Health Inequality Quotes

Of all the forms of inequality, injustice in health care is the most shocking and inhumane.

No, I'm the human here. I'm the life at stake. I'm the one with fingernails, who feels pain. Me.

There are two visions of America a half century from now. One is of a society more divided between the haves and the have-nots, a country in which the rich live in gated communities, send their children to expensive schools, and have access to first-rate medical care. Meanwhile, the rest live in a world marked by insecurity, at best mediocre education, and in effect rationed health care―they hope and pray they don't get seriously sick. At the bottom are millions of young people alienated and without hope. I have seen that picture in many developing countries; economists have given it a name, a dual economy, two societies living side by side, but hardly knowing each other, hardly imagining what life is like for the other. Whether we will fall to the depths of some countries, where the gates grow higher and the societies split farther and farther apart, I do not know. It is, however, the nightmare towards which we are slowly marching.

rest of my teachers maybe did the best they could, but they just needed a lot of help making their best better. There were so many things we needed in those classrooms, in our city, in our state, in our country that our teachers could have provided if they would have gone home and really done their homework. They never once said the words: “economic inequality,” “housing discrimination,” “sexual violence,” “mass incarceration,” “homophobia,” “empire,” “mass eviction,” “post traumatic stress disorder,” “white supremacy,” “patriarchy,” “neo-confederacy,” “mental health,” or “parental abuse,” yet every student and teacher at that school lived in a world shaped by those words.

I believe we have to view inequality as a public health problem.

It is eminently possible to have a market-based economy that requires no such brutality and demands no such ideological purity. A free market in consumer products can coexist with free public health care, with public schools, with a large segment of the economy -- like a national oil company -- held in state hands. It's equally possible to require corporations to pay decent wages, to respect the right of workers to form unions, and for governments to tax and redistribute wealth so that the sharp inequalities that mark the corporatist state are reduced. Markets need not be fundamentalist.

Some angles of evidence now suggest this is the most wealth-inequal moment in human history, surpassing the feudal era for instance, and the early warrior/priest/peasant states. Also, the two billion poorest people on the planet still lack access to basics like toilets, housing, food, health care, education, and so on. This means that fully one-quarter of humanity, enough to equal the entire human population of the year 1960, is immiserated in ways that the poorest people of the feudal era or the Upper Paleolithic were not.

Societies with unequal income distribution tend to be less happy. There are a number of reasons for this. Inequality creates a sense of unfairness; it erodes social trust, cohesion and solidarity. It’s also linked to poorer health, higher levels of crime and less social mobility. People who live in unequal societies tend to be more frustrated, anxious, insecure and discontent with their lives. They have higher rates of depression and addiction.

If poverty is not a result of lack of resources or opportunities, but of poor institutions, poor government, and toxic politics, giving money to poor countries—particularly giving money to the governments of poor countries—is likely to perpetuate and prolong poverty, not eliminate it. The

We live in a society where race is one of the biggest indicators of your success in life. There are sizable racial divides in wealth, health, life expectancy, infant mortality, incarceration rates, and so much more. We cannot look at a society where racial inequality is so universal and longstanding and say, 'This is all the doing of a few individuals with hate in their hearts.' It just doesn't make sense.

Peacemakers who challenge the prevailing concept of peace achieved by violence are often, ironically, called disturbers of the peace. That is only true if peace is defined as an uneasy ceasefire in a world dominated by the corrupt, a tenuous subjugation of the weak by the powerful, a hurting humanity suffering silently en mass for the profit of the bloated few. If, though, peace is defined as freedom, equality, safety, health, opportunity, and a voice for all, then we, the peacemakers, aren't disturbers of the peace. We are purveyors of peace because we are disturbers of the status quo.

Averages are no consolation to those who have been left behind.

Finally, it is also worth noting that nearly every institution of post-independence India has been spearheaded by Brahminical elites. Their dismal performance in delivering even basic social services to the majority of Indians—of education, health, water, sanitation, and electricity—says volumes about their ‘merit’ and argues against leaving them in control of these institutions.

Ever since the days of Hippocrates, it has been considered an axiom of medicine, that the first step to be taken in the treatment of disease, is the removal of all the primary causes,” Harris wrote.

Agriculture makes people dependent on a few domesticated crops and animals instead of hundreds of wild food sources, creating vulnerability to droughts and blights and zoonotic diseases. Agriculture makes for sedentary living, leaving humans to do something that no primate with a concern for hygiene and public health would ever do: namely, living in close proximity to their feces. Agriculture makes for surplus and thus almost inevitably, the uneven distribution of surplus generating socio-economic status differences that dwarf anything that other primates cook up with their hierarchies. And from there it's just a hop, skip and a jump until we've got Mr. McGregor persecuting Peter Rabbit and people incessantly singing Oklahoma.

You can predict a country’s performance on one outcome from a knowledge of others. If – for instance – a country does badly on health, you can predict with some confidence that it will also imprison a larger proportion of its population, have more teenage pregnancies, lower literacy scores, more obesity, worse mental health, and so on. Inequality seems to make countries socially dysfunctional across a wide range of outcomes.

To worry about these consequences of extreme inequality has nothing to do with being envious of the rich and everything to with the fear that rapidly growing top incomes are a threat to the wellbeing of everyone else.

A political movement that focuses on class and ignores the specific ways in which race determines financial health and well-being for people of color in this country will be a movement that maintains white supremacy, because it will not be able to identify or address the specific, race-based systems that are the main causes of inequality for people of color. Health care discrimination, job discrimination, the school-to-prison pipeline, educational bias, mass incarceration, police brutality, community trauma—none of these issues are addressed in a class-only approach. A class-only approach will lift only poor whites out of poverty and will therefore maintain white supremacy.

To call the belief in substantial human equality a superstition is to insult superstition. It might be unwarranted to believe in leprechauns, but at least the person who holds to such a belief isn’t watching them not exist, for every waking hour of the day. Human inequality, in contrast, and in all of its abundant multiplicity, is constantly on display, as people exhibit their variations in gender, ethnicity, physical attractiveness, size and shape, strength, health, agility, charm, humor, wit, industriousness, and sociability, among countless other features, traits, abilities, and aspects of their personality, some immediately and conspicuously, some only slowly, over time. To absorb even the slightest fraction of all this and to conclude, in the only way possible, that it is either nothing at all, or a ‘social construct’ and index of oppression, is sheer Gnostic delirium: a commitment beyond all evidence to the existence of a true and good world veiled by appearances. People are not equal, they do not develop equally, their goals and achievements are not equal, and nothing can make them equal. Substantial equality has no relation to reality, except as its systematic negation. Violence on a genocidal scale is required to even approximate to a practical egalitarian program, and if anything less ambitious is attempted, people get around it (some more competently than others).

I conceive two species of inequality among men; one which I call natural, or physical inequality, because it is established by nature, and consists in the difference of age, health, bodily strength, and the qualities of the mind, or of the soul; the other which may be termed moral, or political inequality, because it depends on a kind of convention, and is established, or at least authorized, by the common consent of mankind. This species of inequality consists in the different privileges, which some men enjoy, to the prejudice of others, such as that of being richer, more honoured, more powerful, and even that of exacting obedience from them.

Marginalized groups face higher levels of data collections when they access public benefits, walk through highly policed neighborhoods, enter the health-care system, or cross national borders. That data acts to reinforce their marginality when it is used to target them for suspicion and extra scrutiny. Those groups seen as undeserving are singled out for punitive public policy and more intense surveillance, and the cycle begins again. It is a kind of collective red-flagging, a feedback loop of injustice.

Pallone spoke of a “fragmented health system” failing children. And he ended his remarks with a quote from Nobel laureate and poet Gabriela Mistral: “Many things we need can wait. The child cannot. Now is the time. His bones are being formed. His blood is being made, his mind is being developed. To him, we cannot say tomorrow. His name is today.

We would be able to map our lives against the destruction of the working class: the demise of the family farm, the dismantling of public health care, the defunding of public schools, wages so stagnant that full-time workers could no longer pay the bills. Historic wealth inequality was old news to us by the time it hit newspapers in the new millennium.

As we’ve seen, they (the companies) routinely reject applicants on the basis of credit scores and personality tests. Health scores represent a natural—and frightening—next step.

It can be bad if the winners try to stop others from following them, pulling up the ladders behind them.

Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.

Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.

Allowing that nature intended we should always enjoy good health, I dare almost affirm that a state of reflection is a state against nature, and that the man who meditates is a depraved animal.

The nation will never drill, fill and extract its way out of what amounts to a public health crisis among some populations. Throwing more ‘treaters’ into the mix amounts to digging a hole in an ocean of disease.

Perhaps the starkest measure of the failure of our economic policies,” Binyamin Appelbaum writes, “is that the average American’s life expectancy is in decline, as inequalities of wealth have become inequalities of health.

Economists focus on income, public health scholars focus on mortality and morbidity, and demographers focus on births, deaths, and the size of populations. All of these factors contribute to wellbeing, but none of them is wellbeing.

Cholera continues to spread and kill not because we lack the tools to understand or treat the disease as we did two hundred years ago, but because each day, as a human community, we decide not to prioritize the health of people living in poverty

What Wilkinson and others have shown is that poverty is not only a predictor of poor health but, independent of absolute income, so is poverty amid plenty—the more income inequality there is in a society, the worse the health and mortality rates.

If, to cut carbon emissions, we need to limit economic growth severely in the rich countries, then it is important to know that this does not mean sacrificing improvements in the real quality of life – in the quality of life as measured by health, happiness, friendship and community life, which really matters. However, rather than simply having fewer of all the luxuries which substitute for and prevent us recognizing our more fundamental needs, inequality has to be reduced simultaneously.

Attributing blacks’ poor health to inherent racial difference allowed whites like Jefferson both to ignore how disease is caused by political inequality and to justify an unequal system by pointing to the inherent racial difference that disease supposedly reveals.

Yes, it is America. It is an essential part of American history. So too is the backlash that occurs when attempts are made to improve the conditions of the poor. Whether it is New Deal polices or LBJ’s welfare programs or Obama-era health care reform, along with any effort to address inequality and poverty comes a harsh and seemingly inevitable reaction. Angry citizens lash out: they perceive government bending over backward to help the poor (implied or stated: undeserving) and they accuse bureaucrats of wasteful spending that steals from hardworking men and women.

(a) Recent U.S. income growth primarily occurs at the top 1 percent of the income distribution. (b) As a result there is growing inequality. (c) And those at the bottom and in the middle are actually worse-off today than they were at the beginning of the century. (d) Inequalities in wealth are even greater than inequalities in income. (e) Inequalities are apparent not just in income but in a variety of other variables that reflect standards of living, such as insecurity and health. (f) Life is particularly harsh at the bottom—and the recession made it much worse. (g) There has been a hollowing out of the middle class. (h) There is little income mobility—the notion of America as a land of opportunity is a myth. (i) And America has more inequality than any other advanced industrialized country, it does less to correct these inequities, and inequality is growing more than in many other countries.

At the moment, world hunger and starvation have everything to do with politics. Political conflicts, insufficient responses to natural disasters, corrupt political institutions, and inequalities in income and education constitute what public health practitioners call the 'root' causes of hunger and malnutrition.

Just as people often confused inequality with poverty, they often confuse the goal of reducing inequality with the goal of fostering economic growth. But the findings on the critical role played by inequality itself - on health, decision making, political and social divisions - argue that economic growth by itself is not sufficient.

This book is about the endless dance between progress and inequality, about how progress creates inequality, and how inequality can sometimes be helpful—showing others the way, or providing incentives for catching up—and sometimes unhelpful—when those who have escaped protect their positions by destroying the escape routes behind them.

The teeth are made from stern stuff. They can withstand floods, fires, even centuries in the grave. But the teeth are no match for the slow-motion catastrophe that is a life of poverty: its burdens, distractions, diseases, privations, low expectations, transience, the addictive antidotes that offer temporary relief at usurious rates. Others

Another New Year's dawned, new opportunities and difficulties are sneaking around you. To take hold of good and let go bad, face the new challenges and open the new chances to anew your life again. Everyday train your brain to solve all difficulties and transform them into opportunities, get rich mentally, physically and financially. Love your family, friends, colleagues and all folks surrounded by you. Take care of your health, children, wealth and travel new exotic places, people and enjoy good food. Life is very short, fully enjoy it. Embrace new ideas, knowledge and every opportunity. And always surround yourself with good people and avoid toxic and negative people to secure your peace of mind and dignity. I wholeheartedly and boldly set my plan as is the best year of my life for financial freedom, good health, richness, love, care and abundance. I do solemnly yearn for the folks around the world a thoroughly Peaceful, Happy and Beautiful New Year free from hunger, poverty, disease, inequality, war and conflict.

Instead, they face heightened anxiety and sleep deprivation, which causes dramatic mood swings and is responsible for an estimated 13 percent of highway deaths. Worse yet, since the software is designed to save companies money, it often limits workers’ hours to fewer than thirty per week, so that they are not eligible for company health insurance.

Globalization gives workers in Asia better access to rich-country markets than ever before, and they can do many of the jobs that used to be done in the rich countries, even without being able to migrate. If this happens on a large scale, Asian wages will rise, and American and European wages will fall, narrowing earnings inequality in the world as a whole. The

There is a parallel in this to arguments that we have heard in New York City in regard to health facilities that serve the rich and poor. There, too, we were told by doctors that the more exhaustive services provided to rich patients may not represent superior health care but a form of “overutilization”—again the theory of “diminishing returns.” But here again it is not argued that the rich should therefore be denied this luxury, if that is what it is, but only that it shouldn’t be extended to poor people. Affluent people, it has often been observed, seldom lack for arguments to deny to others the advantages that they enjoy. But it is going a step further for the Wall Street Journal to pretend that they are not advantages.

Why is financial inequality a problem? There are two very different answers. One kind of harm is material: not being able to get a decent house, quality health care, a proper education, and a hopeful future for one’s children. But there is also a psychological reason why inequality proves so problematic: because poverty is intricately bound up with humiliation. The

As for my own answers to any of this? I have none. I'm far more confused than before I first went. I've had no great epiphanies, no profound realisations, but since returning home I've resigned myself to this one thing: that, putting the economics and politics of it all aside - naive as that may be - what it all boils down to is individuals. It's a simple interaction between just two people: one, a person with opportunities and choices, and who could get a flight out tomorrow should they choose; the other, a person with few options - if any. If nothing else, it's a gesture. An attempt. Food and a tent for Toto. Burns dressing for Jose. A little operating theatre with car batteries and boiled instruments, where Roberto can ply his trade. Free HIV treatment for Elizabeth, who'll never be cured and will always live in a hut anyway, but who'll have a longer, healthier life because of it. And sometimes it's little more than a bed in which to die peacefully, attended to by family and health workers... but hey, that's no small thing in some parts. My head says it's futile. My heart knows differently.

We should also be careful not to count the “leisure” of the unemployed as a benefit. Those who have lost their jobs are not choosing to spend more time at home, and study after study has documented that unemployed people are among the most dissatisfied with their lives. So the data in Figure 1 would not be improved by any mechanical adjustment for the value of leisure.

But before we can even address the mistreatment that occurs once a woman is interacting with the health-care system, we have to address the fact that some women never get that far. We won’t get a true picture of the incidence of endometriosis until we specifically look for it in marginalized communities. And before we can do that, we have to address the disparity in access. Social epidemiologist Jhumka Gupta has said that endometriosis is a social justice issue. In her speech at the Worldwide Endo March in Washington, DC, on March 19, 2016, she said that endometriosis is a social pathology, which she defined as “gender inequality, social injustice, and attitudes of society that keep women and girls from fully reaching their potential.

In these pages, we have made propositions to meet those challenges: a sharply progressive wealth tax to curb the forms of rent extraction associated with extreme and entrenched wealth, an effective taxation of globe-straddling companies to reconcile globalization with tax justice, a national income tax to fund the modern social state and alleviate the crushing cost of health care.

for higher-class parents, children are ‘projects.’ They have tightly scheduled lives and coordinated activities; high-income parents spend significant time and energy thinking about how to fulfill their kids’ ‘potentials.’ For the working class and poor, Lareau argues, parenting is more about ‘the accomplishment of natural growth.’ Top priorities in these families are safety and health.

New York City manages expertly, and with marvelous predictability, whatever it considers humanly important. Fax machines, computers, automated telephones and even messengers on bikes convey a million bits of data through Manhattan every day to guarantee that Wall Street brokers get their orders placed, confirmed, delivered, at the moment they demand. But leaking roofs cannot be fixed and books cannot be gotten into Morris High in time to meet the fall enrollment. Efficiency in educational provision for low-income children, as in health care and most other elementals of existence, is secreted and doled out by our municipalities as if it were a scarce resource. Like kindness, cleanliness and promptness of provision, it is not secured by gravity of need but by the cash, skin color and class status of the applicant.

The three richest people in the world possess more financial assets than all the people in the forty-eight poorest countries added together. The wealthiest one percent of the human population owns more than the bottom seventy percent. And so on. Also, note that these disparities in wealth have been increasing since 1980 to the present, and are one of the defining characteristics of neoliberalism. Inequality has now reached levels not seen since the so-called Gilded Age of the 1890s. Some angles of evidence now suggest this is the most wealth-inequal moment in human history, surpassing the feudal era for instance, and the early warrior/priest/peasant states. Also, the two billion poorest people on the planet still lack access to basics like toilets, housing, food, health care, education, and so on. This means that fully one

If democracy becomes plutocracy, those who are not rich are effectively disenfranchised. Justice Louis Brandeis famously argued that the United States could have either democracy or wealth concentrated in the hands of a few, but not both. The political equality that is required by democracy is always under threat from economic inequality, and the more extreme the economic inequality, the greater the threat to democracy.

Today’s computer technology exists in some measure because millions of middle-class taxpayers supported federal funding for basic research in the decades following World War II. We can be reasonably certain that those taxpayers offered their support in the expectation that the fruits of that research would create a more prosperous future for their children and grandchildren. Yet, the trends we looked at in the last chapter suggest we are headed toward a very different outcome. BEYOND THE BASIC MORAL QUESTION of whether a tiny elite should be able to, in effect, capture ownership of society’s accumulated technological capital, there are also practical issues regarding the overall health of an economy in which income inequality becomes too extreme. Continued progress depends on a vibrant market for future innovations—and that, in turn, requires a reasonable distribution of purchasing power.

One escape route from this negative conclusion is to argue, once again, that progress is being understated because quality improvements and new goods are not being adequately captured in the statistics. That would mean that inflation is being overstated, because some of the increase in prices comes from better things, not just from dearer things. If so, the poverty line is being increased too fast, and an ever-increasing proportion of the poor are not poor at all. If

Liberty and equality are enemies: the more freedom men enjoy, the freer they are to reap the results of their natural or environmental superiorities; hence inequality multiplies under governments favoring freedom of enterprise and support of property rights. Equality is an unstable equilibrium, which any difference in heredity, health, intelligence, or character will soon end. Most revolutions find that they can check inequality only by limiting liberty, as in authoritarian lands.

Once companies amass troves of data on employees’ health, what will stop them from developing health scores and wielding them to sift through job candidates? Much of the proxy data collected, whether step counts or sleeping patterns, is not protected by law, so it would theoretically be perfectly legal. And it would make sense. As we’ve seen, they routinely reject applicants on the basis of credit scores and personality tests. Health scores represent a natural—and frightening—next step.

Once people understand that women are fertile for only a fraction of the time men are, they are especially struck with the inequity of it all. So it’s particularly interesting to examine the ways in which women have been disproportionately exposed to side effects throughout their cycle. For example, there are many who will concede that while the pill was originally designed to sexually emancipate women, it has also had the effect of burdening the woman with the sole responsibility of birth control.

There were so many things we needed in those classrooms, in our city, in our state, in our country that our teachers could have provided if they would have gone home and really done their homework. They never once said the words: “economic inequality,” “housing discrimination,” “sexual violence,” “mass incarceration,” “homophobia,” “empire,” “mass eviction,” “post traumatic stress disorder,” “white supremacy,” “patriarchy,” “neo-confederacy,” “mental health,” or “parental abuse,” yet every student and teacher at that school lived in a world shaped by those words.

Can there be true equality in the classroom and the boardroom if there isn’t in the bedroom? Back in 1995 the National Commission on Adolescent Sexual Health declared healthy sexual development a basic human right. Teen intimacy, it said, ought to be “consensual, non-exploitative, honest, pleasurable, and protected against unintended pregnancy and STDs.” How is it, over two decades later, that we are so shamefully short of that goal? Sara McClelland, a professor of psychology at the University of Michigan, writes about sexuality as a matter of “intimate justice,” touching on fundamental issues of gender inequality, economic disparity, violence, bodily integrity, physical and mental health, self-efficacy, and power dynamics in our most personal relationships. She asks us to consider: Who has the right to engage in sexual behavior? Who has the right to enjoy it? Who is the primary beneficiary of the experience? Who feels deserving? How does each partner define “good enough?” Those are thorny questions when looking at female sexuality at any age, but particularly when considering girls’ early, formative experience. Nonetheless, I was determined to ask them.

The rest of my teachers maybe did the best they could, but they just needed a lot of help making their best better. There were so many things we needed in those classrooms, in our city, in our state, in our country that our teachers could have provided if they would have gone home and really done their homework. They never once said the words: “economic inequality,” “housing discrimination,” “sexual violence,” “mass incarceration,” “homophobia,” “empire,” “mass eviction,” “post traumatic stress disorder,” “white supremacy,” “patriarchy,” “neo-confederacy,” “mental health,” or “parental abuse,” yet every student and teacher at that school lived in a world shaped by those words.

Recall Marx’s fundamental insight about the “bourgeois” limitation of the logic of equality: capitalist inequalities (“exploitation”) are not the “unprincipled violations of the principle of equality,” but are absolutely inherent to the logic of equality, they are the paradoxical result of its consistent realization. What we have in mind here is not only the wearisome old motif of how market exchange presupposes formally/legally equal subjects who meet and interact in the market; the crucial moment of Marx’s critique of “bourgeois” socialists is that capitalist exploitation does not involve any kind of “unequal” exchange between the worker and the capitalist—this exchange is fully equal and “just,” ideally (in principle), the worker gets paid the full value of the commodity he is selling (his labor-power). Of course, radical bourgeois revolutionaries are aware of this limitation; however, the way they try to counteract it is through a direct “terroristic imposition of more and more de facto equality (equal salaries, equal access to health services…), which can only be imposed through new forms of formal inequality (different sorts of preferential treatments for the underprivileged). In short, the axiom of equality” means either not enough (it remains the abstract form of actual inequality) or too much (enforce “terroristic” equality)— it is a formalistic notion in a strict dialectical sense, that is, its limitation is precisely that its form is not concrete enough, but a mere neutral container of some content that eludes this form.

HSBC's executives saw an emerging class of global rich as the bank's path to prosperity. The superwealthy were increasingly stateless. They banked in Geneva. Lived in London and New York. Shopped in Paris and Milan. And they held their assets through offshore companies registered in places like the British Virgin Islands. HSBC executives were reading the telltale signs of a new age of inequality, even if they didn't recognize it as such. Governments were retreating from providing their citizens pension and health organizations, and HSBC strategy report observed. The stateless rich balked at paying taxes in their home countries, to which they felt little allegiance. It made sense to them to base their operations inside tax havens and to bank in Switzerland, where discretion was woven into the country's DNA. These trends represented an opportunity for the wealth management industry.

Now imagine what a change it would be for a young black American to grow up in a society where they didn’t have to settle for the worst schools, the worst health care, the worst jobs, or possibly be subjected to the worst carceral system on Earth. Imagine what it would mean for women if they were more easily able to leave abusive relationships or escape workplace harassment with the help of strong welfare guarantees. Imagine our future Einsteins and Leonardo da Vincis liberated from grinding poverty and misery and able to contribute to human greatness. Or forget Einstein and Leonardo—better yet, imagine ordinary people, with ordinary abilities, having time after their twenty-eight-hour workweek to explore whatever interests or hobbies strike their fancy (or simply enjoy their right to be bored). The deluge of bad poetry, strange philosophical blog posts, and terrible abstract art will be a sure sign of progress.

By structural violence, I mean the violence committed by configurations of social inequalities that, in the end, has injurious effects on bodies similar to the violence of a stabbing or shooting. This is what the English working men described by Friedrich Engels called 'social murder'. Much of the structural violence is organized along the fault lines of class, race, citizenship, gender, and sexuality. (...) Symbolic violence works through the perceptions of the 'dominating' and the 'dominated' (in Bourdieu's words), while it tends to benefit those with more power. each group understands not only itself but also the other to belong naturally in their positions in the social hierarchy. (...) Structural violence - with its pernicious effects on health - and symbolic violence - with its subtle naturalization of inequalities on the farm, in the clinic, and in the media - form the nexus of violence and suffering through which the phenomenon of migrant labor in North America is produced.

The fact that most perpetrators of organised abuse are men, and that their most intensive and sadistic abuses are visited upon girls and women, has gone largely unnoticed, as have the patterns of gendered inequity that characterise the families and institutional settings in which organised abuse takes place. Organised abuse survivors share a number of challenges in common with other survivors of abuse and trauma, including health and justice systems that have been slow to recognise and respond to violence against children and women. However, this connection is rarely made in the literature on organised abuse, with some authors hinting darkly at the nefarious influence of abusive groups. Fraser (1997: xiv) provides a note of caution here, explaining that whilst it is relatively easy to ‘comment on the naïveté of those grappling with this issue ... it is very difficult to actually face a new and urgent phenomenon and deal with it, but not fully understand it, while managing distressed and confused patients and their families’.

Neoliberal economics, the logic of which is tending today to win out throughout the world thanks to international bodies like the World Bank or the International Monetary Fund and the governments to whom they, directly or indirectly, dictate their principles of ‘governance’,10 owes a certain number of its allegedly universal characteristics to the fact that it is immersed or embedded in a particular society, that is to say, rooted in a system of beliefs and values, an ethos and a moral view of the world, in short, an economic common sense, linked, as such, to the social and cognitive structures of a particular social order. It is from this particular economy that neoclassical economic theory borrows its fundamental assumptions, which it formalizes and rationalizes, thereby establishing them as the foundations of a universal model. That model rests on two postulates (which their advocates regard as proven propositions): the economy is a separate domain governed by natural and universal laws with which governments must not interfere by inappropriate intervention; the market is the optimum means for organizing production and trade efficiently and equitably in democratic societies. It is the universalization of a particular case, that of the United States of America, characterized fundamentally by the weakness of the state which, though already reduced to a bare minimum, has been further weakened by the ultra-liberal conservative revolution, giving rise as a consequence to various typical characteristics: a policy oriented towards withdrawal or abstention by the state in economic matters; the shifting into the private sector (or the contracting out) of ‘public services’ and the conversion of public goods such as health, housing, safety, education and culture – books, films, television and radio – into commercial goods and the users of those services into clients; a renunciation (linked to the reduction in the capacity to intervene in the economy) of the power to equalize opportunities and reduce inequality (which is tending to increase excessively) in the name of the old liberal ‘self-help’ tradition (a legacy of the Calvinist belief that God helps those who help themselves) and of the conservative glorification of individual responsibility (which leads, for example, to ascribing responsibility for unemployment or economic failure primarily to individuals, not to the social order, and encourages the delegation of functions of social assistance to lower levels of authority, such as the region or city); the withering away of the Hegelian–Durkheimian view of the state as a collective authority with a responsibility to act as the collective will and consciousness, and a duty to make decisions in keeping with the general interest and contribute to promoting greater solidarity. Moreover,

In March 2002, the National Academy of Sciences, a private, nonprofit society of scholars, released a high-profile report documenting the unequivocal existence of racial bias in medical care, which many thought would mark a real turning point. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care was so brutal and damning that it would seem impossible to turn away. The report, authored by a committee of mostly white medical educators, nurses, behavioral scientists, economists, health lawyers, sociologists, and policy experts, took an exhaustive plunge into more than 480 previous studies. Because of the knee-jerk tendency to assume that health disparities were the end result of differences in class, not race, they were careful to compare subjects with similar income and insurance coverage. The report found rampant, widespread racial bias, including that people of color were less likely to be given appropriate heart medications or to undergo bypass surgery or receive kidney dialysis or transplants. Several studies revealed significant racial differences in who receives appropriate cancer diagnostic tests and treatments, and people of color were also less likely to receive the most sophisticated treatments for HIV/AIDS. These inequities, the report concluded, contribute to higher death rates overall for Black people and other people of color and lower survival rates compared with whites suffering from comparable illnesses of similar severity.

The impact of second-class treatment on black people’s bodies is devastating. It is manifested not only in the black–white death gap but also in the drastic measures required when chronic disease is left unmanaged. Black patients are less likely than whites to be referred to kidney and liver transplant wait lists and are more likely to die while waiting for a transplant.68 If they are lucky enough to get a donated kidney or liver, blacks are sicker than whites at the time of transplantation and less likely to survive afterward. “Take a look at all the black amputees,” said a caller to a radio show I was speaking on, identifying the remarkable numbers of people with amputated legs you see in poor black communities as a sign of health inequities. According to a 2008 nationwide study of Medicare claims, whites in Louisiana and Mississippi have a higher rate of leg amputation than in other states, but the rate for blacks is five times higher than for whites.69 An earlier study of Medicare services found that physicians were less likely to treat their black patients with aggressive, curative therapies such as hospitalization for heart disease, coronary artery bypass surgery, coronary angioplasty, and hip-fracture repair.70 But there were two surgeries that blacks were far more likely to undergo than whites: amputation of a lower limb and removal of the testicles to treat prostate cancer. Blacks are less likely to get desirable medical interventions and more likely to get undesirable interventions that good medical care would avoid.

Critics of the U.S. Constitution say it is an instrument of class oppression – made by the rich to the disadvantage of the poor. They deny the reality of separate powers under the Constitution. For them, the inequalities of the market economy must be corrected by government intervention. A century ago Le Bon wrote of the difficulties involved in “reconciling Democratic equalization with natural inequalities.” As Le Bon pointed out, “Nature does not know such a thing as equality. She distributes unevenly genius, beauty, health, vigor, intelligence, and all the qualities which confer on their possessors a superiority over their fellows.” When a politician pretends to oppose the inequalities of nature, he proves to be a special kind of usurper – personifying arrogance in search of boundless power. Logically, the establishment of universal equality would first require the establishment of a universal tyranny (a.k.a., the dictatorship of the proletariat). A formula for doing all this was worked out in the nineteenth century, and was the program of Karl Marx. Le Bon warned that socialism might indeed “establish equality for a time by rigorously eliminating all superior individuals.” He also foresaw the decline of any nation that followed this path (i.e., see the Soviet Union). Such a society would aim at eliminating all risk, speculation and initiative. These stimulants of human activity being suppressed, no progress would be possible. According to Le Bon, “Men would merely have established that equality in poverty desired by the jealousy and envy of a host of mediocre minds.

The Covid-19 pandemic has made it clear that by several measures, the health status of Black Americans is on par with that of people living in far poorer nations, and that at every stage of life Black Americans have poorer health outcomes than white Americans and even, in most cases, than other ethnic groups. Racial health disparities show up at the beginning of life and cut lives short at the end. Black babies are more than twice as likely as white babies to die at birth or in the first year of life—a racial gap that adds up to thousands of lost lives every year.13 African American adults of all ages have elevated rates of conditions such as diabetes and hypertension that among white people are found more commonly at older ages. In the first half of 2020, owing to the pandemic, the Black-white gap in life expectancy increased to six years, from four in 2019.14 This inequality when it comes to the health of Black people’s bodies is rooted in false ideas about racial differences, developed and spread during slavery, and long challenged by Black medical practitioners and scholars, that still inform the way medical treatment is administered in America.15 To understand the racial divide in the health of our nation that was stripped bare by Covid-19, we must examine the roots of these myths. — In the 1787 manual A Treatise on Tropical Diseases; and on the Climate of the West-Indies, a British doctor, Benjamin Moseley, claimed that Black people could bear surgical operations much more easily than white people, noting that “what would be the cause of insupportable pain to a white man, a Negro would almost disregard.

Dr. Gilligan states: “I am suggesting that the only way to explain the causes of violence, so that we can learn how to prevent it, is to approach violence as a problem in public health and preventive medicine, and to think of violence as a symptom of life-threatening pathology, which, like all form of illness, has an etiology or cause, a pathogen.”160 In Dr. Gilligan's diagnosis he makes it very clear that the greatest cause of violent behavior is social inequality, highlighting the influence of shame and humiliation as an emotional characteristic of those who engage in violence.161 Thomas Scheff, a emeritus professor of sociology in California stated that “shame was the social emotion”.162 Shame and humiliation can be equated with the feelings of stupidity, inadequacy, embarrassment, foolishness, feeling exposed, insecurity and the like – all largely social or comparative in their origin. Needless to say, in a global society with not only growing income disparity but inevitably “self-worth” disparity - since status is touted as directly related to our “success” in our jobs, bank account levels and the like - it is no mystery that feelings of inferiority, shame and humiliation are staples of the culture today. The consequence of those feelings have very serious implications for public health, as noted before, including the epidemic of the behavioral violence we now see today in its various complex forms. Terrorism, local school and church shootings, along with other extreme acts that simply did not exist before in the abstractions they find context today, reveals a unique evolution of violence itself. Dr. Gilligan concludes: “If we wish to prevent violence, then, our agenda is political and economic reform.”163

It is very important to note, however, that the only segment of the population from whom changing our social and economic conditions in the ways that prevent violence would exact a higher cost would be the extremely wealthy upper, or ruling, class — the wealthiest one per cent of the population (which in the United States today controls some 39 per cent of the total wealth of the nation, and 48 per cent of the financial wealth, as shown by Wolff in Top Heavy (1996). The other 99 per cent of the population — namely, the middle class and the lower class — would benefit, not only form decreased rates of violence (which primarily victimize the very poor), but also from a more equitable distribution of the collective wealth and income of our unprecedentedly wealthy societies. Even on a worldwide scale, it would require a remarkably small sacrifice from the wealthiest individuals and nations to raise everyone on earth, including the populations of the poorest nations, above the subsistence level, as the United Nations Human Development Report 1998, has shown. I emphasize the wealthiest individuals as well as nations because, as the U.N. report documents, a tiny number of the wealthiest individuals actually possess wealth on a scale that is larger than the annual income of most of the nations of the earth. For example, the three richest individuals on earth have assets that exceed the combined Gross Domestic Product of the fortyeight poorest countries! The assets of the 84 richest individuals exceed the Gross Domestic Product of the most populous nation on earth, China, with 1.2 billion inhabitants. The 225 richest individuals have a combined wealth of over $1 trillion, which is equal to the annual income of the poorest 47 per cent of the world's population, or 2.5 billion people. By comparison, it is estimated that the additional cost of achieving and maintaining universal access to basic education for all, basic health care for all, reproductive health care for all women, adequate food for all and safe water and sanitation for all is roughly $40 billion a year. This is less than 4 per cent of the combined wealth of the 225 richest people in the world. It has been shown throughout the world, both internationally and intranationally, that reducing economic inequities not only improves physical health and reduces the rate of death from natural causes far more effectively than doctors, medicines, and hospitals; it also decreases the rate of death from both criminal and political violence far more effectively than any system of police forces, prisons, or military interventions ever invented.

Increasingly, progressive voices in the media are shining a spotlight on the need for new businesses that serve both entrepreneurs and local communities. Yes! Magazine is a leading chronicler of independence from the global economy, with features such as “31 Ways to Jump Start the Local Economy,” “Wendell Berry’s 17 Rules for a Sustainable Economy,” “A Resilient Community,” “Small Banks, Radical Vision,” and other numerous stories on how consumers and householders can become producers of energy and food. Epidemiologist Richard Wilkinson, in his bestseller The Impact of Inequality: How to Make Sick Societies Healthier, offered both a survey of our nation’s growing economic inequalities and an eloquent argument that such inequalities will lead to increased anxiety, fear, isolation, health failures, and chronic insecurity.

The terms health disparities and health inequities are generally used in the United States,

The Ottawa Charter for Health Promotion defines health promotion as “the process of enabling people to increase control over, and to improve, their health . . . a commitment to dealing with the challenges of reducing inequities, extending the scope of prevention, and helping people to cope with their circumstances . . . create environments conducive to health, in which people are better able to take care of themselves” (Epp, 1986).

As economists from the University of Chicago, M.I.T. and the University of Southern California put it in a recent research paper, much of America’s infant mortality deficit is driven by “excess inequality.” American babies born to white, college-educated, married women survive as often as those born to advantaged women in Europe. It’s the babies born to nonwhite, nonmarried, nonprosperous women who die so young. Three or four decades ago, the United States was the most prosperous country on earth. It had the mightiest military and the most advanced technologies known to humanity. Today, it’s still the richest, strongest and most inventive. But when it comes to the health, well-being and shared prosperity of its people, the United States has fallen far behind.

Indeed, as we shall see, it is a bad mistake to confuse life satisfaction and happiness; the former is an overall judgment about life that comes from consideration, while the latter is an emotion, a mood, or a feeling, which is part of experiencing life.16

colorblindness is such a bad idea, though, why have people across the political spectrum become so attached to it? For conservatives, the ideal of colorblindness is linked to a commitment to individualism. In their view, society should be concerned with individuals, not groups. Gross racial disparities in health, wealth, education, and opportunity should be of no interest to our government, and racial identity should be a private matter, something best kept to ourselves. For liberals, the ideal of colorblindness is linked to the dream of racial equality. The hope is that one day we will no longer see race because race will lose all of its significance. In this fantasy, eventually race will no longer be a factor in mortality rates, the spread of disease, educational or economic opportunity, or the distribution of wealth. Race will correlate with nothing; it will mean nothing; we won’t even notice it anymore. Those who are less idealistic embrace colorblindness simply because they find it difficult to imagine a society in which we see race and racial differences yet consistently act in a positive, constructive way. It is easier to imagine a world in which we tolerate racial differences by being blind to them. The uncomfortable truth, however, is that racial differences will always exist among us. Even if the legacies of slavery, Jim Crow, and mass incarceration were completely overcome, we would remain a nation of immigrants (and indigenous people) in a larger world divided by race and ethnicity. It is a world in which there is extraordinary racial and ethnic inequality, and our nation has porous boundaries. For the foreseeable future, racial and ethnic inequality will be a feature of American life. This reality is not cause for despair. The idea that we may never reach a state of perfect racial equality—a perfect racial equilibrium—is not cause for alarm. What is concerning is the real possibility that we, as a society, will choose not to care. We will choose to be blind to injustice and the suffering of others. We will look the other way and deny our public agencies the resources, data, and tools they need to solve problems. We will refuse to celebrate what is beautiful about our distinct cultures and histories, even as we blend and evolve. That is cause for despair. Seeing race is not the problem. Refusing to care for the people we see is the problem.

In 2008, there were about 800 million people in the world living on less than $1.00 a day. On average, each of these people is “short” about $0.28 a day; their average daily expenditure is $0.72 instead of the $1.00 it would take to lift them out of poverty.1 We could make up the shortfall with less than a quarter of a billion dollars a day; $0.28 times 800 million is $0.22 billion. If the United States were to try to do this on its own, each American man, woman, and child would have to pay $0.75 each day, or $1.00 a day each if children were exempted. We could cut this to $0.50 a person per day if the adults of Britain, France, Germany, and Japan joined in. Even

Global poverty is a cosmopolitan idea and its measurement must be performed on a cosmopolitan basis.

American family of four could buy enough cheap foods—like bulk rice, oatmeal, beans, and a few vegetables—to survive on $1,460 a year; one recent paper has priced out a “bare-bones” bundle for the United States at around $1.25 a person a day, or $1,825 a year for a family of four.14 Advocates of the validity of the line can also note, correctly, that 22 rupees a day buys a miserable life in India too, and that poor people and their children in India, if not hungry on a daily basis, are among the most malnourished in the world.

After all, millions of people in India live on less than a dollar a day, converted at the PPP exchange rate of about 22 rupees per dollar, and the whole point of these exchange rates is to equalize purchasing power across countries. So if people can live in India on 22 rupees a day—and be far from the worst off—why can’t people in the United States live on a dollar a day?

One key to African growth is what happens to commodity prices. Many African countries have long been and are still dependent on exports of “primary” commodities, mostly unprocessed minerals or agricultural crops. Botswana exports diamonds; South Africa, gold and diamonds; Nigeria and Angola, oil; Niger, uranium; Kenya, coffee; Côte d’Ivoire and Ghana, cocoa; Senegal, groundnuts; and so on. The world prices of primary commodities are notoriously volatile, with huge price increases in response to crop failures or increases in world demand and equally dramatic price collapses, none of which are easily predictable.

In the ensuing chapters, we will look in some detail at particular manifestations of the modern scientific ideology and the false paths down which it has led us. We will consider how biological determinism has been used to explain and justify inequalities within and between societies and to claim that those inequalities can never be changed. We will see how a theory of human nature has been developed using Darwin's theory of evolution by natural selection to claim that social organization is also unchangeable because it is natural. We will see how problems of health and disease have been located within the individual so that the individual becomes a problem for society to cope with rather than society becoming a problem for the individual. And we will see how simple economic relationships masquerading as facts of nature can drive the entire direction of biological research and technology.

Life expectancy rose only modestly between the Neolithic era of 8500 to 3500 BC and the Victorian era of 1850 to 1900.13 An American born in the late nineteenth century had an average life expectancy of around forty-five years, with a large share never making it past their first birthdays.14 Then something remarkable happened. In countries on the frontier of economic development, human health began to improve rapidly, education levels shot up, and standards of living began to grow and grow. Within a century, life expectancies had increased by two-thirds, average years of schooling had gone from single to double digits, and the productivity of workers and the pay they took home had doubled and doubled and then doubled again. With the United States leading the way, the rich world crossed a Great Divide—a divide separating centuries of slow growth, poor health, and anemic technical progress from one of hitherto undreamed-of material comfort and seemingly limitless economic potential. For the first time, rich countries experienced economic development that was both broad and deep, reaching all major segments of society and producing not just greater material comfort but also fundamental transformations in the health and life horizons of those it touched. As the French economist Thomas Piketty points out in his magisterial study of inequality, “It was not until the twentieth century that economic growth became a tangible, unmistakable reality for everyone.”15 The mixed economy was at the heart of this success—in the United States no less than in other Western nations. Capitalism played an essential role. But capitalism was not the new entrant on the economic stage. Effective governance was. Public health measures made cities engines of innovation rather than incubators of illness.16 The meteoric expansion of public education increased not only individual opportunity but also the economic potential of entire societies. Investments in science, higher education, and defense spearheaded breakthroughs in medicine, transportation, infrastructure, and technology. Overarching rules and institutions tamed and transformed unstable financial markets and turned boom-bust cycles into more manageable ups and downs. Protections against excessive insecurity and abject destitution encouraged the forward-looking investments and social integration that sustained growth required. At every level of society, the gains in health, education, income, and capacity were breathtaking. The mixed economy was a spectacularly positive-sum bargain: It redistributed power and resources, but as its impacts broadened and diffused, virtually everyone was made massively better off.

the top 10 percent of tax units in 2011 commanded 47 percent of all income, with an average income of $255,000. (A tax unit is not identical to a family, nor is income for tax purposes the same as other measures of income, but the overlaps are big enough that these trends are not misleading.)

In the early years, top incomes were derived from capital, and the richest people were what Piketty and Saez call “coupon clippers,” who received most of their incomes from dividends and interest. The fortunes underlying these receipts were eroded over the century by increasingly progressive income and estate taxes. Those who used to live off their (or their ancestors’) fortunes have been replaced at the top by earners, people like CEOs of large firms, Wall Street bankers, and hedge fund managers, who receive their incomes as salaries, bonuses, and stock options. Entrepreneurial

The evolution of income can be looked at from three different perspectives: growth, poverty, and inequality. Growth is about the average and how it changes, poverty about the bottom, and inequality about how widely incomes are spread across families or people. The

As we shall see, GDP is a poor indicator of wellbeing, but it is limited even as a measure of income. It includes income generated in the United States that belongs to foreigners; it includes incomes in the form of undistributed corporate profits (which ultimately belong to shareholders) as well as surpluses run by federal, state, and local government.

The part of national income that is available to families, after taxes have been paid and any transfers received, is personal disposable income, which is the second line from the top. It is a good deal smaller than GDP, but the historical picture of growth and fluctuation is very similar. Much the same is true if we look, not at what people get, but at what they spend. This is consumers’ expenditure, the third line. The difference between personal disposable income and consumers’ expenditure is the amount that people save, and the figure shows that the fraction of their income that Americans save has been falling, especially over the past thirty years. We don’t know exactly why this has happened, and there are several possible explanations: it is easier to borrow than it used to be; it is no longer as necessary as it once was to save up to make the deposit on a house, a car, or a dishwasher; Social Security has perhaps reduced the need to save for retirement; and the average American benefited from increases in the stock market and in house prices—at least until the Great Recession.

Rising wage inequality is a by-product of this mechanism and plays a key role in raising the supply of skills. So while the inequality is not particularly welcome in its own right, it is part of a system that is raising living standards for everyone.

If the family incentive scheme runs long enough, inequality may be increased even more if the children save part of their allowances. Even if all children save the same share of their allowances, one is regularly adding more to her wealth than the others, and she will get steadily richer than her siblings. Saving will ramp up the inequality in the allowances, and inequality in wealth will soon dwarf the inequality in allowances, just as, in the actual economy, inequality in wealth dwarfs inequality in earnings. This ramping up of inequality will be even faster if the children who are naturally inclined to be tidy are also those who are naturally inclined to save for the future. In the society at large, the same forces are at work if those who are more oriented to the future and have more self-control are the same people who are more able to benefit from education and more likely to accumulate wealth from their education-enhanced earnings. There is a deep conflict between incentives and inequality, in families and in countries.

As we already know from the poverty numbers, the bottom fifth of families gained very little. The growth in their average incomes was less than 0.2 percent a year over the past forty-four years and, even before the recession, their real incomes were no higher than they had been in the late 1970s. Average incomes of the top fifth, by contrast, grew more quickly, at 1.6 percent a year, though not as quickly as those of the top 5 percent, whose average incomes grew at 2.1 percent a year. Once

Material wellbeing, and measures of it—GDP, personal income, and consumption—have recently received a bad press. Spending more, we are often told, does not bring us better lives, and religious authorities regularly warn against materialism. Even among those of us who endorse economic growth, there are many critics of GDP as it is currently defined and measured. GDP excludes important activities, such as services by homemakers; it takes no account of leisure; and it often does a poor job of measuring those things that are included. It also includes things that arguably should be excluded, like the cost of cleaning up pollution or building prisons or commuting. These “defensive” expenditures are not good in and of themselves but are regrettably necessary to enable things that are good.4 If crime goes up, and we spend more on prisons, GDP will be higher. If we neglect climate change, and spend more and more on cleaning up and repairing after storms, GDP will go up, not down; we count the repairs but ignore the destruction.

Economic growth requires investment in things—more machines, more basic facilities like highways or broadband—and in people, who need more and better education. Knowledge needs to be acquired and extended. Some of that extension is the product of new basic science, and some of it comes from the engineering that turns science into goods and services, and from the endless tweaking and improvement of design that, over time, turned a Model-T Ford into a Toyota Camry, or my clunky personal computer of 1983 into the sleek, almost weightless, and infinitely more powerful laptop on which I am writing this book. Investment in research and development enhances the flow of innovation, but new ideas can come from anywhere; the stock of knowledge is international, not national, and new ideas disperse quickly from the places where they are created. Innovation also needs entrepreneurs and risk-taking managers to find profitable ways of turning science and engineering into new products and services. This will be difficult without the right institutions. Innovators need to be free from the risk of expropriation, functioning law courts are needed to settle disputes and protect patents, and tax rates cannot be too high. When all of these conditions come together—as they have in the United States for a century and a half—we get sustained economic growth and higher living standards.

The spread is often measured by the Gini coefficient, named after Corrado Gini, an Italian economist who worked in the first half of the twentieth century. Gini’s coefficient, or simply the Gini, is a number that lies between 0 (perfect equality—everyone has the same) and 1 (perfect inequality, with one person having everything). It measures how far people are apart on average. (If you really want know the details, it is the average difference in income between all pairs of people divided by twice the average income. If there are two of us, and you have everything, the difference between us is twice the mean, and the Gini is 1. If we both have the same, the difference between us is 0, and so is the Gini.)

Leisure time is not counted at all; if people decide to work less, and take more time for things they value more than work, national income and consumers’ expenditure will fall. One reason that French GDP per capita is lower than American GDP per capita is because the French take longer holidays, but it is hard to argue that they are worse off as a result. Nor do we count services that are not sold in the market, so that if a woman works at home to care for her family, it is not counted, but if she works in someone else’s home to care for their family, it is counted, and national income will be higher. If

The slowdown in growth is likely overstated, because the statisticians miss a lot of quality improvements, especially for services, which represent an increasing share of national output. The information revolution and its associated devices do more for wellbeing than we can measure. That these pleasures are barely captured in the growth statistics tells us about the inadequacies of the statistics, not the inadequacies of the technology or the joys that it brings.