We are facing a crisis. It is systemic in nature encompassing politics, economics, ecology and our social world. In facing it, it is clear that we are not thinking deeply enough. We are guilty of ‘fast thought’. Our system, and its various components, needs re-design.

The key concern in shaping this re-design is to determine clearly what we want our integrated social, economic and political system to do. We are no longer clear about this. This is one of the reasons  why, despite the system being dysfunctional, we seem to be committed to somehow re-booting it again. We are no longer seeing it correctly. Even it could be re-booted, it should not. It is producing harm.

There are surely two key design objectives that we want any system to achieve:

1. Social equality

2. Ecological well-being.

Why are these critical? Because not only are they ethically appealing and appropriate, they are actually in each individual’s self-interest. Social equality produces the best social outcomes across a range of issues and gives rise to the most human and secure societies. Ecological well-being is simply a fundamental pre-requisite for life and happiness.

Our present system is producing antagonisms both within societies, between countries and between humanity and our planet. We need a system that produces harmonies. This is our challenge – to re-design our system to enhance harmony. Achieving harmony – social and ecological – is the political cause for today.

We now need to devote our minds and energies to these new designs. They will include a new, non-commodified economics centred on reciprocal exchange and ecological costings. Think of our traditional meitheal systems and LETS. They will include participative, democratic descion-making at all levels. They will include community-centred ecological planning.

I think this project can begin now. It already has. This is building new culture from the bottom-up. New ideas, new businesses, new exchanges emerging from the old, decaying model. It is in this sense that we might now be at a time of hope. However, to really enhance this momentum we need to make it explicit and visible and make clear that a new model is emerging. It is incremental, tentative, without a blueprint. What it has is an objective and a method.

It’s worth checking out details of this year nobel prize winners in economics. A good link to see details is: http://plus.maths.org/latestnews/sep-dec09/nobeleconomicsindex.html

One of the winners has studied how bottom-up decision-making and organisational structure results in better and more efficient decision. Below is a quotation from the article cited at the link above.

Elinor Ostrom has been honoured for a body of work which closely scrutinises a vast number of case studies of common ownership, from irrigation systems in Nepal to groundwater basins in California. Ostrom’s results show that, while it’s not the best solution in all cases, common ownership can and frequently does work. Often this is down to centuries’ worth of knowledge and experience that have gone into evolving a common ownership system, the subtleties of which external authorities often fail to appreciate. But Ostrom has also identified a set of more abstract rules and procedures which need to be in place to make common ownership work. Some of her more surprising conclusions hold interesting lessons for state-owned or privatised property, too. Ostrom shows, for example, that the users themselves, rather than impartial outsiders, should monitor procedures and dish out punishments where necessary. Decision making processes should be as democratic as possible, allowing every user to take part in building and amending the rules that govern the group. Ostrom also shows that a bottom-up approach to building an organisation, with well-functioning smaller groups coming together to form a larger cooperation, can be more beneficial than the opposite top-down approach.

Is it not abundantly clear that much of the institutional framework of contemporary Ireland has failed? Our political and democratic system has been discredited for some time. Our financial and economic system has been exposed as dysfunctional. The State’s regulatory systems have failed. Our planning system has proven incompetent at best and resulted in houses being exposed to catestrophic flooding. Now, once again, the major religious institution in the country has been shown to be corrupted.

There are many features in common across all of these institutions. First, they are led by morally weak and incompetant people. Self-interest and vanity have been the predominant values. Second, they have been self-serving and protective rather than orientated around serving the people. Finally, an incredible ethical emptiness characterises them all. Doing the right thing has become exotic and alien in our institutional culture.

This is why we need systemic change. We need new forms of social organisation grounded on solving problems and serving people.  I do not claim to know what these may be but I do know they must be grounded on bottom-up structures in a much more de-centralised and harmonised society.

For now, as I have argued elsewhere, we must create new networks de-linked from the present system. These would be economic, social, political and cultural spaces outside the logic and control of the present economic and political system. They might involve local trading systems, new currencies, acts of self-governance, reclamations of civic space, communal self-reliance. These networks may be based upon face to face contact, as are traditional geographical communities, or they may utilise the possibilities created by the Internet for virtual community and long distance liaison. The point is to bring people together now to create real, existentially viable alternatives and support networks in order to begin the process of constructing a new, sustainable society. No limit, bar human imagination and ingenuity, can be placed on what these networks may be like or upon what their de-linking activities might be.

The problems that we are facing are systemic. They are not just isolated difficulties. Instead, we are looking at a systems failure. The government and those with a vested interest in the existing system seem to think that it’s a matter of holding our breath and waiting for it all to re-boot. It won’t. The system itself is broken.

We need a whole new way of thinking and acting. We need a new system modeled to deliver social and ecological harmony. Such a system would be designed to re-build social connections and networks. We cannot have human beings rendered ‘redundant’. We must have meaningful activity for all.

I think this can only be done from the bottom-up. We need to see emerging, and to actively encourage, new types of social and ecologically committed enterprises. This would be a whole new mobilisation outside the current broken institutional framework. It would also be outside our traditional understanding of ‘politics’ and ‘business’.

Here are some suggestions:

We need to stop being dependent and powerless and start acting. We need new ideas, new models and new enterprises. Let’s do it!

We need to build a culture of engagement. We need to take responsibility for our own communities and figuring out together solutions to our problems. The key driver of new business ideas is to solve life’s little problems. This must involve building community democratic participative forums, either in one’s geographical area or virtually through new social network sites. Let’s think and solve together!

We need new invigorated local economic activity. One example is to develop local currencies, local capital exchanges and local systems of barter. Local currencies can be used to reward social activity, such as work with children, youth, elderly, the environment.

We need to maximise local resource mobilisation, especially in food and energy. These new resources can then be traded. All of this should lead to ecological enhancement and meaningful activity for all. This also creates local resilience (providing a buffer against global economic shocks) and a basic security foundation for all citizens regarding a minimum of basic goods and services.

What we have learned is that the economy must rest on real activity, on the real social world and on the real environment. We can begin with bottom-up solutions to fix the small things. Lots of small solutions leads to one big solution!

We are living in a post-democratic society. What I mean by that term is that we have the outward forms of democracy only but not its reality. Yes, we have elections and political parties. But these do not effect real change. That is because effective power lies elsewhere. It lies with those who control the levers of the global market – multi-national corporations, international financiers, large States.

Take Ireland’s current economic policy. Our monetary policy is determined entirely by the European Central Bank. Our fiscal policy is determined by the European Commission. Thus, our present budgetary deficit–GDP ratio is just over 12%. The Commission has insisted this be brought down to 3%. They have given us five years to achieve this. It does not matter which political party or coalition of parties is elected. They must all conform to these budgetary constraints. Our choice lies only in the detail of how we do this.

In effect, our independence and autonomy in these matters are gone. We are in a state of dependency. Our votes will make little difference.

We need a democratic renewal. I have suggested below a mechanism for economic, social and political change that is radical but uses no jargon, involves no protest, is positive, smart and empowering and uses tools already available. It centres on bottom-up participative solution seeking. We need to create a new social movement that does not want formal political power. In post-democracy change will not come from politics!

The government has signaled clearly that in December’s budget they are going to reduce public service expenditure by €4 billion. It appears that €2.7 billion of this will centre on social welfare reductions and social service provisions. This would have an appalling effect on our society. What can be done? Rather than just give off about this, here are four immediate alternative proposals.

First, we clearly need to mobilise the enormous wealth which remains in our society and bring it within the tax net. Much of this wealth is hidden behind a complex array of tax breaks and tax reduction schemes. These need to be radically reformed and almost all done away with.

Second, we need taxes on embedded wealth such as property, capital gains and financial speculative transactions. We should be pushing for the introduction of a Tobin tax system on transnational financial exchanges.

Third, we need a third taxation band that targets those earning more than €100,000. The rate needs to be quite high given our present circumstances – perhaps 60%.

Finally, we need to re-examine our corporation tax system. This should not be an untouchable. Take Shell’s deal regarding Corrib gas. They will pay 25% tax on net profits. The Dept of Finance estimate that the State thereby will take just under €2 billion in taxes from a well currently valued at almost €12 billion. This is clearly wrong. We need a significant windfall profit tax imposed. Whatever about the justification for this regime in the 1990s, the circumstances have now changed. The economy is in crisis and everything ‘is now different’; there has been an enormous rise in the value of natural gas which is not connected to any investment by the developers; we now know more about how fossil fuel use is causing catastrophic climate change. For these reasons, Shell must pay far more – at least 50% of the gross value should be returned to the State.

The point is that the citizens of this State can not and should not see reductions in their economic condition unless it is fair. This means that everyone in society – the wealthy and the corporations – must pay their proportional share and be seen to do so. This is the only basis by which we can proceed from this crisis to create a new, fair and just Ireland.

Today’s decision on the Corrib gas pipeline by An Bord Pleanala finally accepts a critical principle that has longed formed part of the campaign against the Corrib gas project. The Board finds that:

The proposal to route the pipeline at a proximity distance from dwellings which is within the hazard range of the pipeline should a failure occur is unacceptable.

This is a very important vindication of the local community’s campaign. It also specifically validates the position of the Rossport Five. Their opposition caused the original pipeline route to be abandoned.

This principle, obvious as it may seem, has been consistently denied by the government (Ministers Fahey, Dempsey and Ryan), by Peter Cassells and by the Advantica so-called safety review. The ridiculing of local fears on this specific point has been outrageous throughout the last ten years.

Furthermore, Shell’s application on the pipe has been shown not to be ‘complete, transparent and adequate.’ This is also an important finding as it once again undermines Shell’s claims to be trusted and competent and to be a safety-conscious company.

However, it is disappointing that the Board has suggested yet another alternative route, this time up the middle of Sruhwaddoccon estuary. This route raises even further safety concerns.

The fact is that the project is untenable. It should be stopped immediately and completely redesigned according to criteria of health and safety and community consent. Another window now exists to bring this about. Indeed, the entire deal governing the project needs immediate review.

We all know that we are in an economic and financial crisis. We also know that we are in an environmental crisis. We are subjected daily to descriptions and analyses of just how bad things are. Both appear overwhelming, to such an extent that we feel powerless to do anything about them.

 It is clear that what we need is solutions. Yet solutions seem to be in short supply and, insofar as any are being offered, they all appear to be in the realm of macro, ‘big-picture’ structural changes which only governments can bring about. Hence, we wait frustrated and disempowered while our leaders strive for answers.

 Yet, here’s the interesting thing. The solution to both of these problems can best be found through a ‘bottom-up’ participative process. Not only is this the most comprehensive way to deal with our problems and fix them, it will also invigorate our democratic and social culture. What we want to do after all is to build harmonies and find solutions, not accentuate antagonisms and build conflict and despair. Here’s how it can be done.

 First, we need to state clearly what our social and political goal is. What is our State about? This is a debate we rarely have but, particularly at times like this, it’s good to consider what might be thought of as obvious. Part of the answer must be that we want all citizens to be included, to have meaningful social activity, to have the means for a decent quality of life. There can be no more appalling notion than that of someone being ‘redundant’. Now, how do we bring this about? We do it by constructing a system that is more responsive to people and their real needs. The way to do this is to give people the power to define and solve their own problems. The means and ends become harmonised – the means used lead to the ends desired.

 Therefore, second, we need to acknowledge that people can be trusted and empowered. Those affected by issues or those at the frontline of issues, are the best sources of knowledge about what needs to be done. Empower them to do so! Let the power go from centralised, bureaucratised systems! We need to allow all kinds of groups – community groups, citizen groups, disability groups, drug addicts, businesses, public services – to work out their own solutions from the bottom up.

 Third, there is a straightforward method for doing this. Key to the method is that the effected group defines the problems and defines what they need. They do this by developing a generating question. Examples might be as follows. How do we who have disabilities live as independently as possible? How do we as a business improve this organisation’s service and save money? How do we as a community provide activities for our children?

 The critical thing is that the relevant group, i.e. those directly affected or those who directly work in the delivery or activity, are trusted to generate the answers and given the budget directly (however limited this must be) to achieve their own priorities. There are lots of ways that this can be done. These range from open meetings and facilitated gatherings right up to the wonderful possibilities available through the internet such as virtual solution systems and specially created social network sites. Information and ideas can flow and be accessed with greater ease now than ever before. Any problem can be addressed in this way from those that are small-scale right up to large-scale issues such as setting budgets through a participative process.

 If communities and organizations – both real and virtual – could empower themselves we would see a real social, political and cultural renewal. Our people would stop being made dependent and would start acting. We would build a culture of engagement, one that hopefully would sweep away our discredited political system of clientalism. Our organisations would become facilitators of activity not depositories of resources unequally distributed.

 A bottom-up democratic participation would almost certainly give rise to new forms of local economic activity. Local currencies and local credit systems might be developed which would provide the means for a renewed community economy providing a basic stream of goods and services. Local currencies could be utilised to reward useful social activity such as work with children, with our young people, our elderly and environmental enhancement. We need meaningful activity for all our people. Local economies creates local resilience (a buffer against global economic shocks) and a basic security foundation for all citizens regarding a minimum of basic goods and services.

 What is outlined here is not utopian. It is entirely achievable once people have confidence and the impetus to change the way we are doing things. What is required is to reduce bureaucracy and top-down management systems and instead to build smart organisations and communities. This is an agenda for economic, social and political change that is radical but uses no jargon, involves no protest, is positive, smart and empowering and uses tools already available. It centres simply on bottom-up participative solution seeking.

I warmly recommend that, if you can, you watch last Sunday’s Would you Believe on RTE TV. Here you can hear the authentic voice of the local community in North Mayo who are resisting the imposition of Shell’s gas project. The Corduffs have been stalwart and resolute defenders of their community throughout the last ten years. The programme well captures their dignity and dedication.

Below is the text of a speech i delivered to the irish Practice Nurses Association conference in Westport on October 17th. I have been asked to make it available.

Introduction

 I want to begin with a rather well-known quotation. It’s from Maev-Ann Wren’s book Unhealthy State – Anatomy of a Sick Society (2003: 50).

 Irish people die younger because they tolerate an inequality between them which breeds ill-health, and they accept a health care system and a view of health care which implicitly places lesser value on the lives of those with lesser means.

 This is an extraordinary and disturbing sentence or, at least, it should be extraordinary and disturbing. Since 2002/3, when her book was written, we have had a further four years of unprecedented economic growth and prosperity. Does her judgement still ring true? Let me quote now from the more recent book – published this year – by Sara Burke which is provocatively entitled Irish Apartheid – Healthcare Inequality in Ireland.

 We have an apartheid system of healthcare, where those who can afford to, have quick access to what can be life-saving diagnosis and treatment, quicker than those who can’t afford private care. This has always been the case but, in the last decade, the two-tier system of healthcare has been accentuated, with increasing numbers of people incentivised to take out private insurance, privileging them over those who cannot afford to skip the queue (2009: 4).

 What is going on here? What is being described in these books? Is this simply an administrative defect which results merely in inconvenience but little real harm? No, as we know, it is not. This structure of our health system has real implications. A recent report from the Institute of Public Health has shown that 5,400 people die prematurely each year in Ireland due to inequality and poverty. 5,400 people – more than 100 each week. That is a figure so large it almost cannot be comprehended. It is only when this statistic becomes personalised around an individual – such as with Susie Long – that there is any political or media reaction. Susie Long died in October 2007 – two years ago. Has this reality changed? No.

 In this presentation today I want to make a very simple argument. The pattern of illness and sickness in our society tells us something fundamental about our society. Equally, the social structure of our society – particularly the pattern of social inequality within it – tells us something fundamental about the causes and distribution of illness in our society. In other words, there is a clear and demonstrable connection between the pattern of illness and the pattern of social inequality. This connection is so close that we can say that social inequality is a health issue. It is far more than just that of course but it is absolutely a health issue as well. Extraordinarily, far from being a contentious claim, this is widely acknowledged and understood even by those who run our health service. For example, Dr. John Kelleher, the Ass. Nat. Dir. For Health Protection in the HSE was quoted in The Irish Times in Sept 2006 as saying:

 ‘The fundamental issue in relation to poor health is income; if you don’t have that, you’re never going to be healthy again.’ 

 Ireland is a seriously unequal society. This, in turn, has a significant impact on the pattern of illness in our society. In simple terms, the greater the level of social inequality the greater the level of illness and the more unevenly distributed those illnesses are among the population. In short, the poor will be sicker than the wealthy.

 However, and this is important, social inequality is not a phenomenon that only has negative impacts on the poor and disadvantaged. Crucially, it has negative impacts for all in society. If we want a healthy and well functioning society, the most important and effective method by which this can be achieved is by creating and sustaining social equality. At this time of economic and social crisis, the great project of hope which we could grasp onto is to finally bring about a socially equal and just Ireland which would truly transform all our lives, not just the lives of the poor.

 I have made a number of assertions! Let me try now and systematically, if I can, ground these assertions in empirical data. First, is Ireland unequal? Second, does this inequality impact on our pattern of health? Third, does achieving social equality really make such a difference? I will do all this without a single powerpoint slide so I’m going to try to avoid too many statistics!

 Is Ireland Unequal?

It may be difficult for some people to think of Ireland as an unequal society. After all, we don’t seem to have people starving on the streets. But poverty is always a relative concept. You are poor when measured relative to the norms within your given society. In aggregate terms we have been, and remain, a wealthy society. However, the critical factor in understanding poverty in a society is how that wealth is distributed. The key determinant in triggering social consequences and shaping the society is the distribution of that wealth – in other words, the real issue is how big is the gap between the wealthy and the poor.

 Relative to the rest of the EU, particularly Western Europe, and relative to other aggregately wealthy societies, Ireland shows a very high level of social inequality. Only the United States performs worse than us consistently in international terms among the top 20 wealthy societies.

 Some – few! – statistics. Various studies and reports show that we have approximately 16 to 17% of our population living in relative poverty (i.e. with incomes less than 60% of the median income). That’s about 720,000 people. About 6.5% of our population live in consistent poverty (i.e. lack consistently a number of basic material indicators for a comfortable average existence). That’s about 290,000 people. Let me quote now from another Irish Times report in 2006:

Around half of the State’s 1,000,000 children are affected by income poverty at some stage during their childhood. A major study by the ESRI published yesterday, which tracked children between 1994 and 2001, found that young people tended to move in and out of poverty based on factors such as the employment, education and health status of their parents. Of the State’s just over 1,000,000 children, 535,000 experienced poverty at some stage over this period. A quarter of all children (246,000) experienced poverty for a relatively short time of between one and two years. However, just under a fifth (182,000) remained “locked” in poverty for between five and eight years. One in five children experience relative income poverty at any one point in time.

Bank of Ireland’s Wealth of the Nation Report in 2007 showed that the wealthiest 1% of the population owned 20% of the country’s wealth. The top 5% owned 40% of the nation’s wealth. This means that the other 95% of the population had the remaining 60% of the country’s wealth.

 Within this huge group of poor people, certain categories of people are deeply embedded in poverty and deprivation. These include Travellers, asylum seekers, lone parents (38% of whom are at risk of poverty), elderly people, the unemployed (of whom we now have over 400,000).

 One final internationally recognised measure of social equality is the gini coefficient. This is a way of measuring income distribution. If all income went to 1 person and none to everyone else the coefficient would be 100. If everyone had the exact same income the coefficient would be 0. So, the lower the value, the more equal the society. In the mid-1980s Ireland’s gini coefficient was 33.1. In the mid-1990s it was 32.4. By 2000 it had improved to 30. However, by 2005 it had risen again to 32. This can be compared to 23 in Sweden, 24 in Denmark, 28 in France, Germany and Norway.

 The point is that over that twenty-year period – from the grim 1980s to the booming mid-noughties – our level of relative poverty and therefore social inequality remained largely unchanged. We are not a socially equal society. The question that worries me is whether we really want to be or whether we – the relatively comfortable and secure – are happy with the way things are. Poverty seems to be invisible. It is rarely highlighted as a pressing social issue. It is rarely the stuff of heated political debates. It’s almost as if poverty is not our concern. I want to show shortly that this is not so – social inequality affects us all.

 Impact of inequality on health

 We have known for a long time that physical and material conditions have a decisive impact on the patterns of health. Once, within what can be called a bio-medical model of health, it was assumed that the causes of ill-health lay exclusively within the patient’s body and that treatment simply involved identifying the broken or damaged part and fixing it. This was a very mechanical, reductionist perspective.

 We now know of course that each human being is embedded within a complex socio-cultural and ecological setting and that the quality of that setting profoundly affects individual well-being. This occurs to such an extent that the causes for ill-health and mental stress are more likely to lie outside the individual than within. This has come to be called the social model of health.

 Yet even though I am claiming that this is well understood and recognised, it is extraordinary how rarely we hear health debated publicly in terms of the social model. Rather, when talking about health and the health service, our focus tends to be on medicine, on service provision, on treatment regimes and resources. In this sense we have a sickness service not a health service. We are less inclined to enquire into the deep causes of ill-health in our society and enquire into how we can address these fundamental causes in the first place so that we can reduce the number of sick people rather than continuing to focus on expanding our capacity to manage more sick people. As is clear we just can’t keep up. So, it is important to ask, why are so many of us sick? What is going on in the wider society?

 To answer this, we need to understand the social causes of illness. These include assessing the immediate social and environmental circumstances surrounding individuals. What is the quality of the social world? Can people access social services? Are they well connected to the wider society? Are they experiencing stress? Do they feel respected? What is the crime rate? Is there good public transport?

 It also includes the macro social and environmental context. Is the society wealthy? Are the society’s resources available to all or to a few? Are there employment prospects for all? Is the air clean, and the water pure? Does government policy support inclusion and service provision?

 Individual lifestyle is crucial as well. What is the quality of diet? Can people access and afford good quality and healthy food? Do they exercise? Can they access and afford sports and recreation facilities?

 Indeed, when we think about the ingredients of what constitutes a healthy life (both physical and mental) – exercise, food, low stress, social inclusion and connection, comprehensive service provision and access – we can readily see that we are almost entirely thinking about social causes. In this sense, sickness is not simply something you just ‘get’, something that unfortunately ‘happens’. It has clear patterns many of which are identifiable and predictable, patterns which have their roots in the nature and quality of the social world around us.

 We know that social inequality leads to greater levels of sickness. The poorer you are the more likely you are to be ill and in need of medical services. Yet interestingly the key finding of numerous studies is that the key issue here is not the amount of absolute poverty in the society – rather, it is the amount of relative poverty. In other words, it is the level of social inequality that is the determining factor for the pattern of illness. The bigger the gap between the wealthy and the poor, the greater the level of illness generally, and the more those illnesses will be disproportionately experienced by the poor.

 Back to some statistics! Take death. If we compare death rates from various diseases for the richest and poorest socioeconomic groups we find that the poorest have twice the likelihood of dying from cancer than the wealthiest, three times the likelihood of dying from heart disease, almost four times the likelihood from stroke, over five times the likelihood from suicide, six times from accident, almost sixteen times from mental or behavioural disorders, and sixteen times more likelihood from alcohol abuse.[1]

 I have already mentioned the appalling figure of 5,400 deaths per annum directly due to poverty and inequality. Social inequality kills the poor but it degrades all of us.

 Elizebeth Cullen, in an important article in the FEASTA Review of 2004 which reviewed large amounts of data linking poverty and ill-health, has written:

 A report in 2002 found that medical card holders had higher incidences of cardiovascular disease, stroke, hypertension, asthma, osteoarthritis, skin cancer and all other cancers, underactive thyroid, kidney stones, osteoporosis, gallstones, duodenal and gastric ulcers, and diabetes. A further report found that 52.9% of medical card holders suffered from one or more health conditions, in contrast to 22.7% of private insurance holders.

 I could go on and on. But there are is only so much data one can absorb – especially without powerpoint! Let me quote finally from the editors of the British Medical Journal, writing as far back as 1996, in a review of studies confirming the link between income inequality and health:

 The big idea is that what matters in determining mortality and health in a society is less the overall wealth of that society and more how evenly wealth is distributed. The more equally wealth is distributed the better the health of that society.

 Does achieving social equality really make such a difference?

Instead, let me return to the question does achieving social equality really make such a difference? To answer this, I want to rely on a very interesting and important book recently published called The Spirit Level – Why more equal societies almost always do better. It is written by Richard Wilkinson and Kate Pickett.

 The argument of this book is straightforward and not by any means original. They set out to show that the benefits (both socially and in terms of health) of economic growth in rich countries have reached their limit. Now, the quality of life is determined they argue by the equal distribution of wealth. It should be clear that this is a position that I, and most social scientists, would agree with.

 What is particularly important about this book however is the impressive amount of empirical data that they present from around the world to support this argument. They show – I think compellingly – that income equality creates better outcomes across a whole range of social indicators. Specifically, they examine:

•  Community life and social relations (social capital and trust)
• Mental health and drug use
• Physical health and life expectancy
• Obesity
• Educational performance
• Teenage births
• Violence
• Imprisonment
• Social mobility (opportunities).

 They demonstrate that in rich countries health and social problems are closely related to the level of inequality in those countries. In short, the more unequal the society, the greater the level of problems in these nine areas. It is a simple but elegant argument.

 Why might social equality be so important? The answer lies I think in understanding that we are fundamentally social beings who need to belong to the social groups within which we live. We have a compelling need to be accepted, to be able to participate, to be able to access the resources of that society. If we can’t, if we are repulsed, marginalised, isolated, ill-treated, then it has devastating effects on us. To have distance placed between you and the society to which you belong places you in an extremely unsettling position. These distances may be symbolic (the wrong accent, the wrong clothes) or actual (the wrong address, the wrong ethnicity) or, indeed, both. Where income differences are bigger, social distances (symbolic and actual) are greater. The materially comfortable and the poor may live in the same country but they live in different social worlds.

 For their part, Wilkinson and Pickett suggest that social inequality causes wider social problems because it leads to

•  A rise in anxiety
• Loss of self-esteem and social security
• Threats to the social self
• Loss of pride, increase in shame and loss of status and,
• Inequality increases social evaluation anxieties

 Status is so important for the social creature that we humans are. Having low status has a direct and immediate impact on our well-being. It raises our stress levels, suppresses our immune levels, causes us anxiety. It makes us isolated, marginalised and reduced in our very humanity. To quote Wilkinson and Pickett again – ‘Chronic stress wears us down and wears us out’.

 Their argument is that social equality leads directly to social improvements in regards to each of their nine social indicators. It improves community life and social relations, improves mental and physical health, improves educational performance, reduces violence and the need for imprisonment and increases social opportunities and mobility. Hence, equal societies nearly always perform better.

Conclusion

The conclusion I think is that we need income equality in order to create socially and environmentally sustainable societies and, of course, to create healthy societies. The point is that equality is a matter that should concern us all. We all live in society. The better that society is, the better for all of us. None of us can be isolated and asocial unless we wish to live in a hyper-privatised world of private education, private hospitals, private security, private gated communities, etc. This surely is more a dystopian image of the world than something we might aspire to.

 Equality is a health issue. We are of course not used to thinking like this, or putting it like this. Thus, the greatest single contribution we can make to improving the health status of our society is to bring about social equality. That we have done precisely the opposite in Ireland should therefore cause us no surprise when today we see huge amounts of illness and waiting lists and demands for medical services both primary and hospital. Just why are we so ill? What is wrong with us? Why are we surprised that our society is producing so much physical and mental sickness? What I am arguing is that one of the most important reasons is our level of social inequality.

 It seems clear to me that when we are thinking about our society and about its health we are not thinking deeply enough. Our debate is not at a deep enough level. In our present economic crisis, we are proceeding by reflex, by an accounting template of cutting services for all and raising taxes for all. In addition, crucial decisions, which will shape our society, are being made in reality according to the power of various vested sectional interests. When this happens the poor and weak lose – again.

 What we don’t have is a social plan which contains a vision for what type of country we want to have. We have apparently economic-based plans centred on a ‘smart economy’. What about a social plan centred on a ‘just and equal society’? Especially if it turns out that a smart society is in fact a just and equal society. This is surely essential to do so that as we go through this present phase of suffering and pain we can do so with the hope and expectation that we are finally building an Ireland of social equality and inclusion.

I say this on the assumption of course that this is what we really want. I hope it is. Such a society is not an airy-fairy unrealisable dream. We have the models all around us – in Norway and Denmark, for example – countries of comparable size to us and with similar histories.  Let’s study them, copy them directly if need be, at least see what they have learned and apply it to our own situation. We need this vision in order to give ourselves in this dark time a horizon of hope. The bottom line is that achieving social equality is not just about the poor – it’s about all of us. We all benefit.