Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
Advertisement
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
Editor’s Briefing

The Political Determinants of Health

Euan Lawson
British Journal of General Practice 2020; 70 (701): 571. DOI: https://doi.org/10.3399/bjgp20X713525
Euan Lawson
BJGP
Roles: Acting Editor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info
  • eLetters
  • PDF
Loading

Joe Biden will be the 46th President of the US and one of his first actions after winning the election was to lay out plans for his COVID Taskforce. The political and the medical are inseparable. A presidential election is polarising but, increasingly, the calculus of COVID-19 is conducted in base two. Everything is 0 or 1. We argue about the economy or lives; GP practices are portrayed as open or closed; the Great Barrington Declaration is set against the John Snow Memorandum; and we agonise over the false dichotomy of lockdown versus freedom. It’s all black or white. Yet medical practice is colourful, subtle, and complex; nuanced and blotted in uncertainty. Populism’s palette doesn’t extend to such shades.

Sandel sets out to diagnose the root causes of populism and turns his gaze on meritocracy in The Tyranny of Merit.1 We are immersed in it; the meritocratic drivers in society no more apparent to us than water to a fish. While there is an obvious argument in favour of the most capable being picked for any given role, as Sandel points out there is a dark side to meritocracy: ‘In an unequal society, those who land on top want to believe their success is morally justified. In a meritocratic society, this means the winners must believe they have earned their success through their own talent and hard work.’ In any meritocracy there are losers and they are likely to be humiliated and resentful. The winners have little sympathy and the overall result is ‘corrosive of commonality.’

Professor Ilona Kickbusch from the Global Health Centre in Geneva teased out the political determinants of health in The Academy of Medical Sciences and The Lancet International Health Lecture 2020.2 She put forward the association between populist-leaning governments and the ability to cope with COVID-19, culminating in excess deaths. A pandemic stresses the economic, political, and social fracture lines, and meritocratic tenets impact how society respond to people who are undeserving. Benefits for the unemployed or disabled are pared back. And what if you are a smoker? Or you inject drugs or are street homeless? The inevitable and inescapable corollary of meritocratic achievement is personal blame, seldom an effective health strategy.

Importantly, a meritocracy doesn’t address inequalities — it offers self-justification for those on the top of the heap and opprobrium for the rest. Not having a college education is an excellent marker of whether someone would vote Trump (or Brexit) and is bundled with a high risk of drug-related deaths, another epidemic. The post-nominal fetish in medicine confirms how we are beholden to the credentials beloved of meritocrats. We need to be wary of casual discrimination that implies these people are stupid. They are not. Sandel again: ‘… at a time when racism and sexism are out of favor (discredited though not eliminated), credentialism is the last acceptable prejudice.’

  • © British Journal of General Practice 2020

REFERENCES

  1. 1.↵
    1. Sandel MJ
    (2020) The Tyranny of Merit: What’s Become of the Common Good? (Allen Lane, London).
  2. 2.↵
    https://acmedsci.ac.uk/policy/policy-projects/international-health-lecture-2020 (accessed 11 Nov 2020).
View Abstract
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 70 (701)
British Journal of General Practice
Vol. 70, Issue 701
December 2020
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Political Determinants of Health
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The Political Determinants of Health
Euan Lawson
British Journal of General Practice 2020; 70 (701): 571. DOI: 10.3399/bjgp20X713525

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
The Political Determinants of Health
Euan Lawson
British Journal of General Practice 2020; 70 (701): 571. DOI: 10.3399/bjgp20X713525
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • REFERENCES
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Highlights
  • Legislating for the Future: Reshaping Laws
  • Highlights
Show more Editor’s Briefing

Related Articles

Cited By...

Advertisement

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2021 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242