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- Author or Editor: Graham Scambler x
Can society be healthy, and how? Is Britain a ‘healthy society’ in the 21st century?
When people ponder health, they usually consider the health of the individual, but individuals co-exist in a social environment so attention should be placed on the health of communities and populations.
Re-examining health, healthcare and societal health using the latest data and research, this book provides a clear, accessible account of the current state of play. Addressing definitions of health in individuals, communities and populations, definitions of society itself, changes in health over time and the contribution of healthcare to health and longevity, it also suggests ways of effectively tackling obstacles to improving health and healthcare in 21st century Britain.
Chapter Nine shows why it is important to develop testable theories that explain social phenomena. After this, brief expositions are offered of three theoretical perspectives of special salience for understanding and explaining the causal relevance of social structures and cultures for health and the healthy society. These originate and are developed in the works of Marx, Habermas and Bhaskar. Emerging from this triad is an expedient framework for presenting and accounting for the interactions of structure, culture and agency and health-related phenomena.
Chapter Two explores the linkages between social condition, health status and life expectancy. The ‘social determinants of health’ literature is discussed and critiqued. The vital but neglected causal power and relevance of structural relations, and especially those of social class, are emphasised. The ‘greedy bastards hypothesis’ (GBH), asserting that it is the behaviour of rich capitalists and political elites in thrall to them that is decisive for explaining the currently widening health inequalities in the UK, and elsewhere, is defined and defended. Asset flows known to be salient for health and longevity are the media of enactment of class power.
Chapter Four explores the notion of the ‘fractured society’ and argues for the key salience of the explanatory potential sociological concepts of social structure, encompassing gender and race/ethnic relations as well, and class, contemporary culture and agency. The idea of causal ‘dynamics’ is defined and illustrated. The relations between structure, culture and agency are analysed, as is the significance of each both for widening health inequalities and for the collapse of the NHS. The role of culture is discussed in some detail. It is contended that we are in an era of ‘cultural relativity’ which encourages a ‘pick-and-mix’ approach to sense of self and identity, and to commitment.
Chapter One sets the scene by introducing the concepts of health and health care and goes on to consider historical and comparative data on international rates and causes of mortality. Low-, medium- and high-income countries are distinguished and their distinctive health profiles discussed. These data give a point of reference and departure for the ensuing chapters. Six types of sociology are also outlined, each offering its own agenda and approach to the study of health-related phenomena. This sextet includes ‘foresight’ and ‘action’ sociology, which call for an extension of orthodox sociological theory and research.
In Chapter Ten the obstacles to achieving better population health in countries such as the UK, and globally, are confronted. It is argued that these obstacles can only be overcome via transformatory social structural change. At present the reforms being advanced are failing. This is because they sidestep or ignore the need for change beyond piecemeal social engineering. A case is made that it is mass extra-parliamentary action in countries such as the UK that is a prerequisite for deep change, and the preconditions for such action are analysed in the light of contemporary research.
The focus of Chapter Three is on health care. It shows how class relations in general, and the changing dynamic between class relations and state in particular, have precipitated a calculated political strategy post-1970s of undermining the precepts and practices of the National Health Service (NHS) in England and the United Kingdom. The decline of the NHS is charted in detail. In this context Chomsky’s formula – first, underfund public services to, second, create public dissatisfaction then, third, invite private health care providers to rescue ailing public services – is examined.
Chapter Seven extends the analysis of unequal global relations, but with special reference to the links between the human species, other species and the planet they inhabit. The concept and theories of the era of the Anthropocene are explicated in detail. The chapter acknowledges that nature is not external to and independent of humans in the Anthropocene, analyses the evidence for climate change, and focuses on the changing ‘stratified’ relations between humans and their habitat and the relevance of this for health and health care.
A case is made in Chapter Six that if any nation state is to be adjudged a ‘healthy society’, the analysis must be extended as a matter of urgency to incorporate analyses of unequal global relations. Reference is made both to shifts in the global economy of significance for health and health care beyond the English and UK experience, and to contemporary concerns around climate change. World systems theory is introduced to help theorise the linkages between high-income core, middle-income semi-peripheral and low-income peripheral countries.
The focus in Chapter Eleven is on conceiving and delivering effective policies and practices given the very real, entrenched structural, cultural and agential obstacles to their construction implementation. While the bulk of the chapter addresses the situation in core countries such as the UK, the discussion has sustained relevance also to the global context. Sample sets of ‘attainable’ to ‘aspirational’ change in relation to national and global health inequalities, climate change and warfare are broached and defended as part of a programme of ‘permanent reform’.
