Thanks to Luke Slawomirski, a health economist and former healthcare practitioner now working in health policy development, for the review below, in which he says that one of the book’s strengths is that it moves beyond diagnosis, offering some solutions to global economic and health imbalances.
Investigating the distribution of power and health: a book review
“There is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than a new system. For the initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders in those who gain by the new ones.”
– Niccolo Machiavelli
Luke Slawomirski writes:
So much for the end of history. In the two decades since the end of the cold war, more people have died from hunger or disease than have perished from wars and government repression over the entire 20th century.
Even more continue to face poor health and living conditions. Fifteen per cent of the US, the wealthiest nation, lives in poverty.
The global emancipation by the victorious political and economic doctrine has not eventuated. Gavin Mooney’s The Health of Nations: towards a new political economy examines why.
The Health of Nations is about power. Political economy is the ideal framework because power, so fundamental in determining the prospects of people and populations, is its central concern.
Mooney’s central argument is simple: there is an unprecedented inequality in power, both within and between nations. It is this inequality in power, baked into national and international institutions, that drives the world’s problems of poverty and poor health and premature death.
Mooney illustrates by describing the key global organisations, the IMF, WTO, World Bank and the WHO. It becomes clear that the rules governing the very institutions designed to address global poverty and promote development are skewed in favour of wealthy developed countries at the expense of the rest.
Mooney also examines several national and local case studies demonstrating how, despite an absence of material wealth, good health and well being can be achieved with political will and leadership. Contrasts between Cuba, Venezuela and their wealthy neighbour, the USA, are particularly striking.
While these states use various methods to achieve good outcomes, they all instituted ways of distributing power evenly throughout and among communities. In nations where public health is in decline, mechanisms to empower communities are absent. South Africa, where poverty and health are now worse than during apartheid, is a poignant example.
For the failures Mooney squarely blames neoliberalism. Definitions of neoliberalism vary. It’s more or less a type market fundamentalism based on individual self-interest, corporate power, and minimal government regulation (NB it’s a term this reviewer doesn’t favour).
Available evidence overwhelmingly indicates that social and economic policies based on this doctrine tend to accentuate inequality. The literature on public health tells us that inequality is the pivotal factor in population health.
The book rightly focuses on health in developing nations, but western countries are also affected.
I pondered the situation in Australia, where despite enviable economic indicators there is growing unease within the community – a source of much head scratching by commentators.
What’s not often recognised is that while incomes and quality of life have been rising here for two decades, so has inequality. This puts a strain on community cohesion, and we know that this affects well being.
Another key insight the book enabled is that power and wealth are not the same thing. The key reason (there are many) is that power is as much an end in itself as it is a means. While I may be wealthy, do I have power? Am I in control? In a similar sense, Mooney’s arguments capture with the underlying lament of the Occupy movement.
One of the book’s strengths is that it offers solutions. Mooney calls for Citizens’ Juries to set basic policy principles and community preferences; a very practical application of Habermasian democracy.
His suggestion to tax alcohol and fast food companies based on their advertising and marketing spend (not on profits) is elegant. It addresses supply and doesn’t punish consumers at the price point.
The book is definitely polemical. Mooney is clearly passionate. At times this spills over into emotive language (a second edition may wish to tone it down just a fraction in places).
Mooney’s views on capitalism seem a touch extreme at times. A tempered interpretation might say that markets are good servants but appalling masters. In any case, given the current state of the global economy, there is little ground for arguing with that.
Although Mooney is hard, he is fair. He defends ‘big pharma’ on the grounds that companies simply do what is legally required of them: maximise profits. There is no point blaming firms when the system is at fault (however, he does devote a section to examining the ‘capture’ of governments and corporations by big corporations).
Thankfully there’s a distinct absence of loftiness, sneering or elitism. The book is very accessible and suitable for a broad audience.
The Health of Nations (a nice play on words) provides unique opportunity to see the links between economics and health. Given the primacy of health, both intrinsically (a basic right) and in its instrumental effect on shaping our affairs, it is an important and timely work.
Current approaches that divide the world in terms of winners and losers simply cannot alleviate poverty and poor health. Mooney provides a new, urgently needed Weltanschauung and in the process vigorously challenges the status quo.
There will be criticism, possibly personal attack. Machiavelli, the father of western realpolitik warned that change will always resisted. Perhaps ironically, Mooney and others can draw some encouragement from that.
• Luke Slawomirski currently works in healthcare policy development. He was previously a healthcare practitioner in Australia and overseas.
Gavin Mooney. The Health of Nations: towards a new political economy Zed books, London & New York. 2012; ISBN 978 1 78032 059 5 pb; RRP 34.95