Regimes of Inequality : The Political Economy of Health and Wealth

Cover 1 Half-title 3 Title page 5 Copyright information 6 Dedication 7 Contents 9 List of Figures 11 List of Tables 13 Acknowledgments 15 List of Abbreviations 17 1 Explaining Resilient Inequalities in Health and Wealth 21 Introduction 21 The Puzzle of Resilient Inequality 23 The Political Economy of Resilient Inequality 30 The Analytic Strategy 35 Analysis of Policy Frames 36 Case Selection 38 Data Collection and Analysis 42 Plan of the Book 45 2 Theorizing Regimes of Inequality: Welfare, Neoliberalism, and the Reframing of a Social Problem 47 Introduction and Key Concepts 47 Health Inequalities and Their Causes 47 Welfare Regimes 50 Neoliberalism 52 Public Health Approaches to Welfare Regimes and Neoliberalism 55 The Argument of the Book 57 The Genesis of Neoliberal Policy Taboos: Welfare Regimes and Neoliberal Sticking Points 58 The Reframing of Inequality 60 Shifting the Overton Window: Why Reframing Inequality Makes It More Resilient 62 Empirical and Theoretical Contributions of the Argument 65 Conclusion 67 3 Health Inequalities: The Emergence of an International Consensus Policy Frame 68 Introduction 68 A Health Inequalities Primer 69 Defining and Measuring Health Inequalities: A Priority on Outcomes 73 Distinguishing between Health Inequalities and Health Care Inequalities 75 Health Behaviors Are Socially Structured 76 Social Hierarchy and the Social Gradient 78 Social Inequality Itself Is a Cause of Health Inequalities 80 The Emergence of the International Health Inequality Consensus Frame 81 From Social Medicine to the Black Report: World War II to 1980 84 The Health For All Period: 1980–2005 86 The CSDH Era: 2006 Onward 94 The International Health Inequality Consensus in Print 98 Conclusion 101 4 New Labour, the Redistributive Taboo, and Reframing Inequality in England after the Black Report 103 Introduction 103 The English Health Inequality Frame in Brief 104 Setting the Stage: From the Black Report to New Labour 109 The Taboo: How New Labour Adopted Neoliberalism and Abandoned Redistribution 114 Labour Made Redistribution Taboo 114 Why Labour Made Redistribution Taboo 118 Inequality Reframed: From Class Inequality to Social Investment and Health 121 Conclusion 130 5 Inequality, Territory, Austerity: Health Equity in France since the U-Turn 132 Introduction 132 The Emergence of the French Taboo against Social Spending 134 Dirigiste Keynesianism Confronts the Global Economic Order 135 France's European Aspirations Reinforce the Taboo on Public Spending 136 Internal Pressures for Austerity and the Self-Imposition of Taboo 139 Inequality Reframed: From Territorial to Socioeconomic Inequalities in Health 140 Health Inequalities: Discourse in French Government Reports 141 The Territorial Frame in French Health Inequalities Policy Discourse 147 Toward Adoption of the International Health Inequalities Consensus in France 151 Explaining the Growing Salience of the ISS Frame 155 Conclusion 161 6 From Risk Factors to Social Determinants: How the Changing Social Democratic Welfare Regime in Finland Reframed Health Inequality 164 Introduction 164 The Taboo: From Social Democratic Intervention to Respecting Markets 166 Creating Taboo: A Social Democratic Welfare Regime Collides with Neoliberalism 170 Neoliberal Taboos against Devaluation, Taxing Capital, Public Spending 171 European Taboos against Public Service Provision, Product Market Regulation 173 The Finnish Taboo in Comparative Perspective 178 The Reframing 179 The Old Finnish Health Inequality Frame: Medical Care and Proximate Risk Factors 180 The Early 2000s and the New Frame 184 A National Action Plan on Health Inequalities 187 Increasing Salience of Health Inequalities 190 Domestic Politics and the International Consensus 191 Conclusion 194 7 In and Out of the Overton Window: How Talking about Health Inequality Made the Problem Harder to Solve 196 Introduction 196 England: Redistribution Is ''Out,'' Complex Cross-Sectoral Initiatives Are ''In'' 200 France: Spending on Reducing Upstream Inequalities Is ''Out,'' Regional Cross-Sectoral Initiatives Are ''In'' 206 Finland: Upstream Interventions Are ''Out,'' Midstream Interventions Are ''In'' 216 Cross-Country Analysis: Why Are Health Inequalities So Hard to Reduce? 222 8 Regimes of Inequality 227 Introduction 227 Comparative Taboos 229 Variable Reframing 232 The Overton Window 233 How and Why Neoliberalism Matters for Health Inequalities 235 Welfare Regimes, Neoliberalism, and Regimes of Inequality 238 Constructing Inequality 241 Implications for Policy and Politics 242 Conclusion 245 Appendix Content Analysis of Government and Commissioned Health Inequality Reports 247 Introduction 247 Selection Criteria for Reports 247 Coding Procedures 251 The International Consensus Frame 254 References 273 Published Works 273 Interviews 302 Index 305 Since the 1990s, mainstream political parties have failed to address the problem of growing inequality, resulting in political backlash and the transformation of European party systems. Most attempts to explain the rise of inequality in political science take a far too narrow approach, considering only economic inequality and failing to recognize how multiple manifestations of inequality combine to reinforce each other and the underlying political features of advanced welfare states. Combining training in public health with a background in political science, Julia Lynch brings a unique perspective to debates about inequality in political science and to public health thinking about the causes of and remedies for health inequalities. Based on case studies of efforts to reduce health inequalities in England, France and Finland, Lynch argues that inequality persists because political leaders chose to frame the issue of inequality in ways that made it harder to solve. "A spectacular thirty-meter high viaduct spans the Ouseburn river as it makes its way through Newcastle-upon-Tyne, in the northeast corner of England. Modern, bright-yellow and black tram cars ply the viaduct, bringing passengers from working-class Byker to more affluent South Gosforth station in a journey that takes roughly ten minutes. But while the Byker viaduct allows riders to traverse the physical chasm carved out by the Ouseburn with ease, the social differences that separate residents of Byker from their better-off neighbors are much harder to bridge. Twice as many children in Byker (two in five) live in poverty as in Gosforth. And while a fifty-five-year-old man from Gosforth can expect to live another seventeen years in good health, the average fifty-five-year-old in Byker has only another nine years of healthy life expectancy ahead of him (Bambra 2016, 92)"-- Provided by publisher