Inequalities In Health 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.

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.

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.

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.

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

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.

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.

child born in Sierra Leone is over one hundred times as likely to die of tuberculosis than a child born in the United States. This difference, as Dr. Joia Mukherjee writes, is “not caused by genetics, biology, or culture. Health inequities are caused by poverty, racism, lack of medical care, and other social forces.

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.

In today’s world, marked by a mental health epidemic and a loneliness epidemic, coupled with burnout and work stress, rising costs of living, and increasing inequality, Global Holistic Wealth Day is more essential than ever.

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.

There is an enormous difference between seeing people as the victims of innate shortcomings and seeing them as the victims of structural violence. Indeed, it is likely that the struggle for rights is undermined whenever the history of unequal chances, and of oppression, is erased or distorted.

A child born in Sierra Leone is over one hundred times as likely to die of tuberculosis than a child born in the United States. This difference, as Dr. Joia Mukherjee writes, is “not caused by genetics, biology, or culture. Health inequities are caused by poverty, racism, lack of medical care, and other social forces.

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.

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

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.

any barrier to good jobs, safe schools, or basic health care is inequality one and the same.

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

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.

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.

I would never accept a world where Hank might be told: “I’m sorry, but while your cancer has a 92% cure rate when treated properly, there just aren’t adequate resources in the world to make that treatment available to you.” That world would be so obviously and unacceptably unjust. So how can I live in a world where Henry and his family are told that? How can I accept a world where over a million people will die this year for want of a cure that has existed for nearly a century?

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.

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.

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.

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

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.

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

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.

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.

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.

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.

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.

As economic inequality grew, time horizons shrank, and fewer Americans believed that the future held a better version of the present. Lacking a functional state that assured basic social goods taken for granted elsewhere - education, pensions, health care, transport, parental leave, vacations - Americans could be overwhelmed by each day, and lose a sense of the future.

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.

The most profound injustice a government can perpetrate against its people is not the theft of their wealth but the systematic destruction of their education and healthcare systems. A populace deprived of knowledge and burdened by poor health becomes vulnerable, malleable, and susceptible to manipulation, conditioned like Pavlov’s dogs to respond predictably to external stimuli.

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.

Why does the United States have income inequality rates equivalent to those of its Gilded Age more than a century earlier? Why didn’t its citizens insist upon, or achieve, universal public health care before — and especially after — the Second World War, when most of its Western allies and even adversaries did? Why was there, at least in comparative terms, never a viable socialist or serious labor party alternative in mainstream American politics? Why has an unprecedented class- and especially race-based mass incarceration regime developed in the nation that most loudly proclaims its dedication to freedom? And why is it the United States wages undeclared warfare across the planet’s entirety? Many of the answers actually lie in the past, in the historical development of US politics and society.

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.

After almost forty years of research in public health and a lifetime of wrestling with questions of racial and class injustice, I have concluded that a process I call weathering, a process that encompasses the physiological effects of living in marginalized communities that bear the brunt of racial, ethnic, religious, and class discrimination, is critical to understanding and eliminating population health inequity.

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

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.

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.

Most every other industrial nation in the world has pursued "free trade" policies similar to those enacted by the United States since its farm crisis, some combination of outsourcing, privatization, and financial liberalization. But no other wealthy nation has experienced the kind of alienation, inequality, public health crises, and violence that have become routine in the United States. That's because, as part of the post-Vietnam restoration, the United States didn't just restructure but also launched an assault on the social institutions—especially public services and unions—that might have moderated the effects of the restructuring.

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.

In my hometown, the number of children living in poverty has more than tripled since I left.[4] The number orphaned by the opioid crisis has tripled just since 2015.[5] After the jobs went away, heroin helped itself to my hometown, followed by fentanyl and meth. The result of that one-two punch has been a preponderance of trauma that is overtaxing every system meant to address it. “Backward mobility,” economists call this devastating trend, exacerbated by the Great Recession. As corporate profits soared, the median wage for workers, adjusted for inflation, stagnated, and the cost of housing, education, and health care far outpaced inflation. In the four decades between my graduation and Silas’s, inequality grew so dramatically in the United States that the richest 0.01 percent of Americans have accumulated the same amount of wealth as the poorest 50 percent.[6]

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.

A just society is one that allows all of its members access to the widest possible range of fundamental goods. Fundamental goods include education, health, the right to vote, and more generally to participate as fully as possible in the various forms of social, cultural, economic, civic, and political life. A just society organizes socioeconomic relations, property rights, and the distribution of income and wealth in such a way as to allow its least advantaged members to enjoy the highest possible life conditions. A just society in no way requires absolute uniformity or equality. To the extent that income and wealth inequalities are the result of different aspirations and distinct life choices or permit improvement of the standard of living and expansion of the opportunities available to the disadvantaged, they may be considered just. But this must be demonstrated, not assumed, and this argument cannot be invoked to justify any degree of inequality whatsoever, as it too often is.

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.

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.

the politics of inevitability, a sense that the future is just more of the present, that the laws of progress are known, that there are no alternatives, and therefore nothing really to be done. In the American capitalist version of this story, nature brought the market, which brought democracy, which brought happiness. In the European version, history brought the nation, which learned from war that peace was good, and hence chose integration and prosperity. Before the collapse of the Soviet Union in 1991, communism had its own politics of inevitability: nature permits technology; technology brings social change; social change causes revolution; revolution enacts utopia. When this turned out not to be true, the European and American politicians of inevitability were triumphant. Europeans busied themselves completing the creation of the European Union in 1992. Americans reasoned that the failure of the communist story confirmed the truth of the capitalist one. Americans and Europeans kept telling themselves their tales of inevitability for a quarter century after the end of communism, and so raised a millennial generation without history. The American politics of inevitability, like all such stories, resisted facts. The fates of Russia, Ukraine, and Belarus after 1991 showed well enough that the fall of one system did not create a blank slate on which nature generated markets and markets generated rights. Iraq in 2003 might have confirmed this lesson, had the initiators of America’s illegal war reflected upon its disastrous consequences. The financial crisis of 2008 and the deregulation of campaign contributions in the United States in 2010 magnified the influence of the wealthy and reduced that of voters. As economic inequality grew, time horizons shrank, and fewer Americans believed that the future held a better version of the present. Lacking a functional state that assured basic social goods taken for granted elsewhere—education, pensions, health care, transport, parental leave, vacations—Americans could be overwhelmed by each day, and lose a sense of the future. The collapse of the politics of inevitability ushers in another experience of time: the politics of eternity. Whereas inevitability promises a better future for everyone, eternity places one nation at the center of a cyclical story of victimhood. Time is no longer a line into the future, but a circle that endlessly returns the same threats from the past. Within inevitability, no one is responsible because we all know that the details will sort themselves out for the better; within eternity, no one is responsible because we all know that the enemy is coming no matter what we do. Eternity politicians spread the conviction that government cannot aid society as a whole, but can only guard against threats. Progress gives way to doom.

A dramatic example of how reductions in inequality can lead to rapid improvements in health is the experience of Britain during the two world wars. Increases in life expectancy for civilians during the war decades were twice those seen throughout the rest of the twentieth century. In the decades which contain the world wars, life expectancy increased between 6 and 7 years for men and woman, whereas in the decades before, between and after, life expectancy increased by between 1 and 4 years... Both wartime's were characterised by full employment and considerably narrow income differences - the result of deliberate government policies to promote cooperation with the war effort. During WW2 for example, working-class incomes rose by 9 per cent, while incomes of the middle class by 7 per cent; rates of relative poverty were halved. The resulting sense of camaraderie and social cohesion not only led to better health - crimes rates also fell.

Rather than reducing inequality itself, the initiatives aimed at tackling health or social problems are nearly always attempts to break the links between socio-economic disadvantage and the problem it produces. The unstated hope is that people - particularly the poor -v can carry on in the same circumstances, but will somehow no longer succumb to mental illness, teenage pregnancy, educational failure, obesity, or drugs.

What is a just society? For the purposes of this book, I propose the following imperfect definition. A just society is one that allows all of its members access to the widest possible range of fundamental goods. Fundamental goods include education, health, the right to vote, and more generally to participate as fully as possible in the various forms of social, cultural, economic, civic, and political life. A just society organizes socioeconomic relations, property rights, and the distribution of income and wealth in such a way as to allow its least advantaged members to enjoy the highest possible life conditions. A just society in no way requires absolute uniformity or equality. To the extent that income and wealth inequalities are the result of different aspirations and distinct life choices or permit improvement of the standard of living and expansion of the opportunities available to the disadvantaged, they may be considered just. But this must be demonstrated, not assumed, and this argument cannot be invoked to justify any degree of inequality whatsoever, as it too often is.

The health-care system in the United States is also suffering from the single-perspective mind-set: the seemingly reasonable but actually bizarre idea that the market can solve all a nation’s problems. I can understand why people looking at the United States and its inequalities and health-care outcomes would decide that private markets and competition should never be allowed anywhere near the delivery of public goods.

I was born a few days before the fall of the Berlin Wall. One might have thought at the time that after the assumed elimination of the Cold War paradigm, we were going to live in peace. Hmm . . . what we’ve seen, in fact, is a cosmic rise in inequality, the global empowerment of oligarchs, threats to public education and health care, plus a potentially fatal environmental crisis.

The experiences of SARS and Ebola—the two major “dress rehearsals” of the new century—serve as sobering reminders that our public health and biomedicine defenses are porous. Prominent features of modernity—population growth, climate change, rapid means of transportation, the proliferation of megacities with inadequate urban infrastructures, warfare, persistent poverty, and widening social inequalities—maintain the risk. Unfortunately, not one of these factors seems likely to abate in the near future. A final important theme of Epidemics and Society is that epidemic diseases are not random events that afflict societies capriciously and without warning. On the contrary, every society produces its own specific vulnerabilities.

Incarceration is also limited as a tool because it treats violence as a problem of “dangerous” individuals and not as a problem of social context and history. Most violence is not just a matter of individual pathology—it is created. Poverty drives violence.2 Inequity drives violence.3 Lack of opportunity drives violence.4 Shame and isolation drive violence.5 And like so many conditions known all too well to public health professionals, violence itself drives violence.

When Gary Becker, an American economist, in his celebrated `Treatise of Family’ imagined a household as a primary site of production of goods and sustenance in the form of child care, meals, and shelter, besides a range of commodities such as health, happiness, self-esteem, security, sexual pleasure, and so on, he disregarded the fact that a family is also a site of reproducing inequalities and sustaining patriarchal values. Becker proposed the theory of a rational `economic man’ who makes choices based on his self-interest, but he has not contemplated the dire situations of exploitation, blackmail, and extortion within marriages in South Asian patriarchal, hierarchical societies where self-interest would turn into insatiable greediness to create an antagonistic situation where an `economic man’, driven by irrational voracity, ends up torturing and murdering `his wife’, and destroying his own family when his arbitrary demands remain unfulfilled

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-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.

So, why is it that from the start of the pandemic the young and middle-aged in marginalized groups, not just Black and brown but Indigenous groups and people in poor white rural communities, have been more likely to suffer severe COVID-19 and die from it than their white, more affluent counterparts? The answer is part of a broader question: Why are the largest health inequities between these groups and nationwide averages—whether in infectious disease or the early onset of chronic conditions of aging such as cardiovascular disease, hypertension, and diabetes—seen among those aged twenty-five to sixty-five?7 The COVID-19 pandemic has thrown these inequities into stark relief. It’s not just that Black Americans are nearly twice as likely to die of COVID-19 as white Americans.8 Consider these statistics (among the many, many more you will see in chapters to come): Black mothers die during childbirth at an overall rate that is nearly three times as high as the rate for white mothers.9 For Black mothers in their mid-to-late thirties, the figures are even more dire: They die at a rate five times higher than white mothers of comparable age.10 Yet, the working- and reproductive-age years are those we have been led to believe should be the healthiest, following the higher-risk periods of infancy, childhood, and adolescence, and before the most serious risks of aging set in.

What American Healthcare Can Learn from Italy: Three Lessons It’s easy. First, learn to live like Italians. Eat their famous Mediterranean diet, drink alcohol regularly but in moderation, use feet instead of cars, stop packing pistols and dropping drugs. Second, flatten out the class structure. Shrink the gap between high and low incomes, raise pensions and minimum wages to subsistence level, fix the tax structure to favor the ninety-nine percent. And why not redistribute lifestyle too? Give working stiffs the same freedom to have kids (maternity leave), convalesce (sick leave), and relax (proper vacations) as the rich. Finally, give everybody access to health care. Not just insurance, but actual doctors, medications, and hospitals. As I write, the future of the Affordable Care Act is uncertain, but surely the country will not fall into the abyss that came before. Once they’ve had a taste of what it’s like not to be one heart attack away from bankruptcy, Americans won’t turn back the clock. Even what is lately being called Medicare for All, considered to be on the fringe left a decade ago and slammed as “socialized medicine,” is now supported by a majority of Americans, according to some polls. In practice, there’s little hope for Italian lessons one and two—the United States is making only baby steps toward improving its lifestyle, and its income inequality is worse every year. But the third lesson is more feasible. Like Italy, we can provide universal access to treatment and medications with minimal point-of-service payments and with prices kept down by government negotiation. Financial arrangements could be single-payer like Medicare or use private insurance companies as intermediaries like Switzerland, without copying the full Italian model of doctors on government salaries. Despite the death by a thousand cuts currently being inflicted on the Affordable Care Act, I am convinced that Americans will no longer stand for leaving vast numbers of the population uninsured, or denying medical coverage to people whose only sin is to be sick. The health care genie can’t be put back in the bottle.

Over a generation, America has grappled with one problem after another that could be said to have contributed to the decay of its politics and many people’s livelihoods. The American social contract has frayed, and workers’ lives have grown more precarious, and mobility has slowed. These are hard and important problems. The new winners of the age might well have participated in the writing of a new social contract for a new age, a new vision of economic security for ordinary people in a globalized and digitized world. But as we’ve seen, they actually made the situation worse by seeking to bust unions and whatever other worker protections still lingered and to remake more and more of the society as an always-on labor market in which workers were downbidding one another for millions of little fleeting gigs. “Any industry that still has unions has potential energy that could be released by start-ups,” the Silicon Valley venture capitalist Paul Graham once tweeted. As America’s level of inequality spread to ever more unmanageable levels, these MarketWorld winners might have helped out. Looking within their own communities would have told them what they needed to know. Doing everything to reduce their tax burdens, even when legal, stands in contradiction with their claims to do well by doing good. Diverting the public’s attention from an issue like offshore banking worsens the big problems, even as these MarketWorlders shower attention on niche causes. As life expectancy declined among large subpopulations of Americans, winners possessed of a sense of having arrived might have chipped in. They might have taken an interest in the details of a health care system that was allowing the unusual phenomenon of a developed country regressing in this way, or in the persistence of easily preventable deaths in the developing world. They might not have thought of themselves at all, given how long they were likely to live because of their tremendous advantages. “It seems pretty egocentric while we still have malaria and TB for rich people to fund things so they can live longer,” Bill Gates has said.

modern infrastructure—for reliable power, clean water, fast transit, affordable food, and resilient structures—has done more to improve public health than any other modern intervention, including scientific medicine

The rise of the 9.9 percent, I argue, accounts for the paradox of a nation where well-toned abs are an obsession even while pre-existing conditions multiply at pandemic levels, where billionaires look like fitness trainers while the average life expectancy declines. It is the fundamental reason why the nation with the most expensive health care system in the known universe is among the least able to protect its public health. Inequality disrupts progress by distorting our ideas about the only kind of well-being that actually matters, or about actual human prosperity.

Managing inequality almost never includes higher standards of care for those whose agency has been constrained, whether by poverty or by prison bars.

It turns out that maybe breeding bonsai-tree children to become résumé zombies isn’t so good for their mental health.

Disease and death directly attributable to massive health care policy failure was and remains a far more real danger to American lives than any military enemy.

Neoliberal, market-driven public institutions promote antisocial thinking or behavior and inure individuals to inequity and cruelty. Violence is ubiquitous in modern society, from the marketing of the military to imposing financial austerity to the economic decimating of communities, to the exploitation of employees and devaluing human worth at work.

The phrase 'the great epi divide' makes me think of old paper maps and signs about who is allowed to enter and who has to stay out. It is a phrase that points to an American reality: some people are taken care of and others are not. A choice is made. The 'great epi divide' sounds more accurate to me than the more ubiquitous 'disparities in health care,' which suggests that a terrible thing has happened, but without active participation on anyone's part. Disparities arise. Inequalities exists. These words trouble but, at the same time, offer reprieve: no one is implicated. The same is true of the word 'poverty,' that knife of an abstraction. A phrase like 'diseases of poverty' obscures the degree to which we have made choices about funding for public health.

The definition of privilege is in reality much simpler than a lot of social justice discussions would have you believe. Privilege, in the social justice context, is an advantage or a set of advantages that you have that others do not. These privileges are not due 100 percent to your efforts (although your hard work may indeed have helped), and the benefits of these privileges are disproportionately large or at least partially undeserved when compared to what the privilege is for. These advantages can often be ascribed to certain social groups: privilege based on race, physical ability, gender, class, etc. But these privileges can also lie in areas that you may have not considered, like sexuality, body type, and neurological differences. It is in these advantages and their coupled disadvantages that the health and well-being of large amounts of people are often determined. If we are truly dedicated to addressing systemic oppression and inequality, we must understand the full impact of these advantages and disadvantages in order to move toward real change in our society and ourselves. Let’s use a bit of my privilege as an example: I have

The idea of communicative inequity is a powerful anthropological tool that underlines the ways in which, beyond global health fantasies and fetishisations of data sharing, on the actual ground what counts as meaningful and actionable evidence, how information is distributed, and the way this accrues value depend on pervasive racial, gender, and class hierarchies.

Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman.

Universal healthcare ensures that all individuals have access to necessary medical services regardless of their ability to pay. This policy addresses the gaps and inequities in the current healthcare system, where millions of Americans remain uninsured or underinsured. Countries such as Canada and the United Kingdom provide successful examples of universal healthcare systems that deliver better health outcomes at lower costs compared to the U.S. system. Education

Universal healthcare ensures that all individuals have access to necessary medical services regardless of their ability to pay. This policy addresses the gaps and inequities in the current healthcare system, where millions of Americans remain uninsured or underinsured. Countries such as Canada and the United Kingdom provide successful examples of universal healthcare systems that deliver better health outcomes at lower costs compared to the U.S. system. Education policy is another area where progressive alternatives can counteract Project 2025’s agenda. Investing in public education, increasing funding for schools in underserved communities, and promoting inclusive curricula that reflect the diversity of American society are essential steps toward achieving educational equity. Progressive education policies prioritize the needs of students and educators over privatization efforts and standardized testing, ensuring that all children have access to a high-quality education.

This is an invitation to embrace the new systems paradigm emerging at the forefront of science, which is based on the idea that the whole is far more than the sum of its parts. This perspective provides the salve needed to heal our overly yang society by emphasizing connection, giving primacy to the feminine yin values of cooperation and reciprocity to partner with the web of life. This new worldview embraces the unity of mind, body, and spirit, where individual health is seen as indivisible from the health of society and the planet. We are connecting the dots between our lifestyles and our illnesses, between unsustainable growth, social inequality, and ecological destruction. These things can no longer be seen in isolation; integrating them is essential for healing ourselves and our planet

When we undertake interventions that decrease income inequality, we also decrease heart disease and stroke. When we tackle food security, we tackle diabetes. When we improve literacy, we improve life expectancy. We save lives, and we save money. Investments today pay off over time in lowered health, social services, and justice costs, in economic productivity.

In other advanced industrial countries, families don’t have to worry about how they will pay the doctor’s bill, or whether they can afford to pay for their parent’s health care. Access to decent health care is taken as a basic human right.

Today Ethiopia is one of the poorest countries in the world. The income of an average Ethiopian is about one-fortieth that of an average citizen of England. Most people live in rural areas and practice subsistence agriculture. They lack clean water, electricity, and access to proper schools or health care. Life expectancy is about fifty-five years and only one-third of adults are literate. A comparison between England and Ethiopia spans world inequality. The reason Ethiopia is where it is today is that, unlike in England, in Ethiopia absolutism persisted until the recent past. With absolutism came extractive economic institutions and poverty for the mass of Ethiopians, though of course the emperors and nobility benefited hugely. But the most enduring implication of the absolutism was that Ethiopian society failed to take advantage of industrialization opportunities during the nineteenth and early twentieth centuries, underpinning the abject poverty of its citizens today. T

We should remember why those programs were started: before the arrival of Medicare and Social Security, the private sector left most elderly bereft of support, the market for annuities essentially didn’t exist, and the elderly couldn’t get health insurance. Even today, the private sector doesn’t provide the kind of security that Social Security provides—including protection against market volatility and inflation. And the transactions costs of the Social Security Administration are markedly lower than those in the private sector. In addition, many of the people who receive government benefits without paying for them are our young, obviously unable to pay, say, for their own education. But spending on them is an investment in the country’s future. An

Here's the thing about history - it repeats itself over and over and over. The witch hunts, and the demonization of contraception and abortion and the women who provided these services from the fourteenth and fifteenth centuries, are happening all over again. This time, though, the witch hunt is a cynical ploy to distract the populace from some of the truly pressing issues our society is facing: the devastated economy and a Wall Street culture that remains unchecked even after the damage it has done, the raging class inequalities and widening gap between those who have and those who have not, the looming student loan and consumer debt crisis, the fractured racial climate, the lack of civil rights for gay, lesbian, and transgender people, a health care system too many people don't have access to, wars without cease, impending global threats, and on and on and on. Rather than solve the real problems the United States is facing, some politicians, mostly conservative, have decided to try to solve the "female problem" by creating a smoke screen, reintroducing abortion and, more inexplicably, birth control into a national debate.

Lack of health insurance is one factor contributing to poorer health, especially among the poor. Life expectancy in the United States is 78 years, lower than Japan’s 83 years, or Australia’s or Israel’s 82 years. According to the World Bank, in 2009 the United States ranked fortieth overall, just below Cuba.54 Infant and maternal mortality in the United States is little better than in some developing countries; for infant mortality, it is worse than Cuba, Belarus, and Malaysia, to name a few.55 And these poor health indicators are largely a reflection of the dismal statistics for America’s poor. For instance, America’s poor have a life expectancy that is almost 10 percent lower than that of those at the top.56 We

So, the advice I'd give to the 1 percent today is: Harden your hearts. When invited to consider proposals to reduce inequality - by raising taxes and investing in education, public works, health care, and science - put any latent notions of altruism aside and reduce the idea to one of unadulterated self-interest. Don't embrace it because it helps other people. Just do it for yourself.

Currently, the wealthy who have no pre-existing conditions can afford high-quality health care, while the poor and sick are relegated to hoping for and negotiating whatever health care safety net might exist in their area. This neoliberal form of capitalism structuring health care in the United States has led to those with the highest burden of sickness being simultaneously those with the least access to care.

In America, criminal justice policies have become a second line of defense, if you will, against individuals whose development has not been adequately fostered by other societal institutions, like welfare, education, employment and job training, mental-health programs, and other social initiatives.

Social policies that benefit everyone—Social Security and Medicare are prime examples—could help diminish resentment, build bridges across large swaths of the American electorate, and lock into place social support for more durable policies to reduce income inequality—without providing the raw materials for racially motivated backlash. Comprehensive health insurance is a prominent example.

Medicine could be viewed as social justice work, in a world riven by inequity. Who is considered human enough to have that right, if access to health care is considered a human right? Shelter, education, good health care, and clear water are meant to be encompassed in the set of basics that people must have as birthrights.” -Shenita Etwaroo

Here is why the wellbeing economy comes at the right time. At the international level there have been some openings, which can be exploited to turn the wellbeing economy into a political roadmap. The first was the ratification of the Sustainable Development Goals (SDGs) in 2015. The SDGs are a loose list of 17 goals, ranging from good health and personal wellbeing to sustainable cities and communities as well as responsible production and consumption. They are a bit scattered and inconsistent, like most outcomes of international negotiations, but they at least open up space for policy reforms. For the first time in more than a century, the international community has accepted that the simple pursuit of growth presents serious problems. Even when it comes at high speed, its quality is often debatable, producing social inequalities, lack of decent work, environmental destruction, climate change and conflict. Through the SDGs, the UN is calling for a different approach to progress and prosperity. This was made clear in a 2012 speech by Secretary General Ban Ki-moon, who explicitly connected the three pillars of sustainable development: ‘Social, economic and environmental wellbeing are indivisible.’82 Unlike in the previous century, we now have a host of instruments and indicators that can help politicians devise different policies and monitor results and impacts throughout society. Even in South Africa, a country still plagued by centuries of oppression, colonialism, extractive economic systems and rampant inequality, the debate is shifting. The country’s new National Development Plan has been widely criticised because of the neoliberal character of the main chapters on economic development. Like the SDGs, it was the outcome of negotiations and bargaining, which resulted in inconsistencies and vagueness. Yet, its opening ‘vision statement’ is inspired by a radical approach to transformation. What should South Africa look like in 2030? The language is uplifting: We feel loved, respected and cared for at home, in community and the public institutions we have created. We feel understood. We feel needed. We feel trustful … We learn together. We talk to each other. We share our work … I have a space that I can call my own. This space I share. This space I cherish with others. I maintain it with others. I am not self-sufficient alone. We are self-sufficient in community … We are studious. We are gardeners. We feel a call to serve. We make things. Out of our homes we create objects of value … We are connected by the sounds we hear, the sights we see, the scents we smell, the objects we touch, the food we eat, the liquids we drink, the thoughts we think, the emotions we feel, the dreams we imagine. We are a web of relationships, fashioned in a web of histories, the stories of our lives inescapably shaped by stories of others … The welfare of each of us is the welfare of all … Our land is our home. We sweep and keep clean our yard. We travel through it. We enjoy its varied climate, landscape, and vegetation … We live and work in it, on it with care, preserving it for future generations. We discover it all the time. As it gives life to us, we honour the life in it.83 I could have not found better words to describe the wellbeing economy: caring, sharing, compassion, love for place, human relationships and a profound appreciation of what nature does for us every day. This statement gives us an idea of sufficiency that is not about individualism, but integration; an approach to prosperity that is founded on collaboration rather than competition. Nowhere does the text mention growth. There’s no reference to scale; no pompous images of imposing infrastructure, bridges, stadiums, skyscrapers and multi-lane highways. We make the things we need. We, as people, become producers of our own destiny. The future is not about wealth accumulation, massive

Mark Nathan Cohen, whose Health and the Rise of Civilization

DISPARITIES AND HIGH COSTS FUEL THE HEALTH CARE CRISIS America’s health crisis is really three crises rolled into one. The first is public health: America’s average life expectancy is now several years below that of many other countries, and for some parts of the population, life expectancy is falling. The second is health inequality: The gaps in public health according to race and class are shockingly large. The third is health care cost: America’s health care is by far the costliest in the world. The Sustainable Development Goals put good health for all in a central place in sustainable development, notably in SDG 3. This goal calls for massive reductions of the burdens of both communicable and noncommunicable diseases. SDG 3 (Target 3.8) also emphasizes the need for universal and equitable access to quality health care, in order to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines

DISPARITIES AND HIGH COSTS FUEL THE HEALTH CARE CRISIS America’s health crisis is really three crises rolled into one. The first is public health: America’s average life expectancy is now several years below that of many other countries, and for some parts of the population, life expectancy is falling. The second is health inequality: The gaps in public health according to race and class are shockingly large. The third is health care cost: America’s health care is by far the costliest in the world. The Sustainable Development Goals put good health for all in a central place in sustainable development, notably in SDG 3. This goal calls for massive reductions of the burdens of both communicable and noncommunicable diseases. SDG 3 (Target 3.8) also emphasizes the need for universal and equitable access to quality health care, in order to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Inequality and poverty, health and wealth are hand in hand. And if we are all born equal that should be true in all lands. We cannot divide the world between poor and rich countries. It's like saying the ones are good, the others are junkies. That can only increase more prejudice, miseries and sorrow. Turning the wheel today it will lead to a better tomorrow.

Due to these influences and many others, iGen is distinct from every previous generation in how its members spend their time, how they behave, and their attitudes toward religion, sexuality, and politics. They socialize in completely new ways, reject once sacred social taboos, and want different things from their lives and careers. They are obsessed with safety and fearful of their economic futures, and they have no patience for inequality based on gender, race, or sexual orientation. They are a the forefront of the worst mental health crisis ind decades, with rates of teen depression and suicide skyrocketing since 2011.

DOES EVERYONE IN AND NO ONE OUT INCLUDE ALL IMMIGRANTS? Immigrants contribute tens of billions of dollars to our economy, and the sustainability of programs such as Social Security and Medicare to a significant extent depends on taxes paid by such workers. Further, health costs for immigrants are about one-third those of NHWs. Ethical, religious, and humane issues could all be raised to support improving access to care for such immigrants.

1969 a Republican president proposed a Family Assistance Plan that would have guaranteed a basic income for all American families. Editorial opinion then was 95 percent in favor of such support to families. Our values at that time were to decry the poverty in our midst to try to make it vanish from the country. President Nixon’s bill passed the House of Representatives, then languished in the Senate. When Nixon became embroiled in the Watergate scandal it died—along with a credible, feasible plan to strengthen the health of families in this country and prevent what was soon to become a relentless decline in our relative health.

Will smart machines lead to a world of plenty, leisure, health care, and education for all; or to a world of inequality, mass unemployment, and a war between the haves and have-nots, and between the machines and the workers left behind?

When the ten measures were averaged together into a general index of health and social problems, there was no correlation to income, as you can see in Figure 2.2. The countries form a vague cloud with no clear pattern.

According to the economic story, you're free to enter and exit the world of markets as you please. As a buyer, you're free to choose whether to buy something or not. If you want something and can afford to pay for it, it's yours. If nothing pleases you, you can "vote with your dollar" and buy nothing. In practice, if you're less mobile than others in the world of markets somehow, perhaps because you're a child or a senior, or are poor, or have learning disabilities or mental health issues, you don't have the same access to the market as others do who are more independent Instead, you'll likely find it hard to identify your choices and make the best choice, which you need to be able to do for the market to operate efficiently, or you may not have enough money to enter the market to begin with. Sometimes your "best choice" isn't much of a choice at all; if your two options are to starve or to buy bread at extortion rates from the only seller in town, your "freedom" to enter or exit the market doesn't amount to much.

For more than a century, experiments by innovators and studies and reports produced by nonprofits, learned academies, universities, and federal agencies have continued to suggest that dental hygienists, particularly with additional training, could be more widely used to help address the unmet dental needs of millions of Americans. Hygienist leaders agree.

In the American colonies, the first laborers were European indentured servants. When African laborers were forcibly brought to Virginia beginning in 1619, status was defined by wealth and religion, not by physical characteristics such as skin color. But this would change. Over time, physical difference mattered, and with the development of the transatlantic slave trade, landowners began replacing their temporary European laborers with enslaved Africans who were held in permanent bondage. Soon a new social structure emerged based primarily on skin color, with those of English ancestry at the top and African slaves and American Indians at the bottom. By 1776, when “all men are created equal” was written into the Declaration of Independence by a slaveholder named Thomas Jefferson, a democratic nation was born with a major contradiction about race at its core. As our new nation asserted its independence from European tyranny, blacks and American Indians were viewed as less than human and not deserving of the same liberties as whites. In the 19th and 20th centuries, the notion of race continued to shape life in the United States. The rise of “race science” supported the common belief that people who were not white were biologically inferior. The removal of Native Americans from their lands, legalized segregation, and the internment of Japanese Americans during World War II are legacies of where this thinking led. Today, science tells us that all humans share a common ancestry. And while there are differences among us, we’re also very much alike. Changing demographics in the United States and across the globe are resulting in new patterns of marriage, housing, education, employment, and new thinking about race. Despite these advances, the legacy of race continues to affect us in a variety of ways. Deeply held assumptions about race and enduring stereotypes make us think that gaps in wealth, health, housing, education, employment, or physical ability in sports are natural. And we fail to see the privileges that some have been granted and others denied because of skin color. This creation, called race, has fostered inequality and discrimination for centuries. It has influenced how we relate to each other as human beings. The American Anthropological Association has developed this exhibit to share the complicated story of race, to unravel fiction from fact, and to encourage meaningful discussions about race in schools, in the workplace, within families and communities. Consider how your view of a painting can change as you examine it more closely. We invite you to do the same with race. Examine and re-examine your thoughts and beliefs about race. 1

Thus, it is critical that CBPR efforts strive to understand the historical and contemporary social, economic, and environmental contexts that have a significant impact on the communities involved, and work to improve the conditions that foster these health inequities. In addition, as elaborated here, it is essential that the cultural context of communities be understood and respected, explicitly informing partnership approaches to research.

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 explanation for why progress should be so uneven differs from case to case; the reason why poor people are more likely to smoke is not the same as the reason why so many poor children are not vaccinated. These accounts are to come, but for now the point is simply that health progress creates gaps in health just as material progress creates gaps in living standards.

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. The

one careful study estimates that the average income of all the inhabitants of the world increased between seven and eight times from 1820 to 1992.

At the same time, the fraction of the world’s population in extreme poverty fell from 84 to 24 percent. This

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.

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.

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

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 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.

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

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.

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

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.)

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

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

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.

Income inequality in a capitalist system is truly beautiful. It provides the incentive for creative people to gamble on new ideas, and it turns luxuries into common goods. Income inequality nurses sick companies back to health. It rewards hard work, talent, and achievement regardless of pedigree. And it’s a signal that some of the world’s worst problems will disappear in our lifetimes.

There are places where you can live only when you are healthy, in those places when you fall ill it's the end of you for most people there can’t afford medical care.

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

The major credit for the decrease in child mortality and the resultant increase in life expectancy must go to the control of disease through public health measures. At first, this took the form of improvements in sanitation and in water supplies. Eventually science caught up with practice and the germ theory of disease was understood and gradually implemented, through more focused, scientifically based measures. These included routine vaccination against a range of diseases and the adoption of good practices of personal and public health based on the germ theory. The

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

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?

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.

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

If everyone were free to migrate from one country to another, wages in rich countries would fall and wages in poor countries would rise, and the world would be a much more equal place. Of course, opposition to lower wages in rich countries is precisely why people are not permitted to migrate at will, and it is why meals and haircuts are so cheap in poor countries. The price of land, like the price of labor, cannot be arbitraged between rich countries and poor countries. Cheap housing in India or Africa cannot be brought up to American prices by simply moving the land across the ocean. The presence of cheap land and cheap labor in poor countries explains why price levels in poor countries are so much lower than in rich countries. The market sets the exchange rate to equalize the prices of steel, gasoline, automobiles, and computers—everything that can be and is part of international trade—but the price level depends on goods and services that cannot be traded. Because those are cheaper in poor places, the poorer the country, the lower are the average prices.

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.

The decade of the 1960s was the postwar golden age, with an average growth rate of more than 4 percent a year, a rate that is high enough to increase incomes by a half in ten years. Growth

To be able to use rich-country methods of production requires rich-country infrastructure—roads, railways, telecommunications, factories, and machines—not to mention rich-country educational levels, all of which take time and money to achieve. Yet the gaps between rich and poor provide plenty of incentives to make the investment in that infrastructure and equipment, and, as Robert Solow showed in one of the most famous papers in all of economics, average living standards should draw closer over time.4 Why this has not happened is a central question in economics. Perhaps the best answer is that poor countries lack the institutions—government capacity, a functioning legal and tax system, security of property rights, and traditions of trust—that are a necessary background for growth to take place.

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.

The neighbors in Mount Airy were not so different from working-class people across America. Politically disconnected and angry at those they perceived to be bilking the government, they were turning on each other rather than placing the blame on the exploitative pharmaceutical companies that seeded the epidemic and the power-hungry politicians who rolled out the red carpet for them while doing virtually nothing about growing inequality, poor health care coverage, and declining wages that affected everyone, whether they used drugs or not.

Instead of resigning ourselves to the inevitability of bad sex, and even romanticizing it as merely youthful misadventure, we should subject it to sustained scrutiny. Bad sex emerges from gender norms in which women cannot be equal agents of sexual pursuit, and in which men are entitled to gratification at all costs. It occurs because of inadequacies and inequalities in access to sexual literacy, sex education and sexual health services. It trades on unequal power dynamics between parties, and on racialized notions of innocence and guilt. Bad sex is a political issue, one of inequality of access to pleasure and self-determination, and it is as a political issue that we should be examining it, rather than retreating into an individualizing, shoulder-shrugging criticism of young women who are using the tools available to them to address the pains of their sexual lives.

procedures each year. Table 2.5 shows inequities, though possibly not as consistently as for the cancer measure; 22.7 percent of whites received all four procedures within a year, compared to 18.7 percent of Hispanics and 16.6 percent of blacks. Income differences ranged from a high 27.8 percent of the 400 percent or more of the poverty level to a low 16.2 percent

We have conquered or quelled many diseases that used to kill people in droves: smallpox, measles, polio and the plague. People are taller, and formerly life-threating conditions like appendicitis, dysentery, a broken leg or anemia are easily remedied. To be sure, there is still too much malnutrition and disease in some countries, but these evils are often the result of bad government and social inequality, not a lack of food or medical know how.

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.” Meanwhile, life remains the ultimate privilege, the living lording over the dead.

Many of these measures are regulatory. Property rights are often ignored, which allows local governments to seize valuable land from Chinese households to sell to developers. Expropriations were encouraged by the central government’s incentive system for local party officials. Those incentives, which often prioritized reported output growth above all else, also encouraged local governments to ignore pollution and environmental degradation to attract business investment. Ordinary Chinese had their wealth and health taken from them to benefit elites. Their living standards grew far less than China’s domestic production. The share of Chinese GDP consumed by Chinese households fell by 15 percentage points between the late 1980s and the bottom in 2010.

Since 1990, most inflation in the United States has come from higher prices for health care (including prescription drugs), housing, and education—all sectors where the

The rising cost of medical care has also been important; most employees receive health insurance as part of their overall compensation, and most research shows that increases in premiums ultimately come out of wages.16 Indeed, average wages have tended to do badly when health-care costs are rising most rapidly and to do better when health-care costs are rising more slowly.

An exhaustive analysis recently studied Google data on searches initiated in both the most and least prosperous counties in the country (ranked according to an index that includes income and education). The study revealed that the searches most correlated with prosperity include digital cameras, baby joggers, Skype, and foreign travel. By contrast, the searches most correlated with deprivation included health problems; weight loss; guns; video games; and the Antichrist, hell, and the Rapture.

Far from calling for “equal sacrifice” from the citizenry, as would be the case in a genuinely democratic society involved in a war, it has openly practiced a politics of inequality that feeds on the fears of the most insecure members of society. For example, by pushing through an enormous tax rebate that blatantly favored the wealthy, it simultaneously assured that no funds would be available to subsidize programs—such as the democratization of health care, increased unemployment benefits, and protections for pension funds—that might have eased the impact of recession.

Regardless of where they live, workers are required to pay into the national social security system, which covers health, education, pension, and other benefits. Chinese are only eligible to receive those benefits, however, if they are resident where they were officially registered. This has curtailed social spending for hundreds of millions of poor Chinese even as they pay taxes to support relatively rich local governments. Even without these distortions, China’s official tax system

Reproductive justice, a phrase coined by Black feminists at a conference in 1994, remains elusive for African American women who struggle to access affordable health care due to social and economic inequalities. The abortion rate for Black women is nearly five times that for white women. African American women are three to four times more likely to die in childbirth than white women. Furthermore, health conditions that disproportionately affect Black women, such as uterine fibroids, receive very little government research funding. My hope is that this novel will provoke discussions about culpability in a society that still deems poor, Black, and disabled as categories unfit for motherhood.

Trained as a sociologist, I’ve always been more disposed toward structural, macro change targeting policies and institutions over more diffuse cultural transformation that directly engages individuals. I tend to wince at self-help-style books, trainings, and gurus. But in trying so hard to push back on individualistic approaches to empowerment, I went to the other extreme for a while, losing touch with the importance of everyday decisions and actions—what my colleague Imani Perry calls “practices of inequality”—as an essential part of social transformation. Commenting on the many forms of racism that resurfaced during the pandemic, Imani tweeted, “That white male doctor who strangled and assaulted a black girl child for ‘not social distancing’ is also a sign of what African Americans confront in the health care system. It’s not just ‘structural’ racism folks.” This was a needed punch to my disciplinary gut, as I had been trained to critique “the system” and “systemic inequality,” as if these were divorced from everyday human decisions and actions. After all, the doctor, not “the system,” made a choice to violently assault a Black girl child. Yet at the same time, we can uphold unjust systems without physically attacking another person; that, for me, is the risk in highlighting the most obvious cases of brutality: it can let us off the hook. Ultimately, then, this is not a book for those interested primarily in policy, however important policy remains. Rather, this is a call to action for individuals to reclaim power over how our thoughts, habits, and actions shape—as much as they are shaped by—the larger environment.

The pandemic and the growth in technology have compounded the evolution of more polarized views. We have seen an uptick in the encroachment of each other’s boundaries, discrimination, and outright violence. But we don’t just get to blame the new kids on the block. We already had these issues to begin with, and clearly the pandemic hit certain communities harder than others, communities that were already suffering long before the pandemic.

income per capita in developed nations is significantly higher than that in developing countries (Fig. 14), resulting in a much higher expenditure on education, health care, nutrition and housing.

Syridex Bio was founded on the belief that everyone deserves the opportunity to live a healthy life. For too long, deep inequities have persisted across our pharmaceutical, biotechnology, and medical systems. Despite increased public attention on the problem in recent years, progress remains far too slow. At Syridex Bio, we are addressing this gap in the market by strategically investing in therapies that treat diseases disproportionately affecting underserved communities. By financing the development of drugs and treatments addressing the world’s greatest health disparities, we are convinced that we can accelerate health equity globally and achieve strong financial returns for our investors.

In 1910, on the grounds of health and safety, Contestabile supported a law that would have required every cook in Massachusetts to obtain a license.61 By erecting barriers to entry, the cooks revealed that the policing of boundaries to their occupation, rather than broader worker solidarity, was their preferred organizing strategy.

Reproductive Justice - a phrase coined by black feminists at a conference in 1994, remains illusive for African American women, who struggle to access affordable healthcare due to social and economic inequalities. The abortion rate for black women is nearly 5 times that for white women. African American women are 3-4 times more likely to die in childbirth than white women. Furthermore, health conditions that disproportionately affect black women, such as uterine fibroids, receive very little government research funding. My hope is this novel will provoke discussions about culpability in a society that still deems poor, black, and disabled as categories unfit for motherhood.

That’s why “reforming” the police will only get us so far. We need a holistic approach to repair the entire criminal justice system and address inequities across the board. We must improve training and resources with respect to mental health, incarceration, recidivism, legal representation, and the crushing administrative court fees for defendants. We also need more elected officials who understand what it means to serve something other than themselves.

The pattern for patients in the East Bay is echoed more broadly across the country, according to Dr. Renee Hsia, an emergency room physician at UCSF who also researches health care policy. It took 4.4 minutes longer for victims of cardiac arrest in poorer areas to reach the hospital than in high-income areas, her research found. “Four minutes may not sound like much but it represents a significant increase in mortality,” Dr. Hsia said.

The effects of migration on poverty reduction dwarf those of free trade. Migrants who succeed in moving from poor countries to rich countries become better off than they were at home, and their remittances help their families do better at home. Remittances have very different effects than aid, and they can empower recipients to demand more from their governments, improving governance rather than undermining it. Of course, the politics of migration is even tougher than the politics of free trade, even in countries where the urge to help is most strongly developed. A helpful type of temporary migration is to provide undergraduate and graduate scholarships to the West, especially for Africans. With luck, these students will develop in a way that is independent of aid agencies or of their domestic regimes. Even if they do not return home, at least at once, the African diaspora is a fertile (and internal) source of development projects at home.

…I thought about what I'd say if I someday got a soapbox. That income inequality is out of hand. That all people are pretty damn similar so it would be great if we stopped hating each other. That prison sentences for nonviolent crimes are dumb and that drug addiction is a health problem, not a crime problem.

I came to two conclusions. One, being a woman, in this world, ultimately makes you crazy. And, two, you're more likely to be labeled crazy anyway if you're female." I pulled out some sheets from the World Health Organization. "Look, these guys are in charge of the health of the entire WORLD. And they're basically saying gender is the cause of loads of mental health problems. People don't wake up one day and think, Oooh, I think I'll go completely gaga. It's usually a case of spiraling circumstances. And, if you're a woman, think about it, we have a shitload of spiraling circumstances. We're paid less, we're told we have to beautiful, and thin, but we're also told to eat chocolate all the time otherwise we're not 'fun', and we're constantly being objectified and told to calm down when we care about something...Isn't all this likely to make us a little mental? Isn't being subjected to daily inequality going to be a spiraling circumstance?

Every gun, warship, jet and bomb is also a theft from women as a sex class. There is more than enough money for public education, health, state funded day care systems, food and other necessities; there is more than enough money to protect single mothers and their children from deadly forms of poverty and social exclusion. There is more than enough money. Austerity is the propaganda of the new fascism which delivers violent budget cuts against its own citizens just as it ramps up global inequality and steadily arms itself with weapons of mass murder.

suffering in working-class America was not inevitable but rather reflects decades of social-policy mistakes and often gratuitous cruelty: the war on drugs that led to mass incarceration, indifference to the loss of blue-collar jobs, insufficient health-care coverage, embrace of a highly unequal education system, tax giveaways to tycoons, zillionaire-friendly court decisions, acceptance of growing inequality, and systematic underinvestment in children and community services such as drug treatment.

Recall that GDP, gross domestic product, the dominant metric in economics for the last century, consists of a combination of consumption, plus private investments, plus government spending, plus exports-minus-imports. Criticisms of GDP are many, as it includes destructive activities as positive economic numbers, and excludes many kinds of negative externalities, as well as issues of health, social reproduction, citizen satisfaction, and so on. Alternative measures that compensate for these deficiencies include: the Genuine Progress Indicator, which uses twenty-six different variables to determine its single index number; the UN’s Human Development Index, developed by Pakistani economist Mahbub ul Haq in 1990, which combines life expectancy, education levels, and gross national income per capita (later the UN introduced the inequality-adjusted HDI); the UN’s Inclusive Wealth Report, which combines manufactured capital, human capital, natural capital, adjusted by factors including carbon emissions; the Happy Planet Index, created by the New Economic Forum, which combines well-being as reported by citizens, life expectancy, and inequality of outcomes, divided by ecological footprint (by this rubric the US scores 20.1 out of 100, and comes in 108th out of 140 countries rated); the Food Sustainability Index, formulated by Barilla Center for Food and Nutrition, which uses fifty-eight metrics to measure food security, welfare, and ecological sustainability; the Ecological Footprint, as developed by the Global Footprint Network, which estimates how much land it would take to sustainably support the lifestyle of a town or country, an amount always larger by considerable margins than the political entities being evaluated, except for Cuba and a few other countries; and Bhutan’s famous Gross National Happiness, which uses thirty-three metrics to measure the titular quality in quantitative terms.

misopedia” is a word meaning the hatred or disdain of children, but there is no commonly understood word in this language for the specific way this hatred manifests in the lives of Black children. There is no commonly shared word to describe why our children are so uniquely harmed by everything from health-care inequity to lack of access to education. Why our children are so constantly gunned down in the streets by police. And so, in a related vein to “misogynoir,” and in the hopes of illuminating this specific expression of misopedia, I offer “misafropedia” to mean the anti-Black disdain for children and childhood that Black youth experience.

In the developed industrial countries, all social institutions for the purpose of evening out inequalities and ensuring a minimum of security (progressive taxation, health services, unemployment relief, price controls, etc.) have been created and extended at the price of a vastly expanded state bureaucracy, and no one can suggest how to avoid paying this price.

income inequality is out of hand. That all people are pretty damn similar so it would be great if we stopped hating each other. That prison sentences for nonviolent crimes are dumb and that drug addiction is a health problem, not a crime problem.

So let me be clear: race is not a biological category that naturally produces health disparities because of genetic differences. Race is a political category that has staggering biological consequences because of the impact of social inequality on people’s health.

Could these groundbreaking and often unsung activists have imagined that only forty years later the 'official' gay rights agenda would be largely pro-police, pro-prisons, and pro-war - exactly the forces they worked so hard to resist? Just a few decades later, the most visible and well-funded arms of the 'LGBT movement' look much more like a corporate strategizing session than a grassroots social justice movement. There are countless examples of this dramatic shift in priorities. What emerged as a fight against racist, anti-poor, and anti-queer police violence now works hand in hand with local and federal law enforcement agencies - district attorneys are asked to speak at trans rallies, cops march in Gay Pride parades. The agendas of prosecutors - those who lock up our family, friends, and lovers - and many queer and trans organizations are becomingly increasingly similar, with sentence- and police-enhancing legislation at the top of the priority list. Hate crimes legislation is tacked on to multi-billion dollar 'defense' bills to support US military domination in Palestine, Iraq, Afghanistan, and elsewhere. Despite the rhetoric of an 'LGBT community,' transgender and gender-non-conforming people are our 'lead' organizations - most recently in the 2007 gutting of the Employment Non-Discrimination Act of gender identity protections. And as the rate of people (particularly poor queer and trans people of color) without steady jobs, housing, or healthcare continues to rise, and health and social services continue to be cut, those dubbed the leaders of the 'LGBT movement' insist that marriage rights are the way to redress the inequalities in our communities.

The Greek root of crisis is “krisis”—to choose. Solving the climate crisis confronts us with a myriad of choices in redressing social and economic injustice, health disparities, and gender inequality. If we fail in our net-zero ambition, these problems will surely get worse. But here is a more positive outlook: the current emissions emergency is an extraordinary opportunity to address deep inequities that have persisted for generations.

In the United States, housing is not considered a human right, and the ability of people to live in a given place is subject to the whims of the market. Challenging this may sound like a radical proposition, but it is radical only in the United States, in the same way universal health care is a controversial concept only here. Most other industrialized countries have realized the market will not provide for low- and middle-income people, and so their systems have made adjustments, The United States lags behind.

Here, the modern requerimiento pressures Indians either to leave the reservation and enter an American society where they will be bereft and cultureless people in a land where poor people of color suffer systematic oppression and an ever-worsening condition of merciless inequality, or remain on the reservation and attempt to preserve their culture amidst the wreckage of governmentally imposed poverty, hunger, ill health, despondency, and the endless attempts of the federal and state governments at land and resource usurpation.