Professor Martin McKee's presentation to the SHOEs conference in Sandwell on 28 March 2014

1. Health and human rights in
Europe?
Martin McKee
London School of Hygiene and Tropical Medicine
European Observatory on Health Systems and
Policies

2. England’s green and pleasant land

3. … gave way to the dark,
satanic mills

4. 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

5. Even in the same house

6. A baptism of fire
2nd
Lt Harold McMillan

7. All in it together

8. A shared tragedy/
Eine gemeinsame Tragödie

9. 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

10. A world turned upside down
Hamburg, 1945

11. 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

12. Right and left

13. 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

14. Healthcare not for all

15. Race and welfare, by US state
Source: Alesina, 2004

16. Less divided societies
Alesina & Glaeser (2004)

17. 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

18. 2008

19. 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

20. 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

21. 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”

22. But you also need the
undeserving poor

23. The Muslim population in
Europe
1-2%
2.1-5%
60-20%
No data
<1%
>20%

24. But not just “foreigners”

25. Percentage of population over 65

26. How to host a tea party

27. The fundamental question
 Who are we?
 And who are we not?

28. History repeating itself?

29. Greece

30. Inclusion or exclusion?
Switzerland and Belgium

31. … and these views attract
widespread support here

32. The need to speak out
Als 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

33. Rudolf Virchow
“medicine is a
social science,
and politics is
nothing but
medicine on a
grand scale”

34. “making ordinary lives richer
and healthier"