Palgrave Macmillan Author Perspectives

​Clare Bambra is Professor of Public Health Geography and Director of the Centre for Health and Inequalities Research, Durham University, UK. Her research focuses on the effects of labour markets, health and welfare systems on health inequalities.  Ted Schrecker is Professor of Global Health Policy at Durham University, UK. He previously taught environmental studies, political science and population health, and worked as a legislative researcher and consultant for many years. We spoke to them about their new book How Politics Makes Us Sick...

In your new book, How Politics Makes Us Sick, you posit that austerity is bad for our health and recent articles in the press have argued that it doesn’t help economically either. Why do you think austerity is instituted as policy?

The Thatcherite dictum that ‘there is no alternative’ still has a powerful hold on our political consciousness. As feminist historian Donna Haraway said 20 years ago, ‘we are losing effective social imaginaries’. And we must remember that austerity is highly selective; it seldom touches the privileged, while – at least in the UK – their taxes have actually been cut.

In your book you argue that the social and health inequalities that were in decline not so long ago are now on the rise on a global scale – what do you think accounts for this?

There are many reasons. One is the lack of effective social imaginaries – a vision of what a fairer, less predatory society would actually look like. More pessimistically, in some countries a critical mass of people – a decisive political plurality – have become wealthy enough that they see it in their interests to opt out of most forms of collective social provision. Robert Reich, a Cabinet secretary in the Clinton administration, described this in 1991 as ‘the secession of the successful’.

You argue that increasing equality will improve public health – what policies could be implemented to reverse the damage done to social inequality over the past few decades?

We have to start by thinking of public finance as a public health issue. Ensuring that everyone has access to key social determinants of health requires that governments have a certain level of fiscal capacity, and that is now under threat in the UK. In the words of a recent Canadian book on this topic, Tax is Not a Four Letter Word. Beyond that, governments have to apply the first axiom of medical practice – ‘First, do no harm’ – to their entire range of economic and social policies. Many of today’s policies fail that test.

In 2013, Sir Michael Marmot described British social policy as a ‘grotesque parody of fairness’ – do you agree?

Absolutely! And if anything, things have got worse since Sir Michael used those words at the annual meeting of the American Public Health Association. Trying to reduce the deficit on the backs of the working class and the poor is bloodletting passed off as responsible public policy. After the recent elections, we dread the body count from the next five years of neoliberal policies.