Neoliberalism: a sick obsession

Does free-market capitalism foster an environment in which death and disease flourish? That is the question asked by academics Ted Schrecker and Clare Bambra in How Politics Makes Us Sick: Neoliberal Epidemics. In this strident little tome, they argue that the infectious diseases of the Victorian age – which they claim, in a characteristically ahistorical aside, were stamped out thanks to ‘organised resistance by labour, via trade unions’ – are being replaced by an epidemic of non-communicable diseases, such as cancer and heart disease, as a result of ‘neoliberal’ policies. They argue that things are worst in Britain and the US where neoliberalism supposedly burns most brightly, whereas life is better, though far from perfect, in the Nordic countries because they all have a ‘strongly interventionist state’.

Schrecker and Bambra focus on four ‘neoliberal epidemics’ – obesity, insecurity, austerity and inequality – which they portray as the latter-day equivalents of cholera and tuberculosis. Strikingly, none of these ‘epidemics’ are diseases in a medical sense. Obesity and stress are risk factors for disease; inequality is an economic variable; and ‘austerity’ is a hyperbolic term for balancing the budget through fiscal restraint. It is also notable that all of these issues predate ‘neoliberalism’ by many years and can be found in countries that have a considerably more dirigiste economy than the UK.

There is a simple explanation for why cancer and heart disease have become the leading causes of death in rich countries. When there are only two classes of disease, communicable and non-communicable, eradication of the communicable leaves only the non-communicable. Since the concept of a natural death has been defined out of existence, it is inevitable that more people die from non-communicable diseases, albeit usually at an advanced age. It is a trend that should be welcomed.

Schrecker and Bambra concede that these diseases are not confined to market economies, but they claim that ‘the changes associated with neoliberalism increase our susceptibility’ to them. But if ‘neoliberalism is returning us to an environment in which (chronic) disease can flourish’, as Schrecker and Bambra claim, it is not readily apparent from the mortality statistics. Life expectancy continues to rise and it has risen more rapidly in Britain since 1980 than it did in what Schrecker and Bambra call the ‘“golden age” of welfare-state capitalism’, which is to say the postwar era dominated by ‘centralism, universalism and Keynesian economics’. They show a table of life-expectancy figures in the rich world and note that Sweden and Norway perform quite well, but gloss over the fact that the like-minded social democracies of Denmark and Finland are at the bottom of the list, propped up only by the US. Switzerland and Australia, both of which have lower rates of public spending than Britain, outperform them all.

While Schrecker and Bambra do not deny that life expectancy has been rising, they argue that the poor are being left behind, leading to growing health inequalities. Rich people have always tended to live longer than poor people for a variety of reasons, but the reader would have to look beyond the partial evidence provided in How Politics Makes Us Sick to discover that premature mortality from cancer and heart disease has been declining more rapidly in poor districts than in rich districts. Life expectancy for Scottish men has increased by 3.8 years for the poorest and wealthiest quintiles alike in the past 15 years and gains in healthy life expectancy have been much greater among the poor than among the rich. Facts of this kind are conspicuous by their absence in How Politics Makes Us Sick, leaving the reader with the impression that both the incomes and the wellbeing of the poor are in free fall, not only in comparison with the rich, but in absolute terms.

Lacking a clear correlation between economic policy and life expectancy, the authors focus on obesity, presumably because it is relatively common in the US and Britain. They blame neoliberalism’s underregulation of food companies (or ‘corporate disease vectors’ as they call them) and stress-related overeating for people getting fat. In truth, there is little meaningful difference in food regulation between countries, particularly within the EU, that could explain differences in diet, and there are a number of problems with the hypothesis that unsatisfying work, unemployment and job insecurity cause stress that leads people to eat more. Aside from the fact that stress and anxiety can only be measured by subjective self-reporting, the survey evidence shows that the rise in anxiety began long before ‘neoliberalism’ was introduced, as the authors of The Spirit Level conceded when they made a similar argument in 2009. Schrecker and Bambra find somewhat more objective evidence in statistics for antidepressant use, but it is left to the reader to spot that all the Scandinavian countries medicate themselves with these drugs at an above-average rate, with Iceland having the highest prevalence of all. Despite this, Schrecker and Bambra make the bald assertion that ‘prevalence of stress is significantly higher in the most neoliberal countries and lower in the least, as the workplace is more regulated’.

Although it is far from obvious that neoliberal countries have more unemployment than more centralised economies (the US certainly does not), it is plausible that there is more job insecurity, and therefore stress, in a fast-moving modern labour market. Schrecker and Bambra argue that work in the service industry is inherently more stressful than in the manufacturing industries of old, but this requires a rose-tinted view of jobs in factories and coal mines (the loss of which they lament). It may be true that working on an assembly line in a unionised industry induces little anxiety about losing one’s job. It may also be true that a world of wider horizons leads to less boredom and ennui but more stress and status anxiety. This is not necessarily a reason to favour the coal mine over the office.

A more plausible explanation for the rise of obesity, which the authors only hint at, is that free markets promote wealth, office jobs and car ownership. If so, obesity is an unintended consequence of economic prosperity, which would explain why it is less common under centralised economies. As the door closed on hunger, the door to obesity was opened. Obesity may or may not be a serious problem, but it is part of a trade-off between abundance and want. It is not confined to ‘neoliberal’ European economies. It can be seen wherever poverty is on the decline, including China and the Middle East.

By any objective criteria, the problems of the present pale into insignificance when held up against the problems of the past. Schrecker and Bambra go to great lengths to romanticise the postwar era while painting an unremittingly bleak picture of the present day. There is almost no acknowledgement of any progress in material living standards, health and prosperity. Instead the authors cling to a theory of immiseration that flies in the face of observed reality. People are too poor to be able to afford a healthy diet, they claim, and so obesity has risen sharply since the glory days of the 1970s. This would be plausible if incomes had fallen in that time, as Schrecker and Bambra claim, but even among the poorest groups, incomes have doubled.

Such errors and misrepresentations abound. Some are conceptual, such as their assumption that cost-saving by businesses leads to higher profits rather than lower prices. Others are factual, such as the claim that austerity has not reduced the deficit. But it is the evidence that is omitted that is most telling. For example, anyone who is familiar with Britain’s social-mobility literature knows that there is one dataset suggesting that fluidity has declined in recent decades while all the other evidence shows either an improvement or no change. Schrecker and Bambra cite the former, ignore the latter, and tell the reader that ‘social mobility has declined since 1980’.

Similarly, only a reader who knows that the gap between rich and poor has been flat or falling in Britain for the past 25 years would understand why Schrecker and Bambra’s claims about the ‘growth in inequality’ focus almost exclusively on the US. On this topic, Schrecker and Bambra rely heavily on The Spirit Level but fail to mention any of the abundant evidence to the contrary – and there is no discussion of the academic controversy surrounding the inequality-health hypothesis. To the unwary reader, it is settled science.

Schrecker and Bambra note that poverty is defined as a ‘household income below 60 per cent of the median’. Under this measure, poverty has declined in both the short-term (since the 2008 crash) and in the long-term. This evidence does not immediately support a narrative of brutal immiseration, and so Schrecker and Bambra ignore it in favour of survey-based research from a pressure group and claim that poverty rates ‘have risen substantially during austerity’, and are now ‘at their highest level for 30 years’. When they finally acknowledge the official data, they tie themselves in knots, first claiming that child poverty is at a 30-year high, then stating that ‘1.1million children were lifted out of poverty’ between 1998 and 2012.

In the final analysis, the problems that Schrecker and Bambra discuss are too trivial to be mentioned in the same breath as tuberculosis and malaria. Their claims about free markets causing obesity and stress are unconvincing, but even if they were more persuasive it would require a damnable lack of perspective to equate a society in which people die from hunger and infection to one in which people are comfortable, rich and free enough to become fat. In a world in which workers manifestly have more to lose than their chains, Schrecker and Bambra turn molehills into mountains in their attempt to convince the reader that wealthy nations are sliding into the abyss.

How Politics Makes Us Sick ends, as all such books do, with a political call to arms. But this amounts to little more than a strangely anti-climactic plea for greater public spending. Schrecker and Bambra say they want ‘to replicate the politics of the postwar settlement’, but there is no spirit of 1945, no white heat of technology, no New Jerusalem. The Marxist dream of liberating the workers is replaced by a dreary appetite for lifestyle regulation and bureaucratic expansion. Schrecker and Bambra make the unsettling recommendation that governments should ‘start by rejecting the neoliberal rhetoric of individual responsibility’, but the best they can offer in its place is a ‘reinvigorated welfare state’, more powers for trade unions and a vague aspiration for ‘democratic renewal’.

Obsessed with the alleged evils of neoliberalism, Schrecker and Bambra display remarkably little curiosity as to why the postwar settlement was swept away by so many electorates in the first place. They ignore the problems associated with powerful trade unions, nationalised industries, endemic borrowing and protectionism. They explicitly pine for the policy of full employment to be reintroduced without acknowledging that it rarely led to full employment in practice and without asking how such an aspiration could be realised in a modern global economy. There is no discussion of how much their proposals would cost, where the money would come from or what the benefits would be, even to people’s health – which is ostensibly the subject of the book. Essentially, their manifesto boils down to making out-of-work benefits more generous, but it is far from clear that this would reduce obesity, unemployment or stress.

Like The Spirit Level, How Politics Makes Us Sick attempts to harness the language of ‘public health’ for political ends. Unlike The Spirit Level, it makes little attempt to convert those who do not already believe that Britain is a Thatcherite hellhole in which all but the most privileged live off food banks and zero-hour contracts. Its cheerless tone and high price (£20 for 127 pages of text) mean that it is unlikely to reach out beyond the ghetto of left-wing sociology.

Christopher Snowdon is director of lifestyle economics at the Institute of Economic Affairs.

How Politics Makes Us Sick: Neoliberal Epidemics, by Ted Schrecker and Clare Bambra, is published by Palgrave MacMillan. (Order this book from Amazon(UK).)