Introduction

Most research into and discussion of the social determinants of health inequalities has tended to generalise from the experience of advanced capitalist countries. As a counterpoint, this chapter focuses on Greece as a southern European society that took a distinct route to modernity, and along the way radically improved the health status of its people. This is an interesting topic in its own right but may also shed light on wider debates about the social influences on health and their relationship to capitalist modernity. My central question is whether Greece has achieved its impressive health gains despite or because of remaining an economic laggard, being subject to authoritarian government from the 1930s until 1976, maintaining a distinct culture and ‘lifestyle’, and developing less extensive systems of state health and welfare than countries in northern Europe. Do Greek similarities or differences from other forms of capitalist modernity account for improvements in health, and what does the future hold?

There are of course good foundational reasons for seeing universal processes at work in human health. First, people are biologically and psychologically similar everywhere and health is a basic social need for self-realisation across the lifespan (Doyal and Gough, 1992). Second, capitalist modernisation involves similar processes closely associated with health improvement and change: in other words both advances in health and shifts in its patterning. Yet against this convergent trend there are significant national variants in the nature of capitalist modernity, with associated health differences, influenced by distinct cultural values, institutional structures and social mobilisations. In social policy generally these persistent variations in the nature and effects of ‘welfare capitalisms’ since 1945 have underpinned regime theory's assertion of three distinct ‘worlds’ of welfare capitalism, with differential impacts on class inequalities in living standards (Esping-Andersen, 1990). Independently Wilkinson (1996) showed that while the economic growth associated with capitalist modernity led to health gains, beyond a certain point distributional inequalities in income had the greatest impact on health variations within and between countries. One purpose of this chapter, therefore, through examination of the Greek case, is to bring these two ‘paradigms’ closer together, drawing attention to parallel strengths but also weaknesses, some of which are illustrated by the fact that countries like Greece cannot be easily accommodated within their frameworks.