On November 12 2014, Melbourne’s Plan B collective hosted a panel discussion and forum at the Victorian Trades Hall on the topic of “Health vs. Capitalism”. The panel’s four speakers (J. C. Coggo, Professor Hans Baer, David Legge and Dr. Deborah Gleeson) were selected to present a range of academic, professional and activist views on the intersection and impact of capitalism upon modern healthcare and global well-being.
Capitalism makes us sick and we’re sick of capitalism
The first speaker, J. C. Coggo of the Melbourne Street Medic Collective, explained that capitalism’s effect on health is very visible in his work and that it was becoming increasingly clear that, “capitalism makes us sick, [and] we’re sick of capitalism.” During the last 18 years of working as a nurse and nurse educator it had become clear that the purpose and motivations driving healthcare have changed and, as healthcare has become more business focused, the ability of nurses and other professionals to articulate traditional values has been forced out of the picture.
The practical result of this shift is the dehumanisation of nursing labour and the reduction of workers to “productive time units” and the prioritisation of time management over good health objectives.
As well as engaging with peers in the workplace and more widely with the community through union structures, Coggo said that he had found a useful form of resistance in Street Medicine. Street Medicine, he explained, is most interested in discovering and promoting post-revolutionary values that will replace those of the current capitalist paradigm. At the core of the movement is building and strengthening community and Street Medics have traditionally situated themselves in anti-capitalist movements in order to help activists look after themselves while resisting capitalism.
Capitalism is the main driver of ill health
The next speaker was University of Melbourne Associate Professor Hans Baer. Professor Baer is a Medical Anthropologist of considerable standing with some 200 articles and 19 books under his belt who became interested in the political economy of health when reading for his post-doctoral fellowship at Michigan State University in the late 1970s.
Baer accused capitalism of being the main driver of ill health and climate change in the world today. This is because capitalism is interested in “functional health” rather than “experiential health” (which requires a greater focus on holistic and social well-being) and as a result people fall through the cracks and become ill.
He also drew a comparison between the US and Cuban healthcare systems, which share a similar level of GDP expenditure but enjoy very different health outcomes, to make the point that expenditure is not necessarily the primary indicator of good health outcomes. Moreover, the failure of WHO to adequately respond to the Ebola outbreak in West Africa (and to the HIV/AIDS epidemic in Africa and Asia) clearly demonstrates the extent and impact of economic disparity upon health and well-being.
With the current growth model “leading to the destruction of the global environment” Professor Baer argued that we are at an historical junction where we must move past capitalism. The real question is how we might get from our current situation to the ideal, and in this aim we will need to see and create new ideas, organisations and even parties to drive and refine this vision.
Any solution must consider class relations
The third speaker was the People’s Health Movement’s David Legge. In order to understand the global health crisis Legge argued that we need to consider the direct impact of capitalism upon health and well-being (i.e., the extent of inequality and waste) and understand that the political governance of the global economy faces terrible instabilities: economic, financial, ecological and social. Global economic leaders seek to protect transnational capitalism but their solutions often, if not inherently, lead to further instabilities.
The primary instability identified by Legge is the massive overhang of productive capacity compared to consumption capacity, which leads to the stagnation of profits. With this threat in mind, capitalists may react by attempting to monopolise their industries (for a greater share of profits) or else to privatise public services, externalise costs to the environment, drive down wages and replace wage labour with technology. It is clear that the problem is not just with institutions like the IMF or global superpowers but about class relations broadly. Any potential solutions must take this into consideration. Legge’s organisation, the People’s Health Movement, has a presence in more than 70 countries around the world and has two main aims: to confront neoliberalism; and, to link with activist groups who are working to shift the current economic system.
Trade agreements harm health
The final speaker for the night was Dr. Deborah Gleeson of La Trobe University’s School of Public Health and Human Biosciences. Dr. Gleeson focused her portion of the panel discussion on the impact of trade agreements upon health.
Negotiations for the Trans-Pacific Partnership Agreement (TPPA) commenced in 2010 but it was not until draft chapters were leaked in 2011 that the implications for global health began to be revealed. The draft chapters showed that the US had plans to challenge Australia’s Pharmaceutical Benefits Scheme (PBS) and health services, as well as to introduce the ability for foreign corporations to sue signatory governments through an Investor-State Dispute Settlement (ISDS) clause.
The documents revealed the extent to which transnational capital advances its own interests via trade negotiations: despite there only being 12 countries engaged in negotiations at the time, around 600 negotiators were engaged in the process of drawing up the provisions of the TPPA, including corporate representatives and members of trade advisory committees sponsored and staffed by transnational corporations. The direct input of corporations into the draft policies is in stark contrast to the way the public is actively barred from knowing the contents of negotiations. Gleeson also argued that pharmaceutical companies have been trying to use trade deals to prevent regulation designed to promote health due to their potential threat to profit.
From individualism to interconnectedness
At the conclusion of the panel the evening moved into further discussion. One point that was repeatedly raised was the need to combat the hyper-individualism of modern capitalism and its pervasive presence in nearly all forms of social and economic interaction. The failure to appreciate our interconnection with ecology and the environment, not to mention spirituality and emotional well-being, is a potent explanation for the current health crisis and here again the point was made that more must be done to learn from indigenous cultures.
David Legge discussed the Declaration of Alma-Ata, which was designed to ensure adequate provision of health to all people and to incorporate the consideration of social and political issues into assessments and management of health and well-being. Professor Baer also mentioned that patient advocacy has been growing in strength recently and may be a useful area for activists to engage with.
Mental health activism was acknowledged as an important element of anti-capitalist approaches to health. The individualisation of capitalism forces us to approach issues as individuals, placing an often unbearable strain upon our mental, as well as physical, health. Professor Baer recommended the book “Sociological Imagination” by C. Wright Mills, which recognises that “personal struggles are related to social struggles,” and might prove a useful theoretical inspiration to health activists.
To finish the evening a few closing statements were offered by each of the panel members. Dr. Gleeson stated that there are big threats to the public ownership of Medicare and access on the horizon, with the outsourcing of claims processing and the increasing prevalence of insurance companies moving into primary health being evidence of the government’s intense privatisation agenda.
David Legge endorsed Global Health Watch as a good resource for activists, as it is anti-neoliberal and has a strong globalisation analysis. He also stated that the big challenge, in his view, is to keep the global perspective in mind as capitalism is itself global. Finally, he recommended reading a recent BBC report on profit margins in the global pharmaceutical industry, which showed that the industry is spending significantly more money on marketing than on research and development.
Professor Baer stated that regardless of whether we tweak or fix the system we must move beyond the current system as gaps in health and well-being are widening internationally and intranationally. He praised Occupy Everywhere for its attempt to link health activism with global social justice but added that all global justice movements need a focus on health as it incorporates larger questions around poverty, equality and the environment.
Coggo finished the night by saying that this is a discussion that needs to continue. Those present at the forum (and those reading this article) are the people who will fight and bring change.
Thanks to Plan B for hosting an important session and to John Zoidberg for capturing these valuable insights for those who couldn’t attend. This is an edited version of an article that originally appeared on Indymedia. Poster image by Ricardo Levins Morales.