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Across the Western world, there is much anxiety that popular faith in the democratic idea is waning. This chapter argues that in order to understand this trend we need to be more specific in what we mean by ‘democracy’. Drawing on global evidence and a comparison of India and China, the chapter demonstrates an ambiguous interaction between political democratisation and human health. It argues that the credibility of the democratic model requires much deeper forms of social engagement than the sterile formalism of electoral enfranchisement and the periodic vote – a much stronger emphasis on local processes of deliberative dialogue. And it concludes that health, as a matter of intense individual and collective interest, offers a fertile ground in which for such democratic localism to grow.
The concluding chapter argues that ‘crisis’ is defined not by the immediate impact but by the extent to which societies are able to learn and adapt in the aftermath. It reprises the principal arguments offered in each of the six core themes of liberal value, summarising how the evidence from health may help us to redefine our understanding of these values as we enter – and attempt to shape better – a post-COVID world.
Chapter abstract
Over the last 40 years, wealthy Western countries have developed an idea of the ‘perfectable society’ – one which pursues economic growth, individual freedom, social justice, global security, democracy and truth. After the fall of the Berlin Wall, this idea went global. Yet, since then, we have seen inequality rise and crises proliferate as the protective effects of civil society and electoral democracy have crumbled. Increasing social polarisation has collapsed popular faith in this perfectable society. Increasingly uncertain about the direction of their societies and the veracity of their leaders, people seek some concrete point of reference by which to recover a shared sense of the common values by which we may shape society’s post-COVID recovery. The body of this book argues that health offers a uniquely objective yardstick by which to measure the way in which those values can shape our society, quite literally, for good or ill.
In almost all countries, health is assumed to depend on health care, delivered through systems which combine public and private providers. As the costs of care escalate, healthcare reform has become dominated by an emphasis on expansion of private provision – justified as the liberation of individual care choice from oppressive government monopoly. Using evidence from high-, middle- and low-income countries, this chapter argues that neither public nor private care systems perform conclusively better, and that the preference for privatised systems is ideological. It argues that almost all countries will, in the end, have a mixed system of public and private providers; that public healthcare systems based on universal entitlement offer significant sociological advantages by creating collective inclusion and security; and that excessive emphasis on freedom of choice can create fragmented and poorly governed public–private hybrids, characterised by uncertain and inequitable access. The chapter concludes that the freedoms available through universal healthcare require more, not less, government.
We are living in a time of extraordinary global turbulence. Confidence in post-war liberal values – of growth and freedom, justice and security, democracy and truth – is collapsing. In a world of increasing uncertainty, health – the universal human good – offers a uniquely objective measure by which we can test the veracity of these values – the point of crisis to which they have brought us, and their potential reformation as we emerge into a post-COVID world.
This book is about health, society and politics. Not so much how social and political forces generate health – about which much is already written – but how health can illuminate the political and policy choices we make, the values on which we make them, and the kinds of society we get as a result.
Drawing on examples from developed and developing countries around the world, it uses the irrefutable evidence of mortality and morbidity, our systems of care and the social conditions that determine our physical lives to test the key coordinates of the liberal ideal: the benefits and costs of our addiction to economic growth, the hyper-individualist notion of freedom we espouse, the frailties of the social justice we claim to seek and the security we crave, the contradictions deep in the heart of our democratic model, and the profound vulnerability of the idea of truth on which our societies themselves depend.
We are living in a time of extraordinary global turbulence. Confidence in post-war liberal values – of growth and freedom, justice and security, democracy and truth – is collapsing. In a world of increasing uncertainty, health – the universal human good – offers a uniquely objective measure by which we can test the veracity of these values – the point of crisis to which they have brought us, and their potential reformation as we emerge into a post-COVID world.
This book is about health, society and politics. Not so much how social and political forces generate health – about which much is already written – but how health can illuminate the political and policy choices we make, the values on which we make them, and the kinds of society we get as a result.
Drawing on examples from developed and developing countries around the world, it uses the irrefutable evidence of mortality and morbidity, our systems of care and the social conditions that determine our physical lives to test the key coordinates of the liberal ideal: the benefits and costs of our addiction to economic growth, the hyper-individualist notion of freedom we espouse, the frailties of the social justice we claim to seek and the security we crave, the contradictions deep in the heart of our democratic model, and the profound vulnerability of the idea of truth on which our societies themselves depend.
Noncommunicable diseases are now the dominant cause of mortality in countries at all levels of economic wealth. The causes of noncommunicable diseases, commonly characterised as ‘diseases of lifestyle’, are widely attributed to our consumption preferences and the behaviours we adopt. The dominant policy response is to increase individual freedom to make responsible choices – governments deferring in favour of market-led solutions, disregarding the evidence that these do not work. This chapter argues that individual freedom is too often simply overpowered by increasingly concentrated, globalising market forces. Using the example of obesity and diet, the chapter concludes that liberating individuals to make choices while failing to supply the conditions in which such choice is meaningfully possible is an ineffective, inefficient and in the end rather cruel form of freedom.
We are living in a time of extraordinary global turbulence. Confidence in post-war liberal values – of growth and freedom, justice and security, democracy and truth – is collapsing. In a world of increasing uncertainty, health – the universal human good – offers a uniquely objective measure by which we can test the veracity of these values – the point of crisis to which they have brought us, and their potential reformation as we emerge into a post-COVID world.
This book is about health, society and politics. Not so much how social and political forces generate health – about which much is already written – but how health can illuminate the political and policy choices we make, the values on which we make them, and the kinds of society we get as a result.
Drawing on examples from developed and developing countries around the world, it uses the irrefutable evidence of mortality and morbidity, our systems of care and the social conditions that determine our physical lives to test the key coordinates of the liberal ideal: the benefits and costs of our addiction to economic growth, the hyper-individualist notion of freedom we espouse, the frailties of the social justice we claim to seek and the security we crave, the contradictions deep in the heart of our democratic model, and the profound vulnerability of the idea of truth on which our societies themselves depend.
Economic growth is modernity’s religion – the centrepiece of political promise and policy making in countries across the world. Yet growth does not, on its own, result in a healthier or longer life. This chapter argues that an economic concept of progress unduly dominates policy thinking given the limited evidence of its benefit to our lives, and the extent of damage it poses for environmental sustainability. It argues that the key factor mediating between national wealth and human welfare is the quality of governance supplied by government – and that a better governance model is one which combines growth and health not as alternative priorities but as mutually interdependent components of a single social development strategy.
Coming out of the ‘lost development decade’ of the 1980s, global policy makers recognised that human development requires more than just economic growth. The Millennium Development Goals, however, continued to instrumentalise vertical investment in health as, in effect, an input to human capital and economic productivity. Using the example of food and nutrition systems, this chapter argues that, with the transition to the Sustainable Development Goals, the tension between growth, welfare and environmental survival has now become critical – a tension which the current architecture of global governance is unequipped to manage.
