Health inequalities and the social contract: A bad ‘deal’ in and for society

In this respect they also reflect the type of social contract that exists between citizens and the state, i.e., the basis on which we surrender our individual sovereignty and participate in society.  In this lecture health inequalities in England will be used to explore and question the ‘deal’ (both implicit and explicit) that exists between individuals’ and society.  In England there is a clear and persistent social gradient in health (in, for example, life expectancy and healthy life expectancy) that corresponds with socio-economic status and the social determinants of health.  It will be argued that those at the bottom of the distribution are experiencing social costs (after Richard Titmuss), which reflect wider priorities in the social contract including the tendency towards possessive and competitive individualism.  Particular attention will be paid to the political economy and its relationship to both the social inequalities it produces and to the capacity for social policy to respond to these.  Whilst the dominance of a largely medical and treatment/sickness model in health policy will also be considered in relation to how health is viewed and understood in the social contract.  Pessimistically we might conclude that health inequalities are not considered to be sufficiently iniquitous to take the kind of redistributive action that would level the social gradient.  More optimistically there is scope to reimagine the social contract if we raise our expectations about the types of social and economic outcomes it produces. 

The lecture will draw on work undertaken for the Policy Press book: Social Policy, Political Economy and the Social Contract