What has the now global, dominant economic variants of capitalism to do with health outcomes? It has to do with the system of private property, alienation and the continuing struggle for existence, which capitalism seemed to have solved in the rich level 4 countries. Political Economy underpins what is being spent on health care and how it is being spent. More than that, it sets out the material conditions of life which directly affect measures of human welfare such as life expectancy and morbidity patterns, that is to say the Social Determinants of Health.
However, our ‘struggle for the pacification of existence’ continues within the context of impending planetary limits. This struggle is ongoing and the variants of capitalism has not yet fixed it for all. In other words, the health of human populations arises out of how we come together to provide the material conditions of life (food, shelter, water), but the way we have organised this right now does not meet the needs of all people or protects the planet. It gloriously meets the need of the few, the so called 1%, while for the 99% the results are mixed at best. A feature of all societies is that of health inequalities – inequalities of outcome and access.
Marx gave us an analysis of how capitalism works. He was also very aware of its achievements. He argued that it could be flexible and organize itself to produce riches far beyond whatever social systems had previously provided. However, at its heart, lies contradictions. One is the continuing struggle between Labour and Capital for material resources. Capital, as a dynamic system of capital flows, has been very adept at both exploiting the earth’s natural resources and the global armies of cheap Labour. At the same time its bloated beneficiaries of the 1% have been very successful in getting the majority of us to think that there is no alternative.
The resistance to it is legion, but it is disorganised, fragmented, unfocused, without a clear plan and often unsure of who the real threat actually is. Some of the resistance movements of course would misguidedly seek to replace one form of exploitation and crisis generation with another, but with a kinder social democratic or green face.
Marx outlines why we are heading for continued economic disaster which underpins the ecological one, a disaster in which we are lied to as being ‘all in it together’. The distribution of wealth remains in very few hands and is then turned to exploiting the planet’s natural and social capital with often deadly results. This analysis has emotional elements to it, given what the science is telling us about the crossing of planetary boundaries, how could it not? It is not however based on an emotional analysis but an attempt to understand how social worlds change and upon what basis current societies are organised.
It is a complex interdependence of economy and ideology shaping social relationships, which in turn shape who we are. In the coming together as individuals to trade, work, exchange, distribute, sell, buy, advertise we bring our hopes, values and ideals to that process and in turn that process shapes our hopes, values and ideals. We come together to do all of these things within a system of private property and notions of ownership, which are created by human beings for a specific purpose. ‘God’ has not ordained this system. It is man-made and thus potentially open to criticism and change. However, those of us who have done well out of the system do not want it to change too much. Many will cling to notions of God either to ameliorate or and explain gross inequalities or to justify their expropriation of earth’s natural resources for themselves.
In the developed West and in emerging markets many people live the life that were beyond the dreams of avarice in the 19th century and for many in the 20th. However, it is based on extracting the maximum possible from both people and planet and history tells us of the cost in human misery and our alienation from each other, from the notion of work and from ourselves.
This is an agenda that brings together the literature on inequalities in health, the social determinants of health approach and critiques of our current political economy. Political economy simply means the political systems that support and organize our economic systems.
I have a realisation that education has failed us on a grand scale. I have a realisation that a few powerful men (and it is usually men) have commandeered the levers of power and wealth for their own benefit, arguing as they do that it is for our own good. Only when populations wake up to the fact of class war and demand a better way of social organization that we will we have a hope of bequeathing to our children a better world. Well-meaning individual action that does not challenge the fundamental driver of capital accumulation is at best useless and at worse a distraction from the real battle.
Upon what is human health based? It is largely social in nature, determined by the social relationships in a material world. No one lives alone and so it is in the coming together in communities and societies that we fashion the wider determinants of health. I use the term ‘wider’ to indicate that health should not be thought of only in biological terms. There is a biological basis for some individuals but not for populations. Even genetic manifestations are at times made worse or better by the social conditions in which the individuals find themselves. Poverty has a knack of making underlying biological problems much worse.
If health is determined by social and political factors, what are the current forms that give rise to certain patterns of health, illness and disease? We know from studying inequalities in health that socio-economic conditions and relative social status determine populations’ health status including measurable outcomes such as life expectancy and the under 5 mortality rate. Other social relationships such as gender and ethnicity also affect health status. However, these are subservient social conditions to the socio-economic in the last instance. That is not to deny that affluent women and affluent Black and Minority Ethnic groups may also experience ill health disproportionately in certain medical categories. The major driver for global health is the socio-economic relationship based on a certain forms of political economy, i.e. capitalism.
As Ottersen et al in 2014 wrote:
“Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven. Although the health sector has a crucial role in addressing health inequalities, its efforts often come into conflict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals.”
What are the dominant socio economic conditions therefore that give rise to the patterns we note?
A feature of modern capitalism, which in its current form especially has now gone global, is that it determines in the last instance forms of social relationships that are exploitative and unequal. The material conditions of life are shaped by these unequal and damaging social relationships. Thus, how much land you have to feed your family and where that land is, is determined by systems of private property, commodity prices and the rules of the state. The same goes for water and shelter. The fundamental building blocks of life, including eco systems services (e.g. fresh water, waste recycling) are subsumed within capitalist social relationships. Nature (the air, water, livestock etc) upon which we depend has been fashioned into a mere instrument for human survival and development. There is very little ‘nature’ left untouched by human hand. All of nature has been turned into natural capital and is being used up as if it is limitless.
Capitalism has to continue to do what it does because of its surplus capital accumulation problem (SCAP). Capitalism produces profits and surpluses. It continually seeks new markets and new investment opportunities. It cannot stand still or else it risks devaluing of its capital. A billionaire can consume only so much. Therefore, capitalists look for returns in investment and often exploit more and more natural capital in the process. When capitalism comes up against a barrier to this process, e.g. strong labour organisations who demand living wages and pensions, it either designs a solution, e.g. strict labour laws that outlaw strikes and labour organisations or finds other investment opportunities. An example is that it takes manufacturing to countries where there is weak, cheap or surplus labour.
Capitalism has proved to be dynamic and inventive. It has taken on many forms – mercantile, industrial and recently financial and consumer based. Apologists for capital accumulation argue it is good for societies, pointing to the jobs and wealth created while ignoring the social misery that often follows in its wake. Whole populations have been ‘bribed’ by the baubles that capitalism produces which, as the recent credit and consumer led boom and bust has proved, are merely will o’ the wisps. The phrase ‘wage slave’ resonates with many in so called ‘advanced’ societies who are trapped in alienating forms of work ameliorated only by the lures of consumer products and services. The promises of ‘you’ve never had it so good’ turning sour on sovereign and private debt while the ruling class run away with the spoils in ‘Richistan’.
One way to confront this machine is to get off the consumerist treadmill and hope that through collective consumer choices, i.e. not to buy stuff, that the ruling class will mend their accumulative ways, invest in health, education, the conditions of social life and design products that are ‘green‘ and ‘environmentally friendly’.
This is already occurring. The plethora of products from hybrid cars to organic and locally sourced food products indicate that some companies are basing their business models with sustainability in mind. What this does not do however is change the underlying dynamic of the surplus capital accumulation problem which demands growth in the economy and the overuse of natural resources. This means there is a race on between developing goods and services that are carbon neutral and environmentally friendly and the supply of goods that are killing ecosystem services and wreck social relationships. This race occurs within the context of the SCAP, which will seek to overcome any barriers to the investment of that surplus value and will not wait until all goods and services become eco-friendly. If investment in eco-friendly products can be found, and is profitable, capitalism will do so, but it is not fussy in this regard. Canadian tar sands exploitation is an example in which demand for oil and the chance for investing surplus capital to turn a profit cannot be overlooked.
Thus, living the good life runs up against globalised capital surplus accumulation. Green thinking is also a minority sport as it is up against other forces as well. The idea of human progress and technological advances to solve our problems runs in tandem with those who have the capital to invest. This also includes some forms of religious ideology, which affirms man’s right to dominate nature and an anthropocentric world view. Greens need a critique of political economy or risk being side-lined in the Shire as Mordor advances its deathly grip.
The Covid pandemic of 2020 illustrated a flaw in the argument about reducing consumption. Without structural changes, such as universal basic incomes, people lose jobs when other people stop spending. This is what Keynes referred to as the ‘paradox of thrift’. If we all retreat onto islands of thrift, we will face a catastrophe for the livelihoods of billions across the globe. Covid resulted in unemployment and a massive rise in state debt. The ramifications have yet to be fully documented.
It is unlikely that human populations under globalised capitalism will stop the SCAP dynamic. They don’t understand it. What they do understand is that there are winners and losers in the current system. If you win, you win big. Many also feel impotent to prevent the investment decisions being made by suits in the financial districts of level 4 countries. Politicians have let their electorates down or more likely could not deliver as they are merely apologists for the capitalist class executive. Democracy is under challenge, ironic given that many are currently dying for a democratic ideal. Many will shrug and say “nothing can be done”. They may be right. The political power elite and the capitalist class executive may have too powerful a grip and ‘enjoy’ too much of the spoils to change. Meanwhile the political economy of SCAP produces social relationships that determine our current unequal patterns of health.
To date, not enough people are discussing the underlying dynamic of capitalism that produces periodic crises and which may eventually allow Gaia to take revenge. We are locked into a cluster of high carbon systems underpinned by this capitalist dynamic and we don’t have a key. There is an urgent need to design one but our (elite?) Universities are currently so wrapped up in producing technologies for capitalist production and equipping people with skills fit for capitalist purpose that they are ill placed to produce radical thinking, challenges and alternative plans. Education is not the solution; it is the problem. Politics is not the solution it is the problem. Ecology is not the solution it is the problem.
“Philosophers have hitherto interpreted the world in many ways, the point however is to change it”.
That means confronting Capital. Changing the light bulbs isn’t enough and may give a false sense of ‘doing something’.
What you can do, in no order of importance:
- Join/start an anti-capitalist social movement.
- Use social media to connect.
- Confront your elected representatives in writing.
- Identify and contact the ‘suits’
- Find someone who knows what campaigning is and share skills.
- Focus on your core skills, attributes and role and fashion a response that suits them.
- Identify a sphere of influence and work within that.
- Read and understand the issues…or realise that no one cares about any of this, go home and get drunk.
- Look after your family.