Polemics and Politics of Health Inequalities: A Critique

Abstract

This chapter chalks out the resurgence of interest in the socio-economic dimensions of health inequalities. The Black Report of 1980 in Britain dispelled the prevalent notion that contemporary British society is more egalitarian than in the past and showed that health inequalities have in fact increased over time and are strongly correlated to the economic or occupational status of individuals. The contention of this chapter is that income inequalities with their genesis in class structures have led to health inequalities. Prevalent public health policy, which is rooted in the philosophy of neoliberal philosophy, serves to perpetuate inequalities and in doing so reverses public health logic and history. Even Wilkinson’s theory of social cohesion/capital, modelled in the Durkheimian tradition of moral individualism, distances itself from a true population perspective. In fact, it creates a smokescreen through its claim as an alternative paradigm and thereby pushes the task of public health further back. Under Wilkinson’s model, the real shift has been only that of ‘community blaming’ in place of individual ‘victim blaming’. The attainment of better health status becomes the responsibility of the community as a whole through such measures as better social cohesion and solidarity, and better health is the responsibility of the individual through measures such as behaviour modification, self-help and self-control. In both the cases, the state has no role to play and there is no space for macrostructural change.