‘In-equality … is a normative concept, denoting the absence, the lack of something – i.e., of equality. This normativity had better be recognised and reflected upon from the outset’ (Goran Therborn in The Killing Fields of Inequality).
Therborn’s point is a crucial and neglected one. When we engage in attempts to document, understand or explain inequality we assume that it is undesirable and that its reduction would be a good thing. As the philosopher Gilbert Ryle said, equality is a hurrah word, inequality a boo word. The baggage scholars bring to the study of inequality commits them, be they reflexive or not.
Inequality, chameleon-like, can adopt numerous guises. Wealth and income inequality are key, not least for inequalities of health. Strong material asset flows, I have argued elsewhere, tend to be positively associated with the strength of flow of other assets salient for health and longevity; but these asset flows can and do vary independently of each other and compensation between them is not uncommon. Already there is more complexity than a simple boo/hurrah normative binary allows us.
Therborn distinguishes between three types of inequality. Resource inequality refers to wealth and income mal-distribution. Vital inequality refers to ‘socially constructed unequal life-chances of human organisms’ (this is the notion that inequalities of health are ‘inequities’ (i.e. questions of social justice) when interventions to reduce or even eliminate them are available, as pursued by Michael Marmot and others). Existential inequality denotes the unequal allocation of ‘personhood’, that is, ‘of autonomy, dignity, degrees of freedom and of rights to respect and self-development’. There is an abundance of rival typologies of inequality not included in this classification, that is to say inequality is multi-dimensional. However, the mal-distribution of material assets is the (causal) core of inequalities of health.
Let’s remind ourselves just how loudly we might/should boo current levels of material inequality. Oxfam recently went public with a truly astounding statistic: that the 85 wealthiest individuals on our planet have accumulated as much capital as half the world’s population (that is, 3.5 billion people). Just to re-state this point, 85 people on this planet have the same levels of wealth as 3.5 billion people combined. Closer to home, the same body revealed that five families in Britain own more than the poorest 20% of the population. The most affluent family, headed by Major General Gerald Grosvenor, the Duke of Westminster, inherited (in our ‘something for nothing society’) 77 hectares (190 acres) of prime real estate in Belgravia, London, and has been the beneficiary of money flooding in to the capital’s soaring property market in recent years. But the boos often seem under-whelming for reasons I return to below.
What about income inequality? The bottom 10% of the population have experienced a fall in real income over the last 10 years. Four-fifths of the total increase in income over the last decade has accrued to those with above-average incomes; and two-fifths has gone to the richest 10%. The principal beneficiaries of income windfalls, of course, have been the major rentiers, CEOs and Directors of the FTSE 100 and the ‘banksters’: that is, the top 0.1%. About all this there is no dispute. The case for the range and scope of material inequalities is clearly made.
In this blog I want to consider what this means in terms of the logical and moral requirements of any credible sociology of health, illness and health care, faced with such massive mal-distributions of material wealth. The bloated and expanding inequalities of wealth and income alluded to here severely impact – directly, indirectly or circuitously – on health inequalities (and as Richard Wilkinson has long maintained, much else). There is a degree of urgency – few of us would be willingly publicly to ask the impoverished to hang in there for a few more generations. So why are we sociologists still not: (1) exposing their causal ‘tap root’ in the wealth-purchases-power class/command dynamic I have discussed elsewhere; (2) foregoing the study of a handful of individual specimen trees in arcane detail in favour of tackling the wood as a whole; and (3) recognizing and acting on the vision, ambition, imagination and engagement of those ‘classical’ sociologists who came before us?
Re-invoking class offers a ready sociological arsenal for tackling all three of these points. However, it is regularly suggested to me that the summoning of class, is ‘old hat’. Two retorts. First, it should now be possible for those who fell for the concept of a (hands-in-the-air, inequality is just ‘difference’) postmodernised sociology a decade or so back to acknowledge: (a) that this fatally undermines the classic sociological project; and (b) that, because relativism is self-refuting, a postmodernised sociology could only be a pick-and-mix sweet jar of diversion. Postmodernism was disinhibiting not liberating/emancipatory. Second, and in any case, this focus on difference has not got us any further down the road. The sociology of difference still fails to speak to the lack of medical sociological studies of the sequelae of the perverted accumulation of capital and power in the hands of what is now incontrovertibly a ‘governing oligarchy in Britain?
Why does this have to be of consequence to our sociological community? I go back to an argument I made in Sociology in 1996. Drawing on Habermas, I contended that sociology is nothing (that matters) if not part of an unfinished project of modernity, nothwithstanding the obvious need to rethink and reconstruct this project’s historic grounding in the European Enlightenment. I made a case that (medical) sociology is rationally – logically and morally – committed to the rationalisation of the lifeworld, which necessarily involves resisting and countering its colonisation via systemic imperatives issued by what I have come to term the governing oligarchy.
So here is the crux of my message in this short blog. First, picking up on Thorborn once again, phenomena like inequality are essentially normative: when all things are equal we are against them. So we are against the health inequalities we expose and document. Second, sociologists, including those of us who focus on health and health care, are logically and morally for lifeworld rationalisation and against any system rationalisation that trespasses into colonisation. Here for me is the basis for both an action sociology that allies itself with movement activists oriented to lifeworld rationalisation, and a foresight sociology that posits alternative models for sustainable, healthy living in the 21st century. There is not/should not be sociology on the one hand and politics on the other; to do sociology is to accept a formal obligation to engage in what David Kelleher and I called the ‘protest sector’ of the public sphere. This ‘protest sector’, (and this is an important point, is a step beyond Michael Burawoy’s public sociology.