Julia Lynch’s Regimes of Inequality represents a welcome addition to the burgeoning literature on the politics of inequality in liberal democracies. Like many recent contributors to this literature, Lynch struggles with the puzzle—call it the “Piketty puzzle” (Thomas Piketty, Capital and Ideology, 2020)—of why it is that democratically elected governments have not done more to counteract the concentration of income at the top of the income distribution. In parallel, she brings to the fore another puzzle, the “Lynch puzzle”: in Britain, France, and Finland alike, apparently determined government efforts to reduce health inequalities have made very little difference.
We can distinguish two quite separate strands of research on the politics of income inequality. One strand focuses on how inequality affects the policy preferences and political behavior of citizens. According to scholars pursuing this path, the key to the Piketty puzzle is that rising inequality has not been accompanied by any significant increase in public support for redistribution. Citizens misperceive inequality, they consider unequal rewards to be fair, they do not believe that government can fix the problem, or they consider other (“cultural”) issues to be more salient. The second strand of research focuses on income bias in the responsiveness of elected politicians and other policy makers to citizens’ demands, suggesting that this responsiveness has become more unequal with rising income inequality.
Lynch makes an important contribution to the literature on the politics of inequality by bringing health inequality into the picture (a prescient move, indeed, in light of the pandemic of the last year). Equally important, she contributes to this literature by articulating a new approach to the politics of inequality. In contrast to the preferences-for-redistribution and the unequal-responsiveness literatures, the question of how political elites—in the first instance, elected politicians but also civil servants and other policy advisers—understand “the problem of inequality” occupies center stage in Lynch’s approach to the politics of inequality. More specifically, Lynch insists that the way that politicians frame the problem of inequality defines the set of feasible policy options (the “Overton window”) and also shapes the effectiveness of their efforts to reduce inequality.
The three country chapters that constitute the book’s empirical core are primarily concerned with the question of where policy frames come from and the process through which they change. In each of these chapters, Lynch shows how center-left political parties and other progressive political forces have reframed the problem of inequality to render it more consistent with the neoliberal economic policy paradigm that has prevailed since the 1980s (Britain) or the 1990s (France and Finland). The British story, as retold by Lynch, is a simple one: convinced that traditional redistributive policies were no longer economically or politically viable, New Labour reframed the problem of inequality in terms of health, rather than income and wealth. Although the “social determinants of health” policy frame adopted by the WHO and the EU in the 1990s resonated with the Blairite agenda of investing in human capital and equalizing opportunities rather than outcomes, combating health inequality also served as a means to bridge divisions within the Labour Party. The French and Finnish stories are more complicated to the extent that center-left parties have been less explicit in abandoning redistribution. Here Lynch’s reframing story is about the reframing of the problem of health inequality, rather than of the problem of inequality writ large, with the framing of health inequality shifting from unequal access to health care (primarily of a territorial nature) to “upstream” (socioeconomic) sources of health inequality. According to Lynch, this reframing of the problem of health inequality was in both countries a response to budget and regulatory constraints associated with European integration and neoliberalism.
Center-left governments made combating health inequality a priority in the 1990s and 2000s, yet these efforts did not make much, if any, dent in the underlying problem. Lynch argues persuasively that this failure reflects not only the complexities of the policy initiatives that governments launched, involving coordination across policy domains and between national and local authorities, but also lack of adequate funding and, above all, the failure to tackle the upstream determinants of health; in other words, the failure to do something about income inequality. As Lynch points out, there is a curious puzzle here, because the public health policy frame that informed the new policy initiatives very much emphasizes social-economic inequality as the source of health inequality. In one of Lynch’s formulations (p. 82), politicians either did not fully understand the premises and implications of their policy frame or they were simply engaging in “cheap talk,” and it is next to impossible to parse between these interpretations. In a slightly different formulation, Lynch suggests that policy making “tends to drift downstream” in the implementation phase “to more familiar medical and behavioral interventions that have already proven ineffective” (p. 203).
In light of the shortcomings of governmental efforts to tackle the social determinants of health, one might well wonder whether “policy frames” really deserve the analytical primacy that Regimes of Inequality seems to assign to them. More pointedly, I am struck by the contrast between the health policy and economic policy that emerges in the course of Lynch’s case-study narratives. Although the new health policy frame does not seem to have had a lot of impact on what governments actually did, the neoliberal economic policy paradigm seems to have been very constraining indeed. By my reading, this book teaches us that some “policy frames” are more impactful than others. Though Lynch does not explicitly address the contrast between health policy and economic policy, my hunch is that she would agree with me that what distinguishes more impactful policy frames has to do with the economic interests that support them.
The three countries featured in Regimes of Inequality were selected because they each represent one of the types of welfare states identified by Gøsta Esping-Andersen in The Three Worlds of Welfare Capitalism (1990). By her own account, Lynch expected the politics of health inequality to vary across welfare-state regimes. To some extent, the book seeks to rescue this idea by arguing that the “collision” between neoliberalism and welfare-state institutions has generated different political taboos in the three countries: a taboo against redistribution in Britain, a taboo against increased government spending in France, and a taboo against government regulation of markets in Finland. When all is said and done, however, I am not convinced that “taboo specificity” is such an important part of Lynch’s case-study narratives. I am more impressed by the cross-national similarities that her careful process tracing uncovers: in all three cases, mainstream left parties looked to health care as an opportunity to assert their commitment to egalitarianism in an economic and electoral environment that they perceived to be hostile to the redistribution of income, and in all three cases, they failed to make any significant dent in health inequalities.
In closing, I want to commend Lynch’s ambition to think of politics in terms of linkages between different types of inequalities. There is no obvious reason why this ambition should not be extended to encompass other types of inequality—wealth as well as income, and education as well as health—and the “group dimension” of inequality (class, race and gender). Featured in the title of the book, the concept of “regimes of inequality”—a term that Piketty (2020) also employs—represents an invitation to reflect further on the political sources and consequences of the ways that inequalities are bundled.
