By 1997 , 401 pages , ISBN: 978-0304336289. Published by Cassell , London ,
Reviewed by Peter Tait
Ecology and Environment Convenor, PHAA
This not-so-recent book by political philosopher and economist Takis Fotopoulos contributes to public health understanding and action on addressing the bigger picture social determinants of health by providing an expanded analysis of ‘the problem’ and some concrete thoughts about how that might be usefully and practically addressed. In fact, it provides a method for achieving the recommendations of the Commission on Social Determinants of Health recommendations, particularly their overarching second which addresses inequitable distribution.1
The problem, which Fotopoulos names the ‘multidimensional crisis’– defined as market driven ecological and social destruction – is consequent to the globalised market economy. Market economy means growth economy; growth is inherent in sustaining ongoing production and consumption. The first part of the book outlines this, generally from a post-Marxist perspective, setting out the evolution of the current situation and how this impacts on the South in particular and on the environment. This view accords with that of others.2
Consequent and parallel to the internationalised market economy has been a crisis of parliamentary processes, in fact of democracy, exemplified by falling voter participation, reduced respect for parliamentarians and a fall-off in political party membership. Both liberal democracy and Marxist socialism have failed to deliver functional democracy.
The less the state can regulate corporations, the less people value the state; the acceptance by both right and left side of politics of the neoliberal consensus removes real choice from voters who are disenchanted with the status quo.
The second part of the work outlines his proposed solution: reform of democracy, specifically, the transformation of the current system into a confederated inclusive democracy. Democracy is a state of freedom founded in individual and social autonomy, that is self-reflective, and involves a structure and system for equally sharing power and the benefits of the economy. Inclusive means that political, economic, social (household, workplace, etc) and ecological aspects of life are incorporated into decision-taking processes. Confederated means that while democratic organisation is primarily based at a local level, as matters require it can be scaled up through regional to national and international levels.
Fotopoulos outlines in great detail his conceptions of and preconditions for political and economic democracy. This includes critiques of past and present responses to his multidimensional crisis; his major criticism is that these either accept the globalised market economy (for instance, modern ‘social’ democracies) or fail to engage in all of political, economic and ecologic transformation. The social and ecological elements are incorporated into and emerge from the political and economic. Next he maps out the transition “From ‘here’ to ‘there’”. In essence, his plan is to start local, where possible building on existing local movements, and transforming these to inclusive democratic entities. Over time this can scale up to confederations of self-governing communities and replace current ‘statist’ arrangements.
The final part of the book examines the philosophical underpinnings of his proposal. The message from there is that “[d]emocratic society will simply be a social creation, which can only be grounded on our own conscious selection of those forms of social organization which are conducive to individual and social autonomy. … conscious choice does not mean arbitrary choice … the degree to which a form of social organization secures an equal distribution of political, economic and social power is a powerful criterion with which to assess it,” (p.340).
To conclude, I found this a disturbing book. Not because it helps me to envision a way forward, but because that way is a major departure from the present system. Do I really want to go there?