EU health policy often frames economic competitiveness and public health as conflicting, but they can work hand in hand. Addressing wealth inequality is key to achieving both. When resources are more fairly distributed, societies benefit from stronger economies and healthier citizens. Industries can be profitable while promoting wellbeing, as seen in healthier food systems. By prioritising policies that benefit everyone, we can ensure that economic growth and public health support each other for a thriving future. EuroHealthNet's Senior Research Coordinator, Samuele Tonello, discusses the history of wealth inequalities and the consequences on public health policy.
Following recent developments on EU health policy, there's a clear focus on the economic competitiveness of our continent. Too often, this debate frames maximising the economic performance of our societies as being in contrast with preserving the health of EU citizens. However, not only does no such contrast exist—as a well functioning economy is perfectly compatible with societies where health is considered an absolute value—but this framing also neglects the fact that extreme wealth accumulation poses the biggest threat to both the economic wellbeing of our societies and people's health.
The fundamental question in this debate is: why are our societies so unequal? How can a very small proportion of the population possess a disproportionate amount of wealth while the rest are left with just the crumbs?
A 'normal' societal feature?
It's a compelling truth that extreme inequalities have come to define the modern society in which we live. While the United States is the country most often associated with extreme wealth inequality, Europe is not exempt from this problem. The wealthiest 10% of Europe own 67% of the wealth, while the bottom half of adults possess just 1.2%. And this figure becomes even more staggering when we consider how much wealth is concentrated in the wealthiest 1%.
We have become so accustomed to these extreme inequalities that we almost accept them as a ‘normal’ societal feature. After centuries of a king going around naked, no one questions why he can't put on some clothes.
Ever since my university studies, the balance of power and inequality has fascinated me. Much like people who are fascinated by looking at the stars, I became fascinated by how oligarchs not only always hold so much power, but also how they've created a societal system that legitimises this inequality. What intrigues me most isn't just the fact that less than 1% of the population controls the accumulation of wealth, but that the rest of society accepts this imbalance, even though it causes much of the suffering experienced by ordinary people.
After studying Pareto’s law of income distribution—which demonstrates that the lines representing wealth distribution in different societies were all similar one to another—I wanted to understand more. If this law holds true, there must be a common cause that has shaped and sustained this inequality throughout history.
Pareto believed this was down to social heterogeneity. In an ideal world, where social mobility is perfect, wealth distribution would reflect an individual's qualities that allow them to gain wealth. But in reality, social mobility has always been far from perfect. Those who rise to the top often build systems that protect their privileges at the expense of others. This curve is the result of these qualities and the societal barriers that prevent many from realising their potential.
Like Marx before him, Pareto acknowledged that class conflict was the engine of history. As we remove more of these societal barriers, capable individuals—regardless of social class—are more likely to find their place. At the same time, if we allow wealthy families to build institutions that favour their privileges, less capable individuals will remain in power simply because of the advantages they were born into. Pareto saw this as not only unjust but harmful to the whole of society.
Let's hypothetically take the idea of a new ‘Albert Einstein’ who could be born anywhere. For society to function at its best and be equal, we must make sure that even if this person is born in the poorest suburb of the poorest city, then they can still reach their full potential. At the same time, we can't let incapable individuals continue to hold positions of power simply because they benefit from certain societal advantages such as wealth, gender, or race. It goes without saying that we’re still far from achieving this ideal society. But why?
Wealth inequalities: are they unavoidable?
Historically, Aristotle warned about the threat of ‘oligarchy’, explaining that those in power would only care about their own private interests rather than the public good. More recently, Steve Winters published an incredible historical analysis titled ‘Oligarchy.’ In it, he focuses on wealth accumulation and describes oligarchs as “actors who command and control massive concentrations of material resources that can be deployed to defend or enhance their personal wealth and exclusive social position." Using examples from ancient times to the present day, he brilliantly demonstrates that oligarchies have been a constant feature of all societies.
Wealth inequalities seem to be an unavoidable constant in human society. The king has always been naked. However, if we analyse oligarchic behaviour, there is a difference between societies and historical periods.
The defence of their wealth is the main focus for oligarchs, but this has never been a simple task. To different degrees, there has always been a small part of society asking, “Wait, wait, wait. Why should this person own so much wealth?”.
For long stretches of history, oligarchs responded to this question quite simply. Using brute force and armed militias to destroy any opposition—a good recipe for silencing annoying questions. In recent times, however, such strategies have become too costly and unreliable. This might seem like good news because it means that today's oligarchs, those at the top of big industries, face more challenges in defending their wealth than that of a mediaeval lord, right?
Well, actually no. On the contrary, it has become easier. Oligarchs have more rights to defend their property than even before, and they can now rely upon what Winters calls an “income defence industry." This is the modern version of the old armed militia, and it is composed of lawyers, lobbyists, complacent politicians, colluded scholars, etc. whose focus is keeping as much of oligarchs’ property and income outside the hands of the state.
A focus on material wealth is important because it shows that oligarchies do not necessarily need political power. If their wealth is not threatened, they do not need to interfere with governance. However, the more their wealth is attacked, the stronger the response of the ‘income defence industry'.
This point is pivotal from a governance perspective, since Winters’s historical analysis also demonstrates that the better societies have managed to tame the oligarchic thirst for wealth accumulation, the better they function. So, the presence of oligarchies is a constant in any society, but not all oligarchies have been equally powerful and harmful to the common good.
For example, a big achievement of several western democracies is that by redistributing political power throughout society, they had also initially managed to limit wealth accumulation. However, oligarchies did not twiddle their thumbs, and from the 80s onwards, they managed to develop the strongest ‘income defence industry’ ever seen.
Framed in the neoliberal paradigm/ideology of minimising state interventions in economic activities, labour and financial markets, commerce, and investments, they managed in a few decades to restructure the political governance of most countries, leading to, from an oligarch’s perspective, a great success. Not only are oligarchs richer than ever before, but neoliberal political governance makes their lives as easy as ever.
The consequence for public health policy
After decades of napping, public health has finally realised that big corporations’ tactics to maximise their profit are damaging people’s health, and we are now seeing a big increase in the literature on the commercial determinants of health—strategies and approaches used by the private sector to promote products and choices that prioritise profit over individuals' right to health.
Polluted environments, unhealthy food systems, poor housing, etc. are bad policies from a public health perspective, but they are excellent to maximise profits. To take just one of the many examples, the literature is now clear that ultra processed foods (UPFs) and foods high in fat, sugar, and salt (HFSS) have a serious impact on people’s health. At the same time, they are becoming so prevalent because they are extremely profitable for food corporations. This leads to a conundrum at the policy level: can public health requests be reconciled with the interests of big corporations?
On the one hand, public health organisations are asking governments to implement regulations that restrict these products. These include taxing HFSS food, investing in public procurement of food in schools, limiting marketing of unhealthy foods, and subsidising the purchase of fruit and vegetables, etc. On the other hand, food industries ask for less red tape, deregulations, and self-voluntary approaches. Thus, the conundrum.
At both the European and national level, a multi-stakeholder approach is still the dominant rhetoric to solve this conundrum. In a nutshell, all actors are listened to to find a common ground that satisfies everyone.
The problem is that this approach is naively neglecting how oligarchies behave. Any request to limit wealth accumulation on grounds of public health will be seen by oligarchies as a threat to their material wealth and thus attacked. The more oligarchies come under threat, the more they will unleash their industrial defenses to protect their interests. A quick look at the lobby expenses at the European level and the efficiency of the various lobby groups, and it is immediately clear that oligarchies take this action very seriously. Public health actors, by contrast, often have far fewer resources, which typically leaves them at a disadvantage.
Promoting health and wellbeing
Importantly, this does not mean that there is an inherent clash between economic wellbeing and health. The two are perfectly compatible, as it is now promoted by frameworks as the Economy of Wellbeing. On the contrary, it is exactly the framing that pictures this clash that is one of the main commercial determinants of health out there.
What is instead impossible is to enjoy both economic wellbeing and health in a scenario where extreme wealth accumulation is not tamed. Therefore, if we want to properly tackle the commercial determinants of health, wealth power must be singled out as a specific threat to public health policy. Doing so allows us to focus all efforts on taming such interference, insulating the political process from lobbying and external interference.
There is no contrast between health and economic competitiveness on our continent. The contrast is between extreme wealth accumulation and all other factors. As for any society in history, we must acknowledge this threat and limit its influence on the policy process. Only then is it possible to preserve the common good of current, and even more importantly, future generations.
More information
Read more from Samuele on this topic in the latest edition of Eurohealth magazine.
Samuele Tonello
Samuele is focused on strengthening the capacity of EuroHealthNet research platform to enhance associate members’ knowledge related to EU policy processes and instruments, while also cooperating with the Policy platform to help ‘translate’ EU policies into researchable actions and to facilitate scientific excellence of EuroHealthNet’s outputs.