Regimes of Inequality

Regimes of Inequality: The Political Economy of Health and Wealth

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Inequality has become an intractable feature of the rich industrialized democracies, despite consensus among mass publics and experts that more social and economic equality is desirable. This book examines the political dynamics underlying the “new normal” of high and rising inequality since 1980. To do so, it traces the largely unsuccessful attempts of west European governments during this period to reduce socioeconomic inequalities in health. In England, France, and Finland, three quite different countries that span the range of European political economies, governments stated their intention to reduce inequalities in health — yet in all three cases, they were largely unable or unwilling to do what it would take to achieve this goal. I use data drawn from process tracing case studies, in-depth interviews, and content analysis of government reports and mass media to understand why. I argue that when center-left politicians take up the issue of socioeconomic inequalities in health, they do so in response to perceived taboos against redistribution, public spending and market regulation in a neoliberal era. Reframing inequality as a matter of health, rather than of the maldistribution of political or economic resources, is at best a partial solution, however: It reshapes the policy-making environment surrounding social inequality in ways that make it more difficult to reduce either socioeconomic inequality or health inequalities. Technocratic, medicalized inequality discourses result in shifting the Overton window around inequality away from tried-and-true policy remedies for inequality, and toward complex policy levers that are far more likely to fail.

Regimes of Inequality: The Political Economy of Health and Wealth presents a theory of welfare state change grounded in regime analysis, providing an updated assessment of the functioning of welfare regimes in a neoliberal era. It further argues that inequality persists despite growing awareness of the harms it creates because of the way political leaders choose to talk about it — and not only because of economic necessity or demands from the electorate. Bringing together theories and approaches from political science and public health, it analyzes how welfare regimes, partisan configurations, and neoliberalism affect population health outcomes.


“Julia Lynch has written an extremely clever and timely book…. Building on a formidable scholarly profile, she provides an original and often brilliant account of how health and wealth are not only closely related in modern democracies, but constitute distinct regimes and patterns of inequality across these states… Regimes of Inequality is a superbly written and cogently argued book which will rapidly become required reading for scholars of comparative politics.”

–Desmond King, University of Oxford

“An insightful and novel analysis of the evolution of health inequalities policies in Europe from the leading political scientist in the field. An important read for the global public health community”

–Clare Bambra, Newcastle University

“A much-needed critical assessment… It should cause those involved in developing policy responses to health inequalities, as well as those trying to influence these responses, to reflect on what they are proposing and why. As Lynch concludes, the policy levers for tackling inequality are clear; the question is whether policymakers are bold enough to use them.”

–Katherine Smith, University of Strathclyde

“While inequalities are so prominent in the political and academic agenda, very few books are able to trace the politics of inequalities as Regimes of Inequality does. Lynch takes an original and definitively convincing approach to show how studying the policy-making surrounding health inequalities provides us with an understanding of how and why inequalities have increased so much since the 1980s.”

–Bruno Palier, Sciences Po

“In this eloquent and meticulously researched book, Julia Lynch shows that health outcomes in advanced countries are inextricably linked to broader patterns of social and economic inequity. Equally important, she demonstrates that these patterns are not inexorable products of impersonal economic forces, but rather stem from political choices. For Lynch, then, the pathologies of health inequality are not fundamentally economic or physiological, but political. A deeply impressive achievement that revamps our understanding of the relationship between health and wealth and the implications of this relationship for capitalism and democracy.”

–Mark Vail, Tulane University

“Lynch’s book brings political science to a field of public health advocacy and policy that desperately needs it, showing the health inequalities world their existential challenge while bringing a central concern of the last three years of social policy into debates about inequality and politics that somehow missed it. Nobody will fail to learn from this book. Nobody will escape being challenged by it. And if there is such a person, they can still learn about how to write clearly across countries, disciplines, and ideas. Inequality is a focus of political scientists and economists today, but politically engaged health researchers got there thirty years ago. Lynch’s book chronicles the effort to make health inequalities a lever to change politics. Their failures, and occasional successes, should shape our thinking about how to put inequalities onto political agendas.”

–Scott Greer, University of Michigan

“A milestone in research…. Using analytical tools of political science that are often neglected by academic followers of fashion, [Lynch] examines multiple case studies based on a sophisticated understanding of the evidence base that connects health inequalities with their economic substrates. A must-read for all scholars, practitioners, and advocates concerned with this topic.”

— Ted Schrecker, Newcastle University


Related Journal Articles

Lynch, J. 2017. Reframing inequality? The health inequalities turn as a dangerous frame shift. Journal of Public Health 39(4), pp.653-660. [link]

Lynch, J.F. and Perera, I.M. 2017. Framing health equity: US health disparities in comparative perspective. Journal of Health Politics, Policy and Law 42(5), pp.803-839. [link]

Lynch J. 2016. “Class, Territory, and Inequality: Explaining Differences in the Framing of Health Inequalities as a Policy Problem in Belgium and France.” French Politics 14:1, pp. 55-82. [link]

Related Media

“New TWIHL with Julia Lynch” by Nicolas P. Terry for The Week in Health Law podcast

“What Europe Tells Us About Why We Haven’t Fixed U.S. Health Inequities” by Hoag Levins for Penn LDI eMagazine

“Why Framing Inequality as a Health Problem May Make it Harder to Fight” by Julia Lynch for Social Science Research Council

Blog post by Julia Lynch for Society for the Advancement of Socio-Economics (SASE)