Health inequality and social capital: From state to community

In a world of neoliberal imperialist globalisation, there has been a profound growth of social inequalities, between and within nations. This has had a most negative impact on the health and quality of life of large sections of the populations in the developed and underdeveloped worlds. The contention of this paper is that the social production of health inequality, as shaped by neoliberalism, has to be understood in this historical context of the emergence of a new capitalist order which is primarily based on unfettered market with the motives of greed and acquitiveness. This divides societies into very rich and very poor. What a truism of coexistence of great wealth and great poverty/inequality. This offends the notion of a just and equal society. Even Richard Wilkinson’s theory of social cohesion, modelled in the Emile Durkheimian tradition of moral individualism (a system in which the individual willingly performs in accordance with laws and customs of the society), distances itself from a true population perspective. In fact, it creates a smokescreen through its claim as an alternative paradigm, and thereby pushes the task of public health further back. In the Wilkinson model, the real shift has been only that of ‘community blaming’ in place of individual ‘victim blaming’. The attainment of better health status becomes the responsibility of the community as a whole through such measures as better social cohesion and solidarity, and better health is the responsibility of the individual through measures such as behaviour modification, self-help and self-control. In both the cases, the Wilkinson model implicitly suggests that the state has no role to play and there is no space for macro structural change