The Political and Social Contexts of Health

Politics of Sex in Medicine

Vicente Navarro

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781351862790
• Edition: 1
• Topic: Medicine
• Subtopic: Health Policy

This analysis of the political and social forces that shape the well-being and quality of life of populations in developed capitalist countries is written by scholars based in several different countries. The book shows how the varying political traditions in the developed world - social democratic, Christian democratic, conservative, and liberal traditions - have affected populations' health and quality of life in the western democracies. The contributors also analyze the public and social policies derived from each of these political traditions that have affected levels of social inequality (through changes in the welfare states and labor markets) and on health and quality of life.

Chapter 1

INTRODUCTION: OBJECTIVES AND PURPOSES OF THE STUDY

Vicente Navarro

During the last 30 years in many developed capitalist countries, we have witnessed a growth of social inequalities that has had a major impact on the health of their populations. If we take income inequalities, for example, as an indicator of social inequalities, then we can see that income inequalities have increased in 12 of the 18 OECD countries over this period, reversing a trend towards reduced inequalities that had occurred in most of these countries from the end of World War II to the mid-1970s and early 1980s—a period usually referred to as the “golden age of capitalism.”

This situation, widely recognized as problematic, has led to considerable research on two fronts. One has been an analysis of the causes for the reversal in the decline of social inequalities. The other—also a subject of great interest and inquiry—has been an analysis of the possible consequences of the growth of inequalities for the health and quality of life of the populations. Thus, both the causes and the consequences of the growth of economic and social inequalities have been a major concern of researchers. (For a review of the major topics touched upon in this debate, see 1.)

A research group that has been much involved in these areas is the International Network on Social Inequalities and Health (referred to, in brief, as INIH), the authors of this report. This network includes scholars and research centers in the United Kingdom, Italy, Germany, Spain, and Sweden, that have been working together in these areas of research for several years (the network members are listed in Appendix I, p. 6). A characteristic of INIH is its desire to match academic rigor with social relevance. And so, because of this motivation, a characteristic of the reports produced by the network—including this current report—is to include policy recommendations on how to resolve the problems under study. Thus, our objective is to produce, not just an elegant and detailed piece of academic research that will remain forgotten on a bookshelf, but rather a document, easily read and understood, that can contribute to the design of specific public interventions to improve the health of populations. We want to stress, therefore, that, as requested by our funding agencies, this report is a policy report grounded in scientific knowledge (rather than just an academic presentation) aimed at stimulating policy that can reduce social inequalities and so improve the quality of life of our populations.

This report, prepared by the International Network on Social Inequalities and Health, was funded by the Division of Employment and Social Affairs of the European Commission, according to Agreement number VSB/2001/0219. See Appendix I, page 6, for the list of network members.

THE SUBJECTS AND CONTENTS OF THE STUDY

The objective of the study, then, is to analyze the causes of the growth of social inequalities in the developed capitalist countries and its consequences for the health of their populations, and to make recommendations on how to improve the health of these populations through public policies aimed at reducing the adverse effects of such increased inequalities on the well-being of the populations.

As a starting point, we have chosen income inequalities as a proxy for social inequalities, fully aware that income is a limited indicator of either social class, status, or level of well-being. But it is a starting point that allows us to measure and quantify those social inequalities by social class, gender, region, or province. Thus, we have chosen income differentials as a dimension of social differentials. We want, therefore, to distance ourselves from those researchers who have focused primarily on income as the main line of cleavage in our societies or as the instrument that allows citizens’ realization through the world of consumption. Rather, we focus on income as a proxy for something else—that is, social inequalities. Also, income is a much easier variable to collect than class, which would have been our preference.

To analyze the evolution of income differentials, we have studied the evolution of the situation in the labor market, looking at the variables (such as percentage of adult population in employment, participation of men and women in the labor force, rate of male and female unemployment, wage differentials, and national income derived from capital versus labor) we considered most important in defining the income distribution in a country. We did the same for the welfare state, looking at the variables (such as the redistributive effect of the welfare state, the percentage of educated population, public versus private education, public medical care expenditures, public versus private medical care expenditures, and public social protection expenditures) we considered to be of particular importance in affecting the levels of income distribution. (See Appendix II, p. 7.) And we also looked at the evolution of income differentials (measured by either the Theil Inequality index or the Gini coefficient), and analyzed the impact of public policy interventions and income differentials on the health of the populations (infant mortality, life expectancy, and preventable mortality by age group).

Another novel aspect of the study is the analysis of the political and social context of the policies and inequalities. The purpose of this focus—one of the most important of the study—is twofold. First, we need to know the political context if we are to make realistic, achievable recommendations. Second, and equally important, we cannot study public policies without comprehending the political context that determines them. This much-ignored area of research is of paramount importance for understanding why certain policies are being developed and carried out and others are not. We are pleased to have chosen this as an important component of our study, since it turns out—as the summary and conclusions of the study (Chapter 8) will show—that the political variables are extremely important. We thus analyze the impact of the political orientation of the government on the policies that affect social inequalities. We measure the duration of governments and their strength (as measured by electoral support) and the strength of pro-redistribution parties and instruments such as trade unions.

OUR DISAGREEMENT WITH THE CONCEPT OF SOCIAL CAPITAL

One of the most important theoretical developments in policy analysis and social theory over the last ten years has been an awareness of the importance of social capital in explaining social inequalities, including health inequalities, in our societies. It has to be said that social capital has become a very fashionable concept and term. And by referring to it as “fashionable,” we do not mean to trivialize it. But we do not feel comfortable with that concept or with the terms used to define it. The reasons for this discomfort and disagreement have been detailed elsewhere (2). We understand that the term is used repeatedly and widely and for a variety of purposes. Also, and as we would expect, the meaning of the term has varied quite considerably, depending on the cultural context in which it is used. The U.S. meaning of social capital, for example, is quite different from the European meaning (e.g., as used by Bourdieu). Two U.S. authors, James Coleman and Robert Putnam, for example, have used it to define community resources, such as trust among individuals in a community and/or a sense of communitarianism (measured by number of civic associations in the community). In this understanding, communitarianism—a major indicator of social capital—is presented as an alternative to public or state resources. In a recent study (directed by Putnam, its results published in the New York Times; 3) surveying the amount of social capital in the 50 states of the United States, New Hampshire was named as the state with the highest social capital. This is also the state with the weakest state government, lowest income and sales taxes, smallest percentage of civil servants per 10,000 inhabitants, and smallest public expenditures on health care. In the U.S. context, then, social capital is commonly used as a measure of the richness of civil society, presented (erroneously, we believe) as an alternative to public society. We disagree with this interpretation of social capital. Our understanding does not assume a zero-sum situation—that is, that the larger the one form of society, the smaller must be the other.

We want to clarify, right away, that we disagree with that understanding of social capital. Instead, we want to analyze political resources (that intervene in political life) as well as economic, social, and cultural resources (that characterize civil life and civil society). Our understanding fits squarely in the European tradition, in which civil society and political society complement rather than substitute for each other. In that sense, we consider that resources available to individuals and populations very much include social and cultural as well as political resources, based in both civil and public societies. Thus, we regard political values and electoral behavior as key resource...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• 1. Introduction: Objectives and Purposes of the Study
• 2. The Importance of the Political and the Social in Explaining Mortality Differentials among the Countries of the OECD, 1950–1998
• 3. Do Social Policies and Political Context Matter for Health in the United Kingdom?
• 4. Individual and Contextual Determinants of Inequalities in Health: The Italian Case
• 5. Regional Differences in Trends in Life Expectancy and the Influence of the Political and Socioeconomic Contexts in Germany
• 6. Power Relations and Premature Mortality in Spain’s Autonomous Communities
• 7. Social Differentials in the Decline of Infant Mortality in Sweden in the Twentieth Century: The Impact of Politics and Policy
• 8. Summary and Conclusions of the Study
• Contributors
• Index