GBH: Greedy Bastards and Health Inequalities

Over a decade ago, in a calculated bid to rile and provoke engagement with other sociologists, I formulated the ‘greedy bastards hypothesis’ (GBH). This asserted that health inequalities in Britain were first and foremost an unintended consequence of the ‘strategic’ behaviours at the core of the country’s capitalist-executive and power elite. It is a hypothesis even more plausible in 2012 than it was in the late 1990s.

The term ‘capitalist-executive’, borrowed from Clement and Myles, contained what I subsequently called a core ‘cabal’ of financiers, CEOs and Directors of large and largely transnational companies, and rentiers. These individuals were perfectly capable of ‘conspiring’ but despite being involved in fierce competition rarely had a need to do so in the post-1970s neo-liberal era of financial capitalism. This cabal, I intimated, has come to exercise a dominating influence over the state’s political elite (that is, the upper echelons of government together with its multifold ‘new middle class’ tacticians). US historian David Landes’ once asserted that ‘men (sic) of wealth buy men of power’; and my contention was that they got more for their money post-1970s than in the postwar welfare-statist era. So the GBH charged leading capitalists and politicians with what the likes of Engels and Virschow in the nineteenth century called homicide. As Michael Marmot has more recently averred, policies can kill, and when these are reflexively enacted their architects shouldn’t be surprised to find themselves liable to prosecution in the event of a regime change.

If the GBH indicted individuals – and in a 2009 paper I cited a list of names from a column in the Guardian – this was not its primary aim. Notwithstanding allowances for charisma and the like, the stand-out wealthy and powerful are more replaceable than they would have us believe (and doubtless than they believe). As a sociologist my interest was in the social structures these individuals were able to surf while many others were not waving but drowning: the sheer heritability of wealth and power is better researched than it is grasped by the public (hence the need for ‘action sociology’). Core members of Britain’s rapidly globalising capitalist-executive are the beneficiaries of enduring relations of class. Those comprising the more slowly globalising power elite at the pinnacle of our multi-layered state reflect relations of command. My contention was and is that financial capitalist Britain is characterized by a revised ‘class/command dynamic’ whereby class interests exercise greater sway over state policy and practice than hitherto.  This strikes me as blindingly obvious.

Let anyone who doubts the thrust of this argument venture a more telling macro-analysis of the journey of the (English) Health and Social Care Bill into law in March of 2012. This Act is re-commodifying health care. Without mandate, and in defiance of unusually unambiguous comparative research, the ConDem coalition is turning the NHS over to predatory US-style for-profit companies. What better case could be made for the new class/command dynamic?

It would be convenient if type of health care organization and delivery was decisive for health inequalities, but it isn’t. Morbidity and mortality rates do not simply reflect differential access to good quality health care. Although GP Julian Tudor Hart’s ‘inverse care law’ still applies 40 years after its formulation (that is, the provision of health care is inversely related to the demand for it), it is in amongst the basic building blocks of people’s everyday lives that the explanation of health inequalities rests. I have suggested that the notion of (initially) capital and (more recently) asset flows is helpful here. These asset flows, I contend, are the media through which the class/command dynamic, via the GBH, decisively impacts on people’s health and longevity. The noun ‘flows’ is significant here. People do not either have or not have assets positive for health and longevity, rather the strength of flow of these assets varies through the life-course.

So what are these assets? I so far have listed biological, psychological, social, cultural, spatial, symbolic and material assetsl. This is not the place to discuss each in turn, but it is important to stress that a strong flow of one asset can and frequently does compensate for the weak flow of another. Examples: a strong psychological asset flow (i.e. high personal resilience) can cancel out the negative propensities of a weak flow of social assets (i.e. an absence of close-knit social networks); and a strong flow of symbolic assets (i.e. high social status) can mitigate the damage liable from a weak flow of spatial assets (i.e. living in a deprived neighbourhood). There are five points to add:

  1. the strength of flow of material assets (i.e. standard of living via personal and household income) is paramount;
  2. flows of assets tend to vary together (i.e. mostly strong or weak ‘across the board’);
  3. weak asset flows across the board tend at critical junctures of the life-course (e.g. during infancy and childhood) to have especially deleterious effects on life-time health and longevity;
  4. weak asset flows across the board, and I daresay strong asset flows across the board, tend to exercise a cumulative effect over the life-course  (negatively and positively respectively);
  5. the ‘subjective’ evaluation of the strength of an asset flow can exert an effect over and above any ‘objective’ measure of that flow (e.g. a symbolic asset flow perceived as weak relative to that enjoyed by an individual’s reference group can be injurious in its own right).

Ok, it’s complex. But I want to stress (1) here. I regard the material asset flow as vital or prepotent. To assert that it underpins all other asset flows is not to diminish the latter’s salience for health inequalities; but it is to put on record, surely the key lesson of Wilkinson and Pickett’s The Spirit Level, that a purposeful reduction in income inequality is a precondition for taking health inequalities seriously?

This last point takes us back to the GBH and the revised class/command dynamic that underwrites it. Our society, one in which income and health inequalities are rapidly rising, and in which policy-based evidence has allowed a Health and Social Care Act to deliver a proven cost-effective publicly-owned NHS into the hands of transnational profiteers, is slipping into a post-welfare-statist, neo-liberal abyss. And even my fellow sociologists are reluctant use the ‘class’ word.





10 thoughts on “GBH: Greedy Bastards and Health Inequalities

  1. Your recent exposition on Margaret Archer’s criticial realism and the notion of Focused Autonomous Reflexives is also crucial to understanding. You suggest in your paper in ‘Sociology’ that Archer has some empirical evidence for this ideal type and above you publish a list of those you consider to be part of the CCE. To move beyond hypothesis to hard evidence that this class operates in the way you say is of course a crucial step and your example above contributes towards that. In today’s Observer there is a piece: reflecting some bankers’ and financiers’ views on the bonus cap. Again this provides some some small evidence along with Toynbee and Walkers’ ‘Unjust Rewards’ which suggests there is a greedy dysfunctional and unjust cabal in finance. I hear we ‘lefties’ should stop bashing the rich, the wealth creators, and be grateful they provide jobs. In the film ‘Made in Dagenham’, Barbara Castle is shown being given what looks like a threat by Ford’s representative – i.e. Ford will pull out of the UK, takes its jobs with it, if equal pay for women is supported. We know what happened. We are hearing similar now in relation to bankers pay. The fact that the threat might carry some weight (and of course we have little to fall back on today), does nothing to contracdict the basic relationship: GB’s think that the Britiish economy should work for them. Why are sociologists so afraid of ‘class’ ? Everything I read and see today seems still to be debates with the ghost of Marx…class analysis is still pertinent but it ‘dares not speak its name’. I teach student nurses about health inequalities…trying to encourage a ‘sociological imagination’ in the hope that nurse leaders of the future will be able to articulate what is happenning to the service. The lack of a cogerent fight by nurse leaders is based on blindness to thses issues, if sociologists will not use the class word then who will?

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  6. As someone at the blunt end of such inequalities in their multi-faceted forms, I concur that neo-liberal constructs are fully prevalant in the structural sell off through commodification. I also see them as being present through the neo-liberal encroachment into self-management and normalisation which goes with them such as seen in Mental Health. This is in which the “drowning” are ignored from view, by a metaphorical set of blinkers caused by a shield of knowingly held “false optimism”. Now I dont mind optimism, but this neo-liberal tranche is set in the smoothing of the rough sides of oppression and denying stories and narrative to articulate such inequalities unless conducted by further centralised commodification. The lack of fight which is articulated, is based on people turning a blind eye. This is by the creation of a homogenised culture of normalisation to individual stories and using a simplistic reckoner which is set in label popularity and the othering label of the “cynic” or the “pessimist” to awkward narratives. It can also be seen in how the role of the sociologist has become for some on certain portals of media, a status tool, which is an indicator of the challenges ahead. (#sociologicaldesk anyone :))

    To myself, who utilises many sides of health and social care, there has become a regulation of the role of “critical friend” through othering and an expedient need for “spiritual progress”. Indeed, the life course is important and of course, material assets to impact on positive change in health and social inequalities, but to the neo-liberal evangelical masquerade of “progress” the need for these is seen as base. This is ironic as such quasi-mystical pontification only seems to be offered by those in search of status and symbiotic economic relationships while offering the comforting trinkets of the “greater good” to the disenfranchised. I am sorry to go on, within your blog and thank you for highlighting a salient concept which underpins the tyranny permeating within health inequalities which never seems to dissipate.

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