President Dwight D. Eisenhower said he had two kinds of problems: the urgent and the important. “The urgent are not important, and the important are never urgent."
This week is the NHS Confederation’s annual shindig and as with every meeting of this type the great and the good will meet to discuss the urgent. That is usually money, policy fads, structures, maybe vanguards this year, NMCs, ACOs, OBC and any other acronym you can pluck from your alphabet soup. What won’t get a look in is the genuinely important.
In short, young men are dropping out of education at an alarming, and increasing, rate.
So what? The white male has a long history of undeserved privilege and it’s about time the balance tipped slightly out of their favour, no? The steady erosion of the patriarchy is surely one of the major social achievements of the last few decades and this is the logical and necessary outcome. And what has this to do with health anyway?
Looking at events unfolding across the Atlantic, the consequences of a similar situation are becoming frighteningly clear. In West Virginia, where 94% of voters are white, less than one in five has a degree and a similar percentage live below the poverty line, figures from the Drug Enforcement Agency – analysed by a local paper – put painkiller prescriptions at 19 per person across the state in 2009. This is drug addiction on an industrial scale.
And it is not just West Virginia. In every developed country, in every demographic, death rates are decreasing. Except one. Work by the 2015 Nobel economist Angus Deaton discovered that the mortality rate for white middle aged men in the US, with no more than a high school education, is increasing at an alarming rate.
Deaton and his partner Anne Case discovered that the increase was mostly accounted for by drug abuse, alcohol poisonings, suicide, chronic liver diseases and cirrhosis. Although all education groups in the demographic saw increases in mortality from suicide and poisonings, those with less education saw the most marked increases.
This is a very large portion of modern society that feels so disenfranchised, cut off and hopeless that they are killing themselves in myriad ways in their thousands, if not millions, numbing and ending a life they do not want through drugs, booze and ultimately suicide. There is not an epidemic of disease. There is an epidemic of despair.
It’s not simple. There is no one thing that can explain or solve this ticking bomb - education alone is far from a complete answer as to why this very large demographic is withdrawing from the rest of society. And so far the statistics of the US are not quite yet being replicated over here. But failing to confront that we are slowly churning out the same mass demographic of disenfranchised, uneducated white males, that are systematically committing cohort suicide in a similar developed nation, is a monumental public health calamity in the making, not to mention rank stupidity.
The author of the HEPI report, Nick Hillman says that “nearly everyone seems to have a vague sense that our education system is letting young men down, but there are few detailed studies of the problem and almost no clear policy recommendations on what to do about it”.
This is bigger than health, but health will bear the brunt of the consequences. Ignoring it and returning to the NHS comfort zones of finances and fads will change nothing. It is surely the responsibility of those debating the future of healthcare this week in Manchester to raise this important problem, or it will be their urgent problem before they know it.