By Ted Schrecker and Clare Bambra, authors of How Politics Makes Us Sick: Neoliberal Epidemics

In the United States (US) city of Chicago, one of the most segregated cities in the country, life expectancy before the pandemic varied by about 30 years based on location. The areas with lowest life expectancy mapped closely onto concentrations of poverty and African-American residents. In the small United Kingdom (UK) local authority of Stockton-on-Tees, described by the British Broadcasting Corporation (BBC) as ‘England’s most unequal town’, the difference in male life expectancy between wards was 16.7 years for men, and 18.5 years for women – roughly comparable to the difference in national average life expectancy between England and Tanzania. Here again, areas with low life expectancy closely corresponded to areas with high economic deprivation (Figure 1).

In the expanded and updated second edition of How Politics Makes Us Sick, we identify such differences as the outcomes of multiple “neoliberal epidemics” of inequality, insecurity, austerity, and commercial promotion of unhealthy products. An extreme example: we begin our chapter on insecurity with the story of a young New Jersey woman who went to sleep in her car in 2014 and never woke up. She often slept in the car between her three low-wage jobs, and kept a can of gasoline in the car because she was worried about running out of fuel. The can accidentally tipped over and the vapours from spilled fuel ended her life.

These are epidemics because their consequences have spread so rapidly that they would be considered epidemics by any responsible scientist if they involved an identifiable infectious agent. They are neoliberal because they share origins in a distinctive way of thinking about the world: neoliberalism. The US and the UK are the big, rich countries that have travelled farthest down the neoliberal road, and they are the two case studies we concentrate on in the book, although we also use comparative data on other countries, especially those that have rejected at least some aspects of neoliberalism.

Especially for people in North America, the term neoliberalism can be confusing because “liberal” is a word often identified with relatively progressive and compassionate social and economic policies. It even sounds a bit cuddly. But neoliberalism describes a remarkably consistent and ruthless set of perspectives about how the world works, and how it ought to work (Figure 2). Those perspectives date back at least to the establishment of an organization called the Mont Pèlerin Society shortly after the Second World War, and in the book we trace the well-financed promotion of these perspectives through such milestones as the election of Margaret Thatcher’s Conservatives in the United Kingdom in 1979 and Ronald Reagan to the US presidency in 1980. To the point where by the 1990s, as historian Gary Gerstle wrote in 2022, “neoliberalism had become dominant, its advocates compelling all political players to work within its ideological matrix”.

There are many social science publications on all these points. What is distinctive about our book is that we connect the economic and social impacts of neoliberalism with research evidence on how the consequences of neoliberalism make many people sick and shortens their lives, by way of the social determinants of health: the conditions in which people are born, grow up, live, work, and grow old. That body of evidence has expanded dramatically since the first edition of our book appeared in 2015, and since the COVID-19 pandemic swept across the world, revealing a pattern of what one historian has called “necrostratification”. The literature includes research on such topics as the physiology of stress; the effects of increased economic insecurity and outright destitution; and the effects of austerity not only on social protection but also on health care systems like Britain’s National Health Service. In the US, economic inequality and insecurity have always played a pivotal role in how much health care, and what quality of health care, people can access. All these situations and many others we describe in the book can be traced to political choices that could have been made differently, and in many cases – especially in European social democratic countries – have been, despite the global diffusion of neoliberalism.

How does our focus on neoliberalism fit with the disruptions that Donald Trump’s second presidency has already caused? In one key respect, his obsession with protectionist tariffs, his policies represent a clear break with decades of neoliberal consensus, more or less across the political spectrum, in favour of lowering barriers to international trade. In all other respects, the Trump administration has followed the neoliberal playbook: dismantling regulatory agencies that protect public health and safety; removing obstacles to the influence of raw financial power in politics; and reducing taxes on the ultra-rich while intensifying a decades-long pattern of redistributing income, wealth and opportunity upward. All of this is likely to leave many Americans, perhaps most Americans, poorer, sicker, and more insecure. A similar if less drastic pattern appears to be unfolding in the UK, as a second wave of austerity follows the destructive one that began in 2010, with the global financial crisis as pretext.

There are political cures. They involve thinking about taxes (notably including wealth taxes) as a way of making resources available to equalize people’s chances to lead healthy lives, recognizing that it is possible to do more, for more people (in technical terms, the state has greater fiscal capacity), with a Norwegian or French ratio of tax revenue to GDP (44-46 percent) than with a US one (28 percent). The cures mean rejecting the idea that regulation and public spending are inherently suspect – considering government and its available policy instruments not as enemies, but as enablers, as in President Franklin Roosevelt’s New Deal. In these times, the road back from neoliberalism will not be easy, but the journey is not impossible.

Ted Schrecker is Emeritus Professor of Global Health Policy at Newcastle University (United Kingdom). He is a Canadian political scientist who worked in the UK for ten years before returning to Canada in retirement.

Clare Bambra is Professor of Public Health at Newcastle University (United Kingdom). Her research examines health inequalities.