Schrecker, T.and Bambra, C.How Politics Makes Us Sick: Neoliberal Epidemics. Palgrave Macmillan. 2015. 167pp £19.99 (pbk) ISBN 978‐1‐137‐46306‐7 (hbk) ISBN 978‐1‐137‐46309‐8 (pbk)

Abstract

In their strongly partial conclusion to this short text the authors argue: ‘We need, as the film maker Ken Loach has argued, to capture the ‘Spirit of 1945’ and realise that the politics of collectivism and solidarity are our most effective tool in combating ill health and health inequalities. Neoliberal epidemics require a political cure’ (p. 125). The concept of ‘neoliberal epidemics’ is one which allows the authors to put into a single frame four issues which might otherwise be considered separately: obesity, insecurity, austerity and inequality. We have a chapter on each of these four, bookended by an introduction and conclusion. The preface labours hard to get the reader to embrace the concept of neoliberal epidemics as a useful heuristic device for understanding the state we are in, pointing to the transformations required to produce what the British journalist and political economist, Will Hutton, refers to as a society of ‘mass flourishing’. The concept works, sort of, though there is a bit of circularity in their reasoning (these epidemics are neoliberal because they are associated with the rise of neoliberal politics!); and there could have been a more sociologically penetrating discussion of the concept of ‘epidemic’, which remains rather superficial. Nonetheless, there is a tidy Weberian elective affinity (not a term these authors use) between these four horsemen, although they are often addressed in different bodies of literature by different academic disciplines. Obesity feels a little distinctive, but perhaps that is because we are so used to being fed our understanding of it, as it were, via biomedicine, clinical epidemiology, and the ineffectual discourses of behaviour and lifestyle. Certainly, the analysis in this book leaves us in no doubt that the political economy of food is making us sick. What is missing, perhaps, is a broader sweep across what Kevin Morgan and others have referred to as the ‘moral economy’ of food and the municipal activism and civic engagement that might support a sustainable, good food movement. The three other epidemics are interesting. Each has a history, which is at least acknowledged here. The chapter on inequality covers well-worn ground, such as spatial inequalities – the north-south divide in England being used as a ‘case example’. But it also brings into the frame the impact of the current marketisation of the English NHS (as Cerys Matthews famously intoned: ‘Every day when I wake up I thank the Lord I'm Welsh’!) and it uses as another case example Loїc Wacquant's groundbreaking work on the epidemic of African-American men's incarceration in the United States, driven by racist public policies. The chapter on austerity is mostly about our post-2008 condition, and points to the limited challenges to neoliberalism and the current rhetoric of inevitability in austerity policies. The analysis could have been deepened by connecting the current rediscovery of the concept with some historical references (David Kynaston's work on Austerity Britain during that ‘Spirit of 1945’ era, for example). The chapter on insecurity is full of interesting material and the authors clearly demonstrate that neoliberalism has made labour markets and the organisation of work far less secure, with all kinds of impacts on health and wellbeing as a consequence. As you would expect, the majority of the evidence for their argument comes from social epidemiology. This is generally used well, avoiding too many methodological ‘ifs and buts’ and sticking to the narrative development of their political argument. It is there to be contested, if you wish. Although the authors make use of some qualitative material about the texture of everyday life, the book lacks attention to more explicitly sociological interpretation – within medical sociology the work of Graham Scambler and Jennie Popay, for example, is conspicuous only by its absence. We still have some way to go in framing a satisfactory sociology of the social determinants of health. The concluding chapter on political alternatives to neoliberalism is a little disappointing. Much as those of us of a certain age and background might recall with pride the post-1945 achievements of the British people and State, we are not there now; and while we might support the ideas of solidarity and collectivism, we need to find new ways of thinking about and mobilising the relationship between economy, state and citizens that will allow those values to infuse new policies for social and economic life – reference to the work of Karel Williams and colleagues on the ‘foundational economy’, for example, or Roberto Unger's proposals for ‘democratic experimentalism’, might have helped to strengthen the arguments about what is to be done. Nonetheless this is a book which takes a position and makes an argument and, whether you agree or disagree with it, it is all the better for that.