Inequality, it is in the air

Air pollution has been linked to severe mental health problems. This is one health inequality where meritocratic arguments just won’t rub

Dan Robotham

Yesterday, the Prime Minister indicated that he believed the uplift in universal credit (due to Covid-19) should be scrapped. This would leave families £1000 poorer over the course of a year. This may not seem like much to him, but it is a lot for people who need that money to live.

His reasoning behind the statement was something like (and I am paraphrasing, see here for a clip): “we’d like to see people work harder rather than rely on the welfare state”. This belies a ‘meritocratic’ way of thinking that anything can be achieved through ‘effort’ alone. It minimises the structural reasons for the difficulties people face. This is a slap in the face to anyone who thinks about inequality as a structural force.

Such meritocratic arguments are nothing new. For most social and health inequalities there has often been a corresponding argument that attempts to frame these problems as part of an individual’s choice, or lack of effort. To the proponents of these arguments, these are failures of morality rather than failures of society. There are plenty of examples:

Obesity? – “Eat less food”

Mortality gap? – “Don’t smoke”

Poverty? – “Get a job”

Racism? – “You made it up”

Mental health and polluted air

Today, a team of researchers at King’s College London announced findings that air pollution is linked to an increased risk of severe mental illness. This adds to the well-established health risks of air pollution on chronic physical illness (asthma, heart disease, etc) and increasing data on the mental health implications. (For example, a study which showed that growing up in dirty air can quadruple your risk of developing depression, or a review that supported the link between a decline in air quality and an increase in suicide risk).

For some reason, the people (including the politicians) who like to ascribe everything to individual choices and moral failings do not tend to talk about air pollution much. Perhaps it is because this is a cast-iron area where pure meritocratic arguments are easily exposed. Structural inequalities as a cause for poor health simply cannot be denied when talking about things as fundamental as where we live, where we grew up, how we commute, etc.

Hollow argument

It would have been interesting to hear the Prime Minister’s argument if he were talking about the impact of air pollution yesterday, rather than universal credit. How’s this for a soundbite “I’d really like to think people should move house rather than rely on society and the state to clean up the air in the area that they live”?

This is patently ridiculous. And as such, it provides a window into the mindset of those who downplay the existence of structural inequalities. The ‘air’ is all around us. We can’t do much to change it. Every breath we take is a reminder of where we are in space. If that space is polluted, then it affects us on a cellular level. Yes, we could swap our cars for bikes and switch to renewable energy providers (if we are lucky enough to be able to afford the increased rates), but this isn’t going to make a tangible difference on the timescale of an individual life span.

Communities and policymakers together

I’ve had a few conversations with one of the authors of this research, Dr Ioannis Bakolis. We have spoken about the challenges of doing ‘PPI’ (Patient and Public Involvement) in research on the interface between mental health and air pollution. The central problem, for me, is that air is so fundamental that it is impossible to know where to start. Any discussion about air quality and pollution soon reaches beyond individuals and into the structural arena.

It is easy to feel hopeless about whether anything can change, but this is exactly why transdisciplinary approaches to mental health research are needed, along with creative approaches to involving communities in the solutions. These solutions are all about coproducing spaces for people to live, perhaps by designing greenspaces in a way that screens out air particles (anyone who has walked behind a line of trees next to a busy road can see the difference such things can make). For these conversations to be worthwhile, we must bring another actor into any coproduction discussions. Policymakers with financial clout and political will behind them. This requires leaving the meritocratic sensibilities at the door.

So, the next time anyone tells you that structural inequalities do not exist, tell them to think about the air they breathe.

Dan Robotham is Deputy Research Director at the McPin Foundation