14 September 2008

Stop, inequality, you're killing me!



The World Health Organization, in its latest Report, seems to have come up with a shortcut method for the reduction of global illness. Stop concentrating on microorganisms or nutrition, and start blaming ‘injustice’, formerly known as economic inequality.

Well, at least it’s honest. The WHO has come clean and admitted that it is basically predicated on a redistributionist ideology. As redistribution mostly ends up being from private to public sector, this effectively means a pro-state ideology.

By arguing that health is ‘political’, they are admitting that they themselves have a political agenda. And this is difficult to dispute when you look at the some of their statements, which can best be understood as expressions of a political position.

Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair.
"Reasonable action" here, it should be noted, includes more taxation, more state intervention and a bigger public sector. Beyond using the phrase "quite simply", however, it is not explained why such differences are unfair.

The Report's ambitions go much further than mere health. Education, for example, is (like medicine) a "vital social good" and "must be governed by the public sector, rather than being left to markets" (p.14). So private schools should presumably be abolished.
And of course climate change has profound implications for the global system – how it affects the way of life and health of individuals and the planet. We need to bring the two agendas of health equity and climate change together. (p.1)
Climate change and global health? You might think there was little connection. On the other hand, if both are really just planks of the same pro-state ideological programme, it makes sense to see them as linked.
... unequal living conditions are the consequence of poor social policies and programmes, unfair economic arrangements, and bad politics. (p.1)
So inequality must be due to a mistake — something "poor", "bad", or "unfair". The following extract reinforces the same message, in more academic language. Whoever said Marxism was dead?
Inequity in the conditions of daily living is shaped by deeper social structures and processes. The inequity is systematic, produced by social norms, policies, and practices that tolerate or actually promote unfair distribution of and access to power, wealth, and other necessary social resources. (p.10)
Again, "unfair" is not defined. The word 'inequity', it will be noted, is very convenient: it looks like 'inequality', but means 'unfairness' so it's a useful way of creating the desirable effect without defining terms.

The theme of causation (illness is the fault of the wrong social structures) is pushed still further.
water-borne diseases are not caused by lack of antibiotics but by dirty water, and by the political, social, and economic forces that fail to make clean water available to all; heart disease is caused not by a lack of coronary care units but by the lives people lead, which are shaped by the environments in which they live; obesity is not caused by moral failure on the part of individuals but by the excess availability of high-fat and high-sugar foods. (p.35)
"Excess availability" is presumably a tendentious way of writing "failure to prohibit".

* * * * *

So far, so collectivist. Digging a little deeper, we find some inconsistencies. The WHO appears to be full of concern that individuals should be able to lead rich, fulfilling lives.
At the heart of our concern is creating the conditions in which people can lead flourishing lives. People need good material conditions to lead a flourishing life; they need to have control over their lives ... (p.35)
So people need to have control over their lives to achieve optimal health. Yet the WHO's proposals seem to be aimed at less control for individuals and more for the state. People are to have control to the extent they make choices that fit with the elite's vision of the correct life. They shall be prevented from making choices which are considered 'bad' (cigarettes, alcohol, fatty foods, sweets).

The Report's authors want to see change in "the distribution of power within society and global regions, empowering individuals and groups to represent strongly and effectively their needs and interests" (p.18). So people lower down the social hierarchy should have more say about what happens to them, again supposedly to improve mental and hence physical health. Why then is it that the WHO seeks to dictate to nations and other actors what they should regard as their best interests? Why do the 'trained experts' responsible for the Report believe they necessarily know better than local politicians? And why do they think that global governance, which they argue the world needs more of, is a way of increasing the power of individuals over their own lives, rather than increasing the power of elites?

Of course, the whole concept of 'unfairness', which forms the basis of the Report, is philosophical nonsense — but that is another post altogether.

* * * * *

Peter Wilby is clearly a fan of the Report's ideology. His commentary provides a useful illustration of how the inequality-causes-illness philosophy, ostensibly based on empirical data, easily strays into illogical territory — very much like the related happiness-needs-training movement. Quoting from Michael Marmot's Status Syndrome, Wilby says that
a study of office-based civil servants ... found that, at each grade down the Whitehall hierarchy, mortality increased. Between the ages of 40 and 64, those in the bottom grade were four times more likely to die than those at the top.
It's plausible that this research highlighted a genuine phenomenon. Being positioned lower in a managerial hierarchy tends to be more stressful, at least for certain personality types, and stress no doubt affects health. But what is the relevance of this for redistribution or the choice of political system? Prima facie, none. The effect in question derives from organisational structure, not economic inequality or the choice between market and state. We could convert to a communist regime with perfect economic equality, but unless organisational structure is somehow fundamentally different from what it is elsewhere, the stress levels and associated health inequality could easily be higher.

Which, in a more general sense, illustrates the point that life is full of phenomena that could be called 'unfair', but that tackling them by having more collectivisation should be regarded with a good deal of scepticism, and not just taken as the obvious knee-jerk response.

What should also come into question — but never does — is the motivation of people proposing such a move. Are they really driven by concern for the less fortunate, or is it that they stand to benefit from doing down their middle-class rivals?

"The case for social justice", Wilby says, echoing the Report, "does not rest on ideology or class envy, but on an ethical imperative". Now I may feel an ethical imperative to save a person from drowning. I may even feel an ethical imperative to help a relative who is on their uppers. But neither Wilby nor the Report's authors produce any arguments for why I should regard it as an ethical imperative to respond to:
- an unrelated person suffering stress from inequality, by
- forcing others to surrender some of their resources, in order to
- finance an even larger state apparatus.