Göran Therborn published The Killing Fields of Inequality as what looks like an expanded version of a 2009 article on the same subject. And contrary to Picketty’s massive economic volume, Therborn’s book is short and sweet even though it covers some of the same territory. However, Therborn’s book focuses more on theoretical conceptualizations of inequality as well as its social consequences.

This is visible right off the bat in the way Therborn defines inequality:

“Inequality is a violation of human dignity; it is a denial of the possibility for everybody’s human capabilities to develop. It takes many forms, and it has many effects: premature death, ill-health, humiliation, subjection, discrimination, exclusion from knowledge or from mainstream social life, poverty, powerlessness, stress, insecurity, anxiety, lack of self-confidence and of pride in oneself, and exclusion from opportunities and life-chances. Inequality, then, is not just about the size of wallets. It is a socio-cultural order, which (for most of us) reduces our capabilities to function as human beings, our health, our self-respect, our sense of self, as well as our resources to act and participate in this world.” (1)

This is, I think, one of the most powerful statement of what equality truly is, beyond the relatively simplistic (and always contentious, nevertheless) economic indicators that do not capture the multi-layered nature of the impact, and mixing of cause and consequence, of inequality. But it is precisely this multi-layered nature that necessitates a more nuanced and inclusive approach to examining inequality, which is what Therborn focuses on:

  1. a multi-dimensional conceptualization of inequality;
  2. within a historical and global context;
  3. produced through a variety of mechanisms;
  4. and often countered by equalization mechanisms (which Therborn argues for).

The simple idea is that inequality is produced by a variety of mechanisms and is therefore not inevitable (like some weird atmospheric event) and certainly not desirable considering the social devastation it produces (which reproduces it at the same time). As such, equalization mechanisms are needed and available.

So, first of all, inequality means exclusion which comes in two forms:

Two main doors of social exclusion

Out of these, Therborn notes three different effects (click on the image for larger view):

The mechanisms through whichinequality tears society apart

To summarize:

“The social space for human development is carved up and restricted, above all for the disadvantaged, of course, but not only for them. Secondly, the inequality of ownership of, control of or access to economic resources means that what has been produced in a given society can easily be dissipated by the privileged few. Thirdly, inequality of economic resources and their political deployment has negated the nineteenth-century liberal fears of democracy: that citizens’ power would encroach upon private property. Instead, big property owners have, most of the time in most countries, been able to dictate what is ‘sound economic policy’.” (22)

The greater the inequality, the more of all three effects we will observe.

No conceptual work would be complete with some distinction and clarification although I do not find his conceptualization of the difference between difference and inequality persuasive:

Difference Inequality
Assumed or given Socially constructed
No commonality assumed Assumed commonality
No violation of norm of equality Violation of norm of equality
Difference can coexist with inequality

I have to say that I am not really convinced by this. Differences can be as socially constructed as inequalities and these inequalities can be constructing through othering, that is, by denying any commonality with the class of people being stuck at the bottom of the social ladder. Similarly, inequality is often based on some imposed norm of essential inequality (gender, for instance) whether that supposed essence is assumed to be religion, tradition, or nature.

How much equality do we need? Here, Therborn invokes Amartya Sen’s capability approach to punt: inequalities prevent billions of people from full human development. Therefore, the focus should be on increasing capability for all and reducing social bads.

The bulk of Therborn’s conceptual work goes to delineating the different types of inequalities (click on the image for a larger view):

Three kinds of inequalityAccording to Therborn, while the mechanisms of vital and resource inequalities have been amply studied, the social sciences have yet to give existential inequality the attention it deserves. On the one hand, I disagree: Therborn refers to sexism, racism, colonialism, etc. and those have been extensively studied. On the other hand, yes, there have been discussions within the social sciences regarding identity politics as existential inequality, so conceived, goes back to issues of privileges and disadvantages.

Resource inequality refers not just to economic matters but also education, all forms of cultural inequality, inequalities in symbolic and social capital, as well as inequalities of power.

Needless to say, the distinction is conceptual. There is no question that these different forms of inequalities overlap and influence each other, and have impacts on one another.

How are inequalities produced and maintained?

“Inequalities are produced and sustained socially by systemic arrangements and processes, and by distributive action, individual as well as collective. It is crucial to pay systematic attention to both. ‘Distributive action’ is here taken as any social action, individual as well as collective, with direct distributive consequences, be they actions of systemic advance or retardation, or of allocation / distribution.” (55)

Therborn identifies four such distributive actions, each involving both individual actions (what Therborn call ‘direct agency’) and systemic dynamics (click on the image for a larger view):

--Types of distributive action--I numbered these actions because Therborn see them as a cumulative continuum, with distanciation at one polar end, and exploitation at the other polar end of the continuum. Each layer adds more inequalities to the system, with exploitation (which includes slavery as extreme form) as the most unequal.

However, each one of these distributive actions can be countered by an equalizing mechanism:

--Types of equality mechanisms--

I numbered them to refer them to their respective distributive action (and like the distributive actions, these mechanisms can be individual or collective).

So, this is the basic conceptual apparatus that Therborn deploys to then get to the historical and empirical aspects of inequality, that is, match the concepts to the data. Note that the apparatus is more descriptive than predictive.

I have to say that this is where the book gets a bit tedious mostly because of the too-limited use of some data vizualization. It is really useless to read paragraphs and paragraphs of data. I wish these empirical sections had been better visualized. I think Therborn is going to lose a lot of non-specialist readers on that aspect alone even though it is a book that should get a wider audience than academic types.

That being said, Therborn reviews the data based on his inequality three-part apparatus. Regarding vital inequalities:

“For recent increases in vital inequality, there are two main suspects. One is increasing economic uncertainty and polarization, between the unemployed and the labour market marginalized, on the one hand, and the surfers on the boom waves, on the other. The other is nowadays often called ‘lifestyle’, but is better termed ‘life-options’. It is not so much a choice of style as a perspective of possible options. People who have little control of their basic life situation, of finding a job, of controlling their work context, of launching a life-course career, may be expected to be less prone to control the health of their bodies – to notice and to follow expert advice on tobacco, alcohol and other drugs, on diet and exercise – than people who have a sense of controlling their own lives.” (82-3)

Regarding existential inequalities:

“Even though blatant, institutionalized existential inequality, such as racism, sexism and ruthless developmentalism or ‘civilizing’ zeal, have been eroded, existential inequality is still permeating contemporary societies.


There are also current social tendencies driving new forms of existential inequality: de-industrialization outsourcing, immigration of the poor, and labour market marginalizations. Such tendencies are now directed against an ‘underclass’ of people marginalized or excluded from the labour market, the second generation of industrial immigrants, poor single mothers, the children of de-industrialized workers. In Britain, they have been given a new pejorative identity as the ‘chavs’ (Jones 2011). In a US conservative bestseller portrait, they are a new ‘lower class’, unmarried, lazy, dishonest and godless (Murray 2012). Class is here returning as an existential put-down.” (88-9)

[Note: I totally resent that Therborn cites Murray repeatedly, just positing him as a conservative rather than an awful racist who should have been banned for academic status ever since the publication of the giant pile of horse manure that is The Bell Curve.]

And as for resource inequalities, the story is well-known: deindustrialization, rise of financial capitalism, globalization and the rise of transnational forces able to undermine the social safety nets. On education, Therborn, I think Therborn engages in too much generalizing (for instance, that private systems are better at the primary and secondary levels). One cannot, on the one hand, deplore the persistence of educational gaps and not see the impact of private systems on such persistence.

As for power,

“Within nations, social movements, collective associations and wide-franchised elections – democratization, in short – have brought about a major equalization of political resources, once monopolized by monarchs and other despots. But, as with economic resources, political equalization has been stopped or reversed recently, by de-unionization, political party erosion, and general social dissolution of the popular classes. A difference from what has happened to economic resources, which are ever more concentrated, has been the rise of electronic social media and their possibilities of self-generated mass communication.” (99)

I think the jury is still out on that one. There may be a crisis of legitimation, but yesterday’s European Parliamentary elections show that the reaction is not one of demand for more democracy. Quite the opposite.

Therborn shows that progress on vital inequalities is still inadequate, even in some developed countries. At the same time, again, in developed countries, there has been considerable progress on existential inequality (gay rights, for instance), but I would argue that this has been at the expenses of resource inequalities. In other words, the power elite has figured out that they could keep on beating up on unions and the poor, as long as there was some (cost-free) progress on identity politics matters, there would be no class-based social movements to demand changes.

So where does this leave us:

“Violent revolutions, large-scale industrial wars, profound economic crisis – strong storms have been necessary to tame the ferocious anti-egalitarianism of late-feudal, patriarchal and modern capitalist societies. However, there has also been a fourth kind of egalitarian moment. Under certain circumstances, far-reaching peaceful social reform has been possible. This is obviously the experience most relevant to the current world.” (155)

And by fourth moment, Therborn mean “les trente glorieuses” (the post-WWII period until the 1980s) and the current political movement in Latin America.

When it comes to reducing inequalities, Therborn argues that this will require forces of equalization and that these can be divided in two: forces of demand (for equality) and forces of supply (those social actors who can actually deliver equalization) based on their motivations.

So, regarding these forces of demand, exit the labor movement and the working class, enter identify-based movements and what Therborn solidaristic individualism:

“Solidaristic individualism – ‘I want to choose my own lifestyle, but I am concerned about the possibilities of others to make their choice’ – is a vital force of equality. It provided the vibrant, albeit unsustainable, dynamic of the Occupy movements (see, further, Castells 2012; Mason 2012).” (162)

I think he is absolutely right on that.

What of the forces of supply, then?

“Equality derives basically from demand. But as social equality is a social force of cohesion, of combat as well as of development, it has its forces of supply, driven first of all by fear. There is the fear of the unequals, of their anger and their possible protests and rebellion. Secondly, there is the fear of the external enemy, the fear of not being up to the lethal capacity of the latter. Thirdly, there is the fear of backwardness, and projects of inclusive national development. While fear is a basic source of equalization measures by the powerful and privileged, it is not the only one. Ruling elites and/or their staff are not always fully absorbed by their own privileges and greed. They are not necessarily incapable of comprehensive visions and far-sighted strategic calculations – occasionally even of empathy with their subjects.” (163)

Again, here, I would argue that the elites have been able to continue the pursuit of resource inequalities by trading it for existential equalization.

For the future, Therborn sees three potential battlefields (and they are all institutional and systemic: family, capitalism, and nation as all three are essential in producing inequalities. There has been a lot of progress on the family front, not just with the redefinition of family in and of itself (and the progressive acceptance of multiple family forms) but also with respect to children’s rights. Ultimately, that battlefield is about individual rights to form families of one’s choice. When it comes to capitalism, though, Therborn goes back rights tied to labor and against precarization. Finally, the national battlefield goes to rights of citizens:

“Asserting the rights of citizens means, first of all, a vigorous defence of democracy, of people’s right to self-determination. Citizens have a right to assert their collective will regarding their economy and their environment over any private capital interests, or any anonymous global aggregation of, e.g., financial markets. The ongoing 2008 crisis, caused by an absence of any civic control over the opulent little world of reckless speculators and high-stake casino-gamblers, acted out more in Europe than in America, is the costliest defeat of the North Atlantic democracies since the German crash of 1931–3.” (173)

Therborn argues that these battlefields might not be primarily in developed countries but outside of the Global North. But he also thinks that certain factors will lead to fighting for equalization:

  1. the obvious cost of misery that is visible to all;
  2. the crisis of legitimation for the elite after they destroyed the economy;
  3. equality is good for society.

I am not so sure about #1, the rise of the Tea Party, and fascist parties all over Europe are precisely movements that are based on a complete lack of compassion for underdogs and victims of all forms of inequalities. They are based on resentment and hatred. That’s an extra obstacle that Therborn does not consider.

Yes, the elites have been somewhat discredited but the challenges have been limited: a threat of protest at commencement speech, the short-lived Occupy movement and Arab Spring movements. None of the contestation has led to any systemic change.

Yes, equality is good for society and there is ample data to prove it, but the dominant discourse is not that idea at all, and especially considering, again, my response to #1.

So, this is a book very much worth reading and important. I don’t agree with all of it. The conceptual apparatus is worth exploring and using. The diagnosis is sound, but the prescriptions, I think, are a bit too optimistic.

Nevertheless, I think this is required reading for all sociologists.

And while you’re at it, also go read Kathleen Geier’s review.

I found the visualization below to be a very striking illustration of the concept of medicalization:

As you can see, the growth of the DSM perfectly illustrates the range of behaviors that come to be labeled as pathological, and therefore, under the normative purview of the medical profession.

This is also further illustrated by the rise of diagnosing conditions (which is, of course, connected to what is in the DSM):

“The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) is on the rise in American children, with an estimated 2 million more kids receiving a diagnosis of ADHD and 1 million more taking medication for ADHD in 2011 than there were in 2003, according to new data released by the U.S. Centers for Disease Control.

In a 2011 national survey of more than 95,000 U.S. households, the CDC found that 11 percent of children between the ages of 4 and 17 — or 6.4 million children nationwide — had received a diagnosis of ADHD, a disorder characterized by hyperactivity, trouble controlling impulsive behaviors and difficulty paying attention.

Among those children who had been diagnosed with ADHD, 83 percent were considered to currently have the disorder, or 8.8 percent of all kids nationwide. And among the children who currently have the disorder, 69 percent are taking medication to treat it — which comes out to 6.1 percent, or 3.5 million kids nationwide, the researchers said in the CDC report released Friday.”

And one can see the correlation between power dynamics and social control:

“Overall, the prevalence of childhood ADHD increased by 42 percent between the years 2003 and 2011, and the frequency of children taking medication for ADHD increased by 28 percent between 2007 and 2011.

“This suggests an increasing burden of ADHD on the U.S. health care system,” the authors of the study wrote. “Efforts to further understand ADHD diagnostic and treatment plans are warranted.”

The researchers did not indicate why ADHD among children has increased, but offered a few potential reasons: significantly, an increase in parental reports of their kids’ ADHD, or “better detection of underlying ADHD, due to increased health education and awareness efforts,” the authors wrote.

The researchers noted that the “prevalence of ADHD medication use also increased despite an overall downward trend in pediatric medication prescriptions,” and that the study’s data suggest that “the impact of ADHD may be increasing.”

The demographic groups most affected by ADA included boys — 15.1 percent of them had ADHD, versus just 6.7 percent of girls. Nearly one in five high school boys and one in 11 high school girls were diagnosed with the disorder.

In addition, children who were white, who lived in the Midwest, and kids whose families lived above 100 percent of the poverty line were more likely to be diagnosed with ADHD.

In terms of regional trends, children living in the West were least likely to receive a diagnosis of ADHD; state-based estimates of ADHD frequency ranged from 4.2 percent of kids in Nevada and 5.9 percent in California to 14.6 percent of children in Arkansas and 14.8 percent in Kentucky.”

It is amazing that there is no questioning whatsoever of the validity of the label for this condition. It is just accepted as an objective medical diagnosis, and therefore, the only question is how to treat it. The fact that the explanation for the increase is roughly limited to greater reporting rather than greater social awareness that a bundle of behavioral markers have been given a medical label and medical treatment options. There is also no real questioning of the demographics: boys, white, non-poor, that is, people who have access to the medical profession. Boys, of course, are more subject to behavior sanctioning in the school system, that is not new. But instead of being given detention, they get a medical diagnosis.

On this topic, the Very Public Sociologist, PhilBC, does a good job of unpacking the social construction of disorders that are currently in fashion:

“Why have Autism and Asperger’s only recently been codified as a social concern? It could part be media curiosity, part the growth and spread of the internet, and part visibility attained by the disabled rights movement. The inescapable trope of the autistic genius might have a role, too.

But I think something deeper could be going on, something to do with structural shifts in the advanced capitalist countries. Short-sightedness and Dyslexia were not social concerns prior to industrial capitalism. The point came when the demands of capital required something more than able bodies to work in its dark, satanic mills – it needed basic education to record and pass on information at all levels. Since then, particularly over the last 30 years, manufacturing has taken a battering. The old industries have fallen back and in its place are what we used to call tertiary industry: the service sector. This sector, from retail to investment banking, from call centres to consultancies, all absolutely depend on social relationships. Of course, thus it ever was. But now is different – the direction of travel clearly is capitalism’s growing dependence on the wealth that can be mined from relationships. Hence the massive values of social media firms who’ve yet to make a single penny of profit. Hence the obligatory ‘person spec’ placed alongside graduate job adverts. Hence the growth of consultancies selling team-building experiences. Hence the concern with Autism and Asperger’s.

For Autistic and Asperger’s people, the economic shift to service finds them singled out as disabled individuals. In front of the new emphasis on relationships, on the complexity of social cues and the (personal and commercial) premiums on networks; they are the newly dis-abled. And this is a very recent shift.”

But PhilBC makes another connection that is also important: what gets considered a crisis and how it is dealt with within the current social arrangements:

“There is an alternative explanation, but again related to changes in political economy. We know Britain is in the midst of a mental health epidemic. One-in-four of us suffer with a mental health problem during the course of a year. Thankfully, the stigma attached to mental health is beginning to lift and it is starting to be talked about. Partly, this is because these problems are so widespread. Why should we be surprised that more insecure and pressured work situations lead to stress, anxiety and illness? That low wages, crushing debts and attacks on social security screw people up? It is reasonable to assume that more job security, more stability would have the effect of decreasing incidences of mental ill-health. But also, with capital’s emphasis on relationship and service, any health problems impacting on its capacity to do business on that basis is bad news. It’s a concern. A social problem. So, is it possible that the relatively recent problematisation of Autism and Asperger’s is a subset of a wider recognition of a crisis around mental health?”

Emphasis mine.

But, of course, whenever something is defined as a problem, the way to deal with said problem has to be framed within the parameters of dominant ideologies and practices. And so, when mental problems are seen to be increasing because of precarious (or liquid, as Bauman would say) social conditions, then, the remedies are not to be found in changing the social conditions. No, under the norms of advanced capitalism, remedies have to be individualized, medicalized, and fit within corporate power.

Hence, this:

Doctors across Europe are warning that the soaring use of antidepressants is down to growing pressure to “medicalise” unhappiness, complaining that a lack of time and meagre availability of other therapies meant that physicians reach for the prescription pad far too often.

In response to a questionnaire devised by the Guardian and five leading European newspapers, the vast majority of almost 100 European doctors and psychiatrists who replied said there was a “prescribing culture” in their country because other help for people with depression was inadequate.

Many of the doctors – from the UK, France, ItalyGermanySpain, Luxembourg, Belgium and the Netherlands – said they believed antidepressants were an effective treatment for cases of severe depression. But dozens expressed frustration that limited time and even more limited resources mean that they often feel pressured to prescribe pills in less-urgent cases.

We are medicalising common situations: conflict, separation and the vicissitudes of life,” said Gladys Mujica Lezcano, a Barcelona-based hospital doctor.

“They are prescribed much too easily,” added Alain Vallée, a psychiatrist from Nantes in France. “If you take an antidepressant and it doesn’t work, you don’t think it’s because you might not be depressed, but that you need to take a stronger one.””

And if the vicissitudes of life widen, as socioeconomic conditions deteriorate, and insecurity increases, then, individually-prescribed medical remedies are the proper solution and recourse.

This is especially interesting when one considers current discourse on health care: rising costs, over use, etc. So, a lot more behaviors have been medicalized, requiring pharmaceutical treatments prescribed individually (something that is often presented as a freedom: patient rights, etc.), but at the same time, then rising costs will demand potential cuts in health benefits (see: Medicare upcoming “crisis”). Double whammy.

A last piece of the overall puzzle has to do with the fact that US physicians tend to make more money than their counterparts in other high-income countries, but are also fewer in number (see the data at this post by Echidne):

Doc pay

Echidne argues this has to do with market controls: access to the profession is guarded by gatekeepers, whether medical schools or physicians’ professional associations. And there may be very good reasons for this (medical services are not like other consumer markets). And such greater control turns into greater social power not just in who can join the club, but regarding what is considered the prerogative of the medical profession. Which gets us back to my initial visualization on the DSM.

Strict controls over access and numbers in the profession + expanded territory = power ← this goes both ways, of course, in mutually reinforcing dynamics. And as more socially-based pathologies occur, they “naturally” come under the purview of the currently powerful group dedicated to dealing with pathology in general (as opposed to priests, 300 years ago in Europe, for instance).

The risk society is a medicalized society.

Suicide During The Great Depression:

Roy was one of at least 40,000 Americans who took their own lives that year and the next, the two-year span (1937-1939) that suicide rate spiked to its highest recorded level ever: more than 150 per 1 million annually. They are forgotten people, mostly men, and mostly brushed out of existence by a generation preoccupied by World War II and the post-war boom. Three-quarters of a century after Roy’s death, I sat across from an old family friend, a woman in her 90s, who was eager to share stories of that monumental past – except when it came to my great-grandfather. When I finally asked her point bank if she had known him, her blue eyes focused.

“He killed himself, didn’t he?” she asked, but it was more of a statement than a question. “Every family had a story like that. We never spoke of them. Why would we?”

While those of us who read and study suicide know that the highest levels ever recorded were during the Great Depression, what is surprising about this article is the level of shame and almost denial many families were in then and are still in today about the people (mostly men) who killed themselves during that era. And how in many aspects, not much has changed today.

As I began to look deeper into the story, I carried a couple of assumptions with me. First, I assumed there were likely to have been previous suicide attempts. Second, that Roy’s suicide was linked to the economy. Neither assumption is correct enough, as I learned by talking to Alan Berman, the executive director of the American Association of Suicidology. People see being suicidal as a long-term state of mind, but most people who survive a suicide attempt do not later die by suicide.

Being suicidal is better understood not as a permanent state but as an acute mental crisis. In the cases of public suicides the people committing the act are probably in the grip of magical thinking.

“They think, ‘I will get attention in a world where I am feeling not attended’. What becomes magical is that they are dead; they will never feel attended,” Berman said.

An article I read brought this point home. The handful of people who survived the leap from the Golden Gate Bridge told interviewers that as soon as their feet left the bridge, they regretted the act.

I wrote about the article he mentions more than five years ago in this post.

My second assumption, that “the economy,” had somehow triggered Roy’s act, was not specific or concrete enough. When it comes to understanding suicide (or maybe anything), specificity is important.

Detailed studies of individual cases, or “psychological autopsies,” might help researchers draw conclusions about causes, but autopsies have not been done in large enough volume. So correlations are the best we can do, but they need to be as specific as possible. Suicide is not strongly correlated to the economy, but to unemployment. In the modern era, for every 1 percent increase in the unemployment rate, there has typically been an increase of about 1 percent in the number of suicides, according to Steve Stack, a professor at Wayne State University.

Men still, more than women, define their self-worth by how much money they make and their occupations. That partly goes to explain why the suicide rate is three times higher among men than women.

Stigmas, of course, only have the power we give them. The stigma of unemployment helped send Roy and thousands of other forgotten men to their deaths – and still has an effect today. The suicide rates have spiked again following the onset of the Great Recession, rising to 124 per million in 2010 from 115 per million in 2007. The stigma of suicide is in effect, too: Some of those people will be forgotten.

Of course. In that sense, the stigma, shame, and guilt that is associated with suicide hasn’t changed in 75 years. Or maybe ever.

On the numbers, while it is true that suicides have risen (both in real numbers and in rates) since the Great Recession began, it should also be noted that rates of suicide were rising before 2008 as well (up over 30% from 1999-2010). The author is half-correct in saying that suicide isn’t tied necessarily to the economy, but I think it’s a misnomer to assume that unemployment accelerated what was already an upward trend in suicide to begin with. As I pointed out in this post in May, suicide is up in age and various other demographic groups across the board (those too young or too old to work, among military veterans, the middle age, etc.).

We also need to be careful about assuming the “official” statistics are in fact just that. There are correlations to unemployment and economy, certainly, but no causal evidence.

Nonetheless, the point made by Alan Berman is sobering. Suicide is not a “long-term” state of mind, but in fact a very short, sharp reaction to an acute mental or social crisis (unemployment, divorce, rejection, and so forth). As Berman notes, almost every interview we have with people who have attempted suicide shows an extreme “remorse” about their actions and most will not eventually try it again or die by suicide. As the article from five years ago chillingly noted, almost from the moment people jump over the edge, there is instant regret at the decision.

In that sense, the cliche still stands: suicide is a permanent solution to a temporary problem. As Berman notes, when we can “head off the pathways to suicide” and buy people more time (by restricting access to guns, god forbid, or making it more difficult for people to jump) the more lives will be saved.

As it stands now, we are bordering on 40,000 suicides a year in the U.S., significantly more than die by auto accidents, AIDS or homicide. In fact, at 40,000+, we’re getting into the range of cancer deaths.

And until we reconceptualize suicide as a cancer, we’ll remain powerless to stop the epidemic.

Cross Posted From: The Power Elite

By SocProf.

A few weeks back, the Economist’s Daily Chart feature had this highly informative chart:

Compared to other rich countries, the United States has a whole bunch of health and health care outcomes that are out of whack with the rest of high-income countries especially considering the higher % of the GDP dedicated to health spending.

Yesterday, the Washington Post had a series of graphs on the same topic, zeroing on higher prices for procedures and medications. Here are a few.

Cost differential for a regular doctor visit:

Hip replacement:

Cost per hospital day:


Medication: Nasonex.

And last but not least:

So, higher costs across the board, but poorer outcomes in the end.

As always, the essential sociological question: who benefits? (It’s not a hard one)

By SocProf.

I know this is Todd’s territory here but I found this article on the Portuguese approach to drug policy quite interesting:

“One gram of heroin, two grams of cocaine, 25 grams of marijuana leaves or five grams of hashish: These are the drug quantities one can legally purchase and possess in Portugal, carrying them through the streets of Lisbon in a pants pocket, say, without fear of repercussion. MDMA — the active ingredient in ecstasy — and amphetamines — including speed and meth — can also be possessed in amounts up to one gram. That’s roughly enough of each of these drugs to last 10 days.


“The police still search people for drugs,” Goulão points out. Hashish, cocaine, ecstasy — Portuguese police still seize and destroy all these substances.

Before doing so, though, they first weigh the drugs and consult the official table with the list of 10-day limits. Anyone possessing drugs in excess of these amounts is treated as a dealer and charged in court. Anyone with less than the limit is told to report to a body known as a “warning commission on drug addiction” within the next 72 hours.”

In other words, decriminalization. This was passed in 2000, so, they have had this policy in place for about 12 years. Enough time to have some evaluation.

So, what are the results?

“The data show, among other things, that the number of adults in Portugal who have at some point taken illegal drugs is rising. At the same time, though, the number of teenagers who have at some point taken illegal drugs is falling. The number of drug addicts who have undergone rehab has also increased dramatically, while the number of drug addicts who have become infected with HIV has fallen significantly. What, though, do these numbers mean? With what exactly can they be compared? There isn’t a great deal of data from before the experiment began. And, for example, the number of adults who have tried illegal drugs at some point in their lives is increasing in most other countries throughout Europe as well.”

Not bad. The whole idea is to treat addiction as a disease and not a crime.

What is interesting, from the article, is that the opposition to this law and policies is a based not on the possibility that it might actually work but on the moral idea that people should NOT want drugs and should be punished for wanting to use. It is a puritan argument and that is as far as it goes. There is nothing else:

“”It’s important that we prevent people from buying drugs, and taking drugs, using every method at our disposal,” says Manuel Pinto Coelho, 64, the last great opponent of Goulão’s experiment. Pinto Coelho wants his country to return to normalcy, in the form of the tough war on drugs that much of the rest of the world conducts.”

Of course, it is a war on drugs that does accomplish much except filling up prisons and keeping criminal justice systems overwhelmed with low hanging fruits. Perhaps we should have a Gans-type “functions of drug policy” list.

Again, it is not policy, it is moral standing irrespective of the results. It is interesting to have failing policies defined as “normalcy”.