[Including a personal update at the end, under Other Stuff…]

I was intrigued by this recent article by one of my regular reads on medium.com, Umair Haque, on this occasion writing about when luxuries become necessities and necessities become luxuries, which he claims has happened in the US. To summarise, he says that capitalism has laid claim to things that used to be basic essentials (and in many countries still are), like social interaction, medicine, nutritious food, public transport, education … even life itself. At the same time, he says, Americans are bombarded with messages that normalise McMansions, prestige cars, designer clothes, and the kind of physical perfection that for the vast majority of people requires cosmetic surgery, until they start to regard these as necessities.

“Capitalism creates intense, perpetual, ever-mounting status competition this way — by making luxuries false necessities. It preys on basic human needs, and then twists them upside down, teaching people luxuries are necessities, but necessities are luxuries.”

Umair is big on passion, but low on citations, so I decided to do some cross-checking. For example, what is the true story about the price of healthcare?

“America’s getting plenty angry about the rising cost of insulin—and no wonder. Between 2002 and 2013, the average price for this life-saving, injectable drug used by nearly 10 million Americans with diabetes has tripled, according to the American Diabetes Association (ADA).” (OnTrackDiabetes)

“Diabetic ketoacidosis is a terrible way to die. It’s what happens when you don’t have enough insulin. Your blood sugar gets so high that your blood becomes highly acidic, your cells dehydrate, and your body stops functioning. Diabetic ketoacidosis is how Nicole Smith-Holt lost her son. Three days before his payday. Because he couldn’t afford his insulin.” (NPR)

“According to the most recent data available from the Centers for Medicare and Medicaid Services (CMS), “the average American spent $9,596 on healthcare” in 2012, which was “up significantly from $7,700 in 2007.” It was also more than twice the per capita average of other developed nations, but still, in 2015, experts predicted continued sharp increases: “Health care spending per person is expected to surpass $10,000 in 2016 and then march steadily higher to $14,944 in 2023.” Indeed, average annual costs per person hit $10,345 in 2016. In 1960, the average cost per person was only $146 — and, adjusting for inflation, that means costs are nine times higher now than they were then.” (CNBC)

“A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.” (CNBC)

What is it that we should be aiming for?

The last time we as a species took the opportunity to step back and declare our highest aspiration was just after we emerged from the horrors of World War II. Having discovered our own lethal capability when nuclear bombs were dropped on Hiroshima and Nagasaki, we took a moment to reflect and ask ourselves: Who are we? What do we stand for? What do we want our future civilisation to look like?

So there was a flurry of activity including Bretton Woods (1944), the United Nations (1945), the Universal Declaration of Human Rights (1948), and the formation of the World Health Organisation (1946). The WHO Constitution defines health as: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Article 25 of the United Nations’ 1948 Universal Declaration of Human Rights states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”

As we’re increasingly seeing with the Paris agreement on climate change, supranational organisations are great at grand declarations of intent, not so good at ensuring that they are enforced, but my point is that this is what we believed to be important in our moment of highest aspiration, when we were making our post-war, new era resolutions. It seemed self-evident that universal access to the things that support health, and the medicines that restore health, would be a Good Thing, not just for the poor and sick, but for everybody.

Some countries took the resolution and ran with it, like the social democracies of Scandinavia. You will notice that there is a remarkable overlap between the countries that adopted social democracy, and the happiest countries in the world.

We’re all in this together

The core message is that we’re all in this together. A society is happier and healthier when it takes care of all its citizens. Collaboration works better than competition.

But aren’t humans comparative beings? Don’t we like to feel like we’re better off than the next guy? Don’t we prefer to have the best house in a crappy street than an objectively better, but comparatively crappy house in a very grand street?

Yes, but societies as a whole do better when inequality is reduced, when the wealth of a nation is distributed so as to ensure that everybody has enough of what they need – education, food, healthcare.

We have been told (notably by Margaret Thatcher – although she may have been misunderstood) that there is no such thing as society, that we are intrinsically selfish and self-serving, and that perfect competition is the best way to organise ourselves.

Neoclassical economists may tell us this story. But psychologists tell us a different story. They point to the emotional and physical benefits of altruism, with positive impacts on stress levels, mood, health, and even longevity.

Philosophers such as Alain de Botton also encourage greater empathy, and a kinder, gentler, definition of success:

“…in the Middle Ages, in England, when you met a very poor person, that person would be described as an “unfortunate” — literally, somebody who had not been blessed by fortune, an unfortunate. Nowadays, particularly in the United States, if you meet someone at the bottom of society, they may unkindly be described as a “loser… That’s exhilarating if you’re doing well, and very crushing if you’re not… I think it’s insane to believe that we will ever make a society that is genuinely meritocratic; it’s an impossible dream… The idea that we will make a society where literally everybody is graded, the good at the top, bad at the bottom, exactly done as it should be, is impossible. There are simply too many random factors: accidents, accidents of birth, accidents of things dropping on people’s heads, illnesses, etc. We will never get to grade them, never get to grade people as they should.”

The Veil of Ignorance

I’m a fan of the veil of ignorance idea, which suggests that those in a position to make laws or any major decisions that affect a significant number of people in a society or organisation, should imagine that they do not know what their role would be in that society or organisation.

So if, for example, you’re deciding on a healthcare policy, you imagine that you don’t know if you are a billionaire or a homeless person, so you create a policy that works for those extremes of the spectrum, and everybody in between. Ditto for your tax policy, education, justice, gender, employment rights, food standards, and so on. You imagine that you don’t know whether you will be wealthy or poor, male or female, black or white, healthy or sick, young or old. You avoid creating scenarios that you wouldn’t want to be in yourself.

“The natural distribution is neither just nor unjust; nor is it unjust that persons are born into society at some particular position. These are simply natural facts. What is just and unjust is the way that institutions deal with these facts.”
― John Rawls, A Theory of Justice

Sound like a good idea? I think so.

Sound like what most countries have at the moment? I think not.


Other Stuff:

With all these big questions going on, I don’t write much about myself these days, but some people have been curious to know what I’m up to. So here’s a quick update. My primary paid work is as a keynote speaker. So far this year I’ve spoken in London, Kuwait, and Portugal (twice), for clients such as Dell computers, Experian, Patsnap, and the Royal London Group. I also usually do a lot in the US – I made six trips to North America last year, speaking for corporate clients like Autodesk and Clorox, as well as the National Aquarium in Baltimore and the Ocean Institute in California.

I’ve also just started a doctorate at the University of Middlesex (DProf by Public Works) and with the Sisters, my new women’s network, we’re currently piloting a new concept we’re calling Illuminations: a series of deep dives into issues that matter, through individual study and group discussion in real life gatherings, with the intention of sparking projects to create a better future, which we then crowdsource – not just with financial resources, but also with networking and mentoring. I’m working with a team based in the US and Indonesia on a new tech platform that will really support our vision for a vibrant and collaborative network of women around the world.

Some of you ask about my mother, who was such a key member of my team during my ocean rowing years. She’s doing well, still volunteering with a local organisation in Yorkshire and keeping busy, and we celebrated her 80th birthday in January. My sister continues to pursue epic hikes – she and her boyfriend completed the Continental Divide Trail last year, and having done the Pacific Crest Trail in 2012, they are now hatching plans to do the Appalachian Trail to complete the Triple Crown.

And finally, yesterday we went live with a new addition to my personal website – you can now download printable Roz quotes, in English, Hindi, Spanish, French, German, Italian, Chinese, Japanese or Russian! Thanks to Steve Perry for all his good work on this.


  • Given the health care cost comparison above, I am happy that the U.K NHS system remains, whatever the shortcomings!
    I know of some folks who have been sick in the US who have become bankrupt or have resorted to crowdfunding to help cover the costs! At least Mr Obama had an attempt at fixing the horrible divide.
    Currently the prospect of privatising the NHS pre, or post, the nightmare Brexit situation is somewhat frightening.
    Alain de Botton’s words are thought provoking. We are certainly not born equal….. sadly.

    “Rich” is such a silly word .. and so divisive. …
    John Rawls words say it all . Saddening, and I am not sure what society is prepared to sacrifice to adjust the balance in even a small way.
    With descriptions such as “developed” nations and “third world” countries it seems we have a massive divide to bridge. 🙁

  • Good to hear from you, David. I agree about the NHS. I have been fortunate with my health so far, so have had very little interaction with the NHS, other than when my father was dying, but on balance I would prefer to have the security of knowing that I would be taken care of in the event of illness.

    However, clearly others take a different view. I had a well-written and overall very nice message from a reader in the US, expressing the view that whoever provides healthcare gains control over the recipient, and the writer didn’t want to be controlled by government, hence didn’t want “free” healthcare.

    I replied that my concerns are for those most vulnerable members of society, who are both likelier to get sick, and less likely to be able to pay. In my view, a civilised society ensures that medicine is available to all, not just those who work more than 20 hours a week (as my correspondent’s employed staff do, which entitles them to healthcare that their employer pays for). I am sure there are huge numbers of workers who are not as well cared for. I’m not talking about the wilfully idle here, but people who are genuinely disadvantaged through disability or upbringing. My attitude is more “there but for the grace of God…”

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