The Covid-19 pandemic as tipping point (Part 2)

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Acknowledgement:   This commentary was originally written for Policies for Equitable Action on Health.  It reposted here with some additional material with the kind permission of Daniele Dionisio, who runs PEAH.  Further republication consistent with the Creative Commons licence that applies to my entire blog is encouraged.

Introduction: The pandemic and the perils of averages


Figure 1.  Downtown Montréal, March 2023.  Photo: T. Schrecker

I wrote part of this post during my first post-pandemic visit to Montréal, a Canadian city that I love and once called home.  It has not been easy.  While many affluent parts of the city have largely regained their pre-lockdown vibrancy, other districts are now populated mainly by vacant shop fronts (Figure 1).  At the same time, sometimes almost next door, numerous glittering condo towers soaring as high as 61 storeys are under construction (Figure 2).  They are beyond the financial reach of most of the city’s residents, trapped like other Canadian city dwellers in a deepening crisis of housing affordability, which is part of a more general and widespread cost-of-living crunch. 

Policy analysts are lauding governments – and some governments are congratulating themselves – for having sidestepped the cataclysmic lockdown-induced recession that it was reasonable to anticipate (as I did) in the first months of the pandemic.  In both the United States and Canada, temporary responses to the pandemic reduced officially defined poverty rates to a degree that would have been highly improbable under less extreme circumstances.  The US Federal Reserve’s annual survey of households in 2021 found the highest levels of several indicators of financial well-being since the survey began in 2013. On the other hand, in the United Kingdom child poverty (and therefore family poverty) has continued to increase and deepen through the years of pre-pandemic austerity and since then.  


Figure 2.  Downtown Montréal, March 2023.  Photo: T. Schrecker

As this observation suggests, whatever the view from 30,000 feet, ‘on the ground’ the consequences of the pandemic can look very different.  Very early on, data from Montréal made it clear that the impacts of the pandemic were stratified by class and race (Figure 3).  Cities like Montréal may ‘recover,’ in a statistical sense, but many of the businesses that thrived there and the households that lived there are not likely to do so.  There is an important methodological point here.  As in any other inquiry related to the social determinants of population health, averages can be fatally misleading.  Eduardo Galeano wrote: “Where do people earn the Per Capita Income? More than one poor starving soul would like to know.”  Aggregates and averages cannot tell the story of life in a city where buyers of million-dollar condos move in, as tenants dispossessed by a wave of ‘renovictions’ move out.  Here is yet another illustration of why the tipping point concept is important.  Before the pandemic, researchers were writing about gentrification and “condoization” in Montréal.  The pandemic and policy responses to it have accelerated the processes, and as elsewhere magnified the impacts on inequality.  These are likely to be intractable and intergenerational.

The return to business as usual

The pandemic transiently made radical expansion of the realm of the possible in economic and social policy seem plausible.  While rhetoric about “building back better” proliferated, two detailed and thoughtful proposals in this vein actually appeared in 2019.  The annual Trade and Development Report of the United Nations Conference on Trade and Development (UNCTAD) called for a global Green New Deal organized around raising labour’s share of incomes worldwide, raising additional revenue to support fiscal stimuli, and expanding public investment in clean transport and energy systems and sustainable food production.  Also in that year, British historian Simon Szreter and colleagues published a prize-winning UK-focused proposal for “incentivizing an ethical economics” organized around raising taxes to invest in sustainable growth and offering universal care provision in old age – a “new social contract” and “new intergenerational contract”. 

Taking seriously building back better means, in the words of iconoclastic economist Mariana Mazzucato, “we need to radically reform and rearm the state.”  It is not as if the necessary policy instruments are unavailable, be they the public development banks to which UNCTAD devoted an entire chapter of its 2019 report; the range of measures described by Szreter and colleagues; or – to use an example from close to home – the housing co-operatives that provided affordable housing to many Canadians before senior levels of government abandoned the housing sector to market forces.  Especially in an age of long-term geopolitical instability, calling for more rather than less spending on defence, using those instruments to ensure that “the costs and benefits of a green transition are distributed equitably across society so that social injustices are tackled alongside environmental crises” (to quote Mazzucato again) will require substantial new revenue streams mobilized through progressive taxation. 

Both UNCTAD and Szreter and colleagues emphasized the importance of this point, as did later analyses.  In 2020, as the scale of the pandemic’s impacts was already becoming clear, UNCTAD argued that “[in] light of the further increase in inequality resulting from this crisis the case for a wealth tax seems irrefutable.”  Even the Financial Times’ editors conceded that wealth taxes would “have to be in the [policy] mix” (paywalled).  Since then, policy silence on this point has usually been deafening.  US president Biden’s March, 2022 legislative proposal to levy a minimum tax on the ultra-rich and to tax unrealized capital gains on financial assets was a striking outlier, although the perverse structure of Senate representation doomed it from the outset.  Improbably, the UK’s Conservative government in November, 2022 introduced incremental tax changes that slightly reduced the preferences granted to the ultra-rich and lowered the level at which the highest marginal income tax rate applies, but will do nothing to reverse the magnification of inequality and hardship during the pandemic.  More conspicuously than in the aftermath of the 2007-2009 financial crisis, innovation has been abandoned and policy – in particular, commitment to reducing inequality – reset to business as usual in a wave of what the Roosevelt Institute in the US has called zombie neoliberalism. 

The reset is perhaps not surprising given the outsized and growing influence of money in politics, as described by Brooke Harrington, Jane Mayer, and Peter Geoghegan among many others.  Catherine Belton has focused on how Russian flight capital influenced British politics as it penetrated London property and financial markets, and in an important comparative study US political scientist Larry Bartels found “remarkably strong and consistent evidence of substantial disparities in responsiveness to the preferences of affluent and poor people. Insofar as policy-makers respond to public preferences, they seem to respond primarily or even entirely to the preferences of affluent people.”  This dynamic is likely to be more powerful than ever in a more unequal post-pandemic world where resistance emanates not only from transnational corporate tax avoiders and the one percent with their hypermobile assets, but also a substantial stratum of newly enriched property owners with an expanded stake in financialized housing markets. 

It is therefore dispiriting but arguably predictable that (for example) Britain’s opposition Labour Party has recently tried to lower expectations of future change, its leader “constantly calculating which of the people desperately awaiting his government he can afford to ignore because they have no powerful advocates” in the words of eloquent Guardian columnist Nesrine Malik.  The answer, probably, is most of them.  One must hope that such efforts fail, yet at the same time contemplate with unease the politics of desperation that the future is likely to bring. 

The Covid-19 pandemic as tipping point (Part 1)

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Acknowledgement: This commentary was originally written for Policies for Equitable Action on Health.  It is reposted here with the kind permission of Daniele Dionisio, who runs PEAH.  Further republication consistent with the Creative Commons licence that applies to my entire blog is encouraged.

I began a (pessimistic) 2022 book chapter on the prospects for ‘building back better’ after the Covid-19 pandemic by quoting the first sentences of J.G. Ballard’s magnificent dystopian novel High-Rise:

Later, as he sat on his balcony eating the dog, Dr Robert Laing reflected on the unusual events that had taken place within this huge apartment building during the previous three months.  Now that everything had returned to normal, he was surprised that there had been no obvious beginning, no point beyond which their lives had moved into a clearly more sinister dimension.

The giveaway word here is “normal,” and the new normal to which Laing’s world has returned is one in which a deadly class war between the affluent and even more affluent residents of a 40-story tower block has completely destroyed the interior of the building and most of its vital systems, and survivors are reduced to killing and eating the pets of their less fortunate neighbours.  In a scene near the end of the novel, surviving children play with human bones in the tower block’s rooftop sculpture garden.

This rather dramatic introduction was designed not to suggest that post-pandemic societies will literally regress to that extent, although that could happen in some contexts, but rather that conditions of life that come to be regarded as normal in the post-pandemic world will probably look very, very different from those of late 2019, and for most of us more insecure and threatening.  I am more convinced of this now than I was when I wrote the chapter. 

In a recent conference paper, I argued that the pandemic should be understood as a tipping point, initiating processes that magnify and accelerate existing trends, in particular those involving rising inequality and its direct and indirect effects on health. The concept of a tipping point is used in several, slightly different ways depending on context, but it is now most familiar from research on climate change.  Leading climate researcher Timothy Lenton explains: tipping points “occur when there is strongly self-amplifying (mathematically positive) feedback within a system such that a small perturbation can trigger a large response from the system, sending it into a qualitatively different future state.”  Stated more colloquially, “sometimes little things can make a big difference,” or at least a disproportionate difference, “to the state and/or fate of a system.”  

Figure 1.  Schematic representation of cascading effects in the vegetation–rainfall system


(a) Vegetation–atmosphere system in equilibrium. (b) Initial forest loss triggered by decreasing oceanic moisture inflow. This reduces local evapotranspiration and the resulting downwind moisture transport. (c) As a result, the rainfall regime is altered in another location, leading to further forest loss and reduced moisture transport.  Reproduced without change from Zemp, D. C., Schleussner, C. F., Barbosa, H. M. J., Hirota, M., Montade, V., Sampaio, G. et al. (2017). Self-amplified Amazon forest loss due to vegetation-atmosphere feedbacks. Nature Communications, 8, 14681 under a Creative Commons Attribution 4.0 International Licence.

An especially striking example is provided by deforestation in large tropical rain forests (Figure 1).  As much as half of the precipitation that falls on such forests originates from evapotranspiration within the forest itself.   The concern is that deforestation resulting from human activity (forest clearance) will combine with reduced oceanic moisture inflows to lead to a tipping point in which reduced rainfall accelerates forest dieback, and the rain forest transitions to savannah or steppe.  This will itself accelerate climate change, as the forest no longer provides a carbon sink.  Researchers write that findings about multiple processes of this kind “imply that shifts in Earth ecosystems occur over ‘human’ timescales of years and decades, meaning the collapse of large vulnerable ecosystems, such as the Amazon rainforest and Caribbean coral reefs, may take only a few decades once triggered.”  This is a long time in the context of such phenomena as election cycles, but an eyeblink in geological time.  Whatever the time scale, once a tipping point has been reached, the pace of changes that were already under way accelerates rapidly, and entirely new changes may begin.

My pre-retirement colleague Clare Bambra and colleagues have provided an especially compelling account of how distribution of health outcomes during the pandemic reflected and magnified economic inequalities (open access, and essential reading). Looking ahead, here are a few of the patterns (far from an exhaustive list) that suggest the value of considering the pandemic as tipping point:

  • Concentration of wealth at the very top of national and global economic distributions: The number of US dollar millionaires worldwide increased from 46.8 million in mid-2019, the last pre-pandemic year, to 62.5 million in 2021.  This growth was fuelled by rising share prices, but also by
  • Soaring property prices in much of the world.  US homeowners saw their wealth increase by more than US$6 trillion between the start of the pandemic and the third quarter of 2022; average house prices across Canada’s 15 major metropolitan areas rose by as much as 45 percent between 2019 and 2021, depending on distance from the city centre.  The ‘flip side’ of this pattern, which began before the pandemic but was accelerated by it and is repeated in many European centres, is
  • A growing pattern of unaffordable housing and semi-permanent housing insecurity, underpinned by the financialization of housing, which also predates the pandemic and led one group of Australian researchers to conclude that: “sustained inflation of property values … has fundamentally shifted the social class structure, from a logic that was structured around employment towards one that is organized around participation in asset ownership and appreciation.”
  • Housing prices are an important part of a larger cost-of-living crisis, originating in supply chain disruptions associated with the pandemic and worsened by Russia’s invasion of Ukraine and its weaponization of energy exports.  Interest rate increases – a conventional central bank inflation-fighting tactic – cannot address these impacts because they have no effect on supply, and in fact are likely to magnify inequality, as they raise the cost of consumer debt and are passed through to consumers by producer firms.
  • In a global frame of reference, countries differed in the fiscal capacity they were able to deploy in initial responses to the pandemic, which will probably lead to increased inter-country inequality.  Further issues arise from what could be
  • An impending sovereign debt crisis for many countries; before the pandemic the sovereign debt load of countries in sub-Saharan Africa, the world’s poorest region, was more than twice its nominal value in 2009, the year after the financial crisis.  In early 2023 the American Public Health Association called on the International Monetary Fund, World Bank and G20 “to eliminate debt for the poorest countries and expand fiscal space for public financing of health services and public health programs.”
  • Finally, of course, there are the effects of climate change on various social determinants of health, including food security.

The World Economic Forum’s 2023 Global Risks Report devoted an entire chapter to the concept of “‘polycrisis’ – a cluster of related global risks with compounding effects, such that the overall impact exceeds the sum of each part.”  This is a useful way of capturing the interactions discussed here, yet at the same time we must acknowledge that many trends in question will present as crises for many, and opportunities for others.  (Housing price escalation is a case in point.) 

            Perhaps my view of the future is excessively bleak.  After all, high-income countries were able to buffer many of the pandemic’s economic effects, and the US improbably experienced a substantial, if temporary, drop in poverty.  The situation outside the high-income world was, and is, considerably more grim, like the “vaccine apartheid” that has now largely faded from public consciousness, reflecting the multiple dimensions of global inequality and the relative invisibility of the global majority.  Numerous blueprints, some quite detailed, exist for ‘building back better’.  The second part of this posting will direct readers to a few of these; assess some of the formidable political obstacles to their realization against the background of rising inequality; and offer a few conjectures about health in the post-pandemic new normal.  

Globalization and health: Now more than ever, a need for scepticism and multidisciplinarity

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We who have been working in global health for a long time will recall Richard Feachem’s 2001 argument that ‘Globalisation is good for your health, mostly’.  The claim was that the economic growth stimulated by globalization – specifically, increased volumes of trade as a share of a country’s gross domestic product (GDP) – reduced poverty and increased resources available for providing health care.  Although the role of poverty as a primary determinant of ill health is beyond dispute, later assessments called into question both the World Bank data on trade flows and growth on which Feachem relied and the necessary connection among economic growth, poverty reduction and better health.  The work of historian Simon Szreter is especially noteworthy on this latter point.

More than 20 years on, it is disturbing to find The Economist’s leader writers ignoring much of the evidence that has since accumulated about the questionable human benefits of globalization.  Instead, they call (in the weekly’s January 14 issue) for governments to reject such policies as national or regional industrial strategies in a world that has been transformed by the pandemic and the knock-on effects of Russia’s invasion of Ukraine.  The claim in the leader and accompanying briefing (which, to be fair, is considerably more nuanced) is that only renewed efforts to support the global reorganization of production that has occurred over the last four decades or so, in the name of economic efficiency, will continue past progress in reducing poverty and render less formidable the costs of decarbonizing the world economy.

Neither the desirability of reducing poverty nor the imperative of decarbonization is in question, but globalization in anything like its pre-pandemic form is as likely to make things worse as it is to make things better, with important implications for the health of people worldwide.  

Let’s take the decarbonization claim first.  In 2020, the United Kingdom’s National Audit Office (NAO) produced a remarkably detailed examination of the economic and societal changes that will be needed if the UK is to reach its stated goal of ‘net zero’ emissions by 2050.  Any thoughtful reader of this report, which can serve as a model for similar analyses elsewhere, will conclude that market theology of Ayn Randian proportions is required to sustain belief that so-called free markets will do the job.  Creative, thoughtful dirigisme across a range of sectors will be necessary, although not sufficient.  The same is true of any other complex economy one can think of.  The work of innovation scholar Mariana Mazzucato is especially persuasive on this point, and on the misguidedness of past decades’ market fundamentalism more generally.  

Then, there is the claimed connection between globalization and poverty reduction.  Based on the World Bank’s contentious definition of extreme poverty, the meanness of which was commented on by The Economist itself in 2016 (‘It is hard to imagine how anyone could subsist on so little’), hundreds of millions of people have been lifted out of poverty since the start of the era of contemporary globalization.  Even leaving aside the problematic nature of the definition, until early in the new millennium global extreme poverty reduction was entirely a China story.  In other words, everywhere outside China as someone escaped poverty on the World Bank’s definition, someone else fell into it.  According to the Food and Agriculture Organization and other United Nations agencies, before the pandemic healthy diets were unaffordable to three billion people on ‘the most conservative estimate’ and ‘[t]wo billion people, or 25.9 percent of the global population, experienced hunger or did not have regular access to nutritious and sufficient food in 2019’.  This is hardly stellar performance on the part of the dominant paradigm for organizing the global economy during a period when the value of the world’s economic product roughly tripled.

Perhaps the most problematic aspect of The Economist’s encomium to globalization is its indifference to inequality.  In 2013 Serge Halimi, the editor of Le Monde Diplomatique, described globalization – correctly, in my view – as ‘[t]he inequality machine [that] is reshaping the planet’.  The effects have now become too conspicuous to ignore within national borders, and despite some short-term ameliorative effects associated with programmes to compensate for earnings losses, the pandemic amplified the reshaping process.   For example, a 2022 annual report on the world economic situation – one of several under-used resources generated annually by United Nations agencies – observed:  ‘According to preliminary estimates, the top 1 per cent of income earners in the United States registered net wealth gains of about $3.5 million per person between the first quarter of 2020 and the second quarter of 2021. The bottom 20 per cent recorded an increase of only about $5,300 per person’. 

Complicating the picture, even as pre-pandemic globalization eased extreme poverty in China, and more recently in other jurisdictions outside the high-income world, it devastated the economic futures of many working families in countries like the United States – contributing to what Anne Case and Angus Deaton eloquently describe as ‘deaths of despair’ among the left-behind.  In the US the ready availability of guns, the marketization of health care and the criminal marketing practices of commercial opioid producers also played a role, which is probably why the pattern identified by Case and Deaton was distinctive to that country before the pandemic.  Even before we consider the implications of continued growth on earth systems – what key researchers on the Anthropocene Epoch of geological time have called the Great Acceleration – the report card on globalization’s human benefits is decidedly mixed. 

Much more can and should be said about all these matters.  With important exceptions, researchers and practitioners writing in the global health literature do not provide adequate discussions, despite their importance for the future of the field.  Indeed, the same is true of population health more generally.  Rather, it is necessary to explore work that has been generated and published in various areas of social science and law that are not necessarily connected to health in obvious ways – at least, not in ways that are apparent to the biomedical gaze.  This is where multidisciplinarity comes in: ability to engage with a range of disciplines and assess the implications of their findings for global health is indispensable for critical assessment of claims like those about the benefits of globalization. 

The Economist itself is among the business-oriented sources – another being the Financial Times – that have sometimes generated valuable correctives to Panglossian views of globalization.  The Economist’s reckoning, for example, suggests that deaths outside Ukraine from Russia’s weaponization of gas exports will outnumber war fatalities within the invaded country’s borders – hardly a ringing endorsement of the ‘borderless world’ beloved of globalization’s enthusiasts as it involves energy.  Globalization of financial markets has not only multiplied opportunities for fiscally debilitating tax avoidance and capital flight, which among other consequences undermine social protection measures and progress towards universal health coverage, but also facilitated recurring debt crises in the developing world.  The most recent such crises – again as The Economist pointed out – compromised many responses to the Covid-19 pandemic, and are squeezing already straitened low- and middle-income health budgets.

Before I retired, some of my postgraduate students wondered why the learning objectives in my global health courses included the ability to read articles in the business press and explicate their implications for global health.  This is why.

Acknowledgements and disclosures

A shorter version of this commentary has been posted on the web site of the Collective for the Political Determinants of Health, based at the University of Oslo’s Centre for Development and the Environment. Parts of this analysis are based on the author’s chapter on globalization in L. Bharadwaj and C. Schuster-Wallace, eds., Handbook on Global Health and Sustainable Development (Edward Elgar, forthcoming).  The author owns shares in firms including Intel and TSMC that will benefit from US technology subsidy programmes critiqued in the Economist leader cited here, although the merits of that critique were not addressed.  Unfortunately, some of the links used here are protected by paywalls.  The author will endeavour to provide copies of the cited materials for the personal use of readers without access.

Natural disasters?

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Jackson, the small capital city of the US state of Mississippi, is at this writing (4 September) without safe drinking water, and has only intermittent supplies of piped water of any quality.  Unfortunately, much of the best media coverage of this humanitarian emergency, in outlets like the Washington Post and The New York Times, appears to be paywalled, although readers with a university affiliation should be able to access it through Nexis.  (BBC News, which finds investigative journalism easier outside the UK, is a notable exception.)  The proximate cause is flooding of the Pearl River, which has disabled the city’s water treatment plant.  However, the New York Times’ coverage sums up the deeper problem of politically driven infrastructure neglect, one all too familiar in US cities: ‘For decades, the city’s population has been shrinking, an exodus propelled in large part by the flight of white residents — along with their tax dollars — to surrounding affluent suburbs where, by and large, the water on Tuesday was flowing just fine.’

Jackson’s situation brings to mind the title of what I think is still the best book on the politics of Hurricane Katrina and its aftermath, although numerous later journal articles provide added perspective: There Is No Such Thing as a Natural Disaster.  The same analytical point was made several years pre-Katrina by sociologist Eric Klinenberg, in a ‘social autopsy’ of the 1995 Chicago heat wave in which people in the city’s poorest and most African-American neighbourhoods, unable to afford air conditioning, barricaded themselves in their flats while an indifferent and under-resourced city government did not respond adequately.  Water quality and availability crises are in fact becoming all too routine in US cities, as pointed out in a superb 2019 doctoral thesis by anthropologist Nadia Gaber and a special issue of the journal Critical Sociology on the multi-year water crisis in deindustrialised Flint, Michigan.   

Although some such disasters may be triggered by extreme weather events, they are not in any meaningful sense natural.  Rather, they are traceable directly to the hegemony of neoliberal ideas and associated urban austerity – and, in the US case, to a history of systemic racism that goes back literally centuries.  Since such weather events are likely to occur with increasing frequency as the planet’s climate changes, it is worth reflecting carefully on what these observations mean for health inequalities.  For example, they not only add to the already formidable health case against austerity but also would appear to bolster the arguments for climate reparations, not only across national borders but also within them. Observer columnist Kenan Malik notes a broader pattern of purposive reductions in the capacity of states to help those they rule, tracing this (correctly in my view) to the infamous 1975 Trilateral Commission report on The Crisis of Democracy. Here, again, the resulting humanitarian emergencies are not natural.  They are features, not bugs in the neoliberal vision of the world.  Facing a cost of living crisis and a probable prime minister who rails against “the lens of redistribution,” millions of people in the UK are going to experience the sharp, sometimes deadly edge of that vision during the coming winter.  

‘Tax is not a four-letter word’: Why this matters for health inequalities, and why health professionals and researchers must take it to heart

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The title of this post is not at all original.  Rather, it is the title of a book co-edited with his son by the thoughtful former head of Canada’s public service, Alex Himelfarb (after his retirement).  In a newspaper column published at the time, Dr. Himelfarb described the book as an effort to correct the ‘dangerously distorted’ discourse surrounding tax policy, as a result of ‘the neo-liberal economic policy that began to dominate American and British politics in the early 1980s, and emerged more slowly and subtly in Canada at around the same time’.  Almost a decade on, the discourse remains distorted throughout much of the world, with increasingly serious consequences for inequality and quite probably for social stability. 

Exhibit A is the dire state of Canada’s and the United Kingdom’s tax-financed health systems.  (Although the National Health Service and Canada’s multiple provincial and territorial health systems are financed from general tax revenues and are mostly free at the point of use, they are otherwise quite different.)  That similarity is arguably why both countries are facing a crisis in access to care, worsened by the effects of Covid-19, that has demonstrably had fatal consequences.   Whilst users quite rightly and understandably want health systems to provide necessary care in a safe and timely fashion, resistance to the taxes necessary to finance not only the direct provision of care but also such strategically critical activities as training doctors and nurses has generated political paralysis. 

The explanation was succinctly stated around the same time the Himelfarbs’ book appeared by Robert Evans, the magnificently acerbic dean of Canadian health economists: ‘[A] well-functioning modern health system requires the transfer, through taxation, of a very significant amount of money from the healthy and wealthy to the care of the unhealthy and unwealthy’.  When we hear arguments that the NHS or Canada’s systems of health finance are ‘unsustainable’, this is code for saying that the richest members of those societies do not want to pay for the care of those presumptively undeserving others.  This problem is especially acute in the UK, where the rich have the option of buying private insurance or paying directly for care – something not available within Canadian borders outside the renegade province of Québec.  By 2017, HM Government was conceding the inadequacy of the NHS for treating the great and the good (see below).

Such problems are compounded by what is perhaps best described as a lack of policy literacy among the health care and public health community, who often remain unfamiliar with such basic concepts as progressive and regressive tax and spending patterns (and in public finance these terms have a technical, not a normative meaning).  Chapter 6 of David Byrne’s recent book Inequality in a Context of Climate Crisis after COVID provides a superb overview, and it – or something like it – ought to be a required part of all university public health and health policy curricula.

On, then, to Exhibit B: the catastrophic inadequacy of actual and proposed responses to the energy price crisis created by Putin’s weaponisation of Russian energy exports.  Like the equitable financing of a health system, responding to the crisis will require a substantial redistribution of resources from Mr. and Mrs. Range Rover and the corporate treasuries that have been swollen by windfall gains to the majority of UK households that will, based on estimates by the University of York’s authoritative Social Policy Research Unit, be pushed into fuel poverty by the start of the New Year.  At this writing, the silence of the public health community has been deafening.  Unfortunately, those who will be least hurt by energy price inflation, or who will actually benefit from it, can probably exercise an effective political veto over the degree of redistribution that will be necessary to avoid a humanitarian catastrophe.  In this case, the problem is compounded by a tongue-tied political class unwilling to state the obvious:  liberal democratic Europe is at war with Russia, and wartime situations demand wartime sacrifices.  But that is a posting for another day.

Hating to have been right

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In the slightly less frantic period of university activity that precedes my pending retirement and actually offers time to think, I am prompted to look back at some of the predictions I made about the pandemic and the UK’s social and economic future well over a year ago – notably, that post-pandemic economic contraction would mean that ‘the United Kingdom is over as a desirable place to live and work, for a very long time, except for those living in gated communities or behind castle walls’.  Although the contraction does not (yet) approximate the ‘post-Soviet style economic and health collapse’ that I anticipated in January 2021, it was reported on 22 August that the UK economy contracted by 11 percent in 2020 – the largest year-on-year decline in GDP since 1709.  Please note that this reflects only the first year of the pandemic, and neither the short-lived post-lockdown recovery nor the cataclysmic geopolitical events of 2022.  (Proponents of ‘degrowth’ might nevertheless reflect on how well 2020 turned out, and for whom.)

Ongoing uncertainties and supply chain disruptions associated with the pandemic have now been compounded by the inflationary effects of Russia’s invasion of Ukraine; its weaponisation of natural gas trade and, at least temporarily, further disruption of agricultural exports; and a domestic political vacuum that sees the probable next prime minister characterised (accurately) as on ‘holiday from reality’ by a senior Cabinet colleague.  Average real (inflation adjusted) earnings in the second quarter of 2022 fell at a record rate, whilst one forecast was that under existing institutional arrangements, the ‘capped’ amount a British household will pay for energy could rise to more than £6,000 by April 2023, from less than a third of that in August 2022.   This will be a minor inconvenience for Mr. and Mrs. Range Rover, but on one estimate – based on a lower assumed energy price than what is in the latest forecasts at this writing – 45 million people will experience ‘fuel poverty’ on a standard definition.

These impacts are, of course, attributable not only to the pandemic but also to geopolitics, and it is plausible to argue that the impacts I’ve described would be much less severe had the Russian invasion not taken place.  But the world is as it is, not as we might wish it to be.  Further, I was wrong – I am thoroughly delighted to say – about some things, especially the prospects for what turned out to be a relatively successful UK vaccine rollout.  Nevertheless, according to The Economist’s (paywalled) tracking of excess deaths from all causes – the most meaningful measure of successful pandemic response – Britain’s figure of 253 excess deaths per 100,000 people between the start of the pandemic and 23 August is comparable to Chile, Guatemala and Lebanon; almost twice as high as Sweden; and roughly three times as high as Norway, Denmark and Canada.  So the glass is definitely only half full, and the British figure may well deteriorate further against the background of an already fragile and under-resourced health system; a social safety net stretched to the breaking point; and a political leadership seemingly bent on emulating the captain of the Titanic in its response to the economic emergency.  Those castle walls will look awfully attractive to those for whom they are available.

Globalisation and health: Looking backward, looking forward

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This piece was originally written for Policies for Equitable Access to Health, an Italian-based site that now offers a valuable ‘weekly snapshot of public health challenges’.  It is reposted here with their kind permission.

Much of my academic work over the past 20-plus years has focussed on the processes of globalisation and what they mean for population health.  One of the early (2007) major products of that work, co-written with long-time colleague Ronald Labonté, came out of analysis done for the WHO Commission on Social Determinants of health.  It took the form of a three-part series in the journal Globalization and Health, discussing in turn historical context and methodological background; the role of the global marketplace; and prospects for promoting health equity in global governance.  (The later work on globalisation that informed the WHO Commission appeared in book form in 2009.)   In view of the cataclysmic world events of the last 30 months (at this writing) and my pending retirement from salaried academic life, I thought it useful to look back on some of our analysis to see what it got right, what it neglected, and how future research should learn from such reflections.

The work focussed, quite rightly in my view, on how the emergence of a global marketplace and the associated worldwide spread of neoliberal economic ideas and institutions transformed opportunities to lead a healthy life and the options for public policy to reduce health inequalities.  Indeed, we perhaps did not focus intensively enough on neoliberalisation and its transformative impact, about which I have written elsewhere.  The figure below shows (in blue) the seven interacting ‘clusters of pathways’ that we identified in Globalization and Health, and (in red) how I think this analysis needs to be modified and added to in light of recent events.  The rest of this post concentrates on three areas, obviously in insufficient detail.  

The first of these relates to the consequences of global environmental change, now observable in daily headlines about such climate-related phenomena as shrinking polar ice cover, heat waves, megadroughts and wildfires.  As conspicuous as these impacts are, the reflect only one dimension of what is now widely described as the Anthropocene Epoch – a new era of geologic time marked by the scale and extent of human-induced changes in the natural environment, exemplified by (for example) the prospect of the transformation of the Amazon rainforest into savannah as a result of continuing deforestation.  A key concept in the Anthropocene literature is the Great Acceleration, a multidimensional speeding up of economic activity and the associated biophysical transformations beginning, on many reckonings, around 1950 with the post-World War II period of economic growth.  Until recently, that growth was concentrated in the (mostly high-income) OECD group of countries.  Formidable questions of global justice are raised by the implausibility of sustainable growth within planetary boundaries if the rest of the world were to continue pursuing anything like the standard of living taken for granted within the OECD.  Anthropologist Jason Hickel has been one of the most vocal and articulate proponents of ‘degrowth’ in this context; whether intentional degrowth is feasible under any kind of democratic political arrangements is a question yet to be resolved.

The second area of neglect relates to the continued, indeed enhanced danger of transnationally dispersed pandemics.  With 20-20 hindsight, there was little reason for this.  Journalist Laurie Garrett had been warning of the prospect since 1994, and in 2019 – just a few months before the start of the Covid-19 pandemic – published a prescient article warning that: ‘The world knows an apocalyptic pandemic is coming … But nobody is interested in doing anything about it’.  This problem does not appear at first directly connected with the global marketplace, but in fact it is.  Public health infrastructure is one of the key prerequisites of societal survival that the so-called free market cannot and will not provide; it is one of the few truly public goods for health.  The neoliberal turn in public policy is thus implicated in the neglect of public health infrastructure to the extent that Matthew Sparke and Owain Williams recently (and correctly in my view) identified Covid-19 as a ‘neoliberal disease’.  Incredibly, if predictably given the current UK government’s tenuous hold on reality, it  has not learnt from the pandemic: in April 2022 the government announced staff reductions of 40 percent at the Health Security Agency, responsible for pandemic planning and response, at the finance ministry’s insistence.  In the same month, again predictably, a scientifically illiterate US Congress refused to continue Agency for International Development funding for vaccine delivery in low-income countries. 

Third and finally, researchers like myself took too seriously and literally the idea of a ‘Borderless World’ put forward by Japanese economist Kenichi Ohmae.  The book in question, originally published in 1990, remains an iconic paean to a world in which governments have become largely irrelevant; ‘if a corporation does not like its government, it can move its headquarters to other, more hospitable places’; and the future resembles nothing so much as a global duty-free shop.  Many elements of this vision, notably its focus on the footloose corporation and its tacit acceptance of rising inequality, remain accurate if dispiriting descriptions of the world economy.  At the same time, nationalism and geopolitics continue to render the world anything but borderless, and political institutions anything but irrelevant, in many respects.  In 2016, UK voters narrowly supported leaving the European Union and its single market, an act of economic self-harm that will have consequences for decades, most of them magnifying existing inequalities and their destructive effects on health.  And several European countries, Germany most particularly, appear to have believed that the world really was borderless for purposes of energy policy.  This catastrophic inattention to geopolitics led directly to today’s vulnerabilities associated with reliance on Russian natural gas supplies and may yet pave the way to deep recession, widespread social unrest, and domestic political pressure to accept Ukraine’s dismemberment.  Much of this could have been avoided through careful attention to a long list of books drawing attention to Russia’s internal political transformation, going back at least to the late Anna Politkovskaya’s 2004 Putin’s Russia. (She was murdered shortly after its publication.)

Much more can and should be said on all these matters, and others.  For example, global health researchers have not yet come to grips with the implications of a widespread retreat from democracy and drift into autocracy in which, according to the respected Varieties of Democracy Institute, ‘the last 30 years of democratic advances following the end of the Cold War have been eradicated’.   As historical sociologist Margaret Somers points out in the US context, this trend is not unrelated to the hegemony of neoliberalism, although the connections are likely to vary among country cases.   Faced with such complexity, many researchers will be tempted to retreat into the familiar territory of health systems design and what might be called global medicine.  This tendency should be resisted, not least because – as Martin McKee notes in an important recent article – ‘politics is at the heart of public health’.  This is even more true in the global frame of reference than at the national level about which he was writing.  

Plutocrats rule, OK? A Canadian lesson about the realpolitik of ‘building back better’

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Although I have lived in the United Kingdom for eight years, I continue to follow Canadian politics.  As we move towards what we hope will be a post-pandemic world, there are also less personal reasons to consider the Canadian response.  Canada has the most progressive – or at any rate, least reactionary – national government among the G7 countries.  Although its Liberal Party lacks a Parliamentary majority, the slightly more left-leaning New Democrats have indicated that they will not trigger an election in the midst of a pandemic, thus giving the Liberals a temporary functional equivalent of a majority.  More importantly and improbably, in her previous life as an accomplished business journalist finance minister Chrystia Freeland (the counterpart to the UK’s Chancellor of the Exchequer) published an award-winning book called Plutocrats: The Rise of the New Global Super-Rich that described in considerable detail the emergence of the new millennium’s hyper-inequality.  If we leave aside most of the country’s stumble-bum public health response to the  pandemic [i] –  and Canada is hardly alone in that regard – Canada’s first pandemic-era budget, released on 19 April with the uplifting title A Recovery Plan for Jobs, Growth, and Resilience, might therefore provide a useful indicator of just how far the Overton window of political feasibility has shifted in the direction of reducing that hyper-inequality.

Canadian finance minister Chrystia Freeeland

The answer is: not much.  The budget includes numerous, and laudable, incremental increases in federally provided social supports and reiterates, without specifics, an important long-standing commitment to pursue a national subsidised child-care programme of a kind that has long been in place in Québec province.  Like many other aspects of social policy, this is a political minefield in the decentralised Canadian federation because of reflexively and zealously guarded provincial jurisdiction over health care, employment law (most of Canada’s provinces have refused to implement even minimal requirements for statutory sick pay) and social programming.  Except when invoking emergency powers, which it has avoided, the federal government can do little more than write cheques with few strings attached to ensure accountability for their use.  Where the federal government has far more policy space to reduce inequality is in the area of tax policy, where the budget is a virtual vacuum.

The major tax policy change in the budget that is specifically targeted at reducing inequality is a symbolic surtax on luxury cars and boats.  This tax is estimated to bring in C$604 million in revenue (£350 million) over the next five years.  By contrast, the budget takes no steps to raise the marginal income tax rate (the tax on every unit of additional income) paid by top-income taxpayers.  It is also silent on the taxation of wealth, although research from the Canadian Centre for Policy Alternatives shows that Canada’s billionaires increased their wealth by C$78 billion (about £45 billion) in the year since the start of the pandemic.  To put that into perspective, the amount is slightly more than the government of Ontario, Canada’s largest province, plans to spend on health care (C$69.8 billion) in 2021-22.  Likewise, the budget does nothing to address the long-standing preferential treatment of capital gains on asset sales, which are taxed at half the rate paid on wage and salary income – a tax preference that overwhelmingly benefits corporations and the richest individual taxpayers.  According to Canada’s admirable tax expenditure accounts, the finance ministry estimates revenue losses from this provision at C$19.7 billion (£11.4 billion) in 2021 alone.  The complete exemption from tax of capital gains on the sale of principal residences, which in much of Canada have skyrocketed in value over the past year, is estimated to cost the treasury C$7.7 billion (£4.5 billion) in 2020-21 – or twice that amount were the generic tax preference on capital gains to be contemporaneously eliminated.  All these figures are probably underestimates, given recent increases in share and property prices. 

There are now so many property-rich Canadians that trying to tax unearned gains on their principal residences would probably provoke a coup d’état, but that is a post for another day.

If measures like those I’ve mentioned were implemented, tax avoidance strategies would no doubt reduce the revenue gains somewhat, as economists are quick to point out.  But that isn’t the issue; the budgets of governments that choose not to strangle domestic growth and immiserate their populations will be in massive deficit for many years to come.  However, Canada’s current government has not made any of the obvious commitments to reducing inequality in the building back process.  Reducing inequality and its corrosive effects on health, which have been foregrounded by the Covid-19 pandemic, will never be achieved by incremental strategies of trying to level-up.  This is not to minimise the value of those strategies in mitigating the worst consequences of the pandemic … and low- or zero-cost childcare, if it ever happens, could be critical to reducing gender inequalities on multiple dimensions.  But mitigation is not structural change. 

A columnist in Canada’s heavily business-oriented Globe and Mail newspaper (paywalled) cited poll results showing that 79 percent of Canadians support a wealth tax.  That, too, isn’t the issue.  Some of the best comparative political science research, from multiple, mostly high-income democracies, finds ‘remarkably strong and consistent evidence of substantial disparities in responsiveness to the preferences of affluent and poor people. Insofar as policy-makers respond to public preferences, they seem to respond primarily or even entirely to the preferences of affluent people.  Indeed … the influence attributed to poor citizens is not just less than that attributed to affluent citizens, but consistently negative’ (emphasis in original).   

It’s really only the plutocrats whose preferences will count, without far more radical changes in political institutions and resources than seem likely in peacetime.  Plutocrats rule, OK?  Health inequalities researchers must resign ourselves to that, or be far more innovative than we have been so far in coming up with ways to do something about it.   

[i] Sometimes, the vacuity of that response can hardly be believed.  Here is a quotation from Canada’s Deputy Chief Public Health Officer, a highly paid federal bureaucrat, as reported on 22 April in a news story on possible restrictions on travel from India, which curiously has since disappeared from most news organisations’ web sites: “‘Our minister of health, other cabinet ministers and the prime minister are very seized with it. They are having active conversations about the data and so on’, he told a news conference today.   ‘I think there will be a decision or something coming forward shortly’.”  In the ‘decision or something’, Canada then banned direct incoming flights from India for 30 days, but not arrivals transiting from India via a third country. The logic is curious, to say the least.

New Year, New Lockdown: ‘The Great Deception’

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Predictably, the New Year started in the United Kingdom with new lockdowns.  Given the negligent and cavalier stance of the Conservative central government towards basic public health principles since the start of the pandemic, and the consequent peril to the National Health Service, this was inevitable, although one may argue with some of the specifics.  It is important to remember, though, that both the parlous state of the NHS and the neglect and defunding of public health infrastructure are consequences of a homicidal decade of Conservative austerity, correctly described in 2017 by the editor of The Lancet, Richard Horton, as ‘a political choice that deepens the already open and bloody wounds of the poor and precarious’.     

One of the knock-on effects is that we are now living in a police state – so far, a non-violent one, but violence is not a necessary element of the definition.  Hyperbole, you say?  Well, what else would you call a polity in which the decision about what constitutes a ‘reasonable excuse’ for leaving home is decided, in the first instance, by police, who will be defended by Cabinet ministers?   I wish politicians and self-styled progressive colleagues alike would stop dissembling on this point.  They might well defend the situation as necessary, but they should stop lying about its nature.  Presumably some of these fines and arrests will be successfully contested by those with the time and money to do so, should government eventually permit courts to resume routine operation, which is far from certain.  

Speaking of lies, porkies* of Trumpian proportions have been emanating from central government.  We are told that, if we obey the rules and all goes well with vaccination, restrictions might be eased in ‘tulip season’ (May, in these parts) or ‘spring’ (technically, before 21 June).  If any reader believes that, then I can offer a really good deal on some oceanfront property in the Canadian province of Saskatchewan.  (Spoiler alert: there isn’t any.)  Given the government’s record of destroying any public health initiative it touches, the UK will be doing well to be out of the worst of lockdown by September.  In fact, more severe restrictions are threatened.  As John Harris observed in an important Guardian commentary: ‘The lack of alarm about these moves is remarkable’.

Disturbing manifestations of burnout can be anticipated by the end of a summer without holidays (I quote from the government guidance: ‘holidays in the UK and abroad are not allowed’).  Some of us would in theory have the attractive option of sitting on the local seafront and reading once the weather warms up … except that under current guidance this would not count as exercise, one of the ‘reasonable excuses’ to leave home, so would be a crime.  Such constraints weigh most heavily, of course, on those without gardens of their own or with caring responsibilities.  The incidence of deaths of despair is likely to soar, as is the number of employers using depression and anxiety as a pretext for forced redundancies.

All this means that the chances of a post-Soviet style economic and health collapse in the UK, lasting for a generation or longer, are considerably greater than they were when I first raised the possibility last summer.  It could be, of course, that vaccination will proceed more quickly and effectively than expected (pigs might fly, too) or that some other remarkable advance in prevention will be found.  Unfortunately, it is much more likely that the United Kingdom is over as a desirable place to live and work, for a very long time, except for those living in gated communities or behind castle walls. 

The ways in which the pandemic is magnifying inequality – on which I will expand in a subsequent posting, based on material from the postgraduate course in Advanced Social Determinants of Health that I lead – continue to be given limited attention.  Most of the ‘experts’ calling for even stricter lockdowns probably have gardens of their own, job security, and substantial savings, unlike many other Britons; they have generally been silent on inequality issues.  Still less often have they taken up Horton’s pre-pandemic injunction that: ‘The task of health professionals is to resist and to oppose the egregious economics of our times’.  One wishes that members of the government’s Scientific Advisory Group on Emergencies had to disclose their households’ incomes and net worth, along with their professorial titles and British Empire honours, as part of their declaration of interests.

Here is a thought experiment, keeping in mind two propositions.  First, people working in front-line occupations (think essential retail like supermarkets, delivery, driving those buses that continue to operate, Amazon warehouses, meat packing, care homes) cannot work from home, and especially if on zero-hours contracts or without union protection cannot afford to self-isolate after a positive test or if symptomatic.  (The jobs of many others, working in the sector broadly described as hospitality, have vanished under lockdown, possibly never to return.)  Second, as of 25 September almost nine out of ten deaths from Covid-19 involved people 65 or older (more recent figures are maddeningly hard to find on official web sites).  Most of these represented an actuarial boon for the UK treasury, no longer paying state pension, and many for defined-contribution pension plans.   

Now, if you wanted to design a pandemic response that pretended good intentions whilst concealing a subtextual agenda of culling the working class (potential claimants of state benefits, after all, and therefore intrinsically suspect for Conservatives) and the elderly, the current UK response is what it would look like.  The UK is hardly unique in this regard, but along with Canada and its charnel house care homes and even more calamitous vaccine rollout it is an especially egregious case. 

The title of this post refers to what I consider the greatest song by Irish troubadour Van Morrison, ‘The Great Deception’.  Part of the refrain goes like this:

‘I can’t stand it / Can’t stand it nohow / Livin’ in this / World of lies’.

Indeed.

* For those outside the UK: short for porky pies, rhyming slang for lies.

Whistling past the graveyard of dreams: Hard truths about the likely post-pandemic world

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This post originally appeared on 2 November in the excellent global health blog Policies for Equitable Access to Health; it is reproduced here by permission, with minor edits. All views expressed here are exclusively those of the author.  Others quoted here do not necessarily agree with them.

Whistling past the graveyard is a long-ago expression that describes the behaviour of people who are afraid of ghosts, but like to pretend that they are not.  So, they whistle as a show of nonchalance while walking past graveyards late at night.  The expression well describes the current behaviour of academics and apparatchiks alike, in much of the world, as they respond to the coronavirus pandemic.  The malevolent spirits that they try to ignore are long-term economic and health implosion and possible state collapse.  No one really wants to admit how bad things could get, and how long the damage could persist. On the part of political classes and oligarchs, such behaviour is perhaps understandable; they want to risk neither riots nor collapsing financial markets.  On the part of academics who should stand up for serious scholarship, it is inexcusable.

In June 2020 – how long ago that now seems! – I argued in a webinar that the best available model for understanding the probable long-term consequences of the pandemic is the experience of post-Soviet Russia, where over a period of a few years the economy shrank by about 50 percent; social provision mechanisms and large portions of the health care system crumbled; and life expectancy  plunged by several years.  Subsequent economic recovery was accompanied by drastic increases in inequality and massive capital flight, so that half of all Russians’ financial wealth is now held offshore, and the emergence of a new stratum of politically connected billionaire oligarchs.  They now own, among much else, substantial chunks of London.  The leading authority on the post-Soviet mortality crisis and colleagues have pointed out that a quarter-century later, Russian life expectancy still did not reflect the country’s economic recovery.  In other words, it was several years lower than would be expected given its GDP per capita – years lower than in (for example) slightly poorer Brazil, Chile and China.  Back to this model later.

The UK has been an especially disturbing case thanks to the fecklessness, despotic inclinations and corruption of Prime Minister Johnson’s Conservative government.  These have been ably described by George Monbiot, whose commentaries are essential reading. The most disturbing aspect of events over the past few weeks, in Europe in the first instance but not only there, is the demonstration they have provided of just how widespread the evisceration of basic public health capabilities has become.   It helps to understand this process by way of a political science construct known as the Overton window – an idea emanating from a right-wing think tank that was concerned, in the first instance, with ways to soften public opposition to privatising education.  The window frames the universe of public policies that are considered at least plausible, rather than beyond the pale.  ‘Shifting the window’ means that, over time, policies that once were well outside the mainstream, on either end of the left-right political spectrum, come to be considered plausible and, eventually, just common sense.

President Trump’s destruction of a range of political norms is one illustration of shifting the window.  Over the longer term, decades of well-funded neoliberal efforts to shift the Overton window rightward, the trajectory of which is clear for those willing to do the necessary reading, have led to a situation in which maintaining basic public health infrastructure needed for pandemic preparedness came to seem like an extravagance, an unnecessary expenditure on a too-large state, despite authoritative warnings about the economic and public health importance of that infrastructure.  In much of the world, Covid-19 must therefore be understood as a neoliberal epidemic – a phrase my colleague Clare Bambra and I coined in 2015.  As another colleague, public health physician Allyson Pollock, has put it, austerity in the UK has led to a situation in which ‘[n]ational and local expertise has been lost and many of [her] colleagues in communicable disease control were made redundant.’  

The unwisdom of such abandonment of precaution was articulated in 2015, on a small scale, by 267 economists led by Lawrence Summers – Lawrence Summers, of all people – writing about the benefits of universal health coverage: ‘The debilitating effect of Ebola could have been mitigated by building up public health systems in Guinea, Liberia, and Sierra Leone at one-third of the cost of the Ebola response so far.’  If there really were such a thing as the international community, it might usefully reflect on how much it would have been worth investing in measures that could have mitigated a pandemic now anticipated to result in the loss of more than US $12 trillion in economic output in 2020 and 2021 alone, according to the International Monetary Fund.

According to projections from the Institute for Health Metrics and Evaluation at this writing (30 October, 2020), on current trends the virus will have killed approximately 2.5 million people as of 1 February 2021, with a wide variation in outcomes possible depending on what precautions are taken, and where.  This projection deals only with the short term, and cannot address the longer term health consequences of the pandemic, for at least two reasons.  

First, it does not include deaths attributable to reduced access to treatment or prevention for other conditions among people not infected by the virus.  In the UK alone, a former Conservative health secretary is warning of ‘tens of thousands of avoidable deaths within a year.’  Second, it does not and cannot anticipate health impacts of the economic depression and ratcheting-up of inequality that will follow the locking down of major segments of entire economies and societies.  Unfortunately, and despite everything we know about the social determinants of health and health inequalities, in much of the academic world arguing for consideration of these health impacts is immediately equated with callous indifference to human life.  This should not be the case.    

This is why I am more convinced than ever of the distinctive relevance of the Russian experience.  As the UK enters another nationwide lockdown, with an economic cataclysm that will be life-threatening for some certain to follow, all that will remain of some local and regional economies, and millions of individual futures, is wreckage.  Much the same can be said for many other jurisdictions.  It is possible, of course, that an effective vaccine will be developed and rolled out sooner rather than later, avoiding some of the more disastrous scenarios.  But there is no vaccine for the inequalities that were already devastating lives before the pandemic.  As just one illustration, in 2011 – at just the start of the UK’s decade of viciously disequalising Conservative austerity – the ‘Great British Class Survey’ found that one-third of British households, supported by low-wage or precarious employment, had an average of just under £1,000 in savings.   

Even in the best possible post-pandemic world, inequalities that have been further magnified will be remediable only through huge programmes of public investment and direct redistribution, realistically financed by way of long-term borrowing at current low interest rates and progressive income, wealth and land value taxes.  Such policies, for the moment, remain well outside the Overton window anywhere I know of, despite important advocacy by agencies like the United Nations Conference on Trade and Development.   In a world of increasingly ungovernable private wealth and the opportunities for capital flight and tax avoidance offered by a borderless financial world, it is far from clear that most governments even have the political capacity to undertake them.  Many dreams of the young and the old alike will be consigned to the graveyard referred to in my title.  Truth-telling on this point is long overdue.