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20160402 The Health Gap


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The author of this book is also author of the famous Whitehall study of British civil servants that convincingly demonstrated direct correlation between individual’s health outcomes over long time with this individual’s place in the bureaucratic hierarchy: the lower place in hierarchy the less healthy is the individual. These findings demonstrated that typical justification for perks for high-level bureaucrats based on their “sacrifices” and “burden of responsibility” has no value whatsoever. However despite this prove of high cost of hierarchy for its low-level members author seems to see way for improvement in collectivistic solutions such as government healthcare, higher control over individuals by bureaucracy and similar measures.



This starts with the story of author’s discovery of direct mind-body-health connection back in his youth when he was a doctor in Australia hospital. The core of discovery: the stress damages physical health and the good material and psychological conditions of live are necessary for good health. Therefore author objective is “Rise up… against the organization of misery”


  1. The Organization of Misery.

Here author refers to research results for different social strata in Glasgow that demonstrated health and mortality dependency on belonging to one strata of society or another. As one could expect more wealth directly linked to more health. Then this analysis is expanded from one city to different countries demonstrating that it generally applied across the world, however with a caveat that lower strata in rich country could have worse health outcome than top strata in poor country. In short the correlation is not strong between wealth and health of countries on average. Here is a nice graph for this:

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The conclusion at the end of chapter is that it is not only absolute, but also relative wealth that counts for health outcome.


  1. Whose Responsibility

This is about responsibility for one’s health. Author conclusion is that it should be shared. Individual responsibility should be heavily supplemented by free medical services. I really like the rules for healthy living provided by author, even if he believes that much of it does not depends on individuals, but rather on circumstances of their lives:

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  1. Fair Society, Healthy. Lives

This chapter includes discussion on understanding of fairness and justice. It is using ideas of John Rawls, utilitarian Jeremy Bentham, freedom and equality of opportunity, deserving vs. undeserving poor, and such. The key point here is that live inequalities have really tangible consequences in health outcomes. Most interesting is author’s conclusion that the best way to social justice is to maximize freedom and create conditions for people to have control over their lives. At the end of chapter author points out that even if economic status and health influence each other, the main concern should be directed to economics impact on health and therefore effort should be directed at improvement of economic situation of people.

  1. Equity from the Start

This is about impact of childhood circumstances on health and wealth acquisition in adulthood. Here is a very interesting graph for IQ:

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The inference here is that low economic status in childhood has significant impact on all outcomes and in order to achieve real equality of opportunity society should break the link between poverty and early childhood development.

  1. Education and Empowerment

The key point of this chapter is that education and knowledge is not only power, but also health:

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  1. Working to Live

This is analysis of relationship between work and health. Unsurprisingly the conclusion is that hard and routine work with high stress and low security is very unhealthy. However unemployment is even unhealthier. Finally the demanding job with high level of satisfaction providing high income is very healthy, even necessary.

  1. Do Not Go Gentle

This chapter about age and health starts with a very good advice from Shakespeare: one should not get old until he has got wise. Then it goes into analysis of social economic influence on age and health and demonstrates that it is quite significant:

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The conclusion here is that wealth, psychologically rewarding work, and political power provide for better health for older people in developed countries.

  1. Building Resilient Communities

This chapter is about impact of community that individual belongs to on individual’s health both physical and mental. It is not good enough to be wealthy and healthy, it is also important to belong to wealthy and healthy community. Otherwise one’s own well being is always unreliable.

  1. Fair Societies

This is about author understanding of good and bad societies. Author seems to give credit to right wing ideology for good economy, but insists that unbridled markets are bad especially for education and health. At the same time he is very cautious not to support such isms as socialism and communism in view of proved disastrous experience with these systems in XX century. As one would expect, his ideal or something close to it is Nordic (Sweden or Denmark) welfare state with strong caring government keeping check on capitalism.

  1. Living Fairly in the World

This chapter is about worldwide health outcomes and their relation to globalization, trade, and overall economics of various countries. Author uses UN Human development report to come to preordained inference that health directly, positively, and causally related to public spending on healthcare and education. This is followed by discussion of third world and need for global governance to achieve positive results, meaning more equality.

  1. The Organization of Hope

The last chapter is about author activities in international organizations that promote ideas of society organization beneficial for health of its members. It refers to author 3 reports: “Closing gap in a generation”, “Fair society, healthy lives”, and European Review of Social Determinants and Health Divide”. The key point here is that, in author’s opinion based on evidence, the inequality in income and wealth directly causes inequality in health outcome, so in order to improve latter one had to improve former first. Author seems to believe that it could be achievable by Social-democratic means, that is by growing bureaucracy that would have increasing control over economics and human lives in order to make these lives healthier.


I find this book very interesting as source of data and quite primitive as source of recommendations. There is an interesting and, seems to be unavoidable for socialistically minded people contradiction between author’s data in recommendations. His data demonstrate that it is quite unhealthy to be a low level bureaucrat in huge bureaucratic machine even in wealthy country, while his recommendations are directed to increase in bureaucracies not only at the local, but also on the global level. There is also a typical approach to big governmental bureaucracy as some benevolent entity dedicated to common good with complete disregard of existing experience that all bureaucracies are always just mechanism to achieving goals of human individuals who control them. Needless to say that goals and objective of these individual usually fully dedicated to their own well being, with formal “objectives of bureaucracies” being just a façade useful for convincing people transfer resources to them. I believe that big bureaucracies could not possibly be healthy even if they objectives include “common health”. The only way individuals could be healthy is if they have necessary resources available to them on individual basis including ability to decide how these resources are used. Without this ability whatever amount of “public resources” spent on “common health” will eventually be converted into resources spent on wealth and prosperity of bureaucrats in control of these resources.


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