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Geography and social justice
Book
Care’ and ‘Just Genetics’ are further hemmed in by Rawlsian notions of social justice, embodied in the fair distribution of society’s resources. When deciding which genetic practices to fund, members of society assume Rawls’ ‘veil of ignorance’ about their own conditions and reach a compromise allowing reasonable accommodations. The genetically disadvantaged are assisted not to a level of equality, but one of ‘normality’. Daniels and Fleck find that liberal notions of justice need only be modified rather than dismantled to tackle new terrain. But as Marc A. Lappe notes in his final essay, Rawls’ Theory of Justice (1971) was written at a time when we could not know all of the salient features of people. In the genetic era, the politics of human differences will be only more important. In this sense, Justice and the Human Genome Project usefully highlights the limitations of traditional theories of justice oriented towards redistributing resources across pregiven terrain of individual differences laid down by a ‘natural lottery’. Genetic differentiation is anything but random or disinterested. Genetic research is involved in making certain differences even more important tomorrow than they are today. A theory of justice which tackles the politics of genetic research itself and not just its after-thefact damage assessment would first heed the fears of disability body politics in danger of being (dis)embodied and (dis)placed through genetic social engineering. As Iris Marion Young maintains in Justice and the Politics of Difference (1990), these broader justice claims are carried by social movements organized around of domination and discourses oppression. For all of their sense of obligation to the needs of the genetically disadvantaged, the predominant disembodied rationality of Rawlsian moral philosophers is light years away from the situated knowledge of the diseased and disabled whose own physical conditions have been compounded by societal requirements to learn their place. Unless debates over the ethics of data cohection and dissemination are
made accessible and accountable to those populations targeted for improvement or elimination, the genetic revolution will translate into redoubled societal violence and marginalization. Michael L. Dorn University of Kentucky
Geography and Social Justice David M. Smith Blackwell Oxford (1994) 325 pp $59.95 hardback, $22.95 paperback Geography and Social Justice, written by one of the most influential and prolific geographers, is an evocative volume which purports to place social justice at the heart of human geography. David Smith argues for ‘the re-engagement of geography with ethics, morality and social justice’ (p. 15). This book is organized in two parts. The first part surveys elements and different theories of justice, while the second introduces case studies of inequality in different cities in the USA, Europe, and South Africa based on the author’s first-hand research. The discussion in Part 1, Chapter 2 focuses on what should be incorporated, or at least considered, in theorizing about social justice. This is followed by two chapters that, first, review mainstream theories of social justice (namely, egalitarianism , utilitarianism, libertarianism and contractarianism or contractualism) and then, second, examine the reaction to mainstream theories of social justice by focusing on Marxism, communitarianism and feminism. In Chapter 5, Smith provides a ‘bridge’ between theory and practice arguing that social justice is manifest in the reduction of inequality: a ‘process of returning to equality’ (p. 118). The remainder of the book is dedicated to the case studies. Chapter 6 explores the notion of justice as equalization focusing on inequality, with evidence drawn from Atlanta (in Georgia), Jacksonville, Tampa and Miami (in Florida). The question asked is whether there has been race-space equalization over time.
reviews
Smith concludes that racial separation or ‘an unspoken code of social apartheid’ remains (p. 170). Next, Smith explores inequality which emerged in East European cities up to the end of the 1980s. After examining selected cities, he concludes that despite a planning process driven by egalitarian ideals, inequality in living standards and the uneven development of service infrastructure is evident (p. 209). With the collapse of communism in Eastern Europe and the uncritical adoption of a free market system by the new rulers, the vast majority are markedly worse-off in a material sense than they were before 1989. The case of South Africa is explored in Chapter 8, posing the question of reparation as compensation for the past injustice along with the scope for redistribution after apartheid. Apart from the protection of white privilege in the form of a property clause and guaranteeing white civil servants their jobs, a cut off date on land claims from those (Africans) who were dispossessed of land in the past, was enshrined in the new Constitution. Only those who were forcibly removed, evicted, expelled or resettled from their land after 1913 have a legal or just claim to land. This agreement ignores the role played by the wars of dispossession and plunder during the colonial period prior to 1913. This example confirms David Harvey’s argument elsewhere that the ruling class and the powerful in society often impose their own conception of justice. Chapter 9 considers ‘the annihilation of place or topocide’ (p. 254). Smith records that everyone in District Six (Cape Town) died a little when the location was demolished by the apartheid state, many died spiritually and emotionally. Similarly, the razing of a Jewish ghetto in Lodz in Poland and how Jewish claims for compensation generated through persecution in Europe was transformed into claims fixed upon Palestine are examined. In the process the cost was transferred to a people not implicated in the original injustice. Therefore, colonization and national consolidation in Palestine displaced hundreds of Arabs from existing towns and from
73
Book reviews
villages where most of a predominantly agricultural population lived. Chapter 10 concludes that the notion of social justice as equalization has a universal appeal. The most significant contribution of this volume lies in its support for universals in conceptualizing social justice. This departs from some postmodernist discourse which celebrates relativist conceptualization of justice. Smith reasserts the importance of human similarity, and in certain respects their sameness: the capacity for pleasure and pain. Indeed what is locally available to people is an outcome of broader processes of uneven development. However, a number of critical issues can be raised. There is a noticeable silence on how the plebian masses contest the very concept of justice. The active struggles for new and more socially just societies are only mentioned briefly in all case studies. Furthermore, little attention is paid to power relations and power play in the (re)construction and imposition of justice, and in unequal trade relations between the West and the rest of the world. Nothing is mentioned of the debt crisis crippling states in the South, and on the practices of international institutions such as the World Bank and the International Monetary Fund in imposing ‘their own version of equalization programmes under the disguise alleviation of poverty strategies. Nevertheless, this insightful, provocative, and stimulating volume will be debated by many in the 1990s and beyond. Meshack M. Khosa University of Natal
A Future for the NHS? Health Care in the 1990s
W. Ranade Longmans Harlow (1994)
Yet another book on the British health care sector? Given the range of established descriptive texts, such as Ham (1992), or the more theoretically informed commentaries (e.g. Harrison et al., 1990) an addition to the literature has to find a distinctive
74
niche in order to establish itself. However, I think Ranade’s book does this because of its coverage of issues not dealt with in great detail in most texts, because it draws upon recent research into the early stages of the NHS reforms, and because it is written in a brisk, direct style which will appeal greatly to students. There are seven core chapters to the book. After a brief introduction, Chapters 2 and 3 review, respectively, the ideological and environmental ‘contexts’ within which health services operate. I found Chapter 2 somewhat breathless: in barely 14 pages of text, discounting the references, we are led through the ‘main academic and political perspectives on health care which have shaped the debate’ (p. 8), including: the social-democratic consensus; the Fabian model of welfare; challenging the mystique of medicine; ‘wrestling with inequalities’; the McKeown thesis; the radical critique; feminist perspectives, the Marxist perspective; and the New Right and the state. Inevitably, only sketches are presented and perhaps fuller treatment is necessary in order to bring these different perspectives into relation with each other. Chapter 3, the environmental context, is divided into three main sections, considering the influence of technological change (especially information technology), demographic influences on both need for health care and the labour force, and advances in medical technology. Again, partly for reasons of brevity, parts are sketchy, such as the brief, if fashionable, reference to postfordism (pp. 26-28) which merely deploys the terminology without subscribing to the theory. Nevertheless this chapter does cover some important ground and also reviews the emerging literature on measurement of outcomes and the debate, sparked by the Oregon experiment, about the criteria for rationing. Chapter 4 goes on to consider the track record of the Conservative governments in Britain since 1979. It rejects the notion of a ‘creeping privatization’ of the service and gives more emphasis to the ‘privatization from within’ which Ranade had previously argued characterized the
NHS. There is a good summary of the various strands of critiques of the NHS as it existed prior to the 1989 White Paper, which explains clearly some of the technical deficiencies and perverse incentives in the system. Chapter 5 discusses the issues that arose from attempting to impose an internal market structure on the NHS. It draws upon the author’s collaborative research on ‘Monitoring managed competition’, sponsored by the King’s Fund, which represents the major effort, to date, to evaluate the impacts of the reforms. Inevitably the results of such a project are still somewhat provisional, but this chapter provides valuable insights into the dilemmas that are emerging in the operation of the internal market. Chapters 6 and 7 are in some respects the most interesting in the book; both provide useful startingpoints for students needing an exegesis of a complex literature. Chapter 6 reviews the literature on the ‘new public management’ that has emerged in response to the ascendancy of the neoliberal governments of Britain and the USA. In essence this represents an effort to manage decisively while retaining a commitment to social goals. Ranade points to the danger of ‘macho management on Taylorist lines’ (p. 97) (a view with which former NHS Chief Executive Duncan Nicholl at times appeared to express sympathy). Certainly this was one of the problems of importing the generic skills of (private sector) management, without recognizing the specifics of operating in a public service. As Ranade goes on to argue, without a distinction between public and private the ‘search for good management is subverted by the ideology of managerialism: the belief that managerial expertise is the sole legitimate criterion for decision-making in public organizations’ (p. 97) with potentially undemocratic consequences. Chapter 7 introduces a discussion of the concept of ‘quality’ in health care and, as with Chapter 2, covered much ground in a very short space of time without really providing a definitive answer. Perhaps this reflects the inchoate nature of the concept and (as
Care’ and ‘Just Genetics’ are further hemmed in by Rawlsian notions of social justice, embodied in the fair distribution of society’s resources. When deciding which genetic practices to fund, members of society assume Rawls’ ‘veil of ignorance’ about their own conditions and reach a compromise allowing reasonable accommodations. The genetically disadvantaged are assisted not to a level of equality, but one of ‘normality’. Daniels and Fleck find that liberal notions of justice need only be modified rather than dismantled to tackle new terrain. But as Marc A. Lappe notes in his final essay, Rawls’ Theory of Justice (1971) was written at a time when we could not know all of the salient features of people. In the genetic era, the politics of human differences will be only more important. In this sense, Justice and the Human Genome Project usefully highlights the limitations of traditional theories of justice oriented towards redistributing resources across pregiven terrain of individual differences laid down by a ‘natural lottery’. Genetic differentiation is anything but random or disinterested. Genetic research is involved in making certain differences even more important tomorrow than they are today. A theory of justice which tackles the politics of genetic research itself and not just its after-thefact damage assessment would first heed the fears of disability body politics in danger of being (dis)embodied and (dis)placed through genetic social engineering. As Iris Marion Young maintains in Justice and the Politics of Difference (1990), these broader justice claims are carried by social movements organized around of domination and discourses oppression. For all of their sense of obligation to the needs of the genetically disadvantaged, the predominant disembodied rationality of Rawlsian moral philosophers is light years away from the situated knowledge of the diseased and disabled whose own physical conditions have been compounded by societal requirements to learn their place. Unless debates over the ethics of data cohection and dissemination are
made accessible and accountable to those populations targeted for improvement or elimination, the genetic revolution will translate into redoubled societal violence and marginalization. Michael L. Dorn University of Kentucky
Geography and Social Justice David M. Smith Blackwell Oxford (1994) 325 pp $59.95 hardback, $22.95 paperback Geography and Social Justice, written by one of the most influential and prolific geographers, is an evocative volume which purports to place social justice at the heart of human geography. David Smith argues for ‘the re-engagement of geography with ethics, morality and social justice’ (p. 15). This book is organized in two parts. The first part surveys elements and different theories of justice, while the second introduces case studies of inequality in different cities in the USA, Europe, and South Africa based on the author’s first-hand research. The discussion in Part 1, Chapter 2 focuses on what should be incorporated, or at least considered, in theorizing about social justice. This is followed by two chapters that, first, review mainstream theories of social justice (namely, egalitarianism , utilitarianism, libertarianism and contractarianism or contractualism) and then, second, examine the reaction to mainstream theories of social justice by focusing on Marxism, communitarianism and feminism. In Chapter 5, Smith provides a ‘bridge’ between theory and practice arguing that social justice is manifest in the reduction of inequality: a ‘process of returning to equality’ (p. 118). The remainder of the book is dedicated to the case studies. Chapter 6 explores the notion of justice as equalization focusing on inequality, with evidence drawn from Atlanta (in Georgia), Jacksonville, Tampa and Miami (in Florida). The question asked is whether there has been race-space equalization over time.
reviews
Smith concludes that racial separation or ‘an unspoken code of social apartheid’ remains (p. 170). Next, Smith explores inequality which emerged in East European cities up to the end of the 1980s. After examining selected cities, he concludes that despite a planning process driven by egalitarian ideals, inequality in living standards and the uneven development of service infrastructure is evident (p. 209). With the collapse of communism in Eastern Europe and the uncritical adoption of a free market system by the new rulers, the vast majority are markedly worse-off in a material sense than they were before 1989. The case of South Africa is explored in Chapter 8, posing the question of reparation as compensation for the past injustice along with the scope for redistribution after apartheid. Apart from the protection of white privilege in the form of a property clause and guaranteeing white civil servants their jobs, a cut off date on land claims from those (Africans) who were dispossessed of land in the past, was enshrined in the new Constitution. Only those who were forcibly removed, evicted, expelled or resettled from their land after 1913 have a legal or just claim to land. This agreement ignores the role played by the wars of dispossession and plunder during the colonial period prior to 1913. This example confirms David Harvey’s argument elsewhere that the ruling class and the powerful in society often impose their own conception of justice. Chapter 9 considers ‘the annihilation of place or topocide’ (p. 254). Smith records that everyone in District Six (Cape Town) died a little when the location was demolished by the apartheid state, many died spiritually and emotionally. Similarly, the razing of a Jewish ghetto in Lodz in Poland and how Jewish claims for compensation generated through persecution in Europe was transformed into claims fixed upon Palestine are examined. In the process the cost was transferred to a people not implicated in the original injustice. Therefore, colonization and national consolidation in Palestine displaced hundreds of Arabs from existing towns and from
73
Book reviews
villages where most of a predominantly agricultural population lived. Chapter 10 concludes that the notion of social justice as equalization has a universal appeal. The most significant contribution of this volume lies in its support for universals in conceptualizing social justice. This departs from some postmodernist discourse which celebrates relativist conceptualization of justice. Smith reasserts the importance of human similarity, and in certain respects their sameness: the capacity for pleasure and pain. Indeed what is locally available to people is an outcome of broader processes of uneven development. However, a number of critical issues can be raised. There is a noticeable silence on how the plebian masses contest the very concept of justice. The active struggles for new and more socially just societies are only mentioned briefly in all case studies. Furthermore, little attention is paid to power relations and power play in the (re)construction and imposition of justice, and in unequal trade relations between the West and the rest of the world. Nothing is mentioned of the debt crisis crippling states in the South, and on the practices of international institutions such as the World Bank and the International Monetary Fund in imposing ‘their own version of equalization programmes under the disguise alleviation of poverty strategies. Nevertheless, this insightful, provocative, and stimulating volume will be debated by many in the 1990s and beyond. Meshack M. Khosa University of Natal
A Future for the NHS? Health Care in the 1990s
W. Ranade Longmans Harlow (1994)
Yet another book on the British health care sector? Given the range of established descriptive texts, such as Ham (1992), or the more theoretically informed commentaries (e.g. Harrison et al., 1990) an addition to the literature has to find a distinctive
74
niche in order to establish itself. However, I think Ranade’s book does this because of its coverage of issues not dealt with in great detail in most texts, because it draws upon recent research into the early stages of the NHS reforms, and because it is written in a brisk, direct style which will appeal greatly to students. There are seven core chapters to the book. After a brief introduction, Chapters 2 and 3 review, respectively, the ideological and environmental ‘contexts’ within which health services operate. I found Chapter 2 somewhat breathless: in barely 14 pages of text, discounting the references, we are led through the ‘main academic and political perspectives on health care which have shaped the debate’ (p. 8), including: the social-democratic consensus; the Fabian model of welfare; challenging the mystique of medicine; ‘wrestling with inequalities’; the McKeown thesis; the radical critique; feminist perspectives, the Marxist perspective; and the New Right and the state. Inevitably, only sketches are presented and perhaps fuller treatment is necessary in order to bring these different perspectives into relation with each other. Chapter 3, the environmental context, is divided into three main sections, considering the influence of technological change (especially information technology), demographic influences on both need for health care and the labour force, and advances in medical technology. Again, partly for reasons of brevity, parts are sketchy, such as the brief, if fashionable, reference to postfordism (pp. 26-28) which merely deploys the terminology without subscribing to the theory. Nevertheless this chapter does cover some important ground and also reviews the emerging literature on measurement of outcomes and the debate, sparked by the Oregon experiment, about the criteria for rationing. Chapter 4 goes on to consider the track record of the Conservative governments in Britain since 1979. It rejects the notion of a ‘creeping privatization’ of the service and gives more emphasis to the ‘privatization from within’ which Ranade had previously argued characterized the
NHS. There is a good summary of the various strands of critiques of the NHS as it existed prior to the 1989 White Paper, which explains clearly some of the technical deficiencies and perverse incentives in the system. Chapter 5 discusses the issues that arose from attempting to impose an internal market structure on the NHS. It draws upon the author’s collaborative research on ‘Monitoring managed competition’, sponsored by the King’s Fund, which represents the major effort, to date, to evaluate the impacts of the reforms. Inevitably the results of such a project are still somewhat provisional, but this chapter provides valuable insights into the dilemmas that are emerging in the operation of the internal market. Chapters 6 and 7 are in some respects the most interesting in the book; both provide useful startingpoints for students needing an exegesis of a complex literature. Chapter 6 reviews the literature on the ‘new public management’ that has emerged in response to the ascendancy of the neoliberal governments of Britain and the USA. In essence this represents an effort to manage decisively while retaining a commitment to social goals. Ranade points to the danger of ‘macho management on Taylorist lines’ (p. 97) (a view with which former NHS Chief Executive Duncan Nicholl at times appeared to express sympathy). Certainly this was one of the problems of importing the generic skills of (private sector) management, without recognizing the specifics of operating in a public service. As Ranade goes on to argue, without a distinction between public and private the ‘search for good management is subverted by the ideology of managerialism: the belief that managerial expertise is the sole legitimate criterion for decision-making in public organizations’ (p. 97) with potentially undemocratic consequences. Chapter 7 introduces a discussion of the concept of ‘quality’ in health care and, as with Chapter 2, covered much ground in a very short space of time without really providing a definitive answer. Perhaps this reflects the inchoate nature of the concept and (as