A treatable deadly disease
The most common operation in children in the UK is to pull all teeth for untreatable tooth decay. For many families in English society a toothbrush and toothpaste are not a financial priority and routine dental care for children hardly exists. In my consulting room I see a large number of patients with illnesses that are caused by enormous obesity. No surprise if your daily diet only consists of fried chicken, because that is cheap and tasty, fills your stomach and is available at every street corner. Vegetables or fruit are simply unaffordable for large groups of people.
During my last weekend shift at our Emergency Department I counted at least 15 patients with complications of injecting drugs with dirty needles, such as huge syringe abscesses in the groin, infected heart valves or severe lung infections. It is a flashback from an almost forgotten past, because injecting drug addicts hardly exist anymore in Amsterdam because of the municipal health care system’s successful programs for many years.
The army of homeless in London now counts more than 3,000 people and every month about 25 of them die. Or they are hospitalised with serious wounds, infections (such as tuberculosis or hepatitis), or exhaustion and starvation. I had heard about scurvy, caused by a shortage of vitamin C, in stories of seamen sailing the world oceans in the 16th century, but now I can regularly observe this myself in 21st-century patients in London.
Everywhere in London I see poverty-related illnesses that have not occurred in the Netherlands for decades. With a yawning gap between people with a decent or even regal income and people who hardly earn anything, it has never been clearer to me what poverty does to health. The London living wage is a euphemism for the voluntary minimum wage for employers and is approximately £800 a month, of which a family can barely exist in an extremely expensive city like London. Many workers receive a lot less. Social benefits or payments simply do not exist. And the result of that poverty is immediately reflected in A&E, the waste pit of society, because most other social infrastructure has been demolished.
It is evident that poverty is a debilitating and deadly disease. The difference in life expectancy between poor and rich in the UK is nine years. Such a difference also exists in the Netherlands, although it is fortunately much smaller. Unlike many other deadly diseases, poverty is easy to treat. And we all know how.
Marcel Levi is chief executive of University College London Hospitals. Before that, he was chairman of the board of the Academic Medical Center, University of Amsterdam. He writes a weekly column in the Dutch national newspaper ‘Parool’. This column was published on 23 February 2019.