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In February 2010, the UK Government published Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England Post-2010, better known as “The Marmot Review” after its lead author Professor Sir Michael Marmot. The very first words of the report are a variation on a quotation from Pablo Neruda:

“Rise up with me against the organisation of misery” Marmot et al, 2010, p 2

Pablo Neruda was a Chilean writer, a left-wing politician, and a confidant of president Salvador Allende; he died within days of August Pinochet’s coup. An official British document that begins with a quotation from a revolutionary communist would seem to promise unusually radical content.

The Marmot Review (2010) received extensive coverage and acclaim from London’s Guardian newspaper and was covered, albeit more briefly, in the Times and the Daily Telegraph, but few of the initial commentators seemed to believe that any of its main recommendations would actually be implemented. These included improving prenatal and early years provision, better drug addiction treatment, and raising social security payments. Rather than anticipating real progress in tackling health inequalities in the wake of the financial crash, one journalist suggested that:

“This grim situation makes those few Marmot recommendations that need not involve great public expense, such as better workplace procedures to deal with stress at work, all the more important, and every one should now get behind these.”(Guardian, 2010, March 15, p 30)

If all that can be done to reduce Britain’s grievous and persistent inequalities in health is to try to abate stress in the workplace, what does that say about the commitment of the British (government, academics, public health professionals, and public alike) to truly creating a fairer and healthier society?

The Marmot Review (2010) followed an earlier report also led by Sir Michael.

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Figure 1 charts the share in annual incomes received by the richest single percentile of Britons as recorded between 1918 and 2005, both pre- and post-tax. The richest percentile of people in Britain receive some of their income from earnings, but a greater proportion from interest on wealth, dividends and shares, and the returns on investments made in stocks and rent on their land. At the end of World War I, one in every 100 people lived on about a sixth of the national income, 17 or 18 times more than the average family, 100 times more money than the poorest 10th saw in a year.

From 1918 through the 1920s, 1930s, 1940s, 1950s and 1960s the share of national income the affluent received fell. As many of the heirs to great estates had died in the Great War, the government taxed the aristocratic families, but just as crucially, the ‘great’ families became just a little more lax over who they slept with and subsequently married. The arithmetic of homogamy (assortative mating) is simple. Should you be a member of a family in the top percentile of income earners in 1918 you might expect to receive around £150,000 a year in today’s money, or 18 times average individual incomes. If you are careful and ignore 99 potential life partners in every 100, you might in theory meet and only choose from the one percentile like you. Because social networks were so limited it was not hard to avoid at least 90 of the other 99, or meet and mistreat them only If you are very rich you are told ‘be careful’, should your eye stray and you find a young man or woman from the bottom of the top decile more attractive, or caring, or just more understanding or interesting, and you had successfully ignored 90 out of 100 other possible suitors, but not the 91st, and you pair up, then you as a pair will drop out of the top percentile.

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… as old ‘social evils’ have largely been overcome in affluent nations, in one of the most unequal of those countries – Britain – they have transformed into five new tenets of injustice. A continued belief in those tenets both maintains and helps to exacerbate social inequality…

My maternal grandfather was born in 1916, in an era so different from today that women were not permitted to vote. Last year I asked him about the 1929 crash and what life was like for a teenager growing up in Yorkshire in the 1930s. I talked to him about jobs and he said, “You’d know if it were as bad again because – almost no matter what your qualifications – you’d be grateful to take any job.”

For many people in Britain today, especially young adults not living with children, their current experiences and my grandfather’s recollections are not so far apart. However, in other ways social evils today have changed almost beyond recognition. Yet there are some uncanny echoes with the prejudices of the past in how we now think and in how we stall at progress.

In 1942, when my grandfather was 26 years old, William Beveridge labelled the great social evils as ignorance, want, idleness, squalor and disease. I would claim that now those five evils have been fought and largely vanquished, to be replaced by five new evils: elitism, exclusion, prejudice, greed and despair. These result today in one in seven children being labelled the equivalent of ‘delinquent’ and a sixth of households being excluded from modern social norms.

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There are painful similarities between life lived in London now and the unjust inequalities of Victorian times.

Tourists visiting Covent Garden are often drawn to Christopher Roger’s stall at Jubilee market. Among many other eye-catching items, he sells panoramic views of London drawn from a vantage point located somewhere in the sky just south of the river. Hovering over Lambeth and looking North, London’s iconic buildings are spread out: from Parliament in the west to the Gherkin in the East, from the Globe Theatre in the foreground to Hampstead Heath in the distance, all the opulence of the capital is on display.

Images such as this sell, but they cut out most of London, and of the country beyond. The south and east of London is cropped from the frame. The churches, towers and buildings of state and finance block out views of the people and their homes, of commuters, of maisonettes, of children and of markets. In images such as Roger’s “London looking North” the land south of the river appears laid out to service the heart of the capital. Bridges, roads and rail cross the Thames like so many tangled arteries bringing sustenance to the city and square mile.

London is a city of contrasts, not the smooth working concert it can appear to be from the air. From high enough up you can no longer see the people and the whole appears like a machine (see Figure 1). Delve down into the lives of Londoners and it becomes clear that all is not flowing so smoothly.

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David Cameron says he is worried about the poorest in society but clearly does not want a redistribution of the opportunities that the rich have expropriated from the poor over the past three decades.

Frank Field, appointed by David Cameron to lead an independent review of poverty and life chances in the UK, has cast doubt on the mathematical workings and achievability of the Europe-wide poverty targets, which all aim to reduce the number of households living below three-fifths of median incomes in each country, and in Britain, to ensure that no children grow up in such households by 2020.

The median net household income in Britain is £21,000, and 60% of that is £12,700 a year, or £244 a week. After housing costs, that figure falls to £206 a week for a family, or £29 a day.

In January, European Union researchers announced that 23% of children in the UK lived in a household in poverty, and that the UK ranked seventh worst out of 27 EU countries by the measure Field would like to abolish4. Only in poorer countries, such as Romania and Bulgaria, are a higher proportion of children living in poverty.

In Denmark, Finland, the Netherlands, Germany, France and 12 other countries, the child poverty figure is as low as one in 10. One non-EU country, Norway, all but abolished child poverty by this measure as long ago as 2003.

In Britain, the latest official estimates of households living in poverty – the ones Field has been charged with redefining – show that (after paying for housing) just under 2 million pensioners, almost 4 million children and almost 8 million adults of working age still live in poverty.

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…UK wage inequality is approaching levels not seen since the end of the first world war. A cap on bosses’ pay is vital if Britain is to become a fairer place…

Do you know how well you are rewarded and how you compare with your colleagues? Here’s a simple way to work it out. First, calculate how much you are paid an hour, without subtracting tax and national insurance.

At £5.93 an hour, the minimum wage for those aged 21 and over, you are almost perfectly representative of the poorest fifth of employees. Moving up the income ladder, if you receive just over £7 an hour, you are in the next bracket, the “modest” fifth. At £10 an hour, you are now, more or less, the median worker – while £14 an hour takes you into the more “affluent” fifth of employees.

At close to £21 an hour, which translates to an annual salary of just over £40,000, you are bang in the middle of the best rewarded fifth of all employees. You earn getting on to twice the national average. In short, you are, in relative terms, rich.

But here’s the thing. If you are in that top income bracket, you may not feel rich. In fact, although you are heading towards double the median income, you might well feel part of the “squeezed middle”.

This vague term – deliberately vague, perhaps, when used by Ed Miliband, determined as he is to reach out to as many potential voters as possible – seems, at times, to capture all of us who are neither poor nor rich.

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Next time you are talking to someone from the other side of town don’t assume they know what you are talking about – what is normal in Britain is slowly being split in two.

Much about life in Britain is getting better. We are slowly and surely becoming more tolerant of others, for instance, although we still harbour great racism. We may not be becoming happier on aggregate, but for those most distressed, rates of suicide have been falling in recent years. And again at the extremes, our youngest children are safer now than they have ever been, from disease (and from violence from us). However, at the heart of British society something is slowly pulling us apart. This pressure has different effects at different stages in our lives and it is not a pressure that will be well revealed by government statistics.

Indices of multiple deprivation really don’t say much about a place. They are inhuman things, not unlike most social statistics. The map shown here (Figure 1) comes from an atlas which is a little different. In it, for over one thousand areas, we have tried to work out what is normal in each place.

In many large neighbourhoods it is normal for the parents of children aged under five not to have a car. Most under fives live in homes with no access to a car in these areas. Their mums or dads walk everywhere with them, carry the shopping and take it on the bus. And that is normal.

Elsewhere in a huge number of neighbourhoods most under fives live in households with access to two or more cars.

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The first budget of the “progressive” coalition government saw George Osborne promise massive cuts for the poorest in society while offering tax relief for businesses...

George Osborne – flanked by two Liberal Democrats – spoke with the confidence that you would expect of a man with the pedigree of aristocracy. David Cameron had positioned himself behind Osborne so that the camera could not see him as the chancellor gave out the bad news. Thus “Dave” was nowhere to be seen as the axe was wielded across the welfare state, or when it was announced that VAT was to be increased to 20 percent, or that poor pregnant women would have the special benefits being paid to them cut. Dave’s wife is pregnant.

You might think Cameron knew something about PR as he stayed out of shot. What Osborne knows about is unclear. It has been widely reported that his first job was data entry for the NHS. His only reported private sector work experience was shelf-stacking in Selfridges. After those forays into the world of work he moved into the Conservative Party’s central office.

Osborne said he wanted prosperity to be shared among all of the country. He raised the spectre of national default on the country’s debt as the most likely consequence of not following his advice. It was his way or no way at all. It was hard, he said, but he was the man to do it. Further back and far to his side Vince Cable, who had opposed him in the election contest so recently, literally squirmed in his seat.

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