Taking the health impact of economic factors seriously

If (or when) I tire of reading trite articles linking exposure A to outcome B while avoiding even a consideration of context or history, I turn to the International Journal of Health Services.  It is not the best-known journal around, and there are very few quick fixes and takeaway messages.  There are certainly no ‘What this study adds’ boxes à la BMJ stable.  Thank goodness.  The journal provides provocative and deep analysis of the current political and economic system and how it affects health.  Under the editorship of Vincent Navarro the journal has focused on critiquing the mainstream, and while I do not always agree with the views expressed, I always gain something from reading.

For example, the most recent issue contains at least four articles that are now high on my to-read pile.

  1. Nadine Nowatzki takes us down the well-worn path of the cross-national relationship between income inequality and mortality/life expectancy.  She focuses on wealth inequality (perhaps a more insidious form than income, since it is longer-lasting) and finds that while the overall pattern looks similar to that for income inequality, the ordering of nations differs.  Her discussion looks at a range of explanations, including social capital and redistributive policies across classes and the lifecourse.
  2. Carles Muntaner and colleagues continue to consider income inequality, explicitly engaging with Richard Wilkinson and Kate Pickett’s The Spirit Level.  They note that Wilkinson and Pickett focus on psychosocial explanations for the ill-health associated with greater inequality, and go on to challenge the authors on this.  Muntaner et al. prefer to focus on materialist explanations, specifically those which arise from social class in the form of exploitation (cf Erik O Wright), and this leads them to urge greater intervention in the economic structure of societies to improve health.
  3. Gavin Mooney moves us to more conceptual ground.  Mooney’s name is one I know from the Health Economics world, where he has been a careful and trenchant critic of the focus on efficiency over equity in that field.  Now it appears he has a new book out, focusing more on political economy and the impact of neoliberalism on health, and for which this paper is a taster.  The core of his argument (and please note I haven’t read the paper thoroughly yet) appears to be that the WHO and the Breton-Woods institutions (World Bank, IMF) have been co-opted into the global neoliberalist focus on individual rights over communitarian needs and approaches.  And that this has had serious negative effects on health.  Certainly an argument worth engaging with.
  4. Claudio Schuftan considers the links between poverty and broader human rights violations, not so much the direct links but rather the common causes.  She identifies the neoliberal governmental framework, religion and man-made disasters at the fulcrum of the system, driving the failure to implement UN (and other) conventions protecting rights and subsequent powerlessness and resignation amongst the powerless.  These then cascade into numerous direct causes of rights violations, but I’ll leave those for you to read about.  It’s certainly a strongly argued vision of the way the world works, and works to harm the most vulnerable.   This paper in particular, I would like to see linked up with Sen/Nussbaum’s capabilities approach.

All of which adds up to uncomfortable, but (indeed perhaps therefore) important, but never dull, reading.