Since the early 1980s, neoliberalism or ‘market fundamentalism’ has dominated politics and economics across the globe. In this important book, Ted Schrecker and Clare Bambra consider the effects of over three decades of these policies with particular reference to the US and the UK. They focus on obesity, insecurity, austerity, and inequality, arguing that each represents a ‘neoliberal epidemic’ – neoliberal because they are implicated in the rise of neoliberal politics; and epidemics because they have been rapidly transmitted across international populations at a rate seen in epidemics of biological contagions. Crucially, the authors argue that neoliberal epidemics require a political cure in the form of a revitalised and social democratic welfare state.
Since the early 1980s, neoliberalism has dominated discussions about politics and economics across the globe. The policies of neoliberalism – which place markets at the centre of all economic and social life – have been implemented across many countries and have usually been pre- sented as the only alternative. In this book, we consider the effects of over three decades of these policies with particular reference to the US and the UK. We focus on four areas: obesity, stress, austerity and inequality. We argue that they represent four ‘neoliberal epidemics’: neoliberal because, as we will show, they are associated with or exacerbated by the rise of neoliberal politics; epidemics because they are on such an international scale and have been transmitted so quickly across populations that if they were a biological contagion they would be seen as being of epidemic proportions. We also use epidemic because our focus is largely on the health effects of these phenomena, now and in the future. We will show that, during the neoliberal era, obesity has emerged as a new and immensely damaging threat to public health across the world; that insecurity likewise is a common condition for vast swathes of the population, with many negative impacts on health; that austerity – a neoliberal response to the 2008 financial crisis – has caused increases in mortality and morbidity; and that economic, social and health inequalities – once in decline across rich industrialized countries – have increased rapidly as a result of the unhindered neoliberal pursuit of profit. All of these epidemics are associated with neoliberalism, and we argue that alternative political and economic choices would have prevented them – or at least reduced their scale – resulting in a healthier 21st century. Neoliberal politics has made us sick.
In Chapter 1, we examine how health varies internationally among rich countries and the social, economic and political reasons for these differences. We also introduce the concept of welfare state regimes. We then outline the rise of neoliberal economics and politics, particularly in the US and the UK, defining their key aspects and drawing parallels with earlier forms of liberal economics in the 19th century.
In Chapter 2, we start with an overview of our first neoliberal epidemic – obesity. Over the last 30 years, obesity rates have doubled in countries such as the UK and the US, with over 20 and 30 per cent (respectively) of adults now considered obese – an epidemic which has been transmitted to our children, as well. We outline the contours of the epidemic, the serious health effects of obesity and the influence of neoliberal economic policies in shaping the development and spread of the disease, and use international comparisons to show how things are – or could be – different in countries that have made different political choices.
Chapter 3 focuses on the neoliberal epidemic of insecurity. Here we argue that neoliberalism has made the labour market and the world of work far less secure and, consequently, more stressful and health damaging. This insecurity manifests itself through reductions in workplace rights, job security, pay levels and welfare rights (so-called flexibility). We argue that this has led to large increases in chronic stress across the populations of many countries (and particularly in the most vulnerable groups), resulting in a myriad of chronic diseases, including musculoskeletal pain and cardiovascular disease. International comparisons are made with countries that have taken a less neoliberal political path.
Chapter 4 examines austerity as a neoliberal epidemic, a particular political and ideological response to the financial crisis of 2008. We describe the politics of this and draw historical comparisons with earlier periods of cuts in social protection. We outline the economic, social and health effects, with a particular focus on the US and the UK, contrasting the experiences in these – two of the most neoliberal countries in the world – with other international experiences where countries have responded to the crisis with state spending rather than public sector cuts.
Chapter 5 examines how neoliberalism has led to an increase in inequalities – economic inequalities, social inequalities and, particularly, health inequalities. We explore trends in inequality at macro, national levels and also draw on three case studies that show different facets of inequality in the UK and the US today: how neoliberalism has exacerbated spatial inequalities in health within England; how neoliberalism has fuelled incarceration rates in the US; and how neoliberal approaches to public services have been played out through the privatization of the English National Health Service (NHS). We also draw on research showing the importance of equality for public health.
In Chapter 6, we outline some common themes shared across the four neoliberal epidemics that we have identified: some reflections of the evidence of the ill-health effects of neoliberalism and the likely inter- generational transmission of its epidemics. We conclude the book by outlining alternative views of the future of health – both pessimistic and optimistic – arguing that the epidemics of neoliberalism require a political cure.