Tonic adviser Dr John Barnes explains how social inequality can destroy mental and physical health, and why it’s so important in the current climate.
Photo of The Specials original Ghost Town 7” EP cover
The Ghost Town Effect
The 1981 hit Ghost Town by The Specials reflects the anger of young people at social conditions of the time; “no job” and “all the clubs closed down”.
In 2010 I was amazed to learn from health scientist Michael Marmot just how badly physical health and mental health are affected by the conditions in which we are born, grow, live and work.
Focusing on the differences in health outcomes due to economic poverty in this blog, I am calling them the Ghost Town Effect, as it’s less of a mouthful to say than the scientific term Social Determinant(s) of Health (SDOH).
Photo courtesy of Matt Downton
Survival in the pandemic
We know COVID is more likely to be serious if you are over 70 or have predisposing illnesses. If you are from BAME communities your risk is also particularly high and there are rightly calls for specific protection for BAME frontline workers. It’s likely that the Ghost Town Effect is part of this finding. People from poorer areas have had at least a doubling of risk of death due to COVID compared with those from well off areas.
Mental health in the pandemic: What protects it?
Outside an NHS clinic in Southsea, Portsmouth
Temporary respite from school / work
Sense of shared social purpose
People volunteering to help the vulnerable
Use of mobile phones, zoom etc. to stay in touch
What stresses our mental health in the lockdown?
Fears – food, employment, money, infection
Isolation
Lack of sunlight
Lack of exercise
Entrapment / domestic abuse
Is there a Ghost Town Effect on mental health in the pandemic?
Right now in the pandemic:
The initially high levels of anxiety and depression began to fall as lockdown measures were eased. Anxiety and depression remain highest amongst young people, those with lower household income, people with diagnosed mental illness, people living with children, and people living in urban areas.
There has been a decline in appointments for help with common mental health problems.
There have been more relapses of people with psychosis, necessitating longer stays in hospital.
PTSD is affecting frontline health workers and 20% of people who have survived COVID by being on a ventilator in ITU.
A post-pandemic recession would worsen the Ghost Town Effect on poorer people’s physical and mental health.
Further reading: https://www.health.org.uk/news-and-comment/blogs/emerging-evidence-on-covid-19s-impact-on-mental-health-and-health
Ghost Town Effect on physical and mental health in the ten years before the pandemic:
Physical health in the poorest households:
Cuts in government spending have impacted physical health.
Rises in average life expectancy have stopped in the last couple of years.
Life expectancy for women has decreased in the most deprived areas in most regions, and for men in the east and northeast.
People in poorer areas are spending more of their (shorter) lives in ill health.
Mental health in the poorest households:
Children have more emotional and cognitive difficulties from age 3, and three times the risk of serious mental health problems from age 11-16.
Adults are nine times more likely to have a psychosis and twice as likely to experience common mental disorders.
Poorest men in the most deprived areas are up to ten times more at risk of suicide than the well off.
50% of people in debt have a mental disorder compared to 14% of those without debt.
How does the Ghost Town Effect work on our minds and bodies?
Poverty creates a less fertile grounding for child development and fewer chances to get ahead as an adult. This can arise from living in a neighbourhood with poor resources, little active participation in community activities, and a poor physical environment.
Social Determinant(s) of Health (SDOH) can also include discrimination due to gender, ethnicity and sexual orientation, as well as the stigma of mental illness.
All of these difficulties make us less well equipped to lead healthy lifestyles, such as eating 5 portions of fresh fruit or veg a day, even if we can afford them.
But it’s not just that. The feeling of being “left on the shelf”, as the Ghost Town lyric describes it, has a corrosive effect on self-esteem and trust in others. This triggers the brain’s stress reaction inherited from our hunter-gatherer ancestors in prehistory. This hormonal and inflammatory reaction can be helpful in the short term, but if prolonged leads to increased risk of mental and physical disorders.
What can we do about the Ghost Town Effect right now?
We need to reduce the gap between rich and poor, and not only in economic terms, but across all other determinants of health throughout our lives.
This will require action in all areas of society to empower local communities to be active with health, social care and voluntary sectors to create a richer enabling environment that excludes no one. It’s all in the plan that was laid out by Michael Marmot and accepted across government 10 years ago, but progress has been slow.
We are in a precious moment when all society is thinking about the needs of the BAME communities and the economically disadvantaged. I believe that for economic inequality to be reduced, the attitudes in society toward the poor of the last 20 years need to be reexamined in the light of the evidence, and more empathy fostered.
We can be hopeful that by involving ourselves in organisations like Tonic Music for Mental Health on our personal recovery journeys, and by supporting the sustainability of venues for local music culture, we are together part of the solution.
Can music change the world?
Health scientist Richard Wilkinson puts it like this:
“Through its ability to touch our fundamental humanity, music has a role to play not simply in individual, but also in public health and health inequalities. It can encourage people as it did in the 1960s to embrace social and political challenges that move us towards a fairer and healthier world…”
Music, Health and Wellbeing: Exploring Music for Health Equity and Social Justice
Palgrave 2017
Dr John Barnes
All in this Together
Press the play button below to listen to my song entitled All in this Together, which I wrote and recorded whilst writing this blog.
All in this Together
We’re all in this pandemic, but were gonna make it through
We depend on each other, that means me and you
Keep your distance, we’ll be OK
We hope you can be sure
We’re all in this together, we’re gonna make it through
We’re all in this together, it’s what we’ve got to do
Summer lockdown 2020 stretches out like a Tesco queue
Some people shop at Waitrose, others at the foodbank too
Ted worries about Lilly’s tablets
Bill gets them from the pharmacy
Were all in this together, we’re gonna make it through
We’re all in this together, it’s what we’ve got to do
Naa-nana naa nana nana
Naa-nana naa nana nana
Naa-nana naa nana nana
Thursday applauds the front line for selfless sacrifice
Make sure they get their PPE or they will pay a price
Jane works down the care home
Reza on Deliveroo
We’re all in this together, we’re gonna make it through
We’re all in this together, it’s what we’ve got to do
Outbreak of solidarity like in 1948
Health for everybody and a shiny welfare state
No needless want or illness
from the cradle to the grave
We’re all in this together, but not in every road
When how long you get to live depends a bit on your postcode
Health comes from a good economy, that’s what the bankers say
It’s more the chances that you get, and the air that you breathe
It’s what we give each other that makes you believe
In a place we all want to live and feel that we belong
and that’s why together, we sing this simple song
We’re all in this together, we’re gonna make it through
We’re all in this together, let’s try and make this true.
Barnes, J. (2020) All in this together. Tonic Music for Mental Health
Vocals and guitar performed by John Barnes
Feat. flute instrumental composed and played by Zöe Walker