Health and Capitalism.
“Resistance is futile” and if you heard those words uttered by the Borg, it often was. However, that did not deter the crew of the starship ‘Enterprise’ from carrying on resisting. And so it is with our current predicament on his planet. The Borg, for the global population, is the capitalist class executive supported by their political power elite. We could just call them the capitalist class or what Graham Scambler refers to as the “Greedy Bastards”.
One issue is the globalised ‘capital surplus absorption problem’ (Harvey 2010) which drives capital across the globe looking for profit and cheap labour. If capital cannot make a decent return it moves on, as it did in Cornwall’s mining regions in the 20th century.
The resistance to the current global capitalist system is legion (Hawken 2009), but it is disorganised, fragmented, unfocused, without a clear plan and often unsure of who or what the real threat actually is. Some of the resistance movement 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. But, while capitalism exists it never resolves its crises, it merely moves then around the globe.
I seek in to cut through the mess of analysis as to why we are heading for continued economic disaster which is in tandem with the ecological one, a disaster in which we are lied to by a feral elite as being ‘all in it together’, while 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.
This is an agenda that brings together ‘inequalities in health’ (Marmot 2010), the social determinants of health, Ecological Public health (Lang and Rayner 2014) and critiques of political economy. It is a realisation that education has failed us on a grand scale. It is a realisation that a few powerful men, and it is usually men, have been bought by men of wealth and have commandeered the levers of power for their own benefit, arguing as they do that it is for our own good. It is a realisation that only when populations wake up to the fact of this old fashioned 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. It is a realisation that well meaning individual action that does not challenge the fundamental driver is at best useless and at worse a distraction from the real battle.
It is a realisation that the war is very possibly already lost and the best we can hope for is managed decline in human welfare before restructuring of the social economy is forced upon us. There remains optimism of the will but pessismism of the intellect.
Some are more optimistic about our ability to use technology and our transformation of economic models. The Global Commission on the Economy and Climate suggest that economic growth and combating climate change can be done together. In their “Better Growth, Better Climate “ Report (2014), the starting point for this “New Climate Economy” has been to see the issue from the perspective of economic decision-makers. By this they mean government ministers, particularly ministers of finance, economy, energy and agriculture; business leaders and financial investors; state governors and city mayors. None of these decision makers will be anti capitalist and probably have been schooled in either neoclassical economics or economic orthodoxy. I suspect few have read deeply or understood Tim Jackson, David Harvey, Steve Keen or Thomas Picketty, let alone volume’s 1 and 2 of Capital. I suggest that capital accumulation and the contradictions within capitalism is the base issue upon which climate change rests. Naomi Klein has recently (2014) linked these two and brought them into the public sphere in her book “This Changes everything. Capitalism vs Climate”.
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 determinants of health. There is a biological basis for some individuals, and this may account for 30% of premature deaths. However genetic determinants (e.g. in cystic fibrosis) operate at this individual level and are manifest in a relatively minor way. This is not to deny that for the individual the medical condition is anything but minor, but health on population levels are not determined thus. Even genetic manifestations are at times made worse or better by the social conditions in which the individual finds themselves. Poverty has a knack of making underlying biological problems much worse.
Social Conditions and Relations
Marx (1859) wrote “In the social production of their existence, men inevitably enter into definite relations, which are independent of their will, namely relations of production appropriate to a given stage in the development of their material forces of production. The totality of these relations of production constitutes the economic structure of society, the real foundation, on which arises a legal and political superstructure and to which correspond definite forms of social consciousness. The mode of production of material life conditions the general process of social, political and intellectual life. It is not the consciousness of men that determines their existence, but their social existence that determines their consciousness”.
In other words, capitalism as an economic system is formed by particular social relationships which give rise to our laws such as private property, our political system and our ideas about how society should be. The current ‘mode of production of material life’ is capitalism in its various forms and is the basis for our social life and our social relationships. Simplistically, this means economic factors – the way people produce the necessities of life (mode of production) – determine the kind of politics and ideology a society can have.
If health is socially determined by social relationships, what are the current forms of social relationships 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. Thus material conditions and poverty are prepotent conditions for health. That is not to deny that affluent women and affluent BME’s may also experience ill health disproportionately in certain medical categories. However, the major driver for global health are the socio-economic relationships which are based on a certain forms of capitalist political economy.
Graham Scambler argues that a way to understand health is to see ‘asset flows’ operating throughout the life course:
“The noun ‘flows’ is significant here. People do not either have or not have assets positive for health and longevity, rather the strength of flow of these assets varies through the life- course”. So it is not about the static acquisition of wealth or material deprivation that is at work. It is about what assets flow in and out of people’s lives over the course of their life, and this is particularly important in childhood and older age.
The ‘assets’ are:
biological: your ‘genetic inheritance’, sex, your disabilities, your long term conditions. A healthy child born in Redruth in 1960 starts with good biological assets.
psychological: e.g. your self-efficacy, locus of control, learned helplessness. This same child grows up in social world in which she learns that female roles are pretty much limited, her belief regarding her ability to achive anything she wants is limited by the role models and messages around her. Her ‘self efficacy’ is thus reduced to acting within strict and socially moulded goals. Her self belief does not stretch to being Prime Minister. Her psychological asset is not weak but it is certainly not as strong as a young boy at Eton.
social: family network, community networks, friendships. All her friends do not pass the 11 plus and so her network ‘learns’ a factory fodder secondary school education hell bent on training the local girls for the local textiles factory. Father drives a bus, mother works part time at the local electronics factory. No one goes to university out of the county. This girls position on the social gradient is not the worse but it is not the best either. Her social asset is low to medium.
cultural, your lifestyle choices such as smoking. Cigarette smoking is very common, all the adults around smoke, it is a rite of passage at school and fags are relatively cheap. A 20 a day habit is soon formed. This is a very weak cultural asset.
spatial: where you live, leafy Surrey or inner city Glasgow? Thankfully Camborne is a rural small town lacking the street and environemental dangers of a Toxteth or Lewisham.
symbolic: status as a ‘chav’ or as member of the elite. Thankfully growing up in rural Cornwall in the 60’s, the word ‘chav’ is not known, the demonisation of the working class has not started and there is no talk of benefit cheats and scroungers as the girl grows, she is spared this symbolic humiliation, but the ‘gippoes’ at Carn Brea are not.
material: income and wealth. As an adult, the girl ‘marries well’, her husband has a decent job and they live in a nice part of town. The house is not damp, they can afford to heat it and provide adequate food for the children.
In addition, Scambler suggests that we need to understand that:
- The strength of flow of material assets (i.e. standard of living via personal and household income) is paramount. This links with the material deprivation thesis explaining the link between health inequalities and socioeconomic status.
- Flows of assets tend to vary together (i.e. mostly strong or weak ‘across the board’);
- Weak asset flows across the board tend at critical junctures of the life-course (e.g. during infancy and childhood) to have especially deleterious effects on life-time health and longevity: a child born with a chronic illness, into the lowest decile of income distribution, in an abusive psychological and social environment, living in damp squalid housing in which both parents smoke, in an area of high unemployment and poor access to health care and a proliferation of fast food outlets, in a culture that demonises ‘chavs and benefits cheats’…….
- Weak asset flows across the board, and I daresay strong asset flows across the board, tend to exercise a cumulative effect over the life-course (negatively and positively respectively);
- The ‘subjective’ evaluation of the strength of an asset flow can exert an effect over and above any ‘objective’ measure of that flow (e.g. a symbolic asset flow perceived as weak relative to that enjoyed by an individual’s reference group can be injurious in its own right). That is, how we perceive how good or poor our ‘asset’ is, affects us even if that asset is not in itself injurious. This is the social comparison thesis or psychosocial hypothesis.
Scambler regards the material asset flow as vital or ‘prepotent’. Of all assets it is the material conditions of life that underpin much of our health outcomes. In this, Scambler is adopting a Marxist take on health inequalities. To argue that material conditions underpin all other asset flows is not to diminish their importance for health inequalities. This is only highlighting the key point of Wilkinson and Pickett’s The Spirit Level, in that that action on the reduction in income inequality is a precondition for tackling health inequalities.
Danny Dorling (2014) points to the rising levels of inequality and argues that being born outside the 1% has a dramatic effect on a person’s potential – their asset flows – reducing life expectancy, limiting educational and work prospects and adversely affecting mental health. The ‘greedy bastards’ are of course not the 1%, they are part of it, but their wealth puts them more into the 0.01% of income earners.
What are the current dominant socio economic conditions therefore that give rise to the health and illness patterns we note, are affect the asset flows in people’s lives?
A feature of modern capitalism, which in its neoliberal 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 et, 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 the ‘surplus capital absorption problem’ (SCAP). As surplus value accrues to the ruling class, those who own and control the means of production, it has to be reinvested or it is lost. Thus capital continually seeks new markets and new profits. It cannot stand still and so it looks to exploit more and more natural capital in the process. The drive for capital accumulation is the engine of this whole process.
When capital 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 unions, or finds other investment opportunities. It takes manufacturing to countries where there is weak, cheap or surplus labour. This is one of the foundational contradictions of capitalism – the capital and labour conflict. An economy that is not returning 3% growth is seen as sluggish and, as we are experiencing in the UK, recessions which result from lack of aggregate demand and lack of surplus capital investment result in unemployment and social unrest.
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 and various waves of ‘creative destruction’ as it comes up against barriers to accumulation and then seeks new forms. In this manner whole cities, e.g. Detroit, are nearly laid to waste as old forms of capital accumulation, e.g. car manufacturing, becomes unprofitable and shifts across the globe. In Cornwall, capital fled following its inability to make a profit from mining and engineering leaving a service and tourism sector characterised by low wages and precarious seasonal contracts. Camborne and Redruth are hollowed out towns still trying to recover from the creative destruction unleashed by the forces of globalisation that resulted in tin being cheaper in South East Asia.
Meanwhile whole populations have been ‘bribed‘ by the baubles and cheap credit 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’.
We have heard the mantra “we are all in this together” which is supposed to reassure us that everyone in society is shouldering some of the burden of the consequences of the financial crash of 2008. We also hear that the UK’s debt has to be reduced quickly and that means cuts in public spending. This is an international phenomenon affecting the United States as well as Europe. Many other countries are not quite so indebted. Global capitalism is still working very well in certain localities and everywhere for the capitalist class.
Forbes has been reporting global wealth for 25 years and states that 2011 was a year to remember. For positive reasons. The 2011 Billionaires List breaks two records: total number of listees (1,210) and combined wealth ($4.5 trillion). This amount of money is bigger than the gross domestic product of Germany, one of only six nations to have fewer billionaires that year. BRICs led the way: Brazil, Russia, India and China produced 108 of the 214 new names. These four nations are home to one-in-four members, up from one-in-ten in 2006. Before 2011, only the U.S. had ever produced more than 100 billionaires. China in 2011 has 115 and Russia 101. While nearly all emerging markets showed solid gains, wealth creation is moving at an especially breakneck speed in Asia-Pacific. The region now has a record 332 billionaires, up from 234 in 2010 and 130 at the depth of the financial crisis in 2009. High performing stock markets are behind the surge. Three-fourths of Asia’s 105 newcomers get the bulk of their fortunes from stakes in publicly traded companies, 25 of which have been public only since the start of 2010.
Forbes argues that the reason they track this wealth is because these billionaires have the power to change the world. For example, Telecom billionaire and prime minister Najib Mikati supports the Lebanese government. Ernesto Bertarelli, is now focusing on saving the oceans from eco disaster. Bill Gates and Warren Buffett have already traveled to three continents working to change giving practices among the ultra-rich. This is feudal ‘noblesse oblige’, the power of the divine right of kings by dint of wealth with little democratic control. Meanhwile the UK’s Candy brothers like to boast of their wealth and how little tax they pay in the context where “only the little people pay taxes” and in which the rich are winning the class war.
Meanwhile nearly half of the world – 3 billion people – live on less than $2.50 a day and 80% of humanity live on less than $10 a day (2008 figures from the World Bank Development Indicators).
In the UK, the inequality briefings report that the richest 1% of the population have as much wealth as the poorest 55% combined; Oxfam report the 5 richest families are wealthier that the poorest 20% combined.
“We are all in this together”. Right.
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 absorption 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 through alienating labour and growing inequality. 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 accumulation, especially in the form of the subsidized Fossil Fuel industry.
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 and dualist world view.
Greens need a critique of political economy or risk being sidelined in the Shire as Mordor advances its deathly grip.
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 first world countries. Politicians have let their electorates down or more likely could not deliver as they are merely apologists for the ruling class. Democracy is under challenge, more than ironic given that many are currently dying for a democratic ideal.
Many shrug and say ‘nothing can be done’. They may be right. The ruling class 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 so called 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 ain’t enough and may give a false sense of ‘doing something’.
The ruins of Cornwall’s mines stand in silent testament to the destructive forces of globalisation, mirroring the ruins of people’s lives in the sunken inland towns of Cornwall’s backbone, connected together by a road that fails to take them to the golden reaches of England’s South Eastern metropolis 300 miles way.
- Join/start an anti capitalist social movement.
- Use social media to connect for example 38 degrees.
- Confront your elected representatives in writing.
- Identify and contact the ‘suits’.
- Find someone who knows what campaigning is all about 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.
- Consider direct civic action, e.g. ‘Occupy’.
- Read and understand the issues.
…or realise that no one gives a toss about any of this, go home and get pissed or pregnant.