The Social Class Determinants of Income Inequality and Social Cohesion

West Virginia University, MGW, West Virginia, United States
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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    • "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. "

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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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