I have just now sent off a draft of my next book, to be called ‘Health: Policy, Practice, Obstacles’. While I am awaiting comments from reviewers and the series editors, and to pass the time between writing projects – in my local, the King Willie – I thought I’d say something about a concept that plays a central role in the book, namely, that of the ‘healthy society’.
I have written and blogged about population health and health inequalities in the UK as a sociologist, on the whole arguing that socio-epidemiological and even sociological research in these fields neglects to take the idea of social structure in general, and social class in particular, seriously enough. Indeed, it has become customary to conclude research reports and discussions in the field with casual, throw-away references to the causal salience for population health and health inequalities of structures like class without ever going much beyond detailing yet more statistical correlations between proxies of class like NS-SEC and health and longevity. These ‘neo-positivist studies’ have returns of course: (i) they comprise an exercise in social accounting in their own right; (ii) they can inform public health interventions; and perhaps of most sociological relevance, (iii) it can be argued (‘retroduced’) from their findings that there must exist ‘real’ structures like class relations that possess the causal power to impact, even decisively, on morbidity and mortality rates. But this is by way of background.
In my book I argue that these same class relations that impact on population health and occasion health inequalities also function as ‘obstacles’ to interventions designed to improve population health and to reduce health inequalities. In a sentence or two, this is because a hard core of nomadic, transnational ‘capital monopolists’, well under 1% of the UK population, are committed to dominating and exploiting national and global markets in the interests of accumulating yet more company and personal capital. In fact, this tiny element has had capital enough to buy power enough from our (sympathetic) Tory governments post-2010 to fashion economic, social and health policy in its own interests. The post-1970s years of financialised, rentier or asset-based capitalism has witnessed a progressive acceleration of this class-based ‘rule’. We must face up to such compelling – and seemingly irresistible – structural obstacles to accomplishing an improved health status and life expectancy for poorer citizens.
But there is more, I argue in my book, to creating a healthy society than maximising population health status and health equalities nationally, in our case in the UK. In making this argument I refer to three other elements. The first is the health and health distributions to be found in societies other than ours, most obviously in the Global South. We surely cannot regard the UK as a healthy society if the positive health status and its distribution through our population has been achieved via upping UK-capital monopolistic exploitation and state domination overseas, if, in other words, we are simply exporting suffering. Unsurprisingly, acknowledging this ups the obstacles in the way of achieving a healthy society.
But there is yet more. The second element I considered was climate change. The stark urgency of this worldwide threat has insinuated itself into considerations of matters of health. In fact, confronting this threat has, even ought, to surpass issues of health policy and practice. It is not that we do not know what we have to do, and how. But the obstacles are much the same as those inhibiting effective action to improve the extent and spread of good population health. And these obstacles – coalescing in the obstinate and predatory conduct of capital monopolists in finance and the fossil fuel industry – are so far causing successive Tory governments in the UK to whom they generously donate, stuttering from Truss-economics to an increasingly desperate Sunak, to lag far behind what the measures required.
And my third element was warfare. A healthy society, I suggest, cannot be said to exist if either its government sanctions unwarranted armed conflict, that is, for spurious geopolitical or economic reasons, or it permits capitalist monopolists nominally based in the UK to export sophisticated weaponry to any willing purchaser. Currently, the Sunak regime is endorsing Israeli war crimes against the Palestinian population in Gaza (extending to the West Bank), and UK-based arms firms are essentially open to all buyers, including the iniquitous (and doomed) Netanyahu regime. In short, we cannot claim to be a healthy society if we export death and misery around the world whenever it seems profitable or expedient to do so.
Of course neoliberal ideology conveyed by an overwhelmingly right-wing establishment via the ownership and control of the mass media provides rhetorical cover for our capitalist monopoly or plutocracy. And if what I call the ‘class/command dynamic’ (capital buying power to make government policy) is an important and constant theme not only in relation to population health and health inequalities in the UK but across this additional trio of challenges to the formation of a healthy society, it is of course by no means the only causal factor at play, quite the contrary. But I emphasise the role of class and state in my book because they continue to be major players and because class especially is receiving too little serious attention as a prepotent social structural force.
At the very least I feel that my book calls for an expansion of the sociological agenda with regard to the sociology of health and health care and posits a new yardstick in terms of the conceptualisation and promulgation of the healthy society.