On Identity Politics, Poor Governance and Health Inequities

Neoliberals reject actions of the New Dealers to apply their brand of Keynesian, interventionist political economy. In a regime faithful to neoliberal tenants, governance must be carried out within the constraints of the doctrine of limited government and self-regulating markets. This type of management shifts the locus of power away from citizens and their representatives towards those with capital. Governments adopt the neoliberal governance model creating the mechanism of a free market for decision making-processes. This returns to the past to place power in the hands of the bourgeoisie, today recognized as the economic elite – a group who has capital to invest and whose goal is to accumulate more. With the increasing economic gap and reduced social mobility, progressives now focus on the exploitation created by the neoliberal policies of minimal government and regulation. In return, discrimination (reverse racism) has become part of the neoliberal narrative of inequality. Identity politics have become an issue.

The adoption of the neoliberal governance model allows the introduction of the concept of stakeholder. Now a government mandated by the people is reduced to one actor in the decision-making process, rather than the essential dominant decider. Instead of seeing their role as representing the public interest, and protecting that interest by imposing limits on the power of the private actors, this definition of governance puts the government on equal footing with other actors. Instead of being subject to limits imposed by government, private factions then become negotiating partners. There is no longer a role for the government as an advocate for the general interest; instead government is seen as one actor representing a competing interest with other legitimate actors. The public interest is assumed to be met by reaching ‘agreements’ with the various actors. Under the neoliberal era, this concept of governance has contributed to putting decision-making power back into the hands of those who possess capital, and limiting the influence of government and their regulatory agencies.

Private money plays an important role in US politics since the 2010 Supreme Court ruling removed virtually all limits corporations and non-profit groups can spend on federal elections, and how much individuals can give to political action groups. Neoliberal activity has blown the social contract apart. The consequence is intense anxiety from increased economic insecurity that distracts a worrisome percentage of people. What makes our society unstable is when the illusions around income inequality start to disappear. People can or are more willing to overlook income inequality as long as their quality of life remains unchanged. As long as the greediness of the neoliberals does not affect their day to day life – your retirement is funded, you can afford to take vacations – you are willing to look away while the economic elite are doing their thing. However, this ultimately becomes the problem, enough is not really enough for certain rich individuals. Unless there are checks and balances, the economic elite keep working the system until it breaks down.1

When introducing electoral reforms to the British Parliament in 1831, the prime minister, Earl Grey said, “There is no-one more decided against annual parliaments, universal suffrage, and the ballot, than I … I am reforming to preserve, not to overthrow.” The reforms that extended political power from a narrow elite to larger sections of society were immediately viewed as a success not because of some ideal of enlightenment or democracy, rather because the threat of revolution or further unrest was avoided. John Stuart Mill (1806-1873), was one of the greatest 19th century British philosophers, whose ethical theory was to justify the utilitarian principle as the foundation of morals. Mill’s observations on utilitarianism: “Actions are right in the proportions as they tend to promote happiness, wrong as they tend to produce the reverse of happiness.” Dissatisfied with both socialism and capitalism, Mill envisioned a hybrid system in order to promote the individualism of the worker. He was fully aware of the harms wrought by the capitalist system of the late 19th century and notes the system is failing to produce widespread happiness – too many hard-working individuals are unfairly consigned to poverty. Mill’s conclusion: there is no good reason – there is no natural and therefore immutable reason – to live with the consequences of economic laws if we do not like the effects of these laws.2

What about today’s economic governance? Thomas Piketty observes capitalism in the 21st century has concentrated so much wealth in the hands of so few, while the millions left behind are now angry at the system. The middle class society that flourished for a generation after World War II has vanished. After 1980 the lion’s share of economic gains went to the top end of the income distribution, with families in the bottom half lagging behind. Today the economy is not controlled by talented individuals, rather by family dynasties. Piketty’s argument is that in an economy where the rate of return on capital outstrips the rate of growth, inherited wealth will always grow faster than earned wealth. Economic neoliberalism creates levels of inequality that for all intensive purposes is not reversible by itself. Piketty concludes the level of inequality in the US is ‘probably higher than in any other society in the past, anywhere in the world.’

During the primaries, Senator Bernie Sanders was able to tap into the anger of voters – and was able to make income inequality an issue for a reason. Now there is a permanent income inequality plank in the Democratic Party progressive agenda. Republicans have effectively turned identity politics against Democrats with such language as ‘thought police’ and ‘politically correct’. Many believe the Democrats lost the 2016 election because of identity politics – catering to cultural or social interests of groups such as gays, Muslims, blacks and transgender populations. Basically because the Democratic Party embraced racial, religious and sexual minorities, they were abandoned by a significant segment of working-class white people. Remember John Stuart Mill claimed there should be opportunities for individual fulfillment for all members of society. It is not racism that creates differences between classes; it is capitalism. Instead of a more complicated understanding of identity (race, sex), we need a more profound understanding of exploitation.

In the 19th century Bentham recognized the exploitive character of the capitalist relationship. Inequality and inequity are not interchangeable. Inequity is unfair, avoidable differences arising from poor governance, corruption, or cultural exclusion. It is the result of human failure giving rise to avoidable deaths and disease. It is necessary to focus on the economy with its multifaceted connections to social issues. Inequities reduce the freedom and opportunities for an individual to reach their full potential in general, and wellness or good health, in particular. Inequity is the biggest factor affecting the health of the population. Health equity suggests that everyone can reach their full health potential and that they should not be disadvantaged from attaining this potential as a result of their class, socioeconomic status or other socially determined circumstance. The present economic situation is associated with an increasing inequity and poverty in Canada and the US.

Neoliberalism casts inequality as virtuous – as everyone gets what they deserve. Many now believe it is not enough to define poverty as not having enough material resources to merely survive, but rather having enough resources to participate in society in a meaningful way. Peter Townsend’s definition of poverty: people are deprived if they cannot obtain at all, or sufficiently the conditions of life – diets, amenities, standards and services – which allow them to play the roles, participate in relationships and follow the customary behavior which is expected of them by virtue of their membership in society. The consequences of the lack of participation are disengagement from school, community and political affairs. The stress that comes from the inequality of our society, and in particular from economic inequality, may have more effect on our health than any other single factor.

The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries. Poverty is a key factor underlying whether these determinants of health can be obtained. Social inequity is unfair, avoidable, differences arising from poor governance, corruption, or cultural exclusion. With the increasing income gap, many have lost their previous opportunity to achieve their potential – inequities potentially leave the most vulnerable at sustained risk and disadvantage.

Progressives must avoid identity politics in public messaging. This is why it is necessary to focus messaging on poor governance and health inequities associated with neoliberal policies. Health inequities are differences in health status between population groups that are socially produced, and systematic in their unequal distribution across the population, but avoidable and unfair. Living in a society that tolerates large gaps between the rich and the poor is bad for your health. There is a strong and widespread consensus that income and social status are the most important determinants of health across populations. Neoliberal governance is not an innovative and efficient management technique, rather a means to impose unpopular decisions related to the dismantling of New Deal reforms, and to conceal the return of decision-making power to the economic elites. The new system must make economic and environment decisions through the lens of the social determinants of health in order to counter the inequity in the system.

1 Ives, Andrew. Neoliberalism and the concept of governance: Renewing with an older liberal tradition to legitimate the power of capital. (2015) https://mimmoc.revues.org/2263

2 Lenard, Patti. (04 Aug 2016) John Stuart Mill and the importance of individuality. http://www.policy-network.net/pno_detail.aspx?ID=6124&title=John-Stuart-Mill-and-the-importance-of-individuality

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