UCL Health of the Public


Transcript for Cost of Living Crisis podcast

In this episode, Prof Sir Michael Marmot and Jack Monroe explain why there are health inequalities in our society and how the cost-of-living crisis disproportionally affects people on lower incomes.

Xand: Hello and welcome to season three of Public Health Disrupted with me, Xand Van Tulleken

Rochelle: and me Rochelle Burgess. It's really good to be back. Xand is a doctor, writer and TV presenter, and I'm a community health psychologist and associate professor at the UCL Institute for Global Health. 

Xand: So this podcast is about public health, but more importantly, it's about the systems that need disrupting to make public health better.

So join us each month as we challenge the status quo of the public health field, asking what needs to change, why and how to get there. 

Rochelle: In today's episode, we'll be discussing the cost-of-living crisis and its impact on public health. In recent years, most of us will have noticed that prices have been increasing all around us, with everything from housing to food and transportation, becoming more expensive.

This has put a strain on the wallets of hundreds of thousands, if not millions of people, particularly those on low income and has left many struggling to make ends meet. So in today's episode, we ask what does this mean for our health and what impact does financial stress have on our physical and mental wellbeing?

Xand: Several government measures have been taken like the energy price guarantee, but these are short-term measures. They're sticking plasters to mitigate the immediate crisis, but with potential future cuts to public services and social security, difficult times are ahead for very many people in the UK. We know the cost-of-living crisis is a bleak topic, and while we can't ignore the severity of the crisis and the structural change needed in the long term, in today's episode, we're gonna try and shed a bit of light on some of the more positive initiatives the groups and individuals are undertaking to help people combat the cost of living crisis.

So let's introduce you to our guests helping us explore the topic today. We are very delighted to welcome two absolute superstars in this area, Jack Monroe and Professor Sir Michael Marmot.

Rochelle: Jack Monroe is a food writer, journalist, and brilliant activist known for campaigning on poverty issues, particularly hunger relief.

Jack became known for writing a food blog, sharing cheap recipes to provide family meals for less than 10 pounds a. The popularity of this blog now called Cooking on a Bootstrap has led to the publication of numerous cooking books focused on budget cooking, including Thrifty Kitchen published this January.

As well as writing for The Guardian and the Huffington Post. Jack has been an active campaigner for addressing poverty and hunger, working with the Trussel Trust and Oxfam among others.

Xand: And we're also joined by Professor Sir Michael Marmot, director of the UCL Institute of Health Equity and Professor of Epidemiology and Public Health.

Michael has worked on health inequalities for nearly 50 years. He's a towering figure in this area. He chaired the World Health Organization Commission on Social Determinants of Health, several World Health Organization Regional Commissions, and has led influential reviews and reports on tackling health inequality for governments in the UK.

He's the advisor to the W H O Director General on the social determinants of health. He supports a network of local authorities in England working in depth to develop a Marmot approach. Most recently, Michael was conferred Companion of Honor in the New Year's Honours List 2022 for services to public health.

So as we emerge from winter, we're really starting to see the unfolding of what is both an economic and a health crisis in the UK. So to begin, it will be really helpful to take a stock check and Michael can, can I start with you? Can you briefly run us through the current picture of the cost-of-living crisis right now?

What sort of health impacts are we seeing as we come out of winter and what effect is this having on health inequalities in the UK? 

Professor Michael: The current cost of living crisis is the third recent huge stress leading to health inequalities. The first was a dozen years of austerity. The second is the pandemic, which we said from the beginning would expose the underlying inequalities in society and amplify them.

And now the cost-of-living crisis. And we really need to see those previous two as setting the context for what's happening now. And what's happening now is extreme. Take two crucial elements - energy and food. What we know is that energy and food first have higher levels of inflation than other consumables and energy and food make up a higher proportion of.

The household expenditure of people on low incomes, that means that if inflation is running, let's say at 10%, it's more like 17% for people in the bottom 20% of household income. So a headline inflation figure underestimates the impacted inflation on the poor. We produced a report on the 1st of September last year on fuel poverty, cold homes, and health inequalities.

We said, without government intervention, two-thirds of people would be in fuel poverty. This winter, there was government intervention. They claim they're going to reduce that in April so energy bills will go up dramatically and fuel poverty damages the lungs of young children. It has a severe impact on their mental health, on early child development.

Children who grew up in cold homes perform less well in school, and of course it impacts on adults with excess winter mortality that's higher in Britain than in other European countries. Now, fuel poverty has three components. Poverty, the price of fuel, and the thermal property of housing poverty has been increasing as a result of government policy.

Looking at what happened over the decade of austerity, you could say that government policy was to increase poverty. Child poverty went up after housing costs went up from 27% in 2010 to 30% in 2019. It dipped a little bit in the first year of the pandemic, then went up again to 31%, and it's projected to increase to about 34% as a direct result of government policy.

Secondly, we have an absolutely completely bonkers energy market, and that's a technical term. And you've been looking at the news of these fantastic profits the oil and gas companies are making just beyond anything they've ever seen and people are shivering this winter because we've got this bonkers energy market.

And the third element is the thermal properties of housing. The government stopped investing in home insulation in 2012. In 2013, it fell off a cliff austerity, they, you know, to save money, they stopped investing in home insulation so people can't eat their dwellings. And the second is Jack's territory, which is, um, which is food.

Uh, the food Foundation has been monitoring food insecurity in September. One in six households without children had food insecurity. One in four households with children were food insecure. Food insecure means going a whole day without eating, not eating enough to satisfy your hunger, or missing a meal because you can't afford to eat.

I used to say that we were the fifth richest country on the planet, and this is totally unacceptable. In fact, looking at some analyses in the financial times, I no longer say we're a rich country. We're a poor country with a few rich people, and the effect of that is that people at lower incomes, their health is being damaged and the health of the next generation.

So we're storing up problems for the future. I've called it a humanitarian crisis. 

Xand: Michael, thank you very much for that extraordinary portrait of the scale of the problem and some of the thinking and decisions that, the points at which those decisions were taken that have put us in the situation we're in now.

Rochelle: Professor Marmot whenever you talk, I nod my head so much that my neck hurts and I can see that Jack is doing it too. I mean, Jack, your work has always been really, really inspiring to me because you bring the sort of these statistics and, and the, the scale of the problem into the, to use a really weird academic term, like the microcosms of like everyday life, what the reality it means to sort of live through this for a person who is already on, on the margin, someone who is a, a lower income, and I, I wondered if this might be a nice time to talk about the ways in which this inflation and, and this, this crisis are affecting people on lower incomes disproportionately.

We recently read about your Vimes Boots Index, which is. really cool. And I wonder if you could tell us a little bit about that and what that is and, and how it works and where it's come from.

Jack: Yeah so it's called Vimes Boots Theory of, um, socioeconomics, and it's from a Terry Pratchett book. Um, and the, uh, there's a, there's a character in there, commander Sam Vimes. He's a bit of a, sort of a, a gnarly kind of anti-hero really. Um, but he's got, um, it says the reason that the rich was so rich Vimes reasoned was because they managed to spend less money. Take boots, for example. He earned $38 a month plus allowances. A really good pair of leather boots, cost $50, but an affordable pair of boots, which were sort of okay for a seasonal or two, and then leaks like hell when the cardboard gave out, cost about $10. Those were the kind of boots Vimes always bought and wore until the souls were so thin that he could tell where he was on a foggy night by the feel of the cobbles.

The thing was that good boots lasted for years and years. A man who could afford $50 had a pair of boots that would still be keeping his feet dry in 10 years’ time, while the poor man who could only afford cheap boots would've spent a hundred dollars on boots in the same time and would still have wet feet.

And this was the Captain Samuel Vimes Boots Theory of Socioeconomic Unfairness. Now I remember first reading that, um, it's a early, early on in secondary school, so it must have been about 12 or 13. And I was the poor kid at the grammar school. Basically I'd got there by the skin of my teeth and um, and because I'd had two parents who were adamant that I would do something with myself and have opportunities that they themselves didn't have, and, and so I got into a school that was full of people who were not like me. And, um, and so I, I stood out a mile in and I, I was very much like, you know, I didn't have the things that my friends and my peers had, and the things that I had didn't last as well. And they didn't, they didn't work as well, my tights would rip, my shoes would wear through my, the strap on my bag would break.

Um, and. and it sort of, it was the first time that inequality had ever been sort of explained to me in such stark terms that actually those who have less are constantly having to replace it and replenish it. And, and, and the people who can afford to buy good quality things, the people who've got that tiny bit of extra money to invest need only need to buy things once and they've got them for their whole school, their whole school period.

I've referenced it a few times in, in, in sort of parliamentary, um, discussions and inquiries. I, I used it in the Feeding Britain inquiry of Frank Field in 2013. Um, I've used it, um, when speaking to Henry Dimbleby for the school food plan, um, a good few years ago cuz I've always brought come back to it as being a very simple and stark way to explain that people who have more will always have more and people who have less will always have less. And the disproportionate amount of income that people spend when they've got less on the things that other people can take for granted. Um, and that really, um came to the fore about a year ago when I was lying in bed. And I've got an alarm clock radio and I used to have it set to radio four in the mornings because nothing makes me barrel out of bed faster than a dirge of terrible news headlines at six o'clock in the morning to turn it off.

And then I'm up and I'm furious. I'm energized for the day. Um, , it was, the inflation statistics had come in and it was saying that like headline inflation was somewhere around 5, 6%, um, for an average basket of goods at the supermarket.

I was like, that does not chime with my experience at supermarket. And it's certainly not true of the experiences of the food banks that I work with who've seen the prices of basics shoot up. Um, and they know that more starkly than most because they buy those things in bulk for the, their food bank parcels. And, uh, and the more expensive a can of tomatoes or a can of basic beans is, or a can of sardines, the fewer food parcels they can put together. So the fewer people they can help. So I went through boxes of old supermarket receipts from a bit of a hoarder, and I knew they'd come in handy one day, and started to compare the prices of food products at the supermarket from one, two years ago to the prices of them now.

And there were some items that had gone up in price by 344%. And I thought, okay, so my data's a little bit skewed because I've only got my local supermarket to go on cuz these are my receipts. So I did a bit of a, um, I did a bit of a call for sort of crowdsourced information and I asked people to send me their receipts and say, oh, I think we need a new food pricing index that adequately reflects how the people at the sharper end of, um, the lower income deciles, not a term that I ever knew before I started working with the ONS by the way Now I find myself saying it. People who have sort of the lowest incomes suspend a disproportionate amount of, of those incomes on food and on fuel and on housing costs. So when one of those things goes up, and as we've actually seen now, all of those things have gone up, the margin for error is non-existent.

If, if there's no 29p pasta at the supermarket, if you are on the tightest and most stringent of budgets, you don't buy the 80 p pasta because you disproportionately chew a greater amount out of your budget. You just don't buy the pasta and you're constantly having to, you're standing in the supermarket and I've done it myself many, many, many times, having to suddenly juggle, dynamically juggle the contents of a shopping basket where everything looks the same because it's in the same homogenous library of the basics range trying to go, well, if I take that away, does this all still balance?

Will my kid eat it? Will I, can I make a meal out of this? Can I do this? Well that, oh, that's my carbohydrate element. Is there another one that's cheap more stuffing mix? I wonder what I could do with stuffing mix cuz it's only 15 p and it and you suddenly standing there trying to like redesign your entire weekly menu while having a panic, while feeling a little bit upset while sort of raging against the system that's sort of put you there in the first place. Um, with a kid in tow saying, mom can close a chocolate, close some Chris a magazine. No, no, no, we haven't got the money. It's exhausting. It's so stressful. And, um, and it's so at odds with the headlines of certain newspapers that paint people who are on benefits or low incomes as just sitting at home all day in tracksuits watching trash television, um, getting fat off the taxpayer.

Actually, I dunno, a single human being who lives like that and I'm very, very glad Sir Michael Marmot raised the spectrum of austerity because this cost-of-living crisis has been treated by the media as though it has fallen outta a clear blue sky. Like it's a complete shock. Like, oh, oh, no, look, everyone's, everyone's struggling now. We're suffering now. And I think the reason that it's made such, um, headline news is because it no longer affects a sort of an invisible class of people who don't have recourse to the media and whose voices tend not to be raised in old media platforms.

Now it's affecting the friends of the, of the media elites and people that they know, or people they might have gone to school with or people who live in their neighbourhoods. It's suddenly become a problem and a problem that is being widely discussed.

The services that were put in place in order to assist people who were, um, were struggling financially, um, are, have been decimated from benefits to the child benefit cap to which is so disproportionately applied as to be laughable, um, to, you know, the two-child limit on tax credits to the cuts to services. So cuts to social services, cuts to health and social care, the entire dismantling of the NHS in order to justify the private healthcare. We, um, so when people find themselves in difficulty now there's the places where they could have gone for a little bit of help no longer exist. And that's how we've ended up in, in the scale of the crisis that we have.

So what we have now is we have a sort of an underground subterranean ana welfare safety net that sits underneath what used to be the welfare safety net. So we've got this patchwork of community organizations and food banks and fuel banks and baby banks and bed banks and, and organizations that help people out with sort of short term loans or, or short term or just, you know, cash bonds when they need to fill a hole, um, that shouldn't exist in the first place. It's an absolute disgrace. that that need is there in the first place and that that need is reliant on people who don't, people who don't have very much themselves.

And it's a patchwork postcode lottery so there are millions of people who are not getting the help that they need, and um, and the long term impacts of that on health and social care and on the justice system and on education are going to be something that we will not really understand for decades to come. 

Xand: it feels like between the two of you, you've painted a, a very extreme and, and very bleak picture of the origins of the problem and the current actual situation. It is quite disheartening listening to what your describing but it is also kind of energizing and, and does immediately make us want to look for solutions and what can be done.

If we can start with you. Sir Michael, I'm interested in the actual things that would need to happen, but it also strikes me that we do have a sort of narrative crisis of a story of people on benefit sitting around in tracksuits spending their money poorly and, and this idea that you can save your way into being able to afford a house and things like this.

Can you talk about both where the will would come from and the persuasive tools that we'd need to make things happen, and also what would need to happen? 

Professor Michael: The cognitive demand of being poor is extreme. If you are not poor, you go to the supermarket and you get your food and you don't think about it. if you're starting to think about solutions now, I don't know how you change hearts and minds when some of our politicians claim that the problem of the poor is they don’t know how to budget, what we need to do, I think, is show them the evidence that they're dead wrong, a hundred percent wrong.

We really need to change the discussion, you shouldn't blame poor people for their poor choices. Blame their poverty for their poor choices. We've got the causal understanding, completely backwards. And a second problem is I've been involved in health inequalities for a long time and people are always asking the question, what can we do today? What can we do tomorrow? I don't wanna know about long-term solutions. And my problem with that is if we'd started investing in the long-term solutions sometime ago, we wouldn't be where we are now. So the idea that we can just solve this tomorrow and forget about the longer term problems, I want to start solving the longer pro term problems this afternoon. What would that mean? That would mean that, just look at the current settlements. Um, private sector workers are being asked to take a drop in income of about half a percent.

Public sector workers are being asked to take a drop in income of 6%. What's the basis for that? And if it's the case that, um, the two main political parties claim they want economic growth, the way to get economic growth in a sustainable way is to improve the income of the bottom 60% of the population. That's what the evidence shows. It's not to make the rich richer. Making the rich richer, makes the rich richer, doesn't do anything else. If you want to get economic growth, make the poorest 60% richer, then they'll buy pairs of socks for their children and new trainers and they'll paint the living room or whatever else. You know, they'll spend money. They're trying to make low paid people accept even lower pay below inflation levels, and. The arithmetic escapes me of a wage price spiral. If you are offering below inflation wage settlements, how does that lead to a wage price spiral? Um, so the government is dead set on making low paid people accept pay cuts will, that's going to be detrimental to the economy in the long term and detrimental to people's lives in the short term.

Um, it, it's totally self-defeating we need to have a public conversation about these issues and we need it right across the political spectrum. And to come back to Jack's original point, this scandal about prepaid energy meters, this absolute scandal. We want poor people to pay more per unit of energy than rich people. And we are gonna force you to do it against your will. This is, this is scandalous. I don’t know if this is called the operation of the free market. I'm not quite sure what you call that, but it doesn't sound like any kind of free market. To me. It sounds like a cost premium for people who are on low incomes. So we need right now to start addressing the fundamental longer term problems.

Rochelle: I think that that's so, so important. It's so hard to get people to think about doing the long-term work now, I think in public health, we're just in health rather than public health we're really, really interested in these short-term outcomes, these the immediate outcomes. You know, you see a problem, you treat a problem, but you actually need to see a problem in what it produces and then anticipate and, and that's, I feel like that's what public health wanted to always be about, sort of building responses that extended into the long term.

But here we're talking about really long-term projects of social justice. That's what it feels like is the only thing that is really going to address and respond to where we are now. I mean, Jack, I I, I wondered what your thoughts were on this social justice theme.

Jack: studies by the British Medical Journal studies by various, um, disability rights campaign groups, um, disabled people against the carts, et cetera, have shown that, you know, the thousands, if not hundreds of thousands of people are dying prematurely as a result of poverty and poverty is increasing in this country as a result of austerity.

10 years ago, I was in the fire service, I was running half marathons, I was bench pressing - I could bench press the queen. Not that I ever tried in public, but I was bench pressing the body weight of the queen. Um, and uh, I was, you know, I was fit as a fiddle. I was running, I was throwing myself up and down ladders. I was doing a pretty good job, uh, physically and today, 10 years later, I walk with a stick sometimes, I have an entire drawer full of pain relief gels, tens machine, um, shoulder braces, shoulder straps. I have ultrasound guided steroid injections for, um, arthritic in my shoulder joints. I've got a continual respiratory infection, and this was caused by 18 months of living in a cold, damp property. Um, so I've ended up basically sick and disabled from being a, you know, a little Johnny Bravo type character to pottering around the place, um, as a, as a direct result of, of living in a cold, damp home and having an inadequate nutrition for that period of time.

We will not be unpicking the real cost of, of these crises for years and years to come. And when we, when we look back, the history books will not be kind to the architects of austerity and its cheerleaders, but the, there will be too many people who will no longer be around to tell their stories.

Sir Michael was talking about the narrative and how to change the narrative and he said, I'm not sure how to win over hearts and minds. And I think it's really important that, that the part of the story that's never told is who the real benefit cheats are. Because there are people who are playing the system, there are people who are screwing the benefit system for all they can get out of it. And, and they are doing it in broad daylight and they are doing it with government incentives and they're doing it to rounds of applause and they're doing it paying out millions of pounds to their shareholders. And that's large corporations who deliberately pay poverty wages knowing fine well that the taxpayer will pick up the rest of the bill.

The majority of people who claim any kind of benefit are in work. Something like, well the last time I checked and its statistics will be slightly out of date now, but new housing benefit, um, claims, 84% of them were being made by people in work. So we live in a country whereby it is perfectly acceptable for the multinational or larger organizations to underpay people knowing that, that, that that pay is gonna be picked up by tax credits and by housing benefit, by universal credit.

Um, I volunteer at a food bank locally. A woman came into the food bank a couple of weeks ago and she worked at the local supermarket. She still had her uniform on and um, she was just in bits. She was just done. She was absolutely done. And she had three children and she was coming in to pick up a box of basic groceries, three days of emergency food, and she had the food was donated from the supermarket that she worked at. So we have this situation where this young woman is sitting on a supermarket, checkout, scanning products that other people are buying, hoping beyond hope that maybe some of them end up in a basket at the end of her till that will go to a food bank warehouse into a box to go back to her you know, a week later. When what should happen is she should sit on that supermarket checkout, scan some groceries and say, oh, that looks nice. I'll pick it up after my shift. Get paid enough adequate wages that she can, after her shift, go and buy with gusto without even looking at the prices of it anything that she wants for herself and her children. And that's not where we are. So the narrative needs to be that the, the, it's the large companies who are cheating the benefit system. And I looked into the profit margins of, um, a couple of the supermarkets and then I looked into their benefits bills, how much their own workers claimed in top up benefits.

And in every single case, the supermarkets, I'm using supermarkets as example, cause it's a genre that I'm familiar with because, let's be clear, it's pretty much all of the large organizations, they could pay their staff 15 pounds an hour and still make enough money to pay their shareholders exactly the same as they pay them now because the majority of the of their profit margin is almost equal to the amount that is paid in top-up benefits to their staff.

And those top-up benefits are paid for by the taxpayer, which includes the young woman sitting on the supermarket checkout that couldn't afford to buy the can of beans because we are all taxpayers. We pay taxes on practically breathing these days. And all of that goes into a pot that then goes back into, into the into the tax credits and into the pension credits and into the benefit system. So when people think, when you say the word benefit cheats a very specific word will pop into people's heads. And I would like that word, and I would like that picture that pops into people's heads to be the fat cat, CEO buying their next super yacht squiring their money away on the Cayman Islands, because that's the people who are playing the system.

I'm not averse to anyone be being successful or making a success of themselves. you know, good luck to them. But when that success is literally built on the bodies of the people who graft day in, day out, in order to generate that wealth, but see none of it themselves, that's where I start to get a little bit furious.

Professor Michael: we did a report which was requested by legal in general, but they emphasized it shouldn't just be for legal in general, it should be for industry in general, which we called, um, the Business of Health Equity, the Marmot Review for Industry. And we said there are three domains of activities that industry could get involved in. I should say that in public health, we have for good reasons, tended to see industry as the enemy for good reasons. Uh, poor employment practices, tobacco, unhealthy products and the like. But we said, let's bring industry into this discussion, provided they address these three domains.

The first is paying conditions, and Jack’s referred to that. Every worker should be paid a living wage every worker, they're no excuse for doing otherwise. Um, and conditions, job security, career advancement, uh, real jobs.

The second is goods and services. And we said to legal in general, yeah, but you have financial products. Um, what are you gonna do about, um, the stuff people consume to wear and to eat and so on. They said we we're huge investors. Okay then don't invest in any company that refuses to pay a living wage. How's that for an investment strategy?

The third is the impact on the community and environment In the healthcare system, we talk about anchor institutions, but corporations should be thinking about their impact on the community and the environment.

And then what about people who are off the books? Well, legal in general sponsored, um, an activity looking at office support workers, the cleaners, the delivery people that tend to be outsourced with terrible working conditions and low pay.

We've got good examples of employers that do survive and prosper because they have a loyal, well-paid workforce that wants to continue. In fact, it's a no-brainer. Um, a better paid workforce with better conditions is likely to be a more productive, more loyal workforce.

Xand: So both of you have done an extraordinary job of, uh, really two things. I mean, giving anyone listening the tools to engage with this topic in a clear, sensible way where they could, be persuasive, they could maybe alter someone's point of view and where they were looking. And as you really beautifully emphasized, Jack, like where your attention should be in terms of the narrative around who's, who's taking money they don't deserve and, and who's to blame for the problems. Clearly there's a, a hugely daunting crisis unfolding, and I think Michael, your description of it as a humanitarian crisis is exactly right.

Can we finish with this question about things that have disrupted your thinking? Because what's striking talking to both of you is the level of personal passion and commitment you've brought to decades of work in ways that have been extraordinarily  impactful. Um, Michael, can I start with you? Where does it come from? Can you give us an example of a bit of art or musical poetry or a human being, something that sort of sent you down this road that gives you strength?

Professor Michael: I was teaching on a course in Lithuania in the old Soviet Union, and we were told that we were going to fly, we were going to travel from Moscow to Countess in Lithuania. I thought we were gonna fly, but they put us on a train, a 14-hour train journey. So I took out War and Peace, which I promised myself I would read, and it seemed appropriate. We were more or less retracing Napoleon's steps in his retreat from Moscow. Uh, my Russian host took out a bottle of vodka. Um, he made more impact on his vodka than I made on War and Peace. But I did eventually finish war and peace and Tolstoy’s concept of causation um, he's got a very nuanced concept of causation. He, he doesn't think it's as simple as A leads to B. Um, if he asks himself the question, why was Napoleon defeated in Russia?

And he says, you can't answer it by, he lost the Battle of Borodino. Why did he lose the battle of Borodino? Will some historians say it's because he caught a cold and his judgment was clouded and Tolstoy says, are you arguing that the forgetfulness of Napoleon's valet who forgot to put out the emperor's waterproof boots led to the loss of the Battle of Borodino, which in turn led to Napoleon's defeat in Moscow. It's Fatuous saysTolstpy. Causation doesn't work like that. You've gotta look much more the nature of society. And everything I do looks at the nature of society, of our set of social arrangements and health is a consequence, not of did you get exposed to that virus?

Yes, that's important, but how do we organize our affairs in society? Um, that leads to the health patterns that we see. And it's the evidence that we can make a difference and that we're not doing. It gives me the passion to try and work to make that change. 

Xand: That's a, that's a, a beautiful answer. 

Rochelle: I've read War and Peace. And I need to read War and Peace again. 

Professor Michael: Good luck. 

Xand: That's your homework Rochelle!

Rochelle: Yeah, I I'll need it. Probably also the vodka. Jack. 

Jack: It was my father being a Fire Brigades Union rep and the fire strikes of 2002 to 2003 and which were the last nationwide industrial fire brigade strikes. And it was a pay dispute. It was very much like we we're in at the moment. Um, so they, they were offering 4%. The fire, the fire brigade was saying that, you know, it's not enough to live on. Um, and they went out on an, on an all out strike for, um, for months. And it took a combination. Oh, and I was 14 at this time living at home with my parents. Very, very aware of, you know, of things that were going on. And my dad had this big white ring binder and it said on, it cuts cost lives. And I asked him what that meant and I said, what was, you know, cuts cost lives. Um, and he explained that, you know, cuts to the fire service would, would result in fatalities. It struck me and I asked my dad to explain to me about the union cuz he was, he was a union man he said the point of the union is that we all is that, um, some of us go out on strikes to fight for fair pain conditions and everybody benefits. They are, they're fighting for everyone. And I joined the fire service myself a few years later, and the first thing I did was join the union and I'm still a member of the FBU today.

And, um, it is that idea that, that, you know, it only takes a small group of people to put themselves out and to campaign and to negotiate and to raise their voices in order to improve living conditions for everybody. And that's the thing about the campaign that work that, that I do and that many others do, is it, it doesn't discriminate in the same way that poverty doesn't discriminate.

So yes, my disruptor was, um, a big white folder that said cuts cost lives on it.

Xand: Those are two fantastic and very inspiring answers that sort of capture both the huge range of evidence and a causal thinking along with those very, very individual moments of somebody leading by example, which both of you have done so amazingly in, in different ways is a, a incredibly powerful tool for changing the world.

Thank you both very, very much. It's been completely fascinating. I cannot say how grateful we are for your time and your energy and the level of detail and thought you've brought to the discussion. 

Rochelle: That was just so fantastic. 

Professor Michael: Thanks. Bye 

Jack: bye.

Rochelle: You've been listening to Public Health Disrupted. This episode was presented by me, Rochelle Burgess and Xand Van Tulleken, produced by UCL Health of the Public, and edited by Annabelle Buckland and Decibel Creative. Our thanks again to today's amazing guests, Jack Monroe and Professor Sir Michael Marmot. 

Xand: And if you'd like to hear more of these fascinating discussions from UCL Health of the Public, make sure you subscribe to this podcast so you don't miss any future episodes.

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