Lee Humber: Vital Signs: The Deadly Costs of Health Inequality. Pluto Press £17.99.
What determines the health of an individual or of a whole population? Is it the healthcare they receive, or is it more to do with the conditions in which they live? Humber’s answer is that it is very much the ‘social determinants of health’ that affect a person’s wellbeing and life expectancy. Biomedical models focus on a person’s relationship with disease and the expertise of the medical profession, but a more multifaceted approach also looks at factors such as polluted air, overcrowded households, diet, and the pressures of employment.
Of course this does not mean that the kind of healthcare received is beside the point. One claim is that cuts in UK government health spending resulted in 45,000 more deaths among those over sixty between 2010 and 2014. In the US almost twice as much as a proportion of GDP is spent on healthcare than in the UK, yet life expectancy is several years less. About half of Americans can only afford the most basic health insurance, and 45,000 die each year because they lack health coverage. In spite of the importance of diet, GPs rarely ask patients about it.
One chapter is a critique of the ‘inequality thesis’ as set out by various authors. Humber claims that they rely too much on subjective notions such as status and social trust, and pay insufficient attention to social factors such as the quality of food. This overlooks the fact that Wilkinson and Pickett in particular rely on inequality of income as the crucial point, and there is no reason why an inequality-based approach and one looking at other societal factors cannot be combined.
It lacks an overall theme, and does not emphasis inequality as much as the subtitle might suggest, but Humber’s book gives a good picture of the deleterious effects of what others have termed the ‘medical–industrial complex’.
Paul Bennett
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