Oh Bruce. You're above this, surely.
^This remark comes to mind...
As anyone who has managed a 2:2 in first-year uni can understand, the answer to structure vs. agency questions is always "a little bit of both."
It is so obvious as to go without saying that people who neglect their health, abuse drugs and alcohol, mistreat their families, commit petty crimes, or carry out any of the other symptoms associated with poverty and discrimination, bear responsibility for their individual choices. Even among the most prosperous and close-knit communities, people still do cause harm to others and/or themselves.
But when pondering why, for instance, the once prosperous and close-knit industrial communities that for decades drove the economies of the United States and Britain are now national epicentres of the traits I list above, is the suggestion that everyone has simply become less moral than they were before really a satisfying explanation? Might not there be some sort of larger structural forces at work as well?
Is it such a stretch to accept that people who grow up in places characterised by unemployment; low levels of education; poor public services; social and geographical isolation; class prejudice; drug and alcohol abuse; obesity; poor quality food, water, and air; broken families; poverty and despair are more likely than a roomful of public schoolboys to perpetuate these kinds of poor decisions?
Or perhaps, conversely, you really want to see the logic of your post through. Perhaps desperately poor and uneducated agrarian societies like Vietnam, Taiwan, China, or South Korea elevated themselves not through careful state planning and investment designed to lift the common good, and instead, through everyone collectively putting down the Little Red Book and picking up prosperity gospel cliche peddlers like the 1950s equivalent of Jordan B. "Rosa Parks of Pronouns" Peterson, before which time it had never occurred to anyone to work hard and
stand up straight with your shoulders back.
The government can't do much about individual morality and responsibility. But it can and has done much to affect the social and economic conditions in the places described above, and not in their favour. And it could do even more still to improve them, if we could muster the political will.
I've mentioned this several times before (so forgive me), but the latest social science research on community health overwhelmingly indicates that social conditions and perceptions have almost as much impact on an individual's expected health outcomes as any other factor (and I could post a hundred links to this effect if I thought anyone would read them). In Canadian med school, for instance, the first thing anyone learns is that the opposite of health is anomie and inequality. Even the algorithms responsible the MayBot
have recognised this.
The NHS serves as a catchment basin, where all the social ills of post-Thatcher Britain are channeled and concentrated. Yet it has only the means and mandate to address their symptoms (poor health) rather than their largely social and political root-causes.
To improve the public health, it would be much easier and cheaper for America and Britain to think beyond the usual token end-level spending formula tweaks or PFI contract term adjustments, and to instead do what they can to ensure everyone has the same access to healthy food, clear air and water, exercise facilities, quality education and community services, and a realistic shot at a desirable future. To consider health care holistically, in other words (a cliche which I use here advisedly). It's a lot cheaper, more sensible, and better all around to have children eat broccoli early on than it is to administer gastric bypasses and treat their adult-onset diabetes. Sure, not everyone will immediately put the lager down and start reading at night to their children, but government policy the world over can and have served as the driving force in turning chronically deprived places around.
Similarly, though the UK is clearly determined to render itself as marginal and deprived as possible via austerity and Brexit, we could address our chronic and critical productivity gap not by writing off an entire social class as unworthy degenerate chavs, but by emulating Europe rather America, and actually investing in its people. The current method of deploying the state to siphon public wealth into private hands while loading everyone else up with unaffordable bills and credit card debt has bot exactly done wonders in that regard, has it? We've saw where laissez-faire responses to social alienation led us in the 1930s, and it's not a comfortable place for people like you and I.
But as I've said before, meaningful policy change goes beyond the threshold of what the lunchtime-at-Pret-with-The Economist-smartphone-app crowd is willing to countenance. They're likely to continue mindlessly channeling the common wealth to their small coterie of plutocrat patrons, and, bypassing polite chartist constitutionalists like Sanders or Corbyn, lead us headlong toward Trump and beyond.