From where I sit: Dashed hope brings ill wind

Recently, my co-citizens in Massachusetts elected an undistinguished Republican candidate (and centrefold model) to replace the departed brilliant politician and Democratic icon Ted Kennedy as senator. For the American media, this result came to symbolise the national refusal of an Obamaesque vision of an American society that would be more inclusive and embracing of the poor and the working poor, who make up the bulk of those who stand to benefit from healthcare reform.

While the Democratic candidate was asleep at the wheel (making only 19 public appearances during the campaign while her opponent made more than 70), the Republican Party secretly sent troops to assist their handsome candidate. The Democrats smugly misread the situation, and the consequences from the perspective of symbolic politics are enormous.

We know how highly Americans praise individual self-reliance and its evil twin, the American dream. I say evil twin because the faith in this myth appears to be particularly damaging after a decade of growing inequality, when upward mobility appears to many to be ever more elusive. Believing that "those who want can" only leads to greater stress and depression in a period when the market cannot sustain such aspirations. This translates into bad health outcomes, which epidemiologists have abundantly documented. Just what our uninsured need ...

As Michael Marmot, professor of epidemiology and public health at University College London, and others have shown, in all countries, people of lower socio-economic status tend to have worse health than those in higher socio-economic positions - a phenomenon so pervasive that some describe social inequality as the "fundamental cause" behind disparities in population health. Many studies show that the emotional and physiological responses generated by the challenges people encounter in daily life condition their susceptibility to many of the chronic illnesses that have become the dominant causes of mortality in the developed world. The poor fare worst not only because they face more challenges but because they have fewer "buffers" to protect them from everyday life.

Universal access to healthcare is crucial. But there is more to it than that. Societies that view a wide range of people as full members of the community deserving of recognition and support provide more extensive buffers than ones that stigmatise those who are different, including the poor. This is also true of societies where ethnic boundaries are not strongly policed and interracial relationships not stigmatised.

Buffering societies are also ones that empower people by providing them with collective narratives of shared hope and recognition. They give people the tools to imagine "possible selves" that offer routes to a better future. Such images are building blocks on which healthy behaviours can be built and on which collective mobilisation on behalf of healthier living conditions can be based.

Images such as these are undermined by dominant interpretations of the Massachusetts election. Our low-income and uninsured populations will suffer from seeing their co-citizens reverting to a less inclusive view of America that prevailed before Obama. The loss of hope is very costly and should also be factored into our collective cost-benefit analysis, along with the price of the healthcare reform.

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