Vicente Navarro

What We Mean by Social Determinants of Health

This article analyzes the changes in health conditions and quality of life in the populations of developed and developing countries over the past 30 years, resulting from neoliberal policies developed by many governments and promoted by the World Bank, International Monetary Fund, World Health Organization, and other international agencies. It challenges interpretations by the analysts of “globalization,” including the common assumption that states are disappearing. The author shows that what has been happening is not a reduction of state interventions but a change in the nature and character of those interventions, resulting from major changes in class (and race and gender) power relations in each country, with establishment of an alliance between the dominant classes of developed and developing countries—a class alliance responsible for the promotion of its ideology, neoliberalism. This is the cause of the enormous health inequalities in the world today. The article concludes with a critical analysis of the WHO report on social determinants of health, applauding its analysis and many of its recommendations, but faulting it for ignoring the power relations that shape these social determinants. It is not inequalities that kill people, as the report states; it is those who are responsible for these inequalities that kill people.

The political economy of social inequalities : consequences for health and quality of life

Introduction PART I REVIEW OF THE RESEARCH A Historical Review (1965-1997) of Studies on Class, Health, and Quality of Life: A Personal Account Vicente Navarro PART II CAUSES FOR THE GROWTH OF INEQUALITIES AND THEIR IMPACT ON HEALTH AND QUALITY OF LIFE Neoliberalism, Globalization, Unemployment, Inequalities, and the Welfare State Vicente Navarro Health and Equity in the World in the Era of Globalization Vicente Navarro The Political Economy of the Welfare State in Developed Capitalist Countries Vicente Navarro PART III CRITIQUE OF INTERNATIONAL AGENCIES: WHO, PAHO, WORLD BANK, IMF, UNICEF, AND UNDP Ravaging the Poor: The International Monetary Fund Indicted by Its Own Data Gabriel Kolko World Bank Education Policy: Market Liberalism Meets Ideological Conservatism Adriana Puiggros Market Commodities and Poor Relief: The World Bank Proposal for Health Asa Cristina Laurell and Oliva Lopez Arellano Neoliberalism Revised? A Critical Account of World Bank Conceptions of Good Governance and Market Friendly Intervention Ray Kiely In Pursuit of Growth with Equity: The Limits of Chiles Free-Market Social Reforms Pilar Vergara A Fundamental Shift in the Approach to International Health by WHO, UNICEF, and the World Bank: Instances of the Practice of Intellectual Fascism and Totalitarianism in Some Asian Countries Debabar Banerji PART IV NEOLIBERALISM AND SOCIAL AND HEALTH POLICY The Mexican Social Security Counterreform: Pensions for Profit Asa Cristina Laurell Remaking Medicare: The Voucher Myth Jonathan Oberlander A Slippery Slope: Economists and Social Insurance in the United States Richard B. Du Boff PART V DEBATE ON PATHWAYS OF SOCIAL INEQUALITIES AND HEALTH Income Inequality, Social Cohesion, and Class Relations: A Critique of Wilkinsons Neo-Durkheimian Research Program Carles Muntaner and John Lynch Income Inequality, Social Cohesion, and Health: Clarifying the Theory-A Reply to Muntaner and Lynch Richard G. Wilkinson The Social Class Determinants of Income Inequality and Social Cohesion Carles Muntaner, John Lynch, and Gary L. Oates PART VI ANALYSIS OF PROPOSED SOLUTIONS: THE IMPORTANCE OF THE POLITICAL CONTEXT The Political Context of Social Inequalities and Health Vicente Navarro and Leiyu Shi Is There a Third Way? A Response to Giddenss The Third Way Vicente Navarro Toward an Ecosocial View of Health Richard Levins and Cynthia Lopez Development and Quality of Life: A Critique of Amartya Sens Development As Freedom Vicente Navarro Are Pro-Welfare State and Full-Employment Policies Possible in the Era of Globalization? Vicente Navarro CONTRIBUTORS ACKNOWLEDGMENTS INDEX

Professional Dominance or Proletarianization?: Neither

The medical profession has lost much of its power to control the production of knowledge, practice, and organization of medicine, but it was never the dominant force in shaping medicine. Instead, medicine has evolved in response to many different, and often conflicting, social, political, and economic forces, including professional forces. The professions loss of autonomy over the material means of producing, and the systems for funding and organizing, medical services--the corporatization of medicine--should not, however, be identified as proletarianization. The considerable influence that physicians retain and their level of skill keep them from fitting a strict Marxist definition of the proletariat.

Social class, political power and the state and their implications in medicine

Abstract This article presents an analysis of the distribution of power and of the nature of the state in Western industrialized societies, and details their implications in medicine. Divided into three parts, Part I presents a critique of contemporary theories of the Western system of power. It discusses the countervailing pluralist and power elite theories, as well as those of bureaucratic and professional control, and concludes with an examination of the Marxist theories of economic determinism, structural determinism, and corporate statism. Part II presents a Marxist theory of the role, nature and characteristics of state intervention. Part III focuses on the mode of that intervention and the reasons for its growth, with an added analysis of the attributes of state intervention in the health sector, and of the dialectical relationship between its growth and the current fiscal crisis of the state. In all three parts, the focus is on Western European countries and on North America, with many examples and categories from the area of medicine.

What we mean by social determinants of health

Thank you very much for inviting me to give the inaugural speech at the Eighth European Conference of the International Union of Health Promotion and Education, taking place in this beautiful setting in Turin, Italy. Let me start by congratulating you on choosing as a major theme of this conference the social determinants of health. As you know, the WHO Commission on Social Determinants of Health has just published its long-awaited report. The report has, deservedly, created worldwide interest and within a few days has monopolized the health and medical news worldwide – with some notable exceptions such as the US, where the report has barely been noticed in the media. I saluted the establishment of the WHO Commission and now applaud most of the recommendations in its report. But my enthusiasm for the report is not uncritical, and I will enlarge on this later in my presentation. Let’s start with some of the facts presented in the Commission’s report, facts that should cause discomfort for any person committed to the health and quality of life of our populations, because the problems described in the report – how death and poor health are not randomly distributed in the world – are easily solvable. We know how to solve them. The problem, however, is not a scientific one. But before touching on this issue – the major theme of my talk – let’s look at the facts. To quote one statistic directly from the report: “A girl born in Sweden will live 43 years longer than a girl born in Sierra Leone.” The mortality differentials among countries are enormous. But such inequalities also appear within each country, including the so-called rich or developed countries. Again, quoting from the report: “In Glasgow, an unskilled, working-class person will have a lifespan 28 years shorter than a businessman in the top income bracket in Scotland.” We could add here similar data from the US. In East Baltimore (where my university, The Johns Hopkins University, is located), a black unemployed youth has a lifespan 32 years shorter than a white corporate lawyer. Actually, as I have documented elsewhere (1), a young African American is 1.8 times more likely than a young white American to die from a cardiovascular condition. Race mortality differentials are large in the US, but class mortality differentials are even larger. In the same study, I showed that a bluecollar worker is 2.8 times more likely than a businessman to die from a cardiovascular condition. In the US as in any other country, the highest number of deaths could be prevented by interventions in which the mortality rate of all social classes was made the same as the mortality rate of those in the top income decile. These are the types of facts that the WHO Commission report and other works have documented. So, at this point, the evidence that health and quality of life are socially determined is undeniable and overwhelming.

Social class, political power, and the state and their implications in medicine

This three-part article presents an analysis of the distribution of power and of the nature of the state in Western industrialized societies, and details their implications in medicine. Part I presents a critique of contemporary theories of the Western system of power; discusses the countervailing pluralist and power elite theories, as well as those of bureaucratic and professional control; and concludes with an examination of the Marxist theories of economic determinism, structural determinism, and corporate statism. Part II presents a Marxist theory of the role, nature, and characteristics of state intervention. Part III focuses on the mode of that intervention and the reasons for its growth, with an added analysis of the attributes of state intervention in the health sector and of the dialectical relationship between its growth and the current fiscal crisis of the state. In all three parts, the focus is on Western European countries and on North America, with many examples and categories drawn from the area of medicine.

Private Medicine and Public Health: Profits, Politics and Prejudice in the American Health Care Enterprise

* The Big Picture * Access to Health Care * Physicians * Nurses * Hospitals * Managed Care * Alternative Health Care Industry * The Drug Industry * Medical Services * Federal Government * Medicaid and the States * Conclusion