The Social Class Determinants of Income Inequality and Social Cohesion

Institute of Occupational and Environmental Health, West Virginia University School of Medicine, Morgantown 26506-9190, USA.
International Journal of Health Services (Impact Factor: 0.88). 10/1999; 29(4):699-732. DOI: 10.2190/HNC9-BEFF-7UWL-92Y2
Source: PubMed


The authors argue that Wilkinson's model omits important variables (social class) that make it vulnerable to biases due to model mis-specification. Furthermore, the culture of inequality hypothesis unnecessarily "psychopathologizes" the relatively deprived while omitting social determinants of disease related to production (environmental and occupational hazards) and the capacity of the relatively deprived for collective action. In addition, the hypothesis that being "disrespected" is a fundamental determinant of violence has already been refuted. Shying away from social mechanisms such as exploitation, workplace domination, or classist ideology might avoid conflict but reduce the income inequality model to a set of useful, but simple and wanting associations. Using a nonrecursive structural equation model that tests for reciprocal effects, the authors show that working-class position is negatively associated with social cohesion but positively associated with union membership. Thus, current indicators of social cohesion use middle-class standards for collective action that working-class communities are unlikely to meet. An erroneous characterization of working-class communities as noncohesive could be used to justify paternalistic or punitive social policies. These criticisms should not detract from an acknowledgment of Wilkinson's investigations as a leading empirical contribution to reviving social epidemiology at the end of the century.

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    • "We use conflict-based theories for direction and adopt a political economy of health and welfare regimes framework to explicitly focus on issues relevant to the sociology of health and illness – democracy, political traditions, globalization, and welfare states. Though the role and impact of conflict-based theories has been questioned in medical sociology (Cockerham 2001), political economy of health and welfare regime frameworks have been instrumental in highlighting the political context of health inequalities (Navarro and Shi, 2001, Navarro et al. 2003), re-engaging with neo-Marxist models of class division (Coburn 2000, 2004), and testing the health effects of working-class power (Muntaner et al. 1999). Originally developed by political scientists and sociologists (Esping-Andersen 1990, Korpi 1983, Huber and Stephens 2001, Stephens 1979), these frameworks are particularly broad, sensitive to historical changes, and sociologically relevant through their explicit focus on inequality-generating mechanisms such as social class relations (i.e., relative power between capital and labour), neo-liberal ideology (i.e., private profits vs. public goods), and varieties of welfare regimes (i.e., social democratic vs. liberal vs. conservative). "
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    ABSTRACT: In recent years, a research area has emerged within social determinants of health that examines the role of politics, expressed as political traditions/parties and welfare state characteristics, on population health. To better understand and synthesise this growing body of evidence, the present literature review, informed by a political economy of health and welfare regimes framework, located 73 empirical and comparative studies on politics and health, meeting our inclusion criteria in three databases: PubMed (1948-), Sociological Abstracts (1953-), and ISI Web of Science (1900-). We identified two major research programmes, welfare regimes and democracy, and two emerging programmes, political tradition and globalisation. Primary findings include: (1) left and egalitarian political traditions on population health are the most salutary, consistent, and substantial; (2) the health impacts of advanced and liberal democracies are also positive and large; (3) welfare regime studies, primarily conducted among wealthy countries, find that social democratic regimes tend to fare best with absolute health outcomes yet consistently in terms of relative health inequalities; and (4) globalisation defined as dependency indicators such as trade, foreign investment, and national debt is negatively associated with population health. We end by discussing epistemological, theoretical, and methodological issues for consideration for future research.
    Sociology of Health & Illness 09/2011; 33(6):946-64. DOI:10.1111/j.1467-9566.2011.01339.x · 1.88 Impact Factor
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    • "Early criticism includes Mann's (1970) Marxist analysis of social cohesion (measured as shared commitment to values) by arguing that such shared values are only really shared by the ruling elite. The working classes simply need to 'accept' (either falsely or pragmatically), their role in society but there is little need for sincere value endorsement (see also Muntaner et al. 1999). He also points to the vague and often conflictual nature of overarching, general values. "
    Theoretical Perspectives on Social Cohesion and Social Capital, Edited by Marc Hooghe, 01/2011: chapter Reconciling Diversity and Community? Defining Social Cohesion in Developed Democracies: pages 8-43; Brussels: Royal Flemish Academy of Belgium for Science and the Arts.
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    • "There are strong negative associations between our estimates and deprivation scores, especially for volunteering and some forms of associational activity. This might imply that the main dimensions of social capital are largely controlled by, or related to, deprivation; it might also lend weight to arguments that the kinds of social capital characteristic of disadvantaged communities are not captured well by measures of formal, associational activity (Muntaner et al, 1999). We would argue that given this ambiguous evidence, the indicators we have generated cannot be taken as unproblematic measures of social capital. "
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    ABSTRACT: We describe a method of producing small-area estimates of characteristics of the neighbourhood social environment, such as participation in associational life. The method may be characterised as ‘modelling nationally, and predicting locally’ because the initial models are estimated using multilevel data derived from national datasets, calibrated to allow for within-region as well as between-region variation. These models produce coefficients which can then be applied to socioeconomic data at the local scale. As an example we outline a model of the determinants of volunteering. This indicates significant variation between places in the relationship between individual and area characteristics which influence the probability of volunteering. Then we proceed to show how this can be used to generate predictions of the variations between places in a number of aspects of the social environment. The estimates we produce are validated against survey data from other surveys, and a satisfactory degree of correlation is obtained, giving us confidence in the estimates we have produced.
    Environment and Planning A 11/2006; 38(11):2173-2192. DOI:10.1068/a36213 · 1.69 Impact Factor
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