It has become commonplace among sociologists at the time of writing to lament the growing inequality during financial capitalism and to take the 1% to task for their greed. In 1998 Paul Higgs and I edited a book, Modernity, Medicine and Health, in one chapter of which we addressed the task of ‘explaining health inequalities’. I was first drafter and for me it signalled a shift of interest and engagement. We complained (a) about the under-theorization of social class and the reliance on outmoded and unsophisticated methodologies, and (b) about the neglect of the manor and impact on the distribution of health and longevity of the behaviours of Britain’s ruling class. We quoted John Scott, doyen of researchers on the business of ruling: ‘a ruling class exists when there is both political domination and political rule by a capitalist class’. Elaborating – in his Who Rules Britain?, published in 1991 I believe – he argued that this requires that there be ‘a power bloc dominated by a capitalist class, a power elite recruited from this power bloc and in which the capitalist class is disproportionately represented, and that there are mechanisms which ensure that the state operates in the interests of the capitalist class and the reproduction of capital’. If a power bloc is to endure, then it must attain ‘consciousness’ and ‘coherence’ and a capacity for ‘conspiracy’.
In 1999 Paul and I followed up with a paper in Sociology, again bemoaning the fact that the sociology of ‘class-related’ health inequalities lacked a ‘hard’ theory of class. And then, in 2001, in a chapter in a book on Habermas I edited, Habermas, Critical Theory and Health, I gave vent to my greedy bastards hypothesis (or GBH). In the proverbial nutshell (as if any academic excepting perhaps Wittgenstein in Tractatus Logico-Philosophicus can be that concise), the GBH stated that Britain’s growing health inequalities are an unintended consequence of the self-interested strategic behaviours of its ruling class. Pretty uncontroversial I thought
I should add a few comments on the GBH. If theoretically and empirically uncontroversial, it was obviously provocative. This was intentional. I had experienced a rumbling discontent with the putative sociology of health inequalities, principally because it was all but devoid of sociology. The qualitative studies of Gareth Williams, Jennie Popay and others were on the whole ignored and precedence given to socio-epidemiological research masquerading as quantitative sociology. I had nothing at all against socio-epidemiological studies informed by public health issues and oriented to prediction and interventionism; but I wanted something different from sociologists oriented to explanation. In as far as the GBH was wilfully provocative however, it was a failure. It was rigorously and comprehensively ignored not only by socio-epidemiologists (understandably), but by most medical or health sociologists (although there were a few takers from mainstream sociology). Colleagues would applaud me and have a giggle in bars, then opt not to cite me. My interpretation? Maybe they were not convinced; maybe they judged my terminology ill-advised, a poor advert for the discipline; or maybe they were just worried about getting the next grant in
If I ever had a reservation about the GB it was that it might lend itself to individualistic misinterpretation. It never was an hypothesis about individual ‘greedy bastards’, whom I have always regarded as substitutable. It was, as I tried to make clear, about the social structures they surf even as others drown. I was erecting a neo-Marxist building on the plot purchased by neo-Weberian John Scott
My third remark here is one of explication. It may not be entertaining, but then perhaps too much of my life has been lived between my ears. What was the sociology behind the GBH? It was summarized a little later, in 2002, in my Health and Social Change. I drew on the research of Clement and Myles, who had in turn been inspired by Carchedi’s analysis of class. Key for the latter is the notion that classes are formed at the point of production and reproduced throughout social life. Central to class formation are (a) real economic ownership of the means of production and (b) the appropriation of surplus value through control and surveillance of the labour of others (which is part of the ‘global function of capital’). Carchedi distinguishes between control/surveillance and, crucial for any large organization, coordination/unity (which is part of the ‘global function of the collective worker’). The extraction of surplus value and/or surplus labour is particular to the capitalist executive, whose members enjoy the powers of real economic ownership; and a new middle class has emerged to deliver coordination/unity on their behalf
This seemed, and seems, credible to me (I have not yet given up on the labour theory of value). So let me re-state the GBH. Members of the capitalist executive command strategic decision-making, while those comprising the new middle class exercise tactical decision-making. Pivotal for Carchedi and Clement and Myles, however, is the division between the capitalist executive and the working class, namely, that class that has no command over the means of production, the labour power of others, or its own means of realizing its labour. I agree. My concern in the GBH was to focus attention on the structures in this financial phase of capitalism that ‘allow’ a hard core of the capitalist executive to buy (literally) policy from the state’s ‘command’ or power elite. Mine was a present-day variant of US historian David Landes’ thesis that those with wealth purchase power to their advantage. I later summed up this process in terms of a class/command dynamic, suggesting too that this was of greater salience in financial than in postwar or welfare capitalism. I am pleased to note that before the closing of the last century I had put on record my view that post-1970s financial capitalism has witnessed a re-sharpening and bite of objective class relations even as their subjective influence on identity-formation has declined. So, back to the GBH. A honed kernel of the capitalist executive has enhanced its grip on those who mastermind state policy, one by-product of which is a rapid growth of material and social inequality and – further down the line as it were – health inequalities.
I thought as the 1990s passed into the twenty-first century as I think now: how can sociologists in general and medical sociologists in particular ignore or deny the GBH? My response in both Habermas, Critical Theory and Health and Health and Social Change, and I repeat it here, was that they were – personally as well as institutionally – running scared. I have touched on the parameters of financial capitalism in earlier fragments and will doubtless return to it.