Corporealising a Healthy Democracy? Inequality, Bodies and Participation

ABSTRACT

Socio-economic inequality is associated with differentiated levels of health and poor health affects political participation; inequalities are embodied in political life. This contribution, focusing on South Africa, attends to the impact of exposure to environmental hazards and stigmatisation of unhealthy bodies on political participation. The corporealisation of a healthy democratic politics demands not (only) the inclusion of different bodies, but opportunities to radically contest the prevailing socio-political institutions, economic mechanisms and disciplinary norms that make some bodies healthier than others.

KEYWORDS:

• Inequality
• health
• democracy
• political participation
• deliberation

Acknowledgment

We thank Bjørg Evje-Olsen, Øystein E. Olsen and Rod Dacombe for their critical comments and advice on earlier versions of this text.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Source: World Bank. See Gini Index https://www.indexmundi.com/facts/indicators/SI.POV.GINI/rankings. The Gini coefficient is an indicator of total income inequality. A Gini coefficient of 0 implies perfect equality, an index of 1 implies perfect inequality.

2 See http://www.unaids.org/en/regionscountries/countries/southafrica.

3 As Muller et al. summarise

A fundamental cause of lead exposure is a weak regulatory environment … residential segregation, concentrated poverty, discrimination in housing markets, neighbourhood disinvestment, and a limited array of options for tenants seeking to remove lead from their neighbourhoods are also fundamental causes. (2018, p. 274)

4 Hailed as the ‘most important recent advance’ in the ethics of priority setting in health’ (Ford, 2015, p. 217) and as possibly ‘the dominant paradigm in the field of health policy’ (Friedman, 2008, p. 102) the ‘accountability for reasonableness’ approach (AFR) promoted by Norman Daniels and James Sabin offers a Rawlsian deliberative approach to decision-making. AFR demands ‘fair procedures’ and ‘opportunities to challenge and revise decisions in light of the kinds of considerations all stakeholders may raise’ (Daniels, 2000) and suggests that resource allocation decision-making processes in heathcare should satisfy the three conditions of ‘publicity, relevance, and revisability’(Daniels et al., 2008). Despite its prominence, AFR has been criticized for the assumption that fundamental disagreement can be resolved in a ‘reasonable’ way (Friedman, 2008, p. 106) and that the ‘reasonableness’ of an outcome can be established (Ford, 2015, p. 226). Little attention, it seems, has been paid to another implicit assumption of AFR, namely that all stakeholders, including those in need of health care, actually can participate in the deliberative process of determining the fair ‘rationing’ of health care (Daniels & Sabin, 2008).

Additional information

Notes on contributors

Amanda Machin

Amanda Machin is an interim professor of International Political Studies at the University of Witten/Herdecke in Germany. She researches the topics of environmental politics, agonism, citizenship, embodiment, nationalism and ecology and is particularly intrigued by the implications of the recent diagnosis of the Anthropocene for models and institutions of democracy. She has published in journals such as Environmental Politics, Environmental Values and Democratic Theory and her books are Society and Climate: Transformations and Challenges (World Scientific 2019, co-authored with Nico Stehr) Against Political Compromise: Sustaining Democratic Debate (Routledge 2017, co-authored with Alexander Ruser) Nations and Democracy: New Theoretical Perspectives (Routledge 2015) and Negotiating Climate Change: Radical Democracy and the Illusion of Consensus (Zed Books, 2013).

Alexander Ruser

Alexander Ruser is a professor of Sociology at Agder University in Kristiansand, Norway. Previously he was temporary professor for Sociology and Social Structure Analysis and the scientific head of the Centre for Political Communication at Zeppelin University Friedrichshafen (Germany). He holds a PhD in Sociology from the Max-Weber-Institute of Sociology at Heidelberg University and was a Dahrendorf Postdoctoral Fellow at the Hertie School of Governance in Berlin, the London School of Economics and Political Sciences and a visiting fellow at Punjab University, Chandigarh (India). His research focuses on the various roles, empirical questions and theoretical implications of ‘science in society’, the role of experts in climate politics and the impact of ‘knowledge’ on social inequalities and decision-making. Alexander has published in peer-reviewed journals such as Global Policy, Innovation, Current Sociology, The International Journal of Politics, Culture and Society and the Journal of Civil Society. His most recent book is Climate Politics and the Impact of Think Tanks Scientific Expertise in Germany and the US (Palgrave, 2018). E-mail: [email protected]