The Death Gap: How Inequality Kills

The Death Gap explores the disparities in health outcomes across different socioeconomic and racial groups in the United States. In doing so, Ansell addresses the predominant discourses and the ideological underpinnings of health inequality. Ansell’s own views are influenced by certain traditions: Two prominent figures he cites as inspiration are Friedrich Engels and Rudolf Virchow.

Friedrich Engels (1820-1895) was a 19th-century German philosopher and social scientist. He is known for his collaboration with Karl Marx and his work in social theory. In his seminal work, The Condition of the Working Class in England (1845), Engels documented the appalling living conditions and health disparities faced by industrial workers in Manchester, England. Manchester was at the forefront of the Industrial Revolution which, according to Engels, significantly aggravated the living conditions of the working class. Therefore, Engels argued that these improper working conditions were a result of the capitalist system, which prioritized profit over the wellbeing of the labor force. Engels posited that the exploitation inherent in capitalism created an environment where the working class was systematically deprived of adequate housing, nutrition, and healthcare, leading to premature death and chronic illness.

Engels’s insights resonate throughout Ansell’s The Death Gap, particularly in the way Ansell highlights the systemic nature of health inequalities. Ansell echoes Engels by illustrating how modern capitalism and the idea of healthcare as a commodity perpetuate disparities through mechanisms such as unequal access to healthcare, socioeconomic segregation, and environmental injustice.

Rudolf Virchow (1821-1902) was a German physician, researcher, and public health activist. He is often regarded as the inventor of modern pathology and social medicine. Virchow recognized that social conditions were a significant factor in health. Virchow argued that diseases were not just biological phenomena but were heavily influenced by factors such as poverty, education, and living conditions. Ansell draws on Virchow’s work to argue for a broader understanding of health that includes social determinants. Ansell points out that addressing health disparities requires comprehensive social policies aimed at reducing poverty, improving education, and ensuring equitable access to resources. This holistic approach aligns with Virchow’s perspective that health equity cannot be achieved without addressing the root causes of social injustice.

Both Engels and Virchow, though from different backgrounds and professions, converged on the understanding that social determinants significantly impact health outcomes, laying a foundational framework that Ansell builds upon in his critique of modern health disparities. Ansell thus adheres to a social explanation of health, which he contrasts throughout the book with outlooks that favor individual choice, genetics, or other biological factors as causes for disease.