Social mobility for the Rich

Fact of the Day:

“In the UK, the poor stay poor and the rich stay rich”.

It seems to be the case that the greater levels of inequality there is in a country correlates with lower levels of upward mobility.

So choose your parents very carefully.

If your mum has not got a pot to piss in, then choose another one. Choose a Mum that is, not a pot. Preferably one like Lady Mary on Downton Abbey. She is a good choice, especially if you like repressed emotions and pent up sexuality with your cash. Why you should be looking for pent up sexuality in a mother is another issue and one that Freud would have a field day with, you dirty little b*gger. You could of course go for Kate Middleton//Saxe-Coburg Gotha-don’t mention the war-Windsor. Trouble is I think she has done with sprog sprouting for the moment and would welcome your advances to be offspring as she would a dose of syphilis.

If this strategy does not work try getting yourself adopted by some other posh bird. Try hanging around in Kensington and Chelsea looking suitably adorable and cuddley (don’t puke down your babygro and make sure you cover up the piss stains). Try burbling the baby equivalent of ‘Yah daarling’ and drink fizz out of your bottle. Do not wear a football shirt. There is nothing guaranteed to invoke disdain more quickly in the upper classes than a baby oik in West Ham colours.

Avoid certain areas of the country to be born in. Access the Community health profiles ( and do a bit of research to find the area with the highest income decile and lowest social deprivation index. Then get born there. You’ve got be smart these days to join in with the Eton and Harrow crowd. Redruth is of course right out, You’d be better off being born in a manger than in Drump Road.

According to Oxford University, there is social mobility except it is downward. So all you middle class types had better watch out, you and your sprogs could slip down the ladder quicker than a fireman with sh*t on his boots.

“the chances of a child with a higher professional or managerial father ending up in a similar position, rather than in a wage-earning working-class position, are up to 20 times greater than these same chances for a child with a working-class father”.

So choose your dad as well, or get your mum to sh*g a doctor.…/2014-11-06-study-shows-more-us-are-he……

Royalty and the 1%

Fact of the day.


The money taken by the top 1% of earners in the UK each year could be spent instead on 1,100 royal families.

(from Danny Dorling’s Inequality and the 1%).


Just think, we could have over 1000 Charles, Lizzies, Phils and the other ones with the funny haircuts and strange habits. Hundreds of lazy, imperialist and sexist commentators flooding our media with un asked for opinions on the ‘fuzzy wuzzies’, fashion and cake. The Daily Express would have a fit for not knowing which princess to pine for next. As a bonus we could piss off the Australians by sending a royal visitor every day to remind them the Mother Country still has cultural superiority. The Scots tourist industry would get a boost – all those Balmorals for US tourists to drool over. We could charge them to meet a royal in person! We would have to raze Glasgow to the ground in order to provide more grouse moor for the royal shoots. Christ, it would sound like the bloody Somme up there come June.


This is based on the cost of the current incumbents – the saxe-cobourgs, don’t mention the war, aka ‘Windsor’ – being £100,000,000 per year. This figure is hallway between what royalists and republicans think they actually cost. The top 1% of earners in the UK trouser £100 billion, or if you prefer £100,000,000,000. Per annum. I say ‘trouser’ because the majority of the top 1% are men, white, over 55. Those trousers will be worn most often by financiers and bankers and if not Savile Row pin striped will be as expensive as a two week all inclusive holiday in the Maldives or a weekend overlooking the doom bar in Rock.


Alternatively, we could stick with just the one royal family, and let the 1% keep that £100,000,000,000 per year. Oh, sorry, we already do because paying tax is for the ‘little people‘ (that’s you and me).


The next time you wait for a GP appointment, face a rent rise, wonder at the huge class sizes and stressed teachers your kids endure, top up your adult teenager at university, watch your pay shrink and pension disappear (if you have one), and pay some of the highest rail fares in Europe, just bask in the glow that the 1% simply don’t give a f*ck.

The health promotion role of the nurse in response to climate change and Ecological Public Health

“NOTICE: this is the author’s version of a work that was accepted for publication in Nursing Standard. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version will be published in Nursing Standard Accepted 6th November 2014




Nurses have a history of engaging in health promotion and public health and both roles are reflected in the Nursing and Midwifery standards for education. However, future trends such as population growth, new technologies and climate change, suggest that their current understanding of these trends need to develop to adapt to a very different future. This paper argues that nurses need to quickly move beyond adopting individualistic and behaviour changing perspectives (Kemppainen, Tossavainen and Turunen (2012), to that of also adopting an ethico-socio-political role (Falk-Raphael 2006) in health promotion based on a wider understanding of what health promotion may mean. This paper reflects on climate change, an outline of the concept of ecological public health, and Kemppainen, Tossavainen and Turunen’s (2012) integrative review on the nurses’ role in health promotion to support this argument.


Climate Change

Despite the requirement to curb greenhouse gas emissions to prevent catastrophic climate change (Costello et al 2009, Roberts and Stott 2011, McCoy 2014) the world is experiencing a continuing rise in anthropogenic greenhouse gases (IPCC 2014). This emissions growth is expected to persist, driven by population growth and economic activity. This will result in global mean surface temperatures of 3.7o C to 4.8o C by 2100 if there is no further mitigation (IPCC 2014).  This is way beyond the 2o C ‘safety’ threshold (Peters et al 2013, McCoy et al 2014, Marshall 2014), a threshold beyond which there may not be a ‘safe operating space for humanity’ (Rockström et al 2009).

McKie (2014) suggests that global evidence supports the assertion that climate change is already happening, resulting in severe floods, permafrost melts, rising sea levels and lack of snow in the Alps. He states:  “In its latest report, the Intergovernmental Panel on Climate Change estimates that up to 139 million people could face food shortages at least once a decade by 2070”. According to Marshall (2014) we will routinely experience heat waves and extinctions; the feeding of 10 billion people becomes more difficult; the loss of glaciers and ice sheets will result in two-thirds of our major cities under water; and ocean acidification will be adversely affecting the ecosystem over two-thirds of its surface.

According to Climate Central (2014), the risk of record flooding in Washington DC this century is virtually guaranteed. This is a backdrop to thoughts about where it will be better, and safer, to move to in the United States. Alaska, the Mid West and the Pacific North West will fare much better than California and the South East when, according to Mora et al (2014) unprecedented high temperatures could become the norm by 2047. Mora et al go on to argue that Washington DC will reach its tipping point in 2047; Los Angeles, 2048; San Francisco, 2049 and Chicago, 2052. Detroit has until 2051, and Anchorage, 2071.

In other words, some scientists have accepted that temperature and sea level rises will severely impact on cities in the next few decades, requiring major adaptation responses around population migration, land and flood defences and major structural changes in economics and society. This is in accord with the National Climate Assessment (2014) third report which outlines the rises in temperatures and makes it clear we are talking in decades not centuries for the changes to impact.

The health impacts of climate change have been documented elsewhere (WHO 2014a) and is partly based on the social and environmental determinants of health (Barton and Grant 2006, WHO 2008). Barna et al (2012) have also set out what nurses need to know about climate change but the urgency of addressing this issue is increasing, as the National Health Service Sustainability Unit outlines in its ‘Fit for the Future Scenarios 2030 (NHS SDU 2014). All of this this leads us to consider what the health promotion role of the nurse might be in relation to this context.


Ecological and Planetary Public Health.

Horton et al (2014) call for a new social movement in their ‘manifesto from public to planetary health’ to support collective action on Public Health. They introduce the concept of ‘planetary’, rather than just public health.  As with Lang and Rayner’s (2012) discussion of Ecological public health, there is a strong focus on the unsustainability of current consumption and linking this with poorer health outcomes. It implicitly draws upon Barton and Grant’s (2006) health map which has climate stability in its outer ring. Interestingly, an overt political statement is introduced in the ‘manifesto’:

“We have created an unjust global economic system that favours a small wealthy elite over the many who have so little”.

The call is for an urgent transformation in values and practices based on recognizing our interdependence and interconnectedness on a finite planet, and a new vision of democratic action and cooperation.  A principle of ‘planetism’ is invoked which requires us to conserve and sustain ecosystems upon which we rely. Finally, they suggest that public health and medicine can be independent voices of conscience who, along with ’empowered communities’, can confront entrenched interests.

In the same vein, Ottersen et al (2014) are explicitly political on the links between health inequity, globalisation and the current system of global governance, including the actions of ‘powerful global actors’. The tone of the report makes it quite clear that there is a need to address global governance and an analysis of power. This would put the fossil fuel industry clearly in sight as a major contributor to carbon emissions and therefore as a direct threat to Public Health.

Ecological Public Health (Lang and Rayner 2012) might be, they suggest,  the 21st century’s ‘big idea’. Lang and Rayner point out that public health proponents, and by implication public health nurses, have allowed themselves to be positioned within the language of individualism and choice. This leads of course to behaviour change models and theories of rational action. However, their view is that public health is about the bigger social (and political) picture that might threaten vested interests, e.g. of the fossil fuel lobby. They review public health developments over the decades and suggest a rethink is in order. They outline 4 current models of public health but suggest that they are anthropocentric, meaning that the health of the living, natural and physical world – ecosystems health – is marginalised. Climate change challenges those models as it is fundamentally about ecosystem damage and the concomitant threats to health on a global scale. Ecological Public Health (EPH) focuses on interactions, one strand on the biological world, e.g. biodiversity, and one on the material issues such as industrial pollution, including carbon emissions as pollution, energy use and toxicity. This is based on systems thinking and complexity in understanding health. EPH has four dimensions – the material, biological, cultural and social. This takes us way beyond simplistic behaviour change models which cannot deal with socio-political contexts.

“Telling families who live in poverty that they should make healthy choices ignores the conditions that prevent them doing so and is insulting and even futile” (Lang and Rayner 2012 p4).

Telling families to eat less red meat, fly less and to stop consuming without addressing the actions of global corporations is, arguably, similarly insulting and possibly futile in trying to curb carbon emissions.

The domains of Public Health, Medicine and Nursing may be insufficiently politically aware of the scale of these issues that impact on human health. This might be due to the possibly,  up to now, necessary ‘ahistoric’ and ‘apolitical’ education of health care professionals, resulting in a lack of a sociological or political imagination underpinned by a critical analysis of the link between current unsustainable lifestyles, political economies and public health. However, adopting the perspective of Ecological Public Health or seeing the world through a ‘sustainability lens’ (Goodman and East 2012) might move more health practitioners and policy makers into critique and action on current economic and political structures that result in health inequities, and indeed, if some are to be believed, threaten civilisation (Costello et al 2009, Hamilton 2010, Oreskes and Conway 2014, Klein 2014, Marshall 2014). There are countervailing voices who do not see the same level of threat or who even deny climate change is really occurring (Goklany 2007, 2009a,b,c,  ben-Ami 2010, Stakaitye 2014, Delingpole 2014, Lehman 2014), but this view is not shared by many health groups such as the WHO (2008, 2014b,c) the Faculty of Public Health (2014) and the International Council of Nurses (2008).

Nurse’s role in health promotion practice

Kemppainen, Tossavainen and Turunen’s (2012) integrative review on the nurses’ role in health promotion is based on an analysis of research papers from 1998-2011 and therefore misses important research that might have been published since. That being said, some of their conclusions resonate today, and if they still hold, then there is a requirement to change our understanding of health promotion to one that fits more readily with more recent arguments over climate change and the determinants of health. They argue that studies suggest that nurses have adopted an individualistic and behaviour changing perspective to health promotion (p490). This perspective is underpinned by nurses working from either a holistic/patient centred theoretical basis or a chronic disease/medical orientated approach (p492). Neither of these theoretical groundings equip nurses with the knowledge or attitudes to address the emerging public health concept of planetary health as outlined above. Although a common defining concept of health promotion found in the studies,  along with the ‘individual perspective’ and ‘empowerment’, was ‘social and health policy’. However ‘nurses were not familiar with social and health policy documents…did not apply them to their nursing practice’ (p494). Again, if still true then the policy initiatives such as the WHO’s ‘social determinants of health’ and Horton et al’s ‘Manifesto for planetary and public health’ will not be found in nurses’ concepts of health promotion.

As for the health promotion expertise nurses have, this is about being ‘general health’ promoters, ‘patient focused’ health promoters and ‘project management’ health promoters. Commonly this involved health education. The competencies outlined were based on multi-disciplinary knowledge, skill related competence and competence related to attitudes and personal characteristics. Nurses were expected to be aware of economic, social and cultural issues and their influence on lifestyle and health behaviour. Whether this included knowledge of climate change or other ecological issues is not clear and is not mentioned.

This review highlighted the need to clarify the concept of health promotion, and clearly stated that ‘health policies have little impact on nursing practice’ (p499). Therefore health policies directed at future trends, such as the ecological changes indicated above, will gain little traction in practice unless changes are made. Indeed, ‘knowing about future trends affecting population health were not identified as nurses’ health promotion competencies’ (p499). The review concludes ‘it appears that nurses have not yet demonstrated a clear and obvious political role in implementing health promotion activities….instead…their health promotion activities (are) based on knowledge and giving information to patients. (p499). Lang and Rayner (2012) argue that public health must…address complexity and dare to confront power. This understanding ought then to be part of the conceptual language of health promotion used by nurses.



Student nurses will be introduced to the Social Determinants of Health (SDoH) approach as outlined by the World Health Organisation (2008) and in the Rio declaration on the social determinants of health in 2011. The reason for this is that the UK’s Nursing and Midwifery Council state in their 2010 standards for education:


“All nurses must understand public health principles, priorities and practice in order to recognise and respond to the major causes and social determinants of health, illness and health inequalities. They must use a range of information and data to assess the needs of people, groups, communities and populations, and work to improve health, wellbeing and experiences of healthcare; secure equal access to health screening, health promotion and healthcare; and promote social inclusion”.


I think this introduces an ethical imperative and a socio-political role for nursing (Falk-Raphael 2006) as the NMC explicitly state that nurses are to “work to improve health….”.  If health has social determinants based on the ‘distribution of money, power and resources’ then nurses are required to understand what this means. Indeed public health principles are now embracing concepts such as the SDoH and going further in the Ecological Public Health approach (Lang and Rayner 2012).


Climate change and threats to ecosystems are very real health concerns for individuals, communities and populations both currently and in the medium to long term.  The long term, in this instance, being defined as ‘this century’. The world’s scientific community is agreed on the direction of travel towards a warmer world. The wider health community and some nursing organisations are aware of the issues and are advocating for changes to practice and education. There are many who disagree either about the phenomenon of climate change itself or on what to do about it. There is distrust of politicians based on fears of the introduction of global governance and state interference (Klein 2014, Marshall 2014) and many even distrust the scientists themselves. So who is left to trust with health issues? Nurses already have a health promotion role but it has been defined in particular ways that result in an inability to grapple with the new challenges that climate change and ecosystem damage are bringing. There is thus an urgent need to address the emerging paradigm of ecological or planetary public health into nurses’ health promotion definitions and competencies, to confront ‘entrenched interests’ through individual and community empowerment. As Falk-Raphael (2006 p2) argued:

“Nursing’s fundamental responsibilities to promote health, prevent disease, and alleviate suffering call for the expression of caring for humanity and environment through political activism at local, national, and international levels to bring about reforms of the current global economic order”.


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Politics, Climate Change – Impacts and the IPCC

Climate Change – Impacts and the apolitical nature of reports.


The IPCC on the 2nd November 2014 issued a press release: ‘Concluding instalment of the Fifth Assessment Report: Climate change threatens irreversible and dangerous impacts, but options exist to limit its effects’.



Their first statement is:
“Human influence on the climate system is clear and growing, with impacts observed on all continents. If left unchecked, climate change will increase the likelihood of severe, pervasive and irreversible impacts for people and ecosystems. However, options are available to adapt to climate change and implementing stringent mitigations activities can ensure that the impacts of climate change remain within a manageable range, creating a brighter and more sustainable future” (p1).


This much we know from the 5th assessment report, but this release is not about bringing anything new to the table, it is a synthesis of the 3 working group reports published earlier in 2014.


The IPCC feel that progress for human development can still be made if there is the will to do it based on the knowledge brought forward by the thousands of scientists. In this they are placing faith in the ‘Translational model’ of science and policy (Wynne 2010). The ‘Translational’ model assumes that what all policy makers need, and by inference the public, is an understanding of the science to enact change.


However this does not work because as Mike Hulme points out, climate change is an ‘idea’ and not a scientific ‘fact’ for many people. Hulme (2009) and Wynne (2010) argue that what is at issue is not the propositional claims of climate science, but the conditional and epistemic nature of all science which then relates to the complex and often politicised relationship between science and policy; see also Carlisle (2001) in health inequalities and Pielke’s ‘iron law’ of climate policy (2010). Science ‘produces’ knowledge but it is conditional, i.e. always open to be refuted and it uses propositions, not certainty, in its statements. In reality, we accept as fact science’s propositions as the evidence stacks up and refutations achieve less success – who doubts the laws of gravity, a heliocentric cosmos, or aerodynamics?


Politicised uncertainty applies especially to environmental science, which Douglas discussed as far back as 1970. Goldenburg (2010), Ward (2012), Klein (2014) and Marshall (2014) outline the work of the Heartland Institute, the Cato institute, influential politicians and Tea Party members in regard to attempts to refute climate science.


The IPCC point out current impacts on the least developed countries and argue for adaption through cooperative responses. They also argue that adaptation is not enough and that reduction in emissions is still required. However, the report is written within the frame of reference of growth based capitalism, the language of adaption and mitigation is used within this growth paradigm. In other words, the argument is that capitalism requires collective action to change what it does, but not a root and branch reform of the process itself.


The time scale for capitalism to correct its market failures is now measured in decades:


“We have little time before the window of opportunity to stay within 2 degrees C of warming closes. To keep a good chance of staying below 2C, and at manageable costs, our emissions should drop by 40 to 70 percent globally between 2010 and 2050, falling to zero or below by 2100. We have that opportunity, and the choice is in our hands.” (p2).


A counter to this is the fossil fuel lobby and industries which continue to get billions of dollars in subsidies to extract fossil fuels. One measure has this subsidy at between $544 billion and $2 trillion. So while we have scientists telling us we must reduce emissions on one side, we have a very powerful vested interests and billions of dollars invested in continuing that extraction. Populations however must expect rises in energy prices if these subsidies are cut. This pertains if we do not also address wealth and income redistribution. For example In June 2014 Indonesia increased petrol prices by 44% to cut its annual subsidy bill of $20 billion. These sorts of increases hit the poor disproportionally while it is the rich who use cars more and thus benefit from subsidies. This could be addressed using tax transfers and other redistributive measures but redistribution is not on the agenda in many countries.


It perhaps is not the role of the IPCC to delve into politics, however we must make those links because the science can only take us so far. The broader arguments are cultural, moral and political and we must decide which to go.


















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Academic culture in Nursing: devalued, defiant or dead?

Academic culture in Nursing: devalued, defiant or dead? So wrote David Thompson in 2013.

This editorial reflects a continuing and growing concern with academic nursing in Universities, a concern which, like the science of climate change, seems to be documenting a crisis with little or no positive action in response. Gary Rolfe’s idea of the paraversity is a counter and I argue elsewhere that we can begin to build the paraversity to subvert the corporate university from within. However, the forces ranged against academic nursing are formidable and come often from clinical nursing aided and abetted by the managerial approach within a corporate university. Without a sense of irony or shame it has been reported that the desire exists in some NHS trusts and elsewhere to ‘repatriate’ nurse ‘training’ back into hospitals alongside a wish for increased use of band 4 assistant practitioners. The political imperative to save money, the drive for efficiency and effectiveness, is seemingly leaving little room for critical enquiry and provocative pedagogy. It is with sadness that I hear keen first year nurses expressing the need for just such an education just at the time when it is being devalued elsewhere. Nurses used to be called handmaidens to doctors, now I fear nursing is becoming a handmaiden to managerialism. Nurse academics seem powerless to affect a response.

“The University in Ruins”

Health and Capitalism again.

Health and Capitalism.


Resistance is futile” and if you heard those words uttered by the Borg, it often was. However, that did not deter the crew of the starship ‘Enterprise’ from carrying on resisting. And so it is with our current predicament on his planet. The Borg, for the global population, is the capitalist class executive supported by their political power elite. We could just call them the capitalist class or what Graham Scambler refers to as the “Greedy Bastards”.


One issue is the globalised ‘capital surplus absorption problem’ (Harvey 2010) which drives capital across the globe looking for profit and cheap labour. If capital cannot make a decent return it moves on, as it did in Cornwall’s mining regions in the 20th century.

The resistance to the current global capitalist system is legion (Hawken 2009), but it is disorganised, fragmented, unfocused, without a clear plan and often unsure of who or what the real threat actually is. Some of the resistance movement of course would misguidedly seek to replace one form of exploitation and crisis generation with another, but with a kinder social democratic or green face. But, while capitalism exists it never resolves its crises, it merely moves then around the globe.


I seek in to cut through the mess of analysis as to why we are heading for continued economic disaster which is in tandem with the ecological one, a disaster in which we are lied to by a feral elite as being ‘all in it together’, while the distribution of wealth remains in very few hands and is then turned to exploiting the planet’s natural and social capital with often deadly results.


This analysis has emotional elements to it, given what the science is telling us about the crossing of planetary boundaries, how could it not? It is not however based on an emotional analysis but an attempt to understand how social worlds change and upon what basis current societies are organised. It is a complex interdependence of economy and ideology shaping social relationships, which in turn shape who we are. In the coming together as individuals to trade, work, exchange, distribute, sell, buy, advertise we bring our hopes, values and ideals to that process and in turn that process shapes our hopes, values and ideals.


This is an agenda that brings together  ‘inequalities in health’ (Marmot 2010), the social determinants of health, Ecological Public health (Lang and Rayner 2014) and critiques of political economy. It is a realisation that education has failed us on a grand scale. It is a realisation that a few powerful men, and it is usually men, have been bought by men of wealth and have commandeered the levers of power for their own benefit, arguing as they do that it is for our own good. It is a realisation that only when populations wake up to the fact of this old fashioned class war and demand a better way of social organization that we will we have a hope of bequeathing to our children a better world. It is a realisation that well meaning individual action that does not challenge the fundamental driver is at best useless and at worse a distraction from the real battle.

It is a realisation that the war is very possibly already lost and the best we can hope for is managed decline in human welfare before restructuring of the social economy is forced upon us. There remains optimism of the will but pessismism of the intellect.

Some are more optimistic about our ability to use technology and our transformation of economic models. The Global Commission on the Economy and Climate suggest that economic growth and combating climate change can be done together. In their “Better Growth, Better Climate “ Report (2014), the starting point for this “New Climate Economy” has been to see the issue from the perspective of economic decision-makers. By this they mean government ministers, particularly ministers of finance, economy, energy and agriculture; business leaders and financial investors; state governors and city mayors. None of these decision makers will be anti capitalist and probably have been schooled in either neoclassical economics or economic orthodoxy. I suspect few have read deeply or understood Tim Jackson, David Harvey, Steve Keen or Thomas Picketty, let alone volume’s 1 and 2 of Capital. I suggest that capital accumulation and the contradictions within capitalism is the base issue upon which climate change rests. Naomi Klein has recently (2014) linked these two and brought them into the public sphere in her book “This Changes everything. Capitalism vs Climate”.


Upon what is human health based? It is largely social in nature, determined by the social relationships in a material world. No one lives alone and so it is in the coming together in communities and societies that we fashion the determinants of health. There is a biological basis for some individuals, and this may account for 30% of premature deaths. However genetic determinants (e.g. in cystic fibrosis) operate at this individual level and are manifest in a relatively minor way. This is not to deny that for the individual the medical condition is anything but minor, but health on population levels are not determined thus. Even genetic manifestations are at times made worse or better by the social conditions in which the individual finds themselves. Poverty has a knack of making underlying biological problems much worse.


Social Conditions and Relations

Marx (1859) wrote “In the social production of their existence, men inevitably enter into definite relations, which are independent of their will, namely relations of production appropriate to a given stage in the development of their material forces of production. The totality of these relations of production constitutes the economic structure of society, the real foundation, on which arises a legal and political superstructure and to which correspond definite forms of social consciousness. The mode of production of material life conditions the general process of social, political and intellectual life. It is not the consciousness of men that determines their existence, but their social existence that determines their consciousness”.


In other words, capitalism as an economic system is formed by particular social relationships which give rise to our laws such as private property, our political system and our ideas about how society should be. The current ‘mode of production of material life’ is capitalism in its various forms and is the basis for our social life and our social relationships. Simplistically, this means economic factors – the way people produce the necessities of life (mode of production) – determine the kind of politics and ideology a society can have.

If health is socially determined by social relationships, what are the current forms of social relationships that give rise to certain patterns of health, illness and disease? We know from studying inequalities in health that socio-economic conditions and relative social status determine populations’ health status including measurable outcomes such as life expectancy and the under 5 mortality rate. Other social relationships such as gender and ethnicity also affect health status. However, these are subservient social conditions to the socio-economic in the last instance. Thus material conditions and poverty are prepotent conditions for health. That is not to deny that affluent women and affluent BME’s may also experience ill health disproportionately in certain medical categories. However, the major driver for global health are the socio-economic relationships which are based on a certain forms of capitalist political economy.

Graham Scambler argues that a way to understand health is to see ‘asset flows’ operating throughout the life course:

“The noun ‘flows’ is significant here. People do not either have or not have assets positive for health and longevity, rather the strength of flow of these assets varies through the life- course”. So it is not about the static acquisition of wealth or material deprivation that is at work. It is about what assets flow in and out of people’s lives over the course of their life, and this is particularly important in childhood and older age.

The ‘assets’ are:

biological: your ‘genetic inheritance’, sex, your disabilities, your long term conditions. A healthy child born in Redruth in 1960 starts with good biological assets.

psychological: e.g. your self-efficacy, locus of control, learned helplessness. This same child grows up in social world in which she learns that female roles are pretty much limited, her belief regarding her ability to achive anything she wants is limited by the role models and messages around her. Her ‘self efficacy’ is thus reduced to acting within strict and socially moulded goals. Her self belief does not stretch to being Prime Minister. Her psychological asset is not weak but it is certainly not as strong as a young boy at Eton.

social:  family network, community networks, friendships. All her friends do not pass the 11 plus and so her network ‘learns’ a factory fodder secondary school education hell bent on training the local girls for the local textiles factory. Father drives a bus, mother works part time at the local electronics factory. No one goes to university out of the county. This girls position on the social gradient is not the worse but it is not the best either. Her social asset is low to medium.

cultural, your lifestyle choices such as smoking. Cigarette smoking is very common, all the adults around smoke, it is a rite of passage at school and fags are relatively cheap. A 20 a day habit is soon formed. This is a very weak cultural asset.

spatial: where you live, leafy Surrey or inner city Glasgow? Thankfully Camborne is a rural small town lacking the street and environemental dangers of a Toxteth or Lewisham.

symbolic: status as a ‘chav’ or as member of the elite. Thankfully growing up in rural Cornwall in the 60’s, the word ‘chav’ is not known, the demonisation of the working class has not started and there is no talk of benefit cheats and scroungers as the girl grows, she is spared this symbolic humiliation, but the ‘gippoes’ at Carn Brea are not.

material: income and wealth. As an adult, the girl ‘marries well’, her husband has a decent job and they live in a nice part of town. The house is not damp, they can afford to heat it and provide adequate food for the children.

In addition, Scambler suggests that we need to understand that:

  1. The strength of flow of material assets (i.e. standard of living via personal and household income) is paramount. This links with the material deprivation thesis explaining the link between health inequalities and socioeconomic status.
  2. Flows of assets tend to vary together (i.e. mostly strong or weak ‘across the board’);
  3. Weak asset flows across the board tend at critical junctures of the life-course (e.g. during infancy and childhood) to have especially deleterious effects on life-time health and longevity: a child born with a chronic illness, into the lowest decile of income distribution, in an abusive psychological and social environment, living in damp squalid housing in which both parents smoke, in an area of high unemployment and poor access to health care and a proliferation of fast food outlets, in a culture that demonises ‘chavs and benefits cheats’…….
  4. Weak asset flows across the board, and I daresay strong asset flows across the board, tend to exercise a cumulative effect over the life-course (negatively and positively respectively);
  5. The ‘subjective’ evaluation of the strength of an asset flow can exert an effect over and above any ‘objective’ measure of that flow (e.g. a symbolic asset flow perceived as weak relative to that enjoyed by an individual’s reference group can be injurious in its own right). That is, how we perceive how good or poor our ‘asset’ is, affects us even if that asset is not in itself injurious. This is the social comparison thesis or psychosocial hypothesis.

Scambler regards the material asset flow as vital or ‘prepotent’. Of all assets it is the material conditions of life that underpin much of our health outcomes. In this, Scambler is adopting a Marxist take on health inequalities. To argue that material conditions underpin all other asset flows is not to diminish their importance for health inequalities. This is only highlighting the key point of Wilkinson and Pickett’s The Spirit Level, in that that action on the reduction in income inequality is a precondition for tackling health inequalities.

Danny Dorling (2014) points to the rising levels of inequality and argues that being born outside the 1% has a dramatic effect on a person’s potential – their asset flows – reducing life expectancy, limiting educational and work prospects and adversely affecting mental health. The ‘greedy bastards’ are of course not the 1%, they are part of it, but their wealth puts them more into the 0.01% of income earners.

What are the current dominant socio economic conditions therefore that give rise to the health and illness patterns we note, are affect the asset flows in people’s lives?


Political Economy.

A feature of modern capitalism, which in its neoliberal form especially has now gone global, is that it determines in the last instance forms of social relationships that are exploitative and unequal. The material conditions of life are shaped by these unequal and damaging social relationships. Thus, how much land you have to feed your family and where that land is, is determined by systems of private property, commodity prices and the rules of the state. The same goes for water and shelter. The fundamental building blocks of life, including eco systems services, e.g. fresh water, waste recycling, are subsumed within capitalist social relationships. Nature, the air, water, livestock et, upon which we depend has been fashioned into a mere instrument for human survival and development. There is very little ‘nature’ left untouched by human hand. All of nature has been turned into natural capital and is being used up as if it is limitless.

Capitalism has to continue to do what it does because of the ‘surplus capital absorption problem’ (SCAP). As surplus value accrues to the ruling class, those who own and control the means of production, it has to be reinvested or it is lost. Thus capital continually seeks new markets and new profits. It cannot stand still and so it looks to exploit more and more natural capital in the process. The drive for capital accumulation is the engine of this whole process.

When capital comes up against a barrier to this process e.g. strong labour organisations who demand living wages and pensions, it either designs a solution, e.g. strict labour laws that outlaw strikes and unions, or finds other investment opportunities. It takes manufacturing to countries where there is weak, cheap or surplus labour. This is one of the foundational contradictions of capitalism – the capital and labour conflict. An economy that is not returning 3% growth is seen as sluggish and, as we are experiencing in the UK, recessions which result from lack of aggregate demand and lack of surplus capital investment result in unemployment and social unrest.

Capitalism has proved to be dynamic and inventive. It has taken on many forms – mercantile, industrial and recently financial and consumer based. Apologists for capital accumulation argue it is good for societies, pointing to the jobs and wealth created while ignoring the social misery that often follows in its wake and various waves of ‘creative destruction’ as it comes up against barriers to accumulation and then seeks new forms. In this manner whole cities, e.g. Detroit, are nearly laid to waste as old forms of capital accumulation, e.g. car manufacturing, becomes unprofitable and shifts across the globe. In Cornwall, capital fled following its inability to make a profit from mining and engineering leaving a service and tourism sector characterised by low wages and precarious seasonal contracts. Camborne and Redruth are hollowed out towns still trying to recover from the creative destruction unleashed by the forces of globalisation that resulted in tin being cheaper in South East Asia.

Meanwhile whole populations have been ‘bribed‘ by the baubles and cheap credit that capitalism produces which, as the recent credit and consumer led boom and bust has proved, are merely will o’ the wisps. The phrase ‘wage slave’ resonates with many in so called ‘advanced’ societies who are trapped in alienating forms of work ameliorated only by the lures of consumer products and services. The promises of ‘you’ve never had it so good’ turning sour on sovereign and private debt while the ruling class run away with the spoils in ‘Richistan’.


We have heard the mantra “we are all in this together” which is supposed to reassure us that everyone in society is shouldering some of the burden of the consequences of the financial crash of 2008. We also hear that the UK’s debt has to be reduced quickly and that means cuts in public spending. This is an international phenomenon affecting the United States as well as Europe. Many other countries are not quite so indebted. Global capitalism is still working very well in certain localities and everywhere for the capitalist class.

Forbes has been reporting global wealth for 25 years and states that 2011 was a year to remember. For positive reasons. The 2011 Billionaires List breaks two records: total number of listees (1,210) and combined wealth ($4.5 trillion). This amount of money is bigger than the gross domestic product of Germany, one of only six nations to have fewer billionaires that year. BRICs led the way: Brazil, Russia, India and China produced 108 of the 214 new names. These four nations are home to one-in-four members, up from one-in-ten in 2006. Before 2011, only the U.S. had ever produced more than 100 billionaires. China in 2011 has 115 and Russia 101. While nearly all emerging markets showed solid gains, wealth creation is moving at an especially breakneck speed in Asia-Pacific. The region now has a record 332 billionaires, up from 234 in 2010 and 130 at the depth of the financial crisis in 2009. High performing stock markets are behind the surge. Three-fourths of Asia’s 105 newcomers get the bulk of their fortunes from stakes in publicly traded companies, 25 of which have been public only since the start of 2010.

Forbes argues that the reason they track this wealth is because these billionaires have the power to change the world. For example, Telecom billionaire and prime minister Najib Mikati supports the Lebanese government. Ernesto Bertarelli, is now focusing on saving the oceans from eco disaster. Bill Gates and Warren Buffett have already traveled to three continents working to change giving practices among the ultra-rich. This is feudal ‘noblesse oblige’, the power of the divine right of kings by dint of wealth with little democratic control. Meanhwile the UK’s Candy brothers like to boast of their wealth and how little tax they pay in the context where “only the little people pay taxes” and in which the rich are winning the class war.

Meanwhile nearly half of the world – 3 billion people – live on less than $2.50 a day and 80% of humanity live on less than $10 a day (2008 figures from the World Bank Development Indicators).

In the UK, the inequality briefings report that  the richest 1% of the population have as much wealth as the poorest 55% combined; Oxfam report the 5 richest families are wealthier that the poorest 20% combined.

“We are all in this together”. Right.

Green thinking

One way to confront this machine is to get off the consumerist treadmill and hope that through collective consumer choices, i.e. not to buy stuff, that the ruling class will mend their accumulative ways, invest in health, education, the conditions of social life and design products that are ‘green‘ and ‘environmentally friendly’. This is already occurring. The plethora of products from hybrid cars to organic and locally sourced food products indicate that some companies are basing their business models with sustainability in mind. What this does not do however is change the underlying dynamic of the surplus capital absorption problem which demands growth in the economy and the overuse of natural resources.

This means there is a race on between developing goods and services that are carbon neutral and environmentally friendly and the supply of goods that are killing ecosystem services and wreck social relationships through alienating labour and growing inequality. This race occurs within the context of the SCAP which will seek to overcome any barriers to the investment of that surplus value and will not wait until all goods and services become eco friendly. If investment in eco friendly products can be found, and is profitable, capitalism will do so, but it is not fussy in this regard. Canadian tar sands exploitation is an example in which demand for oil and the chance for investing surplus capital to turn a profit cannot be overlooked.

Thus, living the good life runs up against globalised capital accumulation, especially in the form of the subsidized Fossil Fuel industry.

Green thinking is also a minority sport as it is up against other forces as well. The idea of human progress and technological advances to solve our problems runs in tandem with those who have the capital to invest. This also includes some forms of religious ideology, which affirms man’s right to dominate nature and an anthropocentric and dualist world view.

Greens need a critique of political economy or risk being sidelined in the Shire as Mordor advances its deathly grip.

So what?

It is unlikely that human populations under globalised capitalism will stop the SCAP dynamic. They don’t understand it. What they do understand is that there are winners and losers in the current system. If you win, you win big. Many also feel impotent to prevent the investment decisions being made by suits in the financial districts of first world countries. Politicians have let their electorates down or more likely could not deliver as they are merely apologists for the ruling class. Democracy is under challenge, more than ironic given that many are currently dying for a democratic ideal.

Many shrug and say ‘nothing can be done’. They may be right. The ruling class may have too powerful a grip and ‘enjoy’ too much of the spoils to change. Meanwhile the political economy of SCAP produces social relationships that determine our current unequal patterns of health.

To date, not enough people are discussing the underlying dynamic of capitalism that produces periodic crises and which may eventually allow Gaia to take revenge. We are locked into a cluster of high carbon systems underpinned by this capitalist dynamic and we don’t have a key. There is an urgent need to design one but our so called elite Universities are currently so wrapped up in producing technologies for capitalist production and equipping people with skills fit for capitalist purpose that they are ill placed to produce radical thinking, challenges and alternative plans. Education is not the solution, it is the problem. Politics is not the solution it is the problem. Ecology is not the solution it is the problem.

And as for a voice? In the UK it takes a comedian to rattle cages in tandem with a few commentattors such as Owen Jones.

“Philosophers have hitherto interpreted the world in many ways, the point however is to change it”.

That means confronting Capital. Changing the light bulbs ain’t enough and may give a false sense of ‘doing something’.

The ruins of Cornwall’s mines stand in silent testament to the destructive forces of globalisation, mirroring the ruins of people’s lives in the sunken inland towns of Cornwall’s backbone, connected together by a road that fails to take them to the golden reaches of England’s South Eastern metropolis 300 miles way.


  • Join/start an anti capitalist social movement.
  • Use social media to connect for example 38 degrees.
  • Confront your elected representatives in writing.
  • Identify and contact the ‘suits’.
  • Find someone who knows what campaigning is all about and share skills.
  • Focus on your core skills, attributes and role and fashion a response that suits them.
  • Identify a sphere of influence and work within that.
  • Consider direct civic action, e.g. ‘Occupy’.
  • Read and understand the issues.

…or realise that no one gives a toss about any of this, go home and get pissed or pregnant.