Fantasy paradigms of health inequalities: utopian thinking?

Alex Scott-Samuel, Katherine Elizabeth Smith

    Research output: Contribution to journalArticle

    27 Citations (Scopus)
    3 Downloads (Pure)

    Abstract

    This paper argues that, while it can be politically expedient for governments to engage with health inequalities, they cannot, within the confines of neoliberalism, realistically propose actions that evidence suggests will effectively reduce them - such as tackling power inequalities, social status and connections or class inequality. Indeed, a dominant 'policy paradigm' prioritising economic growth restricts the ability of policy actors to imagine alternative, more equitable scenarios. In this context, some policy actors and researchers have devised a parallel fantasy world in which proximal, downstream, easily-tackled exposures are posited as potential solutions to health inequalities. The consequence of this is a widespread public sector culture in which well-meaning policy-makers, practitioners, researchers and members of the public collude in sustaining a 'cargo cult' of health behaviourism. In examining this situation, we draw on accounts and critiques of utopian thinking to help explain: (i) the remarkable persistence of policy proposals to tackle health inequalities via downstream interventions, in spite of the strength of evidence challenging such approaches; and (ii) the limited extent to which more upstream proposals inform policy debates. We argue Ruth Levitas’ notion of ‘utopia as method’ offers an imaginative and potentially useful avenue for future health inequalities research.
    Original languageEnglish
    Pages (from-to)418-436
    Number of pages19
    JournalSocial Theory and Health
    Volume13
    Issue number3-4
    Early online date1 Jul 2015
    DOIs
    Publication statusPublished - 31 Aug 2015

    Keywords

    • health inequalities
    • neo-liberalism
    • utopian
    • power
    • evidence-based policy
    • health behaviourism

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