The Crisis in Public Health
From the waste machine known as the market system, to the debt machine known as the monetary system - hence creating the monetary-market paradigm which defines the global economy today - there is one consequence that runs through the entire machine: inequality. Whether it is the market system creating a natural gravitation towards monopoly and power consolidation, generating pockets of wealthy industries that tower over others regardless of utility - top hedge fund managers in the City of London taking home tens of millions a year for contributing literally nothing, whilst a scientist looking for a cure to a disease might make £40k a year. Or whether it is the monetary system which has class division built right into its structure.
For example, if I had a million pounds to spare and I put it into an account at 4% interest, I will make £40,000 a year. No social contribution, no nothing. However, if I'm a working class person and have to take loans to buy my car or home I am paying in interest which, in abstraction, is going to pay that millionaire with the 4% account. This stealing from the poor to pay the rich is a foundational, built-in aspect of the monetary system, and it could be labelled “Structural Classism”. Of course, historically, social stratification has always been deemed unfair but obviously accepted overall, seen as the top 1% of the population now owns 40% of the planet's wealth. But, material fairness aside, there is something else going on underneath the surface of inequality, causing an incredible deterioration in public health as a whole.
People often are puzzled by the contrast between the material success of our societies - i.e. unprecedented levels of wealth - and the many social failings. If you look at the rates of drug abuse, violence, self-harm amongst children or mental illness, there is clearly something going deeply wrong with our societies. This data simply shows the intuition that people have had for hundreds of years, that inequality is divisive and socially corrosive, is truer than we ever imagined.
There exist very powerful psychological and social effects of inequality, more to do with feelings of superiority and inferiority. This kind of division perhaps goes hand in hand with feelings of disrespect - people feeling looked down on at the bottom which, by the way, is why violence is more common in more unequal societies - the trigger to violence is so often people feeling looked down upon and disrespected.
If there is one principle to emphasise, it is that the most important principle underlying the prevention of violence is equality. The single most significant factor that affects the rate of violence is the degree of equality versus the degree of inequality in that society.
So, what we're looking at is a form of general social dysfunction. It's not just one or two things that go wrong as inequality increases, it seems to be everything, whether we are talking about crime or health or mental illness or whatever.
One of the really disturbing findings out there in public health is that you should never ever make the mistake of being poor, or being born poor. Your health pays for it in endless sorts of ways: something known as the 'health socioeconomic gradient'. As you move down from the highest strata in society, in terms of socioeconomic status every step down, health gets worse for umpteen different diseases. Life expectancy gets worse, infant mortality rate - everything you could look at. So, a huge issue has been why is it that this gradient exists?
Some suggest that it is because poor people in countries lacking universal healthcare can't afford to go to the doctor; it's about healthcare access. Yet you see these same gradients in health outcomes in countries with universal health care and socialized medicine. Okay – next 'simple explanation': On average, the poorer you are the more likely you are to smoke, to drink and indulge in all sorts of other lifestyle risk factors. Yes, these contribute, but careful studies have shown that it explains maybe about a third of the variability. So what's left? What's left has a lot to do with the stress of poverty. The poorer you are, the worse your health is. This tells us something really important: the health connection with poverty - it's not about being poor, it's about feeling poor.
Increasingly we recognize that chronic stress is an important influence on health, but the most important sources of stress are the quality of social relations. And if there is anything that lowers the quality of social relations it is the socioeconomic stratification of society. What science has now shown is that regardless of material wealth the stress of simply living in a stratified society leads to a vast spectrum of public health problems and the greater the inequality, the worse they become:
Life expectancy: longer in more equal countries.
Drug Abuse: less in more equal countries.
Mental Illness: less in more equal countries.
Social Capital - meaning the ability of people to trust each other: naturally greater in more equal countries.
Educational Scores: higher in more equal countries.
Homicide rates: less in more equal countries.
Crime and Rates of Imprisonment: less in more equal countries
It goes on and on: infant mortality – obesity – teen birth rate: less in more equal countries. And, perhaps most interestingly: innovation: greater in more equal countries, which challenges the age-old notion that a competitive stratified society is somehow more creative and inventive.
Moreover, a UK-based report called The Whitehall Study confirmed that there is a social distribution of disease as you go from the top of the socioeconomic ladder to the bottom. For example, it was found that the lowest rungs of the hierarchy had a fourfold increase of heart disease-based mortality compared to the highest rungs. This pattern exists irrespective of access to health care. Hence the worse a person's relative financial status, the worse their health is going to be on average.
This phenomenon is rooted in what could be termed 'Psychosocial Stress', and it is at the foundation of the greatest social distortions plaguing our society today. Its cause? The monetary-market system. Make no mistake: the greatest destroyer of ecology; the greatest source of waste, depletion and pollution; the greatest purveyor of violence, war, crime, poverty, abuse and inhumanity; the greatest generator of social and personal neurosis, mental disorders - depression, anxiety, not to mention the greatest source of social paralysis - is not some corrupt government or legislation, not some rogue corporation or banking cartel, not some flaw of human nature and not some secret hidden cabal that controls the world. It is, in fact, the Socio-Economic System itself at its very foundation.