Dependency denied : health inequalities in the neo-liberal era

Peacock, M; Bissell, P; Owen, J

Abstract

The ways in which inequality generates particular population health outcomes remains a major source of
dispute within social epidemiology and medical sociology. Wilkinson and Pickett's The Spirit Level (2009),
undoubtedly galvanised thinking across the disciplines, with its emphasis on how income inequality
shapes the distribution of health and social problems. In this paper, we argue that their focus on income
inequality, whilst important, understates the role of neoliberal discourses and practises in making sense
of contemporary inequality and its health-related consequences. Many quantitative studies have
demonstrated that more neoliberal countries have poorer health compared to less neoliberal countries,
but there are few qualitative studies which explore how neoliberal discourses shape accounts and experiences
and what protections and resources might be available to people. This article uses findings
from a qualitative psycho-social study employing biographical-narrative interviews with women in
Salford (England) to understand experiences of inequality as posited in The Spirit Level. We found evidence
for the sorts of damages resulting from inequality as proposed in The Spirit Level. However, in
addition to these, the most striking finding was the repeated articulation of a discourse which we have
termed “no legitimate dependency”. This was something both painful and damaging, where dependency
of almost any sort was disavowed and responsibility was assumed by the self or “othered” in various
ways. No legitimate dependency, we propose, is a partial (and problematic) internalisation of neoliberal
discourses which becomes naturalised and unquestioned at the individual level.We speculate that these
sorts of discourses in conjunction with a destruction of protective resources (both material and discursive),
lead to an increase in strain and account in part for well-known damages consequent on life in an
unequal society. We conclude that integrating understandings of neoliberalism into theorising about
inequality enriches sociological perspectives in this area.

Citation

Peacock, M., Bissell, P., & Owen, J. (2014). Dependency denied : health inequalities in the neo-liberal era. Social Science and Medicine, 118, 173-180. https://doi.org/10.1016/j.socscimed.2014.08.006

• Journal Article Type: Article
• Acceptance Date: Aug 7, 2014
• Online Publication Date: Aug 7, 2014
• Publication Date: Oct 1, 2014
• Deposit Date: Jun 12, 2015
• Journal: Social Science and Medicine
• Print ISSN: 0277-9536
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 118
• Pages: 173-180
• DOI: https://doi.org/10.1016/j.socscimed.2014.08.006
• Keywords: United Kingdom, health inequality, neoliberalism, discourses, women's lives, no legitimate dependency, shame, social comparison
• Publisher URL: http://dx.doi.org/10.1016/j.socscimed.2014.08.006
• Related Public URLs: http://www.sciencedirect.com/science/journal/02779536