‘How Politics Makes Us Sick: Neoliberal Epidemics’ by Ted Shrecker and Clare Bambra (Palgrave Macmillan, 2015)
How Politics makes us Sick: Neoliberal Epidemics is a well written, engaging and mind opening book. The authors’ present reasoned and well defined arguments for their proposals that reflect neoliberal politics and political decision making and the influence this has had on human health. The contextualisation of human health over the past three decades since the emergence of neoliberalism in the 1980 in terms of political and economic policies makes this a relevant, interesting, and timely book.
Often the domains of health, politics, and economics are researched and examined in isolation, what the authors have done in this work is demonstrate an inter-connection of causality and related outcomes. One domain has informed and influenced the other. For the reader it allows the perspective to see the relationship of these various disciplines and expands and integrates the boundaries between them. In terms of understanding and relevance the authors present a new approach to the contextualisation of these domains. In the introduction this is clarified by the following passage:
So while the diseases of today differ significantly from those of the 19th century and there has been a clear epidemiological transition from communicable to chronic disease, the determinants of health remain political and economic. These parallels do not augur well for the future of global health, as in order to increase profits and the economic freedom of a few, the spread of neoliberalism is eroding the conditions conducive to health life for the many. (p.20)
The book examines and illustrates complicated political and economic subject areas and relates that to understandable and contextualized material in relation to health and health issues. In particular the authors address the complexity of issues from a balanced perspective of the obesity epidemic and rising poverty levels the authors provide an excellent understanding to interrelated factors that are impacting on these growing problems.
The material examined in How politics makes us sick has relevance for a range of disciplines and perspectives. While an excellent choice for a reading list in the subject area medical humanities it also would be suitable for sociology, political science, economics for example but also relevant in the areas of broader social sciences and health policy. The topics examined in this book are not constrained to the lecture hall or research departments but would also be of interest to the everyman who seeks to understand the society he lives in, the value of participation not only in their own health and wellbeing but that of the global society generally and their own country specifically. Decisions and policies in one domain are having impacts, some quite devastating in other realms. Those involved in researching and reporting news and current events to broad audiences would also find this book useful. It is written in a structured and logical format that illustrates this inter-relationship.
One aspect of the book that was illuminating was the discussion around the international perspective in regard to austerity as a structural adjustment. It examines the roles and approaches of different organisations such as the IMF, UNICEF, and European Central bank in regard to recent economic problems in the European most notably the challenges faced by the Greeks. There still remains a disconnect between these types of policy makers and the health systems, resources and funding for health services and the general health of people caught up in austerity measures which so impact on their daily lives (p. 84). This lack of integration and awareness create long term problems for citizens and governments and the nature of the web of all these external policy makers makes it very hard to disentangle to identify causality in a concrete detached way.
The discussion around health and social and political environments is explored in a range of geographical settings, such as the epidemic of incarceration in the USA (p. 84) as well as examining neoliberalism and the privatization and marketisation of the English National Health Service (p. 102). This provides the reader with a broad range of narratives that help to understand the relationship between politics and health, whilst not always immediate and obvious, more often the not damage done to individuals specifically and society generally can have a long tail. By looking for the initial link between these situations and political decisions or environments can help adjust negative trends and provide valuable insights to re-adjust for the greater good.
Regarding the medical humanities, this book would be useful in helping to understand the experiences of personal health. In particular the sections that deal with the epidemic of obesity. Often times it is far too easy to ascribe the “fault” of this epidemic on the people who are affected by it, but having an understanding of the complexity of this condition as well as the social, economic and political aspects will shift the emphasis from individual targeted blame (and shame) to the proactive approach of an integrated solution. A key aspiration of medical humanities is understanding and the recognition of the impact and relationship between health and other aspects of life. This book has a place in this process of understanding.
Reviewed by Jane Burns (MBA, MLIS, MPhil, FLAI) who is the Research Officer in the Health Professions Education Centre at the Royal College of Surgeons in Dublin as well as an occasional Lecturer in the School of Information & Communication Studies, University College Dublin. Jane is currently a PhD candidate at UCD in the School of Education and her intended area of research is medical humanities and its role in Digital Curriculum Development.
Correspondence to Jane Burns.