7 - Innovative solutions and cultural change

Summary

Neoliberal political discourses have become inculcated in British and other northern European cultures, to the extent that it is normal to assume that individuals are responsible for their health and wellbeing, regardless of the inequalities they may have faced based on their social class, gender or ethnic background. However, this ignores how structural advantages and disadvantages accumulate across the lifecourse, producing contrasting experiences in later life, including in relation to health outcomes and life expectancy (Van de Mheen et al, 1998). Healthism is a political response often used at times of crisis when governments wish to deflect blame onto individuals (Crawford, 1980). This is illustrated in the UK government's response to COVID-19, which has generally ignored the structural inequalities faced by older people (ageism), people from minority ethnic backgrounds (racism), people with ‘dis’abilities (disablism) and people from working-class backgrounds (classism), and how these put them at greater risk of contracting and dying from the virus. Older people's lives have been systematically neglected in residential, domiciliary and hospital care (Horton, 2020; Calvert and Arbuthnott, 2021). Furthermore, people from minority ethnic and working-class backgrounds have also been systemically disadvantaged and discriminated against in their workplaces and everyday lives (Lawrence, 2020). The intersectionality of inequalities has been demonstrated in the high death rates within these groups during the pandemic. However, these inequalities are far from new. Those with less economic, social, cultural, physical and cognitive capital have always had worse outcomes in health and social care systems, and these inequalities have been deepening in the UK since the 1980s.

Globalisation and neoliberalism need to be challenged. Governments and nation-states have a choice about whether to adopt policies that exacerbate inequalities and whether to outsource publicly run and financed services. Although globalisation and neoliberalism have been conceptualised as two entrenched yet resurgent systems of class and racial inequality, in the context of post or late modernity, developments in finance and information technology have occurred at a speed and breadth never seen before (Beck, 1999). Neoliberalism has been used to re-establish elite class power; however, like all discourses, it has changed over time (Mirowski, 2013).