On Inequalities
I think the idea that health differences are unjust or unfair is the principal
reason advanced for policy action. Not only is it unfair at a point in time but
it is unfair across the life course and across generations via the reproduction
of inequality. Are Margaret Whitehead's categories useful? She says : A natural
biological variation in health, randomly distributed through the population
would not be unfair; neither would variations in health that resulted from
freely chosen behaviour, such as participation in organised sports and pastimes.
However, health-damaging behaviour where the degree of choice of lifestyles is
severely restricted, exposure to unhealthy living and working conditions, and
inadequate access to essential health and other public services, are avoidable,
and the resultant health differences are unjust.
On Power
Is Steven Lukes' 1974 three dimensions of power still useful? I think so. The
first dimension comes from Dahl- that "the behaviours of one or more units (the
responsive units, R), depend in some circumstances on the behaviour of other
units (the controlling units, C)". This view relies on a mechanistic view of
power as a force operating in a situation of conflict.(Is this Ken Thompson's
example? - to get what you desire against opposition) Lukes second dimension is
drawn from Bachrach and Baratz, there is also non decision-making, which limits
the scope of actual decision-making by controlling the agenda, thereby limiting
the discussion to issues that do not affect C's interests. The absence of a
challenge does not mean power is not being exercised, as the responsive unit may
elect not to challenge in anticipation of defeat. Lukes argues that the emphasis
on observable behaviour leads to study of decision-making, in particular where
there is a difference in preference, that is, in conflict. However, if power
only shows up in cases of actual conflict, it follows that actual conflict is
necessary to power. But this is to ignore the crucial point that the most
insidious use of power is to prevent such conflict from arising in the first
place. So the third dimension - Lukes says A exercises power over B also by
influencing, shaping or determining B's very wants; controlling thoughts and
desires; preventing nondecisions by shaping perceptions, cognitions and
preferences in a way that roles are accepted either because people can not see
or imagine an alternative or they see it as natural and unchangeable or they
value it as divinely ordained and beneficial. (Is this Barbara Starfield's
response to Ken? "those that lack the most expect the least".
Brian Fleming
Adelaide
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