Health and human rights in Europe?

Martin McKeeLondon School of Hygiene and Tropical MedicineEuropean Observatory on Health Systems and Policies

England’s green and pleasant land

… gave way to the dark, satanic mills

Two nations

“Two nations between whom there is no intercourse and no sympathy; who are as ignorant of each other's habits, thoughts, and feelings, as if they were dwellers in different zones, or inhabitants of different planets. The rich and the poor.”

Benjamin Disraeli

Even in the same house

A baptism of fire

2nd Lt Harold McMillan

All in it together

A shared tragedy/ Eine gemeinsame Tragödie

John Rawls: A theory of Justice

Citizens’ representatives are placed behind a “veil of ignorance” that prevents them from knowing the characteristics of those whom they represent

In these circumstances they will adopt the “maximin” position, making the choice that produces the highest payoff for the least advantaged

... as they must assume that those they represent could be the least advantaged

A world turned upside down

Hamburg, 1945

The result: the European social model

A system of transfers From rich to poor From young to old From employed to

unemployed From healthy to ill

Right and left

But in the USA it was no more than a dream…

“I have a dream that one day, down in Alabama, with its vicious racists … little black boys and black girls will be able to join hands with little white boys and white girls as sisters and brothers.”

Martin Luther King

Healthcare not for all

Race and welfare, by US state

Source: Alesina, 2004

Less divided societies

Alesina & Glaeser (2004)

But is it really race? Support for welfare higher among

people who live near to many welfare recipients of the same race Geographic isolation may be a cause of

“separate-group” thinking. Support for welfare lower among

people who live near to welfare recipients of another race People have a hostile reaction to

recipients of another race, but sympathetic reaction to recipients of the same race

Support for welfare greater among whites who “have …had a black person for dinner in

your home in the last few years?”Source: Luttmer, 2001/ Alesina 2003

2008

Never waste an opportunity

Repeatedly, neo-liberal politicians have taken advantage of crises to undermine social solidarity

In some countries they are rubbing their hands with glee in the current economic crisis

How to reduce a deficit (not)

Increase tuition fees and set up student loan system that costs more than what it replaced

Remove child benefit from higher rate taxpayers so 500,000 more people have to complete self-assessment forms

Cull QUANGOs and spend millions in redundancies, and then rehire people

But there is a reason...

Even though means testing introduces complexity, costs money to administer, and lets people fall through gaps

Removal of middle classes from welfare system erodes support for welfare Strong support for welfare in Scandinavia with

universal benefits Low support for welfare in USA with poverty

relief Richard Titmuss “A service for the poor is a

poor service”

But you also need the undeserving poor

The Muslim population in Europe

1-2%

2.1-5%

60-20%

No data

<1%

>20%

But not just “foreigners”

Percentage of population over 65

How to host a tea party

The fundamental question

Who are we? And who are we not?

History repeating itself?

Greece

Inclusion or exclusion?Switzerland and Belgium

… and these views attract widespread support here

The need to speak outAls die Nazis die Kommunisten holten,habe ich geschwiegen;ich war ja kein Kommunist.

Als sie die Sozialdemokraten einsperrten,habe ich geschwiegen;ich war ja kein Sozialdemokrat.

Als sie die Gewerkschafter holten,habe ich nicht protestiert;ich war ja kein Gewerkschafter.

Als sie die Juden holten,habe ich geschwiegen;ich war ja kein Jude.

Als sie mich holten,gab es keinen mehr, der protestieren konnte.

When the Nazis came for the communists, I remained silent;I was not a communist.

When they locked up the social democrats,I remained silent;I was not a social democrat.

When they came for the trade unionists,I did not speak out;I was not a trade unionist.

When they came for the Jews,I remained silent;I wasn't a Jew.

When they came for me,there was no one left to speak out.

Martin Niemöller

Rudolf Virchow

“medicine is a social science, and politics is nothing but medicine on a grand scale”

“making ordinary lives richer and healthier"