In 2015, my colleague Clare Bambra and I published a book subtitled neoliberal epidemics. Since then, the destructive consequences of ‘austerity’ in the United Kingdom, where I live and work, have underscored the value of this critical perspective.  So, too has the extent to which austerity and tropes like ‘scarce resources’ have become normalised in the official and professional discourses of public health.  I put the terms in quotation marks to emphasise that the scarcities in question are highly selective; resources are abundant for the priorities of the powerful – think HS2, which is  at least in part a welfare programme for propertied money launderers along the planned route – among many other examples.  Yet at the same time, many public health researchers and practitioners are reluctant to engage with neoliberalism as a political phenomenon.  I recently participated in a workshop in which some accomplished researchers simply refused to talk about it.   Precarious employment status is one reason, but in various contexts I have observed a lack of familiarity with the term itself, and its core propositions.

Unlike some academic colleagues, I have argued that there is a set of core propositions that are relatively easy to identify, especially once we recognise that history matters and a trajectory can be observed leading (at least) from the establishment of the Mont-Pèlerin society in 1947, through the installation of the Pinochet dictatorship in Chile in 1973 and the election of Thatcher and Reagan at the end of that decade, to the current context of homicidal austerity in the UK and elsewhere.

Anyone who questions the use of the adjective ‘homicidal’ just has not been paying attention.  I will address this issue in more detail in a future posting.

There follows a list of sources for those interested in exploring neoliberalism further, building on a list developed for a doctoral candidate I advise.  Many of these sources have nothing directly to do with health.  Answering the ‘what’s all this got to do with health’ question relies on a much larger literature on social determinants of health,  Some of the sources draw on this literature, and WHO’s training manual on Health in All Policies is a valuable starting point.

Comments and suggestions for additions to the list are welcome!

TS

Birch, K. (2015). Neoliberalism: The Whys and Wherefores – and Future Directions. Sociology Compass, 9, 571-584.

Brodie, J. (2015). Income Inequality and the Future of Global Governance. In S. Gill (Ed.), Critical Perspectives on the Crisis of Global Governance: Reimagining the Future (pp. 45-68). London: Palgrave Macmillan UK.

Evans, P. B. & Sewell, W. H. (2013). Neoliberalism: Policy Regimes, International Regimes, and Social Effects. In P. A. Hall & M. Lamont (Eds.), Social Resilience in the Neoliberal Era (pp. 35-68). Cambridge: Cambridge University Press.

Farnsworth, K. & Irving, Z. (2018). Austerity: Neoliberal dreams come true? Critical Social Policy, 38, 461-481.

Fraser, N. (2017). From Progressive Neoliberalism to Trump—and Beyond. American Affairs, 1, 46-64.

Fudge, J. & Cossman, B. (2002). Introduction: Privatization, Law, and the Challenge to Feminism. In B. Cossman & J. Fudge (Eds.), Privatization, Law, and the Challenge to Feminism (pp. 3-40). Toronto: University of Toronto Press (important source on the multiple dimensions of ‘privatisation’).

Goodman, P.S. (2018, May 28). In Britain, Austerity Is Changing Everything. New York Times.  Retrieved from: https://www.nytimes.com/2018/05/28/world/europe/uk-austerity-poverty.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news.

Harvey, D. (2006). Neo-liberalism and the restoration of class power. In his Spaces of Global Capitalism (pp. 9-68). London: Verso.  (This is the most succinct and least over-theorised of Harvey’s several works on this topic.)

Horton, R. (2017). Offline: Not one day more. The Lancet, 390, 110 (eloquent must-read critique by the editor of The Lancet).

Jones, D.S. (2012).  Masters of the Universe: Hayek, Friedman, and the Birth of Neoliberal Politics.  Princeton: Princeton University Press.

Kentikelenis, A. E. (2017). Structural adjustment and health: A conceptual framework and evidence on pathways. Social Science & Medicine, 187, 296-305.

MacLean, N. (2017). Democracy in Chains: The Deep History of the Radical Right’s Stealth Plan for America. New York: Viking.

Marchak, P. (1991). The Integrated Circus: The New Right and the Restructuring of Global Markets. Montreal: McGill-Queen’s University Press (indispensable historical source on the early policy initiatives that advanced neoliberal globalisation).

Metcalf, S. (2017, August 18). Neoliberalism: the idea that changed the world. Guardian.  Retrieved from: https://www.theguardian.com/news/2017/aug/18/neoliberalism-the-idea-that-changed-the-world.

Phillips-Fein, K. (2009). Business Conservativees and the Mont Pèlerin Society. In P. Mirowski & D. Plehwe (Eds.), The Road from Mont Pèlerin: The Making of the Neoliberal Thought Collective (pp. 280-304). Cambridge, MA: Harvard University Press.

Powell, L. F. (1971). Attack on American Free Enterprise System. Washington, DC: US Chamber of Commerce. Retrieved from: http://law.wlu.edu/deptimages/Powell%20Archives/PowellMemorandumPrinted.pdf (a key historical turning point; Powell was later appointed to the US Supreme Court by Richard Nixon).

Schmidt, V. A. (1995). The New World Order, Incorporated: The Rise of Business and the Decline of the Nation State. Daedalus, 124, 75-106.

Schmidt, V. A. & Thatcher, M. (2014). Why are neoliberal ideas so resilient in Europe’s political economy? Critical Policy Studies, 8, 340-347.

Schrecker, T. (2016). ‘Neoliberal epidemics’ and public health: sometimes the world is less complicated than it appears. Critical Public Health, 26, 477-480.

Spooner, M. (2018). Qualitative Research and the Global Audit Culture. In N. K. Denzin & Y. S. Lincoln (Eds.), Sage Handbook of Qualitative Research (5th ed.). Los Angeles: Sage.

Springer, S. (2013). Neoliberalism.   In K. Dodds, M. Juus & J. Sharp (Eds.) The Ashgate Research Companion to Critical Geopolitics.  Farnham: Ashgate.

Steger, M.B., & Roy, R.K. (2010). Neoliberalism: A Very Short Introduction.  Oxford: Oxford University Press (very useful road map).

Stuckler, D., & Basu, S. (2013).  The Body Economic: Why Austerity Kills.  London: Allen Lane (now a classic).

Stuckler, D., Reeves, A., Loopstra, R., Karanikolos, M., & McKee, M. (2017). Austerity and health: the impact in the UK and Europe. European Journal of Public Health, 27, 18-21.

Wacquant, L. (2010). Crafting the Neoliberal State: Workfare, Prisonfare, and Social Insecurity. Sociological Forum, 25, 197-220.

Wacquant, L. (2012). Three steps to a historical anthropology of actually existing neoliberalism. Social Anthropology, 20, 66-79.

Ward, K. & England, K. (2007). Introduction: Reading Neoliberalization. In K. England & K. Ward (Eds.), Neoliberalization: States, Networks, People (pp. 1-22). Oxford: Blackwell.  Online: https://download.e-bookshelf.de/download/0000/5793/44/L-G-0000579344-0015233877.pdf.  

(This article was originally published by the International Network for Critical Gerontology; republished here with their kind permission)

As we get old, unless we have the glow of money about us, we gradually become invisible.  This is nowhere more the case than in transport policy and planning.

Throughout the Anglo-American world, pedestrians and public transport users of any age are second-class citizens.  Cars and those who can afford to own and run them rule, often with substantial public subsidy for the fossil fuels they consume, and sometimes more direct subsidies as well.  (Good green Germany, for example, subsidized each company car to the tune of 2,500 euros per year a few years ago.)  In much of the low- and middle-income world, the situation is even worse, with motorways and high-speed commuter lines claiming scarce resources that could serve the mobility needs of the disenfranchised majority.

For older people, the problems posed by this transport apartheid can be especially serious, because of reduced physical mobility (we can’t walk as fast as we used to); limitations on driving; and, often, the difficulty of running a car on a fixed income.

Here’s a simple example: crossing the street to Newcastle’s Royal Victoria Infirmary (above), where my office is located, the signal transitions from ‘walk’ to ‘wait’ after six seconds, and the overall length of the crossing time is 14 seconds – hardly enough for someone with reduced mobility, of any age, to cross safely.  The junction itself is thoroughly confusing, even for those of us who use it regularly.  Illustration 2 shows an especially hazardous traffic sewer in downtown Ottawa, Canada, where I lived and worked before moving to the United Kingdom.  Predictably, several pedestrian fatalities occurred within a few hundred metres of this location in the years before I left.  Many suburban junctions are even worse.

Like so many other determinants of health, the problems are socioeconomically patterned:  my former Ottawa colleague Theresa Grant has done splendid work on how high-income neighbourhoods are much more ‘walkable’.   Although her focus was on older people, the health and safety benefits accrue to every age group.

The situation is similarly grim for bus users.  US-owned Greyhound Lines recently cancelled all long-distance bus services in Canada’s western provinces, stranding a large number of rural residents and raising the question of why the provision of non-automotive mobility should be left exclusively to the private marketplace.  (Even asking the question is difficult in today’s climate of market fundamentalism.)  The isolation of rural residents without access to a car can be soul-destroying.  In the United Kingdom, several years of savage cuts to local authority budgets, which come largely from central government, have led to widespread reductions in subsidies for bus transport, higher fares, and the cancellation of many services.  Older residents of many local authority areas are eligible for free bus service, but this means little when the service isn’t there.  A bus no longer runs from the neighbourhood where I lived until December, 2018 to the local hospital.  For those who don’t drive, the options are taxis, finding a ride with a friend or neighbour, or a one-kilometre walk to a bus stand in the town centre.

Some researchers have long recognized the problem.  Karen Lucas, of the University of Leeds, is perhaps the world’s leading authority on (and advocate for) inclusive transport; her work on ‘transport poverty’ and the need for inclusive transport policy is inspirational.  She writes with typical British understatement that: ‘What is still severely lacking in terms of progress in this research domain … is its transfer into policy and practice’.  If anything, policy and practice in many jurisdictions are moving in the opposite direction, probably reflecting growing inequality in the distribution of money and political influence.

An equity-oriented phase change (in physics, the transition between states of matter) is overdue.  Some short-term remedies are simple and inexpensive.  Pedestrian crossing times at junctions can be lengthened.  Zebra crossings (crosswalks) can be made more numerous, and better marked. Speed limits in residential areas can be reduced to 20 mph (32 km/h); this change has already been widely adopted in the United Kingdom, based on strong evidence for improvements in child safety).  Once enacted into law, prohibitions on blocking pedestrian crossings (see below), like pedestrian right of way in crosswalks, can be enforced using traffic cameras and automatic fines for vehicle owners.  Other remedies, like de-subsidizing fossil fuel and company cars and using road tolls to fund public transport, will take longer if they ever happen.  They will require fundamental reorientation of transport policy away from the convenience of drivers, and therefore be politically conflictual.  The challenges are formidable, to say the least, but population aging could make for a more receptive audience.

Health professionals who care about such matters can help by insisting on the vocabulary of ‘road violence’, and foregrounding the uneven distribution of its consequences.  (For example, of 408 pedestrians killed in the United Kingdom in 2015, more than half were over the age of 60, although this age group makes up just 24 percent of the total population.)  In New York City, pedestrian death investigation remains a low priority.

I first wrote about transport equity as a human rights issue more than 20 years ago.  Although international human rights instruments make no specific reference to mobility, the overarching human rights norm of antidiscrimination is clearly relevant, as is the right to the highest attainable standard of physical and mental health – which for many is daily threatened by car-centred transport planning.  To raise the visibility of non-inclusive transport, the United Nations Human Rights Council would do well to consider establishing a special procedure related to mobility in the context of the antidiscrimination norm and the economic, social and cultural rights to which most of the world’s countries have committed themselves.