The Limitations of Social Movements
as Catalysts for Change
Constance A. Nathanson
[W]hen equal protection of interests is at stake, the voluntary activity that
counts is necessarily political.
—Schlozman, Verba, and Brady 1999: 427
In this paper I explore the limitations of collective action outside the polity—whether by labor unions, political parties, or social movements—as vehicles for the attainment of economic, social, and/or medical justice for the poor. This exploration assumes a particular state structure and political context, that of the United States, a country where—relative to comparable industrialized democracies—collective action in the form of social movements and other varieties of organized political advocacy plays an unusually large role in the political process. I concentrate on action by or on behalf of the poor for two reasons, both related to the focus of this volume on health-related social movements (although my examples are by no means limited to “health”). First, class and income inequalities in health in this country are profound and continuing, and are largely ignored except in narrow academic circles. Ours is not a government with a mandate to address social inequalities of illness and death. Absent collective action, these inequalities will continue to be ignored. Collective action may, as I argue, be a weak reed, but it is at least possible that analysis of its limitations will show how some weaknesses might be overcome. Second, the current last, best hope for addressing the health of the poor is some form of national health insurance. Knowledge of the circumstances under which state benefits for the poor have (or have not) been forthcoming in the past may help us in planning for the future.