. And there's no doubt that living standards, people's quality of life, and so on has moved on astronomically in the last 150 - 200 years. Life expectancy is much greater, different types of challenges that people face. And as I mentioned before, you still see consequences of not just income inequalities, but the result and health inequalities.

TFC: Oh, yes. And you mentioned the short distances apart that people can live and have extraordinary different, not just life expectancies, but expectancies of health.

RN: So, we often think about life expectancy, which is exceptionally important. But what's also important is healthy life expectancy. You might find that someone, you know, may live till they're 78. But actually, the last 28 years of their life had been horrendous. You know, it's been very, very uncomfortable for them every single day to just get by, because they've just been chronically ill, they've been suffering from, you know, a combination of different chronic illnesses. And I mentioned before one particular book that's a favorite of mine, but arguably, the favorite book of mine is the ragged trousered philanthropist by the author, Robert Tressell, whose actual name was Robert Noonan, and Tressell was a pen name. My book was published on the 22nd of April 2024, and Tressell’s book was published 23rd of April 1914, so almost 110 years to the day. And the reason why that's got striking parallels, not just in terms of dates of publication, or name, but its message. Because what he was saying 110 years ago, his main message was around how the capitalist system, you know, was degrading on the health, and on the English working class. And also as well, he died before the book went to publication and he was buried in a pauper's grave in Liverpool, which was the city that I was born and raised in, and so on. So, there's so many different parallels between those two books. So, he was talking about the social determinants back then, he was saying that the pills and the medicine that he was given by the doctors back then, it's not really going to do more good, because he was still asked to endure the horrendous working and living conditions to survive. And daily, you know, I'm worried about the kind of psychological trauma of, you know, ‘Is he going to be able to afford a loaf of bread?’.

TFC: …and work has become more and more insecure with fixed term contracts, zero hours contracts, and even living conditions with no fault evictions here in the UK?

RN: Yeah, most definitely. One of the books that was published over a decade ago now, I think it was in 2011, was by an author Guy Standing, it's a really good book. It's called ‘The Precariat’. And he talks about how that we started to see a huge rise in precarious work, and the impact that that has, you know, the psychological impact that it has. One of the other factors that very rarely gets discussed is the fact that when people are in precarious work, and perhaps not only the wages low, but perhaps they haven't got the number of hours that they need to be able to live, and the income that needs to meet their living costs, they then have to work a second job, or they have to work a third job. And the point is, the reason why that's an issue is not only as a physically demanding, and you know, psychologically taxing on them, but it has an indirect effect on their health, because as I talk about in the book, some of the wellbeing enhancing activities that was evidenced by the New Economics Foundation, in 2008, when they published the report on the five ways to wellbeing, the activities that the NHS at the case and encourage connecting, being active, taking notice, and learn and, and these are the types of activities that economically cost very, very literally just cost people's time. And as people are having or indirectly forced to work more to survive, then they don't have the opportunity to engage in these activities, where there's strong evidence showing that it's healthy enhancing, you know, meeting with family members, and friends, and so on. So, that's another way it has a double kind of consequence of double burden doesn't just have a direct effect through the disproportionate conditioning and the physical stresses, it has an indirect effect on health as well.

TFC: That's very, very interesting. And, again, you mentioned the importance of Liverpool, in your work and in your thinking…

RN: Yeah, I mentioned this briefly in the book, from a very young age, you start to see the importance of environments, and how the environment shapes health behaviors. Now, health behaviors shape health. And, you know, what I could see from a very young age is the cost that this has on people's health by virtue of the opportunities that they have available to them. And I mentioned in the book, the government's often focused on that sticking plaster approach that I mentioned before, rather than actually investing in communities, investing in green spaces, investing in, you know, opportunities for people to be able to go to places where they can socialize. And a lot of these costs that the system can bring along with significant regulation and redistribution and can be put in place through, you know, income and wealth distribution. But what we've actually seen in recent years, is the government's often doing the opposite. So, if we're thinking about income inequalities, when the government decides whether or not to cut taxes for wealthy individuals, what this does is this lessens the distribution of wealth and widens income inequality. When they dismantled trade union power, it gives companies and employers greater freedom to suppress workers’ wages, and as we were talking about earlier, in terms of freedom and freedom for who, I think if you gave companies freedom to, you know, make changes to terms and conditions of workers’ contracts, whether that's around working harder for longer, or you know, putting them into precariousness, where that doesn't necessarily mean that it's favorable freedom for the individual, who's on the receiving end of them particular decisions, but also as well, something that I focus on in the book is around things to do with obesity and physical inactivity. And, you know, something that I that I feel very, very passionately about is around delays in regulations aimed at limiting and marketing of junk foods. There's a substantial amount of evidence that's out there from academics in the University of Liverpool and many other institutions around the consequences of food advertisement, young people's dietary choices.

TFC: You did, you did mention in the book, people working long hours, and maybe a second job, and then grabbing a quick ready meal, and then having a drink in the evening, rather than doing something healthy. And I was slightly concerned you had a camera in my house…

RN: I haven't! I haven't! I haven't done that. I guess, you know, if that is the case, it's probably quite consistent, and a mirror image for so many people, because it goes back to that productivity, what's at the heart of the book is the consequences of focus on productivity and going faster and faster, and a focus on consumption. And a lot of those issues that I allude to in the book are related to that in terms of the productivity aspect, and the consumption aspect. And from a physical activity perspective. You know, coming back to the regulations, the governments in a lot of cases deciding to drop regulations that in many respects, reduce car use, improve air quality, and make neighborhoods safe from and walkable, the very things that actually and needed to be able to make positive improvements to create environments that support people to be able to be physically active. You know, I mentioned in the book the sort of policy actions that could be done. You know, there's two big policy options that I talk about and one of them is around regulation, which we've spoken about an awful lot today, you know, the regulations are country's most powerful mechanism, you could argue, to change some of these impacts that we've been talking about change culture and change behavior. Lots of examples. We talked before in SAMSA sanitary reform, but you think about legislation around seatbelt use, you think about some of the positive improvements that's been made, in terms of smoking cessation, through restrictions in public spaces, there's lots of examples of success stories, where there's been a combination of different multi-pronged approaches to tackling some of these kinds of societal challenges. If we add restrictions, more restrictions around the challenges to people's health, then well that's one way that you could make a dent and other options designed in our communities, not just for cars, but for people. You know, we design our communities for cars, car dependence, but then you know, people are kind of encouraged to be physically active but you know, the streets and the roads around our communities that everyone's bought, we've built this kind of system that is actually the for cars. A point to make in the book is that we should have more investment in these particular area is because we should be supporting people to be physically active. The government needs to ensure that everyone has the opportunity to be active, to play, to connect, and above all, be safe in their community. And the other point that I make, which is a little bit more kind of, you know, it's a much bigger task and will take a much, much longer time to be able to achieve is around changing the goal of the economy, you know, which is a consistent analysis. Throughout the book, I talk about regulation and the benefits that it can have. And I've spoken about some of the other examples that you can see in the century where that's been useful. But if you change the goal, this ensures that everyone's reading off the same sheet. One of the issues that we tend to face not just in the public sector, but right across all sectors, is this joined up thinking thing, it was in 2006. Now, you know, the concept of health in all policies was spoken about. And what it means is inter-sectoral collaboration, basically, to make sure that if you're in planning, and I'm in health, and we've got someone else who's in education, making sure that the policies that are put in place in the decisions that may are getting us towards the shared objective, making sure the health is the main objective. But from what we actually see based on some of the evidence that gets presented, you could argue that we haven't made a great deal of progress in that area. And it's often down to the fact of what We alluded to before, in terms of them short-term economic gains being taken, rather than the expense of the health and the societal costs further down the line, there's a comeback to that policy approach. Now, the goal is around wealth over health. But if you switch the narrative, if you change the analysis, and you say, well, actually no, health is going to be more important than wealth. And you start to recognize that actually, social justice is really important. Wellbeing is really important. And actually, social justice and wellbeing are going to be valued more than money. You change the analysis then. And essentially what I'm getting at is, it's time to measure some of these particular outcomes alongside the economic targets.

TFC: Thank you for listening to today's episode. For more information about Rob Noonan, and for a transcript of today's episode, please see our show notes on our website. I would like to thank Daniel Ridge for his help for today's episode. And Alex Jungius from This is Distorted. You've been listening to the Emerald Podcast Series.