Income inequality, social cohesion, and class relations: A critique of Wilkinson's neo-Durkheimian research program

Wilkinson's "income inequality and social cohesion" model has emerged as a leading research program in social epidemiology. Public health scholars and activists working toward the elimination of social inequalities in health can find several appealing features in Wilkinson's research. In particular, it provides a sociological alternative to former models that emphasize pov erty, health behaviors, or the cultural aspects of social relations as dete rminants of population health. Wilkinson's model calls for social explanati ons, avoids the subjectivist legacy of U.S. functionalist sociology that is evident in "status" approaches to understanding social inequalities in hea lth, and calls for broad policies of income redistribution. Nevertheless, W ilkinson's research program has characteristics that limit its explanatory power and its ability to inform social policies directed toward reducing so cial inequalities in health. The model ignores class relations, an approach that might help explain how income inequalities are generated and account for both relative and absolute deprivation. Furthermore, Wilkinson's model implies that social cohesion rather than political change is the major dete rminant of population health. Historical evidence suggests that class forma tion could determine both reductions in social inequalities and increases i n social cohesion. Drawing on recent examples, the authors argue that an em phasis on social cohesion can be used to render communities responsible for their mortality and morbidity rates: a community-level version of "blaming the victim." Such use of social cohesion is related to current policy init iatives in the United States and Britain under the New Democrat and New Lab or governments.