Morbid Symptoms: Health under Capitalism
The latest Socialist Register, which was published in October 2009, is called Morbid Symptoms: Health Under Capitialism. As one of the editors, Colin Leys says, the aim was to show that health is a subject that currently isn’t but needs to be considered as part of Political Economy and should be something that is an important topic for socialists.
The volume provides a range of fascinating and very detailed essays on health in a global context, as well as specific studies on a country basis, and shows how internationally the trend with developed/neoliberal economies is to increasingly move health policy towards the privatization of health care, thereby providing a further means of capital accumulation rather than improving the health outcomes for their citizens.
You don’t need to have read Sara Burke’s recent book Irish Apartheid: Health Inequality in Ireland to see that the same is happening here at an alarming rate.
It’s a great book and deserves to be read by anyone interested in the current state of health policy. Hopefully we’ll be publishing a review of it in the New Year.
According to Colin Leys in an interview in The Bullet last November, there are two core issues that Morbid Symptom addresses:
One is the need to focus on the militant campaign that is now being waged by capital — the health insurance industry, the pharmaceutical and biotechnology industry, and big healthcare provider companies — to break up state-funded and provided healthcare systems in every country that has them, and turn them into fields of accumulation. In middle- and high-income countries we are talking of potential markets worth from 7 to 12% of national income or even more. The power of the corporations moving in on public health services is huge, and growing. In Canada and the UK and other advanced capitalist countries they are major actors in the restructuring of states on neoliberal lines that has been pushed through to a greater or lesser extent in all countries over the past 30 years. They are increasingly installed at the heart of government policy-making. Health ministries and departments have been downsized and policy development has been handed over to private sector personnel as consultants, or appointed to government posts, while ministers and career civil servants leave to take lucrative jobs in the private health sector. The boundary between public and private interests is increasingly blurred, especially in relation to health. This is not nearly as well understood as it needs to be.
The second core issue is the fact that healthcare, important as it is, is not the most important thing: the crucial determinants of health, wherever you live — India, Canada, South Africa, the US, it makes no difference — are good food, good shelter, safety at work and protection against infections, so whether you and your family are healthy or not is above all a matter of equality. The poorest countries have the worst health, and so do the poorest people in all countries, including rich ones. Unless public policy is geared towards equality, even in rich countries most people’s health will remain a lot worse than it should be. But the more neoliberal a government is, the less policy is concerned with equality. In the US and the UK, where inequality has been dramatically increased, it is condemning growing numbers of people to pain, disability and early death. The same is true internationally.
As Dr Jonathon Tomlinson, who will be launching the volume in London in January said at the Sixth Historical Materialism conference, the priority of the commericalisation of health care is on money, not the patient:
When healthcare is commercialized, human health is commodified; that is, people are broken down into diagnostic categories and biological parameters that can be quantified, i.e. given a relative worth which is given a financial value. So doctors are paid for reductions in the weight or blood pressure of their patients, for diagnoses made and for tests carried out. The relief of suffering becomes a secondary end, achievable only if it occurs as a consequence of treating the illness. Many treatments, such as drugs to treat hypertension and high cholesterol, screening for breast cancer and immunisations cause rather than relieve suffering. Though their ultimate aim is to prevent future suffering, the markets for preventative services (screening, statins and so on) are greater than those for curative services because far greater proportions of the population are ‘at risk’. This results in a shift of emphasis from the relief of suffering to the management of risk factors, i.e. from caring for the ill, towards medicating the healthy.
According to the logic of capitalism, only commodities count because only they can be counted. When a patient comes to see me I am reminded by my computer of a list of biometric data that I need to collect. If I fail to collect the data my practice will lose money. You may wish to discuss your failing memory or the side effects of your chemotherapy, but we’re only going to get paid for measuring commodities, not for listening. Listening is too hard to measure, but not time; if I keep you waiting I’ll be fined, and if I give you the time you need I’ll be fined for keeping the next patient waiting.
There are also audio recordings embedded at the end from the Sixth Historical Materialism conference, which includes Colin Leys discussing the volume, as well as three other contributors who discuss mental health, the capitalist food industry, and shaping global health policy.
Audio courtesy of the Finnish site Tampereen yhteiskunnallinen opisto
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