The Failure of Reformism Admitted

The NHS cannot tackle the health gap between rich and poor by itself and can only provide a "sticking plaster" for such inequalities, according to the convener of Holyrood's Health Committee. MSPs on the Scottish Parliament's Health and Sport Committee found that while there had been "many well-intended initiatives" aimed at reducing the differences in health between affluent communities and those in deprived areas "none has made any significant difference". The committee concluded most causes of health inequalities are "rooted in wider social and income inequalities"

Committee convener Duncan McNeil said: "That your income, your education and where you live contribute to how healthy you are is an issue that as a society should bring us significant shame. Since devolution, successive governments have made this a political priority and invested significant amounts of public money in tackling this complex issue. But sadly none have made any significant difference." He added: "Our NHS can offer a sticking plaster, but without a new approach we will not tackle the root causes of inequality and improve the health outcomes of thousands of people across Scotland."

In their report MSPs said "Despite many well-intended initiatives, none has made any significant difference. Indeed, although health is improving, it is doing so less rapidly than in other European countries and although the latest figures are a little more encouraging, health inequalities remain persistently wide."

The poorer - the sicker

A Scottish government report covering a 15-year-period from 1997 to 2012 revealed that hospital admissions for heart attacks were three times higher in poorer areas than in the least deprived areas. The report said the admission rate for heart attacks in the most deprived areas had increased by 45% since 2007 and by 15% in the last year. Deaths from heart disease are about five times more likely in Scotland's worst-off areas, compared with its most affluent communities.

 Cancer is more common in deprived parts of the country. Those aged 45-74 who are diagnosed with the disease in deprived areas are also more than twice as likely to die.

The rate of  alcohol-related admissions in the most deprived areas is around eight times higher than in areas of low deprivation.

Deaths in the poorest areas of the country were more than three times as common as in the most affluent in 2012.

Public Health Minister Michael Matheson said "At the root this is an issue of income inequality - we need a shift in emphasis from dealing with the consequences to tackling the underlying causes, such as ending poverty, fair wages, supporting families and improving our physical and social environments."

Andrew Fraser, director of public health science at NHS Health Scotland, said: Measures such as the ban on smoking in public places and minimum unit pricing (MUP) for alcohol are likely to be effective, as would further regulation of the food industry. However, many of the most important causes of inequalities relate to taxation, welfare provision, education and opportunities for good work.

"As the impact of current welfare and tax changes come to fruition, competition for less-skilled jobs tightens, and as in-work poverty continues to rise, these factors may well increase health inequalities in the coming years.”

The Cancer Industry

The international tobacco industry makes about £30 billion in profits each year – a profit of approximately £6,000 per death from smoking.

Tripling tobacco taxes around the world could cut smoking by a third and prevent 200 million premature deaths by the end of this century, researchers claim. In the European Union, a doubling of cigarette prices would prevent 100,000 deaths a year in the under-70s. 

The new tax would encourage people to quit smoking rather than switch from more expensive to cheaper brands, and help to stop young people taking up the habit, say the scientists. They came to the conclusion after conducting a systematic review of 63 studies on the causes and consequences of tobacco use in different countries. In high-income countries, 50 to 60 per cent of the price of a pack of cigarettes is tax. But in low- and middle-income countries, tax makes up only 30 to 40 per cent of the cost. Tripling tobacco taxes would also increase global government revenues from tobacco by a third, from £180bn a year to £240bn, said the researchers.

“Globally, about half of all young men and one in ten of all young women become smokers, and, particularly in developing countries, relatively few quit. If they keep smoking, about half will be killed by it, but if they stop before 40, they’ll reduce their risk by 90 per cent.”

The Burnt-out NHS

Doctors in Scotland are suffering “stress and burnout” as growing NHS workloads take their toll, medical leaders today warned.  BMA Scotland chairman, Dr Keighley has warned that the fall in hospital bed numbers over a number of years has led to rising waiting lists and more pressure on Accident and Emergency.

Health boards and the Scottish Government are struggling to deal with the pressures of an ageing population, Westminster-led funding cuts and rising expectations from patients which include a shift towards a seven day working week in hospitals. New contracts are now being proposed for doctors, along with “radical” changes to training and greater weekend working. Dr Keighley insisted doctors are ready to look at new ways of working.

The crucial contact between doctors and patients has particularly suffered, according to Dr Keighley.

The “inexorable rise of managerialism” in the NHS has been a “major cause of dysfunction”, he added, and there is a need to return to clinical priorities. “I disagree with suggestions that managerial and process change holds the solution to sustaining high quality care and believe instead that it is only by working with doctors and other healthcare professionals that a solution will be found.

Poverty to blame for bad health

Poverty and not Scotland's lack of sun is mainly to blame for a catalogue of illnesses associated with low levels of vitamin D, a new scientific study suggests.

Previous findings identified links between Scotland's lack of sunlight and conditions such as multiple sclerosis and depression. However, a study commissioned by the Food Standards Agency (FSA) in Scotland and the Scottish Government claims the country's inhabitants do get healthy levels of sunlight.

According to the researchers, the study gives added credence to other documented links between vitamin D levels and wealth, with those from deprived areas and with the lowest incomes exhibiting lower levels of the vitamin. The researchers said that "There is a link between vitamin D levels and socioeconomic status, with those deprived areas and with the lowest incomes exhibiting lower levels of vitamin D,"

Capitalism isn't fit for purpose

In the most deprived communities, men and women can expect to spend 22.7 years and 26.1 years respectively in "not good" health.

That compares to just 11.9 years and 12 years for men and women in most affluent parts of Scotland.

 Cancer and heart attack rates remain higher among those living in deprived areas.

Since 2008 "the admissions rate in the most deprived areas has increased at a faster rate than in the least deprived areas", leading to an increase in both relative and absolute inequality.

Dr Brian Keighley, chairman of the BMA in Scotland explained "... "for those people living in the most deprived communities the inequalities in health have never been more apparent. We cannot simply continue to argue that public health policies are working to improve the lives of Scots when the differences between rich and poor are so apparent...whilst doctors can do all they can to treat these illnesses, they will not reduce the drivers of inequality in society."

The poor health of the poor

The gap between rich and poor is leading to thousands of unnecessary deaths in Scotland, health experts say. NHS Health Scotland examined 30 years of health trends and found large differences in preventable causes of death across social groups. It revealed that there was little difference in death rates from non-preventable diseases such as brain and ovarian cancer, but large differences in more preventable causes like alcohol-related deaths and heart disease. The common factor suggested for the persistence of health inequalities was social inequalities.

Dr Gerry McCartney, head of the public health observatory at NHS Health Scotland, said: "Health inequalities represent thousands of unnecessary and unjust deaths per year across almost all social groups in Scotland.”

Director of Public Health Science Andrew Fraser said these patterns of death were not inevitable. "The answers lie in tackling the causes of inequalities, and not just the recognised causes of disease. Patterns of death that are evident in this report are the end-points of circumstances that span Scottish life rather than focus on a particular disease group. Prevention is achievable, and inequalities are not inevitable."

Sadly, Socialist Courier would not agree that inequalities are not inevitable. Capitalism creates such inequality and until capitalism disappears, disparities in health will persist. Nor are we alone in our pessimism. Inequality Briefing – a collective project supported by a range of organisations and individuals, on their website states: "Inequality has been growing for the last 30 years. The gap between rich and poor is the widest since the second world war... If current trends continue, we will have reached Victorian levels of inequality in 20 years." It continues: "Inequality has an impact on all aspects of life in Britain today. It means that some families are going hungry, children are left behind. Health and life expectancy of the poor are lower than that of the rich. Social mobility is at its lowest point in a generation and those born into poverty are likely to stay there."

Crazy Capitalism

Few visitors to the Socialist Courier blog will need to be told of the great frequency and seriousness of mental and emotional disturbances which afflict large masses of the working population, including not only those who receive psychiatric treatment but also the members of the families living in the same household.

Marxists approach the topic of illness as a whole in society, rather than dividing it along the traditional line between body and soul. It means recognising the unity of the physical and mental sides of a person, and talking about whole ranges of different types of ‘illness’ which may be neither particularly physical nor psychological. This approach would reveals how mental and physical health stems more from the economic demands of the system of production. Mental illness is always a sign that basic human needs are not being satisfied; that there is a lack of love, a lack of reason for being, a lack of justice; that something important is missing and, because of this, pathological trends are developing.

For a long time, the hell of mental illness was regarded as arising primarily from an ‘illness’ at all but seen as caused by “moral weakness” The stigma of mental illness still operates very powerfully, even in these allegedly enlightened days. Mental stress and breakdown, whether psychiatrically treated or not, is one of the most grievous hidden costs of life in this type of society. There is no way of gauging how many thousands of individuals have the lives poisoned or wrecked in the secrecy of their own dwelling, while maintaining an apparently cheerful public ‘front’ outside the home.

The care and treatment of mentally ill persons has undergone a revolution. The Victorian lunatic asylums have disappeared. The concept of the voluntary patient has replaced it. Only those who are so disturbed to be a danger to themselves or others are sectioned and hospitalised compulsory and only the criminal insane are detained in a non-hospital environment.

Some radical commentators have claimed that since life in our society is repressive and exploiting, mental illness is one more form of protest which deserves our sympathy and solidarity. And the psychiatric treatment of mental illness is seen as a part, perhaps an essential part, of the brainwashing, head-fixing, mind-dulling apparatus of modern capitalism. This message is in many respects true but not wholly true and leads to the conclusion that if there is no such thing as mental illness, we can have no use for the idea of mental health. We can therefore make no demands on the system to provide better facilities, material and personnel, for the treatment of the mentally ill,  no need for arguing  for a greatly improved psychiatric service within the NHS or demand more and better mental hospitals and clinics, more and better doctors and nurses. The burden of mental illness is thrown back on to the working class, to be dealt with in the isolated, behind the walls of the home-situation.

The working class and socialist movement must make it clear that society as a whole must accept responsibility for the care of the mentally ill – not on the cheap, by impersonal mass-produced treatment in overcrowded hospitals, but as expertly as we would wish to be treated ourselves.  There is nothing shameful about seeking medical help during a time of emotional distress. Sadly the existing NHS facilities can only discourage and frighten them. We know, (still need to be told), that many mental hospitals are bad, that many psychiatrists are incompetent (and reactionary). The same, of course, applies to hospitals, doctors and nurses dealing with physical medicine, only nobody thinks of using this to attack the very existence of public amenities for treating physical illnesses.

 Erich Fromm wrote “If parents really wish that their children be not only successful but also to be mentally healthy, they must consider as essential those norms and values that lead to mental health and not only those that lead to success.”

Helen Caldecott winner of the Nobel Peace Prize and a world renowned campaigner against nuclear weapons says that our species is “mentally sick… The whole society is sick”. We are in the grip of a death wish. She points out that 1 in 25 people are sociopaths with “no moral conscience” and these are the people who rise to the top; who are in charge.

Sociopaths and psychopaths are characterised by their lack of empathy; the ability to experience the feelings and emotions of others. Guilt and remorse are a foreign to politicians (Blair is a prime example). Those character types are both irresponsible and have an overblown sense of entitlement. Nothing is ever their fault. All these are traits which we can readily recognise among the power elites of our mad world such as in banking, with the expectation of bail-outs at the expense of the poor and vulnerable. More than 10 million people across the US have been evicted from their homes in the last six years, foreclosed on by the banks.

We all know, scum rises to the top. We all know that bosses are like smoking dope - the more you suck the higher you get. Psychologist Robert Hare, a researcher on corporate psychopaths puts the numbers between 3 and 12 percent of managers.

 There are seventeen thousand nuclear weapons in existence; enough to incinerate everyone on the planet many times over as well as destroying most of the other nine million species we share the planet with. Is this sane?  Nevertheless, Obama has recently allotted $537 million to upgrade 180 aging nuclear bombs to make them more accurate! Each bomb can destroy a major city the size of London or New York. Is this sane? Each year, around $45-60 billion worth of arms sales are traded. The 5 permanent members of the UN Security Council (US, Russia, France, United Kingdom and China), together with Germany and Italy, account for around 85% of the arms sold between 2004 and 20115 and most arms sales (something like 75%) are to developing countries. It is justified  by saying if we didn’t do it someone else would. Is this sane?  Global military spending is over $1.7 trillion dollars mostly by  powers purported to be peace-loving and law-abiding. Despite hundreds of years of experience to the contrary, political leaders still behave as though the best way of solving a dispute is invasion. Making war to stop war is like pouring petrol on fires to put them out. Is this sane?

Contamination from a single failure at Chernobyl spread right across Europe. 27 years later at Fukushima three complete meltdowns of reactor cores have been emitting radioactive material for over two years and nobody knows how to stop it. Capitalism is refusing to abandon a technology which can, through a single accident, pollute countries and continents. Is this sane?  Kyoto, the only international binding treaty on emissions cuts, has failed to slow global carbon emissions. The extreme weather of recent years, which has caused countless deaths is believed, by most meteorologists and climate scientists to be an indicator of what is to come from climate change. Excessive increase in global temperature will result in famine, floods, water shortages, large population movements, and land and resource wars. Yet there is a lack of political will to implement policies in governments, their state of denial and lack of urgency encouraged by powerful economic interests. Is this sane?

Capitalism is insane. 

Your Choice - Mending or Ending Capitalism

In America Obamacare, reforms to the health system of that coutry has been called “creeping socialism” by the free-marketeers and the American public has been barraged by propaganda against any form of “socialized medicine”. The problem of medical costs for people in the United States is a severe and often tragic one. In the UK we possess the much acclaimed National Health Service. The NHS is very far from perfect, but it works far better than the health system in the US, where almost all care is bought and sold in the market place. The NHS is the centrepiece of the welfare state. For over 90 percent of the population it provides their only access to health care. It is immensely popular, despite its inadequacies. The well being of workers concerns the ruling class and, for sure,  this is reflected in the priorities of the NHS. Acute medicine for the able bodied of working age is better funded and includes the most prestigious areas of medicine. Those caring for the elderly and the physically and mentally handicapped remain the “Cinderella” services.

The National Health Insurance Scheme started in 1912, it was decided to pay the money to the different health insurance agencies already in existence. Some were cooperative undertakings, some were run by trade unions, and some by insurance companies, so that there arose the anomaly of a national, compulsory insurance scheme being administered through separate, private insurance organizations. The benefits tended to vary. Employed workers were covered by but not their wives, children and other dependents. A sick insured worker had the care of a doctor and free medicine, but none of the ancillary necessities were provided – X-ray, hospitalization, surgery, etc. Low wages and recurring unemployment made even care by a doctor and free medicine a doubtful blessing for the average worker. While the sickness benefit remained fixed by law, some of the wealthier organizations gave additional services, dental care, eyeglasses and so on, while the poorer ones gave only the minimum. There were also local health authorities which were responsible for certain aspects of public health These included clinics, midwifery, maternity and child welfare, water supplies, sewage and refuse disposal, control of epidemics and the provision of domestic help for families unable because of illness to look after themselves. The main difficulty lay in the fact that there were over 400 authorities, many of them too small and too poor to carry out their functions. As a general rule, medical help received by this means was not of a high standard.

In 1942, Sir William Beveridge, a Liberal member of Parliament, proposed a comprehensive health service which would “ensure that for every citizen there is available whatever medical treatment he requires in whatever form he requires it...”
The Labour party steered the necessary legislation through parliament and in November 1946 the National Health Service Act became law and came into effect on July 5, 1948.

The National Health Service is available to every man, woman and child in the country without any qualification. Everyone is free to choose his or her own doctor and the doctor is free to accept or reject a prospective patient.

The NHS was regarded as a charge on national income in the same way as education and the armed services. It is recognized that it is as necessary to spend money on healthy bodies and minds as it is to provide education for the people. Welfare provision is contradictory. On the one hand it benefits workers but on the other it also reflects capital’s interest in the reproduction of labour power. The state represents capital’s interest in maintaining the conditions for the reproduction of labour power, but this imposes a cost on capital. There is a constant tension between the desire for healthy, well trained workers and the costs of such provision. In 1951 the Labour government, introduced legislation imposing charges on dental treatment. The following year the Conservatives added additional charges to the service. Pricing  has been expanded over the decades by both parties but  nevertheless remains largely a “free” service available to all. The priorities of the NHS have no bearing on what patients can pay – only to what they need.

“The National Health Service is the envy of the world.”  said Enoch Powell, minister for health in 1962.
“The National Health Service is safe with us.” said  Margaret Thatcher, prime minister in 1983.

The attack on the NHS today takes two forms. The first is the outright demand for privatisation of the entire health service and a full return to the market where people who can’t afford medical fees don’t get treated.  The other attack pretends to favour the principles of the NHS but then argues for the gradual erosion of those principles by moving towards a two-tier system, a private insurance model for wealthier patients while leaving the NHS the unprofitable areas of care, for the chronically sick, the mentally handicapped and the like.

The NHS is a very good example of a past reform vigorously opposed by conservative forces such as the doctors lobby, the BMA, at the time. It was very much in the interests of the great mass of the people, and especially of working class people. It was also, from the beginning, something of a compromise, but a compromise more in our favour than otherwise. Despite all its faults the principles the NHS incorporates are socialist ones. There will always be some system of priority and how is the NHS rations is on the basis of need. He or she who needs more, gets priority over him or her who needs less. It is not rationing by the size of a person’s wallet or purse.

With the deepening crisis of capitalism it is now the National Health Service is fighting for its life. “Saving” money is seen as important, however, reducing the profit level of the multinational drug companies is no part of plans. The NHS continue to allow brand name drugs to be prescribed when generic prescriptions would lower costs. While pharmaceutical company profits have risen enormously the original conception of the NHS has been quietly abandoned.

 Attacks on the health service are deeply unpopular. One of the easiest ways of dismantling the NHS is to impose strict budgets and  make the working conditions and pay so unattractive and unrewarding that it literally becomes impossible to staff it. Closing a ward here and a ward there, or shutting this or that local hospital and no-one notices that it is gone until it is too late.

As critics of reformism, the Socialist Party are not, of course, opposed to particular reforms. But it has to be understood that no gain is permanently guaranteed so long as the means of production  remain in the hands of the capitalist minority. The never ending struggle to protect the benefits of the National Heath Service is proof of the pudding. To permanently achieve a decent society we must break the power of the capitalist class.

Alienated Lives

Why are Scots sicker than the rest of the UK?

Dr Phil Hanlon and researchers at the Centre for Population Health have compared life, incomes and health outcomes in Glasgow, Liverpool and Manchester. They found “deprivation profiles” were almost identical, but premature deaths in Glasgow were 30 per cent higher.

This excess mortality ran across almost all ages, males and females and deprived and non-deprived neighbourhoods. It was not, surprisingly, lung cancer, heart and liver disease were not the factors tipping Glaswegians over the UK average.  It was higher levels of drug and alcohol misuse, suicide and death through violence.

Why are some Glaswegians so prone to self-harming and life-shortening behaviours?

Chief Medical Officer Harry Burns cites the work of Aaron Antonovsky, who maintained that a sense of coherence (SOC) is necessary for adult health. The  medical sociologist defined the SOC as “the extent to which one has a feeling of confidence that the stimuli deriving from one’s internal and external environments are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement”.

In other words, good health is a mixture of optimism and control that relies on life being comprehensible, manageable and meaningful. Comprehensibility allows people to perceive events as ordered, consistent, and structured. Manageability allows people to feel they can cope. Meaning allows life to make sense, and challenges to seem worthy of commitment.

Socialist Courier would rather phrase it in Marxist terms - Scots are more alienated. So many people are stuck in meaningless lives they can only self-medicate using drugs, booze or food.

Or perhaps as John Lennon puts it  “you can't really function you're so full of fear” and  they “keep you doped with religion sex and tv”

Patients are not Widgets

Dr Brian Keighley, chairman of the British Medical Association (BMA) in Scotland, hit at the NHS Trusts.

 "We now see health boards talking about 'their' patients, almost implying that the doctors it employs or contracts with are mere technicians in the pursuit of their corporate aim. What an insult to those of us who came into medicine to treat patients to the best of their ability." He said: "Bean counting and clinical direction by managers with top-down politically-inspired targets are not compatible with relationships founded on trust between physician and patient. Patients are not widgets and I get upset when they are treated as such, and when I am considered a mere tool within a corporate design. This slavish addiction to an ethos of corporatism and managerialism has led to doctors, nurses and other clinicians becoming progressively disempowered." He added: "What I want to see for my successors in the NHS is a return to what is at the heart of laudable patient safety and quality initiatives - the centrality of the patient and his or her relationship with their doctor, nurse or therapist,"

Good health, but at what price?

A woman awaiting a transplant for a rare condition, atypical haemolytic uraemic syndrome (aHUS), an inherited condition that has destroyed her kidneys had her operation cancelled at the 11th hour because the Government refused to pay for the drug she needs to prevent the organ being rejected. Up to 70 patients are in the same position. They have been forced to put their lives on hold, and risk their condition deteriorating, while ministers and officials argue over whether the NHS can afford the drug, Eculizumab, which costs more than £300,000 per patient per year. The health minister, Earl Howe, rejected a recommendation from an expert committee that the drug be "routinely provided nationally".


Instead, Earl Howe referred the drug for further investigation by the National Institute for Health and Care Excellence (Nice), which took over responsibility for treatments for rare diseases. Nice has yet to explain how it is going to assess drugs for rare diseases. Nice's verdict on Eculizumab, brand name Soliris, is not expected before summer 2014. The drugs can be life-saving but are hugely expensive because they affect very small numbers of patients. They cannot therefore be assessed according to the usual cost-effectiveness threshold of £30,000 per patient per year (adjusted for quality of life) .

Experts fear the move could signal a tough new approach to the funding of expensive treatments for marginal groups. But that would undermine the role of a national health system to pool the risks for the whole population in order to fund individuals with exceptional health needs.

MP Madeleine Moon, chair of the All-Party Kidney Group, said: "It was heartbreaking to see the agony that people denied access to Eculizumab went through... The Government has made a heartless decision to allow existing trial and new patients access to the drug but not those who have been refused access on cost grounds by their hospital."

Professor Tim Goodship, chair of aHUS Action, said: "A transplant transforms people's lives. This opportunity has been dangled in front of them and then withdrawn. I feel it is just cruel."

The cost of cancer

Allan Cowie, general manager for Macmillan Cancer Support in Scotland, has revealed that after fear of pain, money worry is patients’ greatest cause of stress. And demeaning work assessments ruling people are fit to work are also causing unnecessary suffering.


Many Scots, according to the charity boss, have been left with the fear of being labelled scroungers, meaning vital benefits go unclaimed. Cowie said:

“ We worry the stigmatisation of those on benefits may mean patients with cancer are too ashamed to claim. We have encountered cases of terrible poverty. We have heard of instances where people only worry about benefits when they face losing their home. Up until that point, they are more concerned with the dreadful worry of if they will live or die. We have also heard of cases where people have no food in their homes because they have channelled all their money into keeping a roof over their heads. This is not acceptable in this day and age.”

Cancer sufferers face additional costs of a staggering £470 a month – the same as many mortgage payments.

He said: “This is the average cost associated with a cancer diagnosis in Scotland. It accounts not only for heating bills and travel costs for appointments, and dietary needs, but also the reduction in their income. People often can’t work during treatment or rehabilitation. Cancer mounts a two-pronged attack on people’s finances.”

Patents or Patients

When HIV/Aids took hold around the world and antiretroviral (ARV) drugs became available from 1987, the  drug treatments required then cost $15,000 a year, which very clearly limited their use to well-insured or relatively rich western patients. Prices for AZT3 officially started at $25 per pill in South Africa. Although HIV/Aids was the scourge of Africa in the 1980s, its management ad treatment was initially completely out of reach of  those hit by "slim" disease as it was then known as locallywho were just expected to go away and die. And millions, denied medication, did die. An estimated 10 million people perished between 1996 and 2003 thanks to denial of drugs by Big Pharma. And all the while the medicines were just sitting there ... out of the financial reach of the inflicted. Big Pharma was quite happy to see millions of deaths in order to keep patent law - and its profits.

 Thanks to India's 1970 patent law, drugs could be made to the highest technical standards (a fact often denied by a propaganda campaign of the western drugs companies) .The Pfizer patent for fluconazole (used for treating Aids-related fungal infections) in South Africa was deliberately broken by importing it from India. The price per capsule in South Africa stood at $40, while in Asia it was 5 cents. With Africa hosting two-thirds of the world’s HIV/Aids cases, this kind of action made an impact politically. In 2000, Yusuf Hamied’s Cipla generic pharmaceuticals company agreed to produce  a three-ARV combination that would cost patients $1 a day - at $350 a year this was less than a 40th of the cost demanded by western drugs companies.

Big Pharma's argues the expense of its products is due to development costs: in fact, marketing budgets in drugs companies are very much higher than those for research and development, which averages a risory 1.3% of expenditure across top pharmaceutical companies. In fact, 84% of research and development worldwide is carried out by government and public bodies, whereas pharmaceutical companies contribute only 12% and account for only three out of every 10 new drugs invented.

 The Executive Director of the Joint UN Programme on HIV/AIDS, Michel Sidibé, said “It is outrageous that in 2013, when we have all the tools we need to beat this epidemic, 1.7 million people still die each year because they cannot access treatment.”

Now with India’s government adopted the WTO’s Trade-Related Intellectual Property Rights (Trips) patent regulations it may well be all over for generic medicines. The pharmaceutical companies will be able to continue to grossly overprice its drugs. People are going to die needlessly once again.

We need a need-based health service

The NHS is failing to provide needs-based care in areas of blanket deprivation, GPs working in Scotland's poorest areas will tell MSPs. The GPs from The Deep End group, which represents 100 practices in the poorest parts of the country are expected to warn that the health service's approach is a "recipe for widening health inequality" when they appear before the Public Audit Committee.

The report warned that the distribution of GPs in Scotland does not reflect the higher levels of poor health and greater need in poorer areas and that "deep-seated inequalities remain between the least and most deprived communities" despite research showing higher rates of multimorbidity (more than one chronic medical condition) in patients from the most deprived areas.

This, combined with "dysfunctional links between general practice and other parts of the NHS", is "a partial explanation of 20 years of failure in addressing inequalities in health. The GPs called for more time for doctors seeing patients in deprived communities, as well as better integration with other services such as social work and addiction services. "The focus should be on sustainable development, with an emphasis on continuity and the productive power of long-term relationships."

The Tyranny of Work

The mental health of Scottish workers is being put at risk thanks to the "relentless pressure" of management systems meant to increase their productivity. Unions and researchers claim workers have suffered extreme stress, depression and in a few cases threatened suicide.  Austerity has allowed some firms to use management techniques to make their staff's lives a misery.

The impact on the mental health of employees was highlighted in the report Performance Management And The New Workplace Tyranny. Phil Taylor, professor of work and employment studies at the university in Glasgow, carried out the research.  He said performance management had evolved into a "continuous, all-encompassing" process of "tight monitoring and strict target compliance".

Taylor said: "Many who have been in the workplace for 10, 15, 20 years, talk with great pain about how the workplace they joined has been transformed beyond all recognition over those decades and the aspects of work that gave them a degree of happiness or satisfaction – such as talking to colleagues, satisfying customers or doing a good job – have been subordinated to the pressure of targets. That is a genuine degradation: people shouldn't have to work like this. You are only as good as your last score, and you can have people who have been utterly loyal and committed to an organisation and excellent performers, then being thrust into the underperformance camp. That can exacerbate feelings of pressure and can lead to stress, which compounds the difficulties of actually doing the work and makes it difficult to get out of that category."

Mary Alexander, deputy regional secretary of Unite in Scotland, said an example from the financial industry showed it could take as little as six weeks from being put on a performance improvement process to being fired. She said, sales targets which were being set were often "not achievable and unrealistic".

Dr Andrew Fraser, director of public health science at NHS Health Scotland said: "We know that a tough and unsupportive working environment, and specifically workplace bullying and harassment can have a negative impact on a person's mental health and that, as a result of sustained bullying, some people may experience stress and anxiety. If that experience is sustained and not addressed by management at all levels, workplace stress may lead to depression which is a major risk factor for suicide." 

Meanwhile another report  reveals than more than 500 Scottish construction workers were blacklisted for jobs because of union activity. Personal details about 3213 workers were discovered at a Worcestershire-based firm called The Consulting Association. The files were used by more than 40 firms including Balfour Beatty, Robert McAlpine, Laing O'Rourke and Costain to check the backgrounds of potential workers. On the list are 142 workers from Glasgow, Clydebank and Dumbarton, 53 from Ayrshire, 51 from Edinburgh, and 28 from Aberdeen.

 The Consulting Association had links with police and security services. Construction industry directors were addressed by a "key officer" from the National Extremism Tactical Co-ordination Unit (Netcu), a Huntingdon-based police organisation set up to counter "extremist" protest groups.

Depressed Scotland

The number of people in Scotland prescribed antidepressants has reached record levels, with more than one in seven people taking the drugs. There has been a steady rise in usage. There were 1.26 million drugs dispensed in 1993/94, increasing to 5.01 million in 2011/12.

The diagnostic criteria for depression as two weeks of low mood, irrespective of any change in the circumstances of the patient which might have left them feeling down. It even proposes that being low two weeks after bereavement should be considered depression.

Glasgow GP Des Spence argues treating depression like a medical condition is distracting attention from what really makes patients unhappy. "I think we use antidepressants too easily, for too long and that they are effective for few people (if at all)." Dr Spence's  concern about the widespread use of antidepressants is they leave the real reason for someone's poor mood unexplained. He said: "Improving society's wellbeing is not in the gift of medicine nor mere medication, and over-prescribing of antidepressants serves as distraction from a wider debate about why we are so unhappy as a society."

Deprived Scotland

A boy born in the most deprived 10 per cent of Scotland would have a life expectancy of just 68. That is eight years younger than the national average, and 14 years below boys born in the least deprived parts of the country.

 Rates of mortality for heart disease are twice as high in deprived areas, at 100 per 100,000 under-75s, compared with the national average. Cancer mortality rates are 50 per cent higher in poorer areas, at 200 per 100,000.

The number of Scots aged under 25 who are out of work has doubled to 90,000 since 2008, the Joseph Rowntree Foundation said.

The report also highlighted the rise in part-time employment, from 70,000 in 2008, when the economic crisis hit, to 120,000 now.

The Scottish Government insisted Westminster benefit cuts were the biggest threat when it came to poverty and inequality. Julia Unwin, chief executive of the Joseph Rowntree Foundation, said: “The Scottish Government has powers to do a lot now. They don’t need to wait for constitutional change."

Rickets is back

Rickets is making a comeback. Cases of rickets have risen fourfold since the mid-1990s  Half of Britain's white population, up to 90% of the multi-ethnic population, and a quarter of children, are suffering from vitamin D deficiency, the main cause of rickets.

Scottish health apartheid

New figures revealed men in the wealthiest areas live 11 years longer than those in the most deprived parts of the country. For women, the gap is 7.5 years between the poorest areas and the most affluent. Deprived area residents have higher rates of heart disease, obesity, diabetes and drug and alcohol abuse as well as poorer mental health.