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Dependency denied: Health inequalities in the neo-liberal era

Peacock, M, Bissell, P and Owen, J 2014, 'Dependency denied: Health inequalities in the neo-liberal era' , Social Science and Medicine, 118 , pp. 173-180.

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The ways in which inequality generates particular population health outcomes remains a major source of dispute within social epidemiology and medical sociology. Wilkinson and Pickett's The Spirit Level (2009), undoubtedly galvanised thinking across the disciplines, with its emphasis on how income inequality shapes the distribution of health and social problems. In this paper, we argue that their focus on income inequality, whilst important, understates the role of neoliberal discourses and practises in making sense of contemporary inequality and its health-related consequences. Many quantitative studies have demonstrated that more neoliberal countries have poorer health compared to less neoliberal countries, but there are few qualitative studies which explore how neoliberal discourses shape accounts and experiences and what protections and resources might be available to people. This article uses findings from a qualitative psycho-social study employing biographical-narrative interviews with women in Salford (England) to understand experiences of inequality as posited in The Spirit Level. We found evidence for the sorts of damages resulting from inequality as proposed in The Spirit Level. However, in addition to these, the most striking finding was the repeated articulation of a discourse which we have termed “no legitimate dependency”. This was something both painful and damaging, where dependency of almost any sort was disavowed and responsibility was assumed by the self or “othered” in various ways. No legitimate dependency, we propose, is a partial (and problematic) internalisation of neoliberal discourses which becomes naturalised and unquestioned at the individual level.We speculate that these sorts of discourses in conjunction with a destruction of protective resources (both material and discursive), lead to an increase in strain and account in part for well-known damages consequent on life in an unequal society. We conclude that integrating understandings of neoliberalism into theorising about inequality enriches sociological perspectives in this area.

Item Type: Article
Uncontrolled Keywords: United Kingdom, health inequality, neoliberalism, discourses, women's lives, no legitimate dependency, shame, social comparison
Themes: Health and Wellbeing
Schools: Schools > School of Health Sciences
Journal or Publication Title: Social Science and Medicine
Publisher: Elsevier
Refereed: Yes
ISSN: 0277-9536
Related URLs:
Funders: University of Sheffield doctoral studentship
Depositing User: M Peacock
Date Deposited: 12 Jun 2015 09:12
Last Modified: 05 Apr 2016 19:27

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