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argued that, once societies have reached a David Coburn’s view, it is not so much that
certain level of affluence or prosperity, they income inequality produces lower cohesion
pass through the threshold where the and trust, leading to poor health, but that
absolute standard of living of a population ‘neo-liberalism (market dominance) produces
is no longer associated with improvements both higher income inequality and lower
in life expectancy. Instead what matters is social cohesion’ (Coburn, 2000: 137). He
where people stand in relation to others; argues that lack of social cohesion is the
that is, relative deprivation. Marmot dubs product of the social inequality and social
this ‘status syndrome’. The argument is fragmentation of society caused by the com-
that, striving for status generates social hier- petitiveness of laissez-faire capitalism and its
archies which in turn generate gradients undermining of the welfare state. Similar
in health. It is therefore subjective experi- views are expressed by British researchers
ence that matters; it gets under our skin and others who deplore the romanticized pic-
and impacts upon the biological body ture of the traditional community in much
(Wilkinson, 2005). Those with more power social-capital theory (Pearce and Smith,
and status, more control over their life cir- 2003: 128). They suggest that this rhetoric
cumstances, and greater social support fare sets unrealistic expectations of community
better in terms of health. Those lower in the involvement and resources, and diverts atten-
status hierarchy suffer from feelings of tion from the health effects of macro-level
hopelessness, anxiety, insecurity, and anger, social and economic policies. In this way,
and this leaves its mark on their health, social-capital theory offers little in the way of
directly through biological stress pathways effective intervention.
related to weakened immunity and indirectly Critiques of social-capital theory of health
through negative health behaviours such as have also been presented by advocates of the
cigarette smoking, and excess consumption political economy perspective stemming
of alcohol and high fat and high sugar ‘com- from Marxist theory (e.g., Navarro, 2002;
fort foods’. Wilkinson (2005: 315) advances Waitzkin, 2000). The materialist perspective
that, ‘it is only by improving the quality of on health inequalities emerged in the 1970s
social relations that we can make further to draw attention to the way in which social
improvements in the real quality of our class inequalities are reflected in inequalities
lives’. In his view, it is not simply a matter of in health status and access to health care
reducing those social divisions that promote (e.g., Navarro, 1976, 2002; Waitzkin, 2000).
stigma, stress, and intolerance, but also of The neo-materialist interpretation suggests
reducing the status competition that fuels the that health inequalities result from the differ-
pressure to consume. ential accumulation of exposures and experi-
Critics of social-capital theory and of the ences that are based on material living
psychosocial perspective point to the overem- conditions (e.g., Lynch et al., 2000). Taking
phasis on the positive effects of strong social up this theme and drawing on the work of
networks, arguing that such networks can Jürgen Habermas, with reference to Britain,
also be experienced as coercive. Bartley Graham Scambler (2001: 103) emphasizes
(2004) and others take issue with the empha- that health inequalities are the product of the
sis that is placed on people’s perceptions of growth of inequality within the shift from
their place in society. As she puts it, ‘there is ‘organized’ to ‘disorganized’ capitalism,
something rather depressing about [the] idea which is characterized by the destabilization
that not being a “top dog” in some kind of of work and the emergence of new forms of
fixed hierarchy could be so psychologically inequality (as well as derivative processes
catastrophic as to have an effect on life such as the new individualization).
expectancy itself … Do people die of envy?’ The invisibility of the structural sources of
(2004: 125–6). In Canadian health sociologist health inequalities, especially economic