Tag: social justice

Planetary and Public Health – its in our hands ?

From public to planetary health: a manifesto.

The Lancet (Horton et al, 2014) has just published  a manifesto for transforming public health.

You can read the full one page easy to read manifesto here.

This is a call for a social movement at all levels, from individual to the global, to support collective action for public health. Public Health has been widely defined in this manifesto and draws upon the ideas of Barton and Grant’s health map which has climate change, biodiversity and global ecosystems as the outer ring of the determinants of health.

The current definitions of public health, for example from the Faculty of Public Health,  draw upon Acheson’s 1998 definition “The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society”.  However this definition may now be outdated as there is no mention of environmental or ecological determinants of health and no express action on planetary health at all.

Therefore this manifesto is an implicit call to redefine what public health means. Currently you can read the FPH’s approach to public health and fail to consider issues around climate change, biodiversity loss or the crossing of planetary boundaries which delineate a ‘safe operating space for humanity‘. This needs changing.

The main points within this manifesto  include a definition of ‘planetary’ , rather than ‘public’ health which they argue is an “attitude towards life and a philosophy for living… emphasising people not diseases, and equity not the creation of unjust societies”.  There is a strong focus in the manifesto on the unsustainability of current consumption patterns of living, based on the harms this has on planetary systems. They argue “overconsumption…will cause the collapse of civilisation”. Jared Diamond is worth a read on the collapse of civilisations,  and this argument is in line with his analysis.

Interestingly, an overt political statement is introduced: “We have created an unjust global economic system that favours a small wealthy elite over the many who have so little”. They attack the idea of progress, and of neoliberalism  including ‘transnational forces”, for deepening this ecological crisis and for being socially unjust. There is also a hint of the ‘democratic deficit‘ in which trust between the public and political leaders is breaking down.

The call is for an urgent transformation in values and practices based on recognizing our interdependence and interconnectedness, a new vision of democratic action and cooperation.  A principle of ‘planetism’ is invoked which requires us to conserve and sustain ecosystems upon which we rely.

Finally they suggest that public health and medicine can be independent voices of conscience who along with ’empowered communities’ can confront entrenched interests.

So far so good, and in a one page document the detail is necessarily missing.  The principles outlined in this manifesto and the analysis focusing on neoliberalism and ‘entrenched interests’ point us in a direction. However, there is now a need for a map.

I am not convinced that public health, medicine and certainly not nursing, is sufficiently politically aware of the scale of the issue and the sheer force and dynamic of capitalism to even begin constructing the map. That may be an unfair criticism because the education of health care professionals is ‘ahistoric’ and ‘apolitical’ by nature,  they simply lack a sociological or political imagination underpinned by a critical theory of capitalism. And for good reasons.

However, if doctors and nurses are to engage with this manifesto and to debate and argue for an alternative world view, then there is an urgent need to understand the forces railed against them. This manifesto rightly points out the political nature of the issue and the authors no doubt have a clear idea what they mean, however I doubt very much if the majority of healthcare professionals really understand, or even perhaps care about,  the concept of neoliberalism.

In the UK we will be having an election in 2015, in which we will be offered similar versions of the system that is causing the mess. There will be little in the way of mainstream reporting or argument on radical alternatives to consumption or finance capitalism. Indeed parties will be arguing over who can best manage the system.  The only exception will be the Green party who are a fringe party, in terms of votes.

As an example of the scale of the problem, consider Bill McKibbens’  ‘three numbers‘ argument: 2 for two degrees, the threshold beyond which we should fear to tread; 565 gigatons of CO2 we might be able to put into the atmosphere and have some hope of staying below or around 2 degrees; 2795 gigatons which is the amount of carbon in current reserves, but is the the amount of carbon we are planning to burn!  Further, the wealth of investors is tied up in this number and would evaporate like petrol in a hot day should we globally decide that this reserve should stay in the ground. This is an example of an entrenched interest backed by neoliberal politics which is antithetical to global and governmental regulations. The current TTIP negotiations which is trying to establish a free trade area between the US and the EU,  possibly exemplifies the powerlessness of states in the face of lawsuits by corporations if George Monbiot is correct. TTIP is a public health issue and forms part of the backdrop to this manifesto.

I welcome this manifesto, and would urge public health bodies to become overtly political in their statements about public health, perhaps revisiting Acheson and redefining public health to include planetary health.

Following that observation, a new publication published in February 2014, appears to address the politics in an overt way. The Lancet – University of Oslo Commission on Global Governance for Health argues in a document called ‘The political origins of health inequity: prospects for change’ : “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.”

This then sets up political determinants of health which sit alongside the social determinants of health. Whether it goes as far as critiquing the underlying dynamic of various forms of capitalism remains to be seen.

Making our own histories – we can change things if we want to and are free to.

Musing on the freedom to act in society, and on the nature of capitalism and its pernicious effects upon us, it might do to consider that we are free to change and we are not free to change. Capitalism at once exists and acts and feels like a cage while at the same time does not exist and is also only a product of our own imaginations and our social relationships that we have chosen to engage in. This matters because real lives are affected by the decisions that others in positions of power take, and they take these decisions as if capitalism is immutable, all pervading, inevitable…as a fact of life. This then justifies the use of batons, tear gas and surveillance drones in civil society and in putting down protest, and it justifies fixing the legal, financial and political framework so that big money fulfills big money’s needs.

In response to a recent email exchange I engaged in, a suggestion was made to me that there is a tendency to ‘objectify’ capitalism in many discussions – to make it seem indeed like a cage – a thing that has its own almost material existence and ‘essence’. This means that we may talk about capitalism as if it has objective existence and also a fixed nature. Capitalism is, in Emile Durkheim’s phrase, ‘sui generis’ – ‘of its own kind’. This derives from thinking that capitalist society over time replaces individuals with others, yet the ‘essence’ of society will not necessarily change. Over the course of a few decades, many individuals die and are replaced, however, the society retains its distinctive character. It is a thing of itself existing independently of individuals. An entire society that is built in this manner has its own ‘essence’. It has this ‘essence’ before any individual currently living in it is born, and is therefore “independent of any individual” existing almost as an ‘objective fact.’ We acknowledge this objective existence when we use such phrases as “Society today is worse/better than it was back in the day when…”

Some commentators might use different labels for capitalism. For example ‘casino capitalism‘ or ‘responsible capitalism‘ which reflects thier differing understandings of what capitalist society might be like. This tendency to label and to treat it as an objective fact, however, may overlook the fact that capitalism, like any ism, is dynamic and on the move. Historically that has been true: we have seen mercantile capitalism, industrial capitalism, post industrial or financial capitalism. Nonetheless and however it has been labelled, we must remember that capitalism is not an ‘objective fact’, although it can certainly feel that way especially to those who feel the full force of economic decisions made in far away board rooms.

Capitalism is a dynamic ever changing social system which finds expression and manifestation in human social relationships. The ‘objectivity’ of capitalism is a chimera; we may reify it and miss the essential nature of human decision making and social relationships that underpins it. Susan Strange argued “economists simply do not understand how the global economy works” due to a poor understanding of power and an over-reliance on abstract economic models. In other words, economist are apt to treat capitalism and the working of markets based on a false premise: that there is a objective system that can be understood theoretically using mathematics and a theory of self interested utility maximising rational actors, the ‘homo economicus’ of JS Mill and Adam Smith. To be fair to Smith he tempered this view in his Theory of Moral Sentiments.

What economists often miss is that what we are talking about here is a set of human relationships characterised by an imbalance of power.

“Men make their own history, but they do not make it as they please; they do not make it under self-selected circumstances, but under circumstances existing already, given and transmitted from the past” (Marx). What have ‘we’ been given and transmitted from the past? Anti capitalist sentiment such as some of us in the sustainability or others in the Transition Towns movements express, are confronting Big Oil, and a cluster of high carbon social systems (John Urry) which are based on certain capitalist relations of production. ‘We’ ignore capitalist class relations at our peril. ‘We’ may confront power elites who have made, and are trying to continue to make, history in their own image: how that history will pan out depends on our collective and individual responses to Power, e.g. the Military-Industrial-Security complex, the World Bank, IMF, OECD, G8, Davos, Bilderberg (?), EU and other Regional blocs, the Trioka, the Corporate Class Executive and the Political Power Elite. We, e.g. ‘anti-capitalists’ or the Transition Towns or Environmentalists, are trying to remake history; history as we please, but within a certain socio-political context and power play not of our choosing. We do not have ‘self selected circumstances’ and that is what makes capitalism feel like a cage. Ask yourself: who has the guns?

For an example of circumstances being shaped by the powerful, note how successful the right wing press has been in sowing the seeds of doubt in the population about climate change,  and also for blaming the poor for their position while supporting austerity in the midst of one the greatest transfers of wealth from poor to uber rich (the 0.01%) we have seen, and the movement of private bank debt to sovereign public debt. There is ample evidence that the neoliberal agenda, which unites many of groups mentioned above, are antithetical to a ‘no growth economy’ and to social democracy.  In the West, there is only one game in town: growth based on neoliberal economics.

There are countervailing voices, e.g. Paul Hawken’s ‘Blessed Unrest’,  but some are increasingly despairing, Will Hutton articulates this well.

The post financial crash shifts of 2008 are playing out, but we don’t know in 10 years what this will look like. So far however, report after report shows the wealthy elite entrenching their power and wealth* while the occupy ‘movement’, the indignados, the precariat, come under increasing demonisation, e.g. skivers v strivers, surveillance and crack downs, using para militiary type tactics. The monolith of Capitalism stands while we crash against it.

Capitalist social relationships are backed by ideology and often force. Some argue it is the best of a bad lot, and that like democracy it is the worse system we have except for all the others, that it is the only game in town. Marx himself marvelled at its ability to produce abundance. However, is this really the best we can do? Is this really the best world in the best of all possible worlds? Growth capitalism, and there is no other sort, is leading us towards ecological disaster, while the social determinants of health result in inequalities in health whereby millions die prematurely and needlessly because of our socio-political arrangements.  Many of us bluster and blog and rage and rant and protest, some of us quietly get on with living differently, remaking our social relationships as best we can.

We are free but everywhere we are in chains.

 

*the richest 1,000 persons, just 0.003% of the adult population, increased their wealth over the last three years by £155bn. That is enough for themselves alone to pay off the entire current UK budget deficit and still leave them with £30bn to spare.

marxism and health care

Marxism and Health Care

You can also find this paper on my academic website:

http://plymouth.academia.edu/bennygoodman/Papers

 

Contents

 

 

Introduction. 2

 

1. An outline of Marxist philosophy. 3

 

2. From a philosophy to health. 9

 

3. The Social Determinants of Health and the health worker’s role. 11

 

References. 14

 

A worker’s speech to a doctor. 15

 

 

Introduction

 

The philosophers have only interpreted the world in various ways; the point is to change it”.    Theses on Feuerbach. XI  Marx K  c 1888

 

This paper is in three parts:

 

1)    An outline of Marxist philosophy.

2)    A discussion of its application to health.

3)    The Social Determinants of Health and the health worker’s role

 

Finally, Bertold Brecht’s poem ‘A worker’s speech to a doctor’ is presented for reflection.

 

This outline of Marxist philosophy focuses on 3 key ideas:

 

1)    Material Conditions. To understand our experience as human beings we must begin with rooting that experience in the material conditions of everyday life.

2)    Dialectical Materialism. Those material conditions of everyday life are characterised by conflicting social forces, the outcome of which ‘determines’ our experiences.

3)    Alienation. A result of our current material conditions of life is that we are alienated from our human self, from each other and from the nature of work.

 

These 3 lead us to consider that a fuller understanding of human health involves an analysis of the material conditions of living and its effects on health and illness; an understanding that competing and powerful groups shape those material conditions and that this shaping of material conditions results in alienating experiences and behaviours that lead people to make unhealthy lifestyle choices. These collectively are the ‘causes of the causes’ of ill health.

 

Marx never wrote explicitly about health problems, or the role of health professionals, his was an analysis of the progressing conditions of man in the pre modern (feudal, agrarian) and the modern (industrial) era, but it is in this analysis that we find the above ideas that may speak to us of some of the causes of a modern malaise.

 

The malaise is this. We live in an epoch of unprecedented wealth; financial, material and intellectual. The success of capitalism and technological advances, such as the internet, facilitate both the movement and development of capital and knowledge. Life expectancy and infant mortality have gone in the right directions. We live longer and in better health. Marx himself wrote very favourably about the ability of capitalism to be innovative and creative in furthering human progress.

 

However, alongside this wealth is continuing material poverty, a poverty of spirit as well as seemingly insurmountable problems: climate change, pre enlightenment religious fervour linked to terrorism, drug/alcohol abuse, and war. The United Nations struggles to contain inter state conflict and to deliver the promises of the Millenium Development goals. Alongside the huge increases in wealth, is the vastly increasing inequality in both social conditions, and inequalities in health and wealth of the global population. The gains ushered in by modernity are increasingly going to a wealthy ‘elite’ despite a growing middle class in many developing countries. We might be getting richer but we are not necessarily getting happier, and as austerity policies bite, many people are getting stressed, anxious and even suicidal.

 

Far from ushering in an era of global peace and prosperity the dominant mode of production, i.e. capitalism, is in urgent need of revision in order to meet the challenges the global community faces. If it does not do so, it might face what Jürgen Habermas called a ‘crisis of legitimacy’ as publics become less accepting of the social problems and the democratic deficit it seems to entail.

 

It is this cultural and economic critique that (neo) Marxist writers such Theodore Adorno, Louis Althusser, Jurgen Habermas and Antonio Gramsci have drawn attention to. In the 21st century these neo Marxist thinkers have been joined by writers who do not openly call themselves Marxist but they draw upon Marxist thinking, notably the idea of the material conditions of life affecting health e.g. The Black Report 1980 and the Marmot Review 2010; ideas around alienation affecting mental health, see Oliver James’ selfish capitalism;  and that of a ruling class elite see Graham Scambler’s ‘Greedy bastards hypothesis’.

 

 

1. An outline of Marxist philosophy

 

 

Condensing Marxist philosophy into a few paragraphs is just not possible. Therefore what follows is a snapshot, an interpretation (a thesis) open to critique and refutation (an antithesis) which may lead to a synthesis which in its turn may be challenged.

 

In 1844 Marx began collaborating with the affluent industrialist Friedrich Engels who was fresh from working as a mill manager in Manchester where he had been much affected by the poverty of the workers. The result was first The Holy Family and then in 1846 The German Ideology.

 

Marx’s understanding begins with the acceptance, his first premise, that it is the material conditions of man which conditions everything else, including man’s consciousness and his ‘ideas’. Thus his philosophical position is that of metaphysical naturalism.

 

‘The first premise of all human history is, of course, the existence of living human individuals. Thus the first fact to be established is the physical organisation of these individuals and their consequent relation to the rest of nature.’ (Marx and Engels 1846).

 

 

The focus is on the ‘physical organisation’ of human existence. Supernatural explanations (God or gods) for the condition of humanity are not needed. It is this premise that has led many, especially in the United States, to reject Marx from the outset as it is atheist in nature. History does not progress through ‘ideas’ alone, or though Allah’s or God’s will, or as a manifestation of Hegel’s ‘Geist’ (Spirit), but through the changing material conditions of existence, and the struggles of humanity to pacify the conditions of their existence. Look to how human beings in their physical existence organise themselves in their struggle to exist in a material physical world, as a starting point for social analysis.

 

 

‘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.’ (Marx 1859).

 

Marx suggests that primarily we need to feed, drink, clothe and house ourselves and to do so we must enter into social relationships to achieve this. An examination of history reveals the form of those social relationships (the serf-lord, the working class-bourgeoisie) that exist in a particular economic mode of production (pre-agrarian, feudal and then capitalist). It is the ‘mode of production’, currently capitalism, that ‘determines’ the form of social relationships, and the ways we think. Therefore the feudal serf-lord relationship was swept away with the rise of industrial capitalism, it simply could not continue to exist as a dominant way of organising social life. One could no longer think as a feudal lord when the feudal mode of production disappeared, just as a feudal lord could not think like a merchant capitalist trading in goods across the globe because that mode or production did not yet exist.

 

 

 

 

 

 

 

 

 

Key concepts 

Means of production: land, tools, technologies

Forces of production: labour power and knowledge of technologies

Relations of production: the totality of social relationships that people must enter into to survive.

Mode of production:  a combination of the forces of production and relations of production.  Two modes are feudalism and capitalism.

 

 

 

 

In a society where there is no social provision for health, such as that in pre 1948 Britain, and which the dominant thinking is that all goods and services should be provided by private individuals rather than governments, then it is very difficult to think of a national health service paid for by taxes. This idea came about as part of the class struggle in industrial Britain when workers who could not afford to pay for doctors, finally got around to demanding health care irrespective of ability to pay. In the United States many people have accepted the idea that state provision for health is akin to Marxism and communism. The anti-Obama rhetoric on this issue is very clear on this point. Those with an interest in private medicine and those with a visceral hatred of state provision for anything, mounted a very successful campaign tapping into ordinary Americans love of individuality and scepticism about state involvement.

 

The form of the social relationships of production, e.g. proletarian – bourgeoisie, workers-ruling class, are defined by the mode of production. In the modern industrial era, this relationship is characterised by who owns and controls capital (the main means of production) and who does not (and only has their labour to sell).

 

This gives us the second concept: Dialectic Materialism. This suggests that if an understanding is required as to why we have the laws we do, the social relationships we have, the politics that are played out, the forms of artistic production and expression, and the health care systems that are in place, we have to understand our material existence based on the economic mode of production. This material existence includes the opposition of social classes that, through conflict and struggle in relationship to each other, gives rise to a new social order that in time may itself be challenged. Start with material conditions and then see that there are ‘dialectics’ or opposing social forces/classes at work. The sort of society you get results from the interplay of these two classes.

 

The dominant class in any historical era gets to set the agenda. If the subordinate class accepts the ruling class’ view on the proper social order then society ‘settles’ for a while. However, as the forces of production change with the development of new technologies for example, this impacts on the social relations of production, thus eventually changing the mode of production. This change of mode of production from feudalism to capitalism for example is not inevitable. Many so called ‘primitive societies’ have had sustainable social structures with an unchanged mode of production i.e. hunter-gatherer, for centuries. Marx realised however that capitalism was an extremely dynamic mode of production capable of unleashing upon the world social and technological revolutions never before seen or experienced.

 

Modern, globalised (post-industrial/financial and industrial) capitalism shapes our lives in deeply profound ways and it is to the nature of the 21st century form of capitalism that we should look to understand our modern social world and the world of ideas. Historical Materialism is the application of dialectic materialism to history and sociology. It is the view that social, political, artistic and cultural life is determined mainly by the material facts of economics and the forms of social relationships thus created, and not God or by human reasoning alone.

 

The health care system within capitalism results from this dialectical interplay between the social classes. Capitalism has now provided technologies and advances which allow for many different relationships and forms of health care to emerge, but at its heart is the relationship between its social relations of production: labour (proletarians) and capital (bourgeoisie). The exact nature of the health system differs from country to country, but it results from whichever social force is best able to set the agenda.

 

Currently, Capital, in the form of private sector corporations,  is dominant and channels funding, or withholds funding, for health care though its various spheres of influence.  If private sector corporations can influence Nation States to allow them to provide health services for a profit they will do so. If working class, i.e. labour, interests insist that health care is provided free at the point of delivery paid for out of general taxation, and that idea wins out, we end up with an NHS. In the UK, private sector corporate interests have successfully introduced market forces into a publicly funded state health system. In the United States, private sector health interests have blocked anything but the most basic of public funding for health. In many other countries the interplay between capital and labour has resulted in mixed public/private provision.

 

 

A defining characteristic of capitalism, Marx suggested, is that it alienates man from himself, from the true nature of work, from others and from nature. Alienation is suggested as a third concept in understanding modern existence, especially in terms of mental health and ideas of well-being. Anyone who only has their labour, skill or knowledge to sell in return for a wage or salary may reflect on the alienated meaning of their existence. Billions of workers are engaged in low pay, repetitive, precarious and zero contract hours to produce ‘stuff’ that ultimately is unsatisfying and which paradoxically leads to the consumption of more ‘stuff’ as a means of escape. There is now discussion of a ‘new dangerous class’ – ‘the precariat’.

 

Alienation may be partially moderated by consumption and by accepting the dominant ideas of what is the ‘good life’. In Roman times this was understood by the Emperors’ provision of bread and circuses. The plebeians needed distraction to prevent them from seeing the true nature of their subjugated existence. Soap operas and celebrity culture may have a similar function today. Other ways of ameliorating this alienation is through organised religion or a spiritual quest, or one can resort to easing the anomic pain with drugs and alcohol. We might also engage in art or philosophical musings to escape the feelings of disconnection from ourselves, our work, each other and from nature.

 

The ‘poverty of philosophy’ is its concerns with abstractions, ideas, ‘facts’ or consciousness devoid of their material context. That is, a philosophy or any understanding of how the world works which does not take into account the material conditions that man finds himself and the power relationships that result, is an empty philosophy. Removing the analysis of power relationships allows the ‘Ruling Class’ to promote their own interest in the form of ‘Ruling Ideas’. Therefore, encouraging people to ‘find themselves’ without a class analysis lets the ruling class completely off the hook because this requires no changes whatsoever in the mode of production. Capitalism can embrace any amount of ‘new age’ philosophy as long as that philosophy does not challenge  the basic power structures of wealth accumulation and distribution.

 

The counter culture in the 1960’s was initially threatening.  In being inviting young people to ‘drop out’, and with the advocacy of using LSD, capitalism would be deprived of workers who would shoulder their share of the burden. Of course the actual argument was couched in terms of ‘drugs are bad for you’, which is seen an easier sell to otherwise rebellious youth rather than ‘drug use may make you question the system’ which is not, and may actually be quite an appealing reason to take drugs.

 

The class which has the means of material production at its disposal, and which has control at the same time over the means of mental production, and over thinkers, as producers of ideas, can sell and promulgate those ideas as the ‘right ‘ones. The ruling class can regulate the production and distribution of ideas and define them to serve their own causes. ‘Liberty’ to the ruling class means something quite different to those who have nothing but the shirts on their backs. This does not mean there will not be rebels in thought and deed, only that ruling ideas tend to become ‘taken for granted’ and ‘common sense’ and anyone not willing to take part in selling their labour is then classed as deviant or criminal. Thus we have social and political issues with ‘out groups’ such as travellers, chavs, skivers v strivers. Countervailing voices are pushed to the margins and tolerated as long as they don’t do a anything practice to change things.

 

Escaping from these social relations of production is increasingly harder to do as more and more people in a globalised economy become part of the overall mode of production we call globalised capitalism.

 

To keep it that way, the ruling class, identified by Scambler as the Corporate Class Executive and the Political Power Elite, has at its disposal a Repressive State Apparatus: Police, Military, Executive government,  and an Ideological State Apparatus: newspapers, broadcast media, the churches/mosques. These act as agents of social control trying to prop up the legitimacy of current power structures and the structures of rewards and punishment. Ruling class interests are better served if the subjugated classes accept their position themselves and regulate themselves by accepting, as natural, the ruling systems. Democracy in this schema is a chimera, the State (party politics) exists mainly to serve the interests of the ruling class:

 

‘the modern Cabinet is but the executive committee for managing the affairs of the entire bourgeoisie’ (Communist Manifesto).

 

Ideas, and the definitions of ideas, such as the ‘rule of law’, ‘market forces’, ‘free trade’, presents particular class interests as being in the general social interest. It is as if these ideas float down like manna from heaven untainted by the need to serve a particular class interest. This may lead to hegemony, the political, social, ideological, economic dominance of one class over others in a system in which all are supposedly equal. A result of which may be that the subjugated class, by accepting the tenets, ideas and concepts of the dominant class has a false class consciousness, i.e. a false understanding of their true social position and interests. That is how you get low paid workers supporting social security cuts for low paid workers. Turkeys voting for Christmas.

 

The goal of philosophy should therefore be to reveal the true nature of abstract concepts e.g. parliamentary democracy and a health service, as arising from the material existence of those who produce them and the struggles of opposing social forces.

 

 

Reflecting on such a critical philosophy leads to certain questions. It may be argued that Marxism assists in developing a necessary critical perspective in that it’s key concepts asks us to engage in criticism which has:

 

‘plucked the imaginary flowers on the chain not in order that man shall continue to bear that chain without fantasy or consolation but so that he shall throw off the chain and pluck the living flower.’ (Marx 1843-4, p 244).

 

There is a need to get beyond the illusory to the real, to separate fantasy from reality, to free empirical butterflies from under the wheels of philosophical fantasy. Marxism argued that there is a material reality, often hidden by delusion, deception and class interests.

 

We may suggest that in the current era a global multinational corporatist class exists for whom such concepts of the maximisation of profit, shareholder value, the extraction of natural resources on an industrial scale and the value placed on market solutions to various social, political and health issues are dominant. It wants and needs a healthy workforce only as long as the costs are not threatening to profits. Hence the health needs of poverty stricken, war torn Africans are not a priority. The health care needs of unproductive members of society: children, students, the elderly, the sick, learning disabled and mentally ill, are a costly burden to be born if possible by individuals and families. This in practice means care is to be undertaken by women supported by patriarchal notions of biological determinism of female nurturing.

Capitalism allowed the welfare state to exist on sufferance in the UK and not all in the US. Now that it has decided that the welfare state is too costly in the UK, it is withdrawing state support as quickly as public opinion will allow it to go. Corporate class interest does not need this cost burden. It prefers privatising and individualising risk rather than being asked to support public health delivery systems. The ideology it sells includes an over emphasis on individual lifestyles choices as part of the ‘responsibility deal’. You are fat because you over eat. Simple. The solution? Stop eating. Simple.

 

2. From a philosophy to health

 

In any social, cultural and political activity, a Marxist analysis thus assumes a dominant class exists which continues to own, manage and control the means of production, distribution and exchange and the production of ruling ideas. Scambler (2013) in his “Greedy Bastards Hypothesis” identifies a ‘cabal’ of wealthy and influential individuals forming the Corporate Class Executive who work with the Political Power Elite to further their own interests over that of society. His example is the introduction of the UK’s Health and Social Care Act (2012) which opens up health service delivery to “any willing provider”, such as private sector organisations. Those now charged with buying health care provision, the Clinical Commissioning Groups led largely by Doctors, will be required to open up to tender the provision of services despite the potential conflict of interest whereby many doctors also have an interest in companies who will bid for that service.

 

What are the ruling ideas and whose interests do they serve? A current example is the UK government’s use of ‘Skivers v Strivers’ rhetoric aimed at gathering public support for the withdrawal of the State from welfare provision. This idea argues that because of an increasing welfare bill which exists in a time of ‘fiscal austerity’, “there is no money left” to pay for a range of social security benefits. Therefore individuals and families should work more to provide for themselves, to break free from an entitlement culture and welfare dependency that has been associated with social ills. It may suit the ruling class to say that there is no money left and indeed it is strictly true if one only thinks about government money. What is left for critics to point out is that there is a great deal of money but that it is owned by a very small number of people and often in secretive offshore tax havens where it cannot be touched. One estimate puts this figure at $32 trillion.

 

Marxist analysis, because it highlights opposing social forces,  asks the power questions: Who sets the political and social/health agenda and why? Who are the winners and losers in a global economy and health system? How are global resources for health allocated and why? What health issues get researched and supported and why? Who has the power and who is powerless?

 

 

A Marxist take on health may suggest.

 

  • Poverty is now accepted as linked to health, but often was denied.
  • The material conditions of life have a causal relationship to health and illness. Therefore to improve health outcomes, improve material conditions.
  • Capitalism will invest in profitable enterprises, so how do you ensure finance capital invests in highly expensive low/no profit care services?
  • The social and political causes of illness and disease have been overlooked and under researched.
  • Once people lose economic usefulness their value drops and their health needs are poorly served. Take elder care and its provision as an example.
  • Research into health needs may disproportionally favour the health needs of affluent societies and the affluent in affluent societies because that is where the investment returns are.
  • Health services may be about keeping workers as productive and as economically active as possible. Therefore health services are designed to establish productive capacity not human flourishing or well being. So they invest in high tech hospital services with clear medical outcomes.
  • The National Health Service is accepted by the ruling class as the provision of ‘bread and circuses’. The provision of health services buys off the discontent of the workers and only came into being by Marxist influenced social democratic politics.
  • Health systems may favour the wealthy and well off by the design and delivery of services that they want. See for example ‘The inverse care law’ and the Health and Social Care Act 2012.
  • A ruling class idea is that ‘Responsibility for health is the individual’s, who must also pay for its provision’ thus diverting attention away from injurious to health working and cultural practices.
  • Healthcare professionals are either unwittingly working in a system that is largely about keeping the worker healthy or are self serving professionals getting affluent on the back of the ill, poor and the vain.
  • A professional ethic which emphasises altruism masks self interest from professionals themselves and from others.
  • The medical profession is a self serving elite profession, diagnosing the wrong problem, overlooking iatrogenic illness and often coming up with unhelpful solutions. It is too focused on downstream solutions to health problems caused upstream.
  • Defining health needs solely in medical terms distracts attention from the political and social determinants of health.
  • Medical definitions of mental illness may construct a deviant subculture than can, and has to be, controlled.

 

 

 

 

3. The Social Determinants of Health and the health worker’s role

 

There are three main explanations for inequalities in health.

 

1)    Cultural/lifestyle.

2)    Material.

3)    Psychosocial.

 

The first focuses on the unhealthy lifestyle choices made by people, the second focuses on the material conditions of life and the third draws in social comparisons that people make between themselves. There is a fourth – the biological/hereditarian perspective which of course has explanatory power but cannot account for the unequal patterns of health and illness we see outlined in for example “Fair Society Healthy Lives” (The Marmot Review 2010).

 

Marx and Engels would certainly have seen how the material conditions of the English working class in the 19th century caused the ill health and disease seen in urban slums. These material conditions are part of the social determinants of health which:

 

“are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”. (World Health Organisation).

 

They are the ‘causes of the causes’ and help to explain, or at least ask us to consider why, people’s lifestyle choices for example smoking, are poor for their health. Marxists would look beyond simple explanations that blame poor people for smoking and seek to address why they are making those choices and who benefits from those choices. This is not to say that their choices are causally determined by tobacco companies, but it is to suggest that the interplay of material conditions, life chances and lifestyle choices are quite complex and open to subtle but powerful influences.

 

This too goes for obesity. Too much emphasise in getting individuals to eat less and exercise more while ignoring the production, marketing, distribution of high sugar, high calorie cheap foodstuffs through allowing industry to police itself with voluntary codes of practice is a partial solution. The context of food has also to address how we have replaced it with fossil fuels as a source of energy. We don’t walk, we drive. The automobile industry is not interested in public health, is antithetical to investment in public transport and the provision of cycling as active modes of transport.  Free market thinking in transport, leads to the insanity of Los Angeles freeways in the US, and the Beeching Rail cuts in the UK. Free markets are not always self-correcting, and when they do, they may leave a wave of ‘creative destruction’ in their wake.

 

Poverty and the poor material conditions of life are inextricably linked to illness and disease. It has been said that the poor are always with us and that we have had plague, famine and poverty since biblical days. Therefore the existence of ‘haves and have nots’ does not ‘prove’ Marxist philosophy.

 

However, understanding that the material conditions of life exist under a particular political and social structure, means understanding health in terms of poverty and how poverty is allowed to continue.  Poverty is a result of war, ideological conflict, famine and ruling ideas rather than it being a ‘natural’ state of affairs or god given. Poverty can be ameliorated if the ruling classes in each country have a mind to prioritise it as a goal.

 

The concept of a ruling class owning and controlling wealth and the production of ideas suggests that there is a global struggle for material well being, a struggle for the use and control of the means of production, and that the sides (classes) in this struggle are largely unequal in power and resources. There are winners and losers. Many more are on the losing side.

 

The losers get sick.

 

The losers get poor.

 

The losers get defeated.

 

The losers get mad.

 

The losers get even.

 

Health professionals focused on healing the individual sick and injured often can’t take the time to combat the forces that cause illness and injury.

 

‘Many professions take losers as the object of their studies and as the basis for their existence. Social psychologists, social workers, nurses, doctors, social policy experts, criminologists, therapists and others who do not count themselves among the losers would be out of work without them. But with the best will in the world, their clients remains obscure to them: their empathy knows clearly-defined professional bounds’ (Enzensberger 2005).

 

As Enzensberger (2005) goes on to argue:

 

‘one thing is certain: the way humanity has organized itself – “capitalism”, “competition”, “empire”, “globalisation” – not only does the number of losers increase every day, but as in any large group, fragmentation soon sets in. In a chaotic, unfathomable process, the cohorts of the inferior, the defeated, the victims separate out. The loser may accept his fate and resign himself; the victim may demand satisfaction; the defeated may begin preparing for the next round. But the radical loser isolates himself, becomes invisible, guards his delusion, saves his energy, and waits for his hour to come’.

 

Global capitalism has not yet solved this crisis for humanity. Marx offered revolution as an answer, a communist society….but so far the capitalism Marx knew has evolved partly due to the dialectical forces of marxist and socialist thinking , partly due to the advances in science and technology and partly due to religious philanthropy and humanist altruism.

 

What to do?

 

Health care professionals are motivated by many things, but they fool themselves to think it is a caring ethic alone that drives their practice. Caring and healing is socially and politically mediated, shaped by forces and agendas often tacitly accepted by professionals, often unknown by professionals, often ignored by professionals. Marx calls us to remove the flowers from the chains so that we may see health and illness as they really are, rooted in the material conditions of social life.

 

Health care ameliorates the worse ravages of post industrial and industrial capitalism, as well as producing some wonderful technological fixes for real human problems. But its success can only be seen to be so at the individual level. If the focus is kept at the individual then the real health issues can be hidden away, for medicine historically was largely silent in the face of poverty and inequity. Health care professionals, and the research they undertake, focus too much on the needs of the rich world and on the rich in the rich world, while practice may be based on profit not need. Quick fix expensive drugs with the promise of shareholder profits are preferred to painstaking analysis and costs of putting right social and political causes of illness – the material conditions of life that bring misery.

 

Health care professionals need to get political and join in the example of those few brave catholic priests in South America who engaged in liberation theology. Priests, who were engaged in activities unsupported by their masters in the Vatican, often suffered beatings and death while the Catholic hierarchy preferred to keep their dissent to prayer and sacraments. Religious, political and health care hierarchies may peddle an ‘its not our business leave it to the proper authorities’ ideology, however the social gradient in health and illness continues. Health care professionals know what makes people sick. Healthcare professionals know what makes people well. Healthcare professionals could argue for the focus of research and health care delivery to be turned on those known factors that lead to illness, depression and suicide. Resources should be sequestered away from the GB’s in their offshore tax havens towards meeting the needs of people. Governments should enforce a framework that ensures investment gets channelled into directions that improves human well-being even at the expense of short term shareholder profit. An ethic of civic duty and social care ought to replace an ethic of profit at all costs and that this ethic arising from moral teachings has also legislative force. Civic society must hold to account the GB’s and reclaim democracy for the people. This last however is a visionary forlorn hope, as utopian as Marx’s own dream of a communist society based ironically on a biblical event in the Book of Acts:

 

“From each according to his ability, to each according to his need”.

 

 

 

References

 

 

Enzensberger H (2005) The Radical Loser Der Speigel 7th  November 2005

http://www.signandsight.com/features/493.html accessed 5th April 2013

 

Marx K (1843)  A Contribution to the Critique of Hegel’s Philosophy of Right. Introduction. Early Writings.

 

Marx K. and Engels, F. (1846) The German Ideology Critique of Modern German Philosophy According to Its Representatives Feuerbach, B. Bauer and Stirner, and of German Socialism According to Its Various Prophets.

 

Marx K. (1859) A contribution to the critique of political economy (Preface).

 

Scambler, G. (2013) GBH: Greedy Bastards and health inequalities. 4th November http://grahamscambler.wordpress.com/2012/11/04/gbh-greedy-bastards-and-health-inequalities/    accessed 8th April 2013

 

 

 

 

 

 

 

 

 

 

 

 

 

A worker’s speech to a doctor    Bertold Brecht

 

 

We know what makes us ill.

When we are ill we are told

That it’s you who will heal us.

 

For ten years, we are told

You learned healing in fine schools

Built at the people’s expense

And to get your knowledge

Spent a fortune

So you must be able to heal.

 

Are you able to heal?

When we come to you

Our rags are torn off us

And you listen all over our naked body.

As to the cause of our illness

One glance at our rags would

Tell you more. It is the same cause that

Wears out

Our bodies and our clothes.

 

The pain in our shoulder comes

You say, from the damp; and this is also

The reason

For the stain on the wall of our flat.

So, tell us;

Where does the damp come from?

 

Too much work and too little food

Makes us feeble and thin.

Your prescription says:

Put on more weight.

You might as well tell a bullrush

Not to get wet.

 

You’ll no doubt say

You are innocent. The damp patch

On the walls of our flats

Tells the same story.

 

Students who acquire large amounts of debt putting themselves through school are unlikely to think about changing society

“Students who acquire large amounts of debt putting themselves through school are unlikely to think about changing society. When you trap people in a system of debt, they can’t afford the time to think. Tuition fees increases are a disciplinary technique and by the time students graduate they are not only loaded with debt but have also internalised the disciplinary culture.  This makes them efficient components of the consumer economy”.

 

(attributed to Noam Chomsky).

 

University tuition fees, and the student’s preoccupation with ‘occupation’ as the defining goal of higher education, reflect the realities of current education provision within modern capitalist societies. Societies have to reproduce themselves and education is part of that process. Getting students and society to accept this version of education requires an ideological straightjacket underpinned and reinforced by a disciplinary practice, e.g. debt or fear of unemployment, or fear of exclusion from desired goods and services, or fear of poverty in a post welfare state economy.  This fear is reinforced by the globalisation of labour power in which vast reserve armies of labour have been drafted into the relations of production in a competitive race to the bottom. A race which requires ‘flexible’ labour markets. Students, and their parents, are increasingly aware that skills and knowledge is being ‘outsourced’ to the emerging economies in a competitive globalised market. Those who cannot compete will be relegated to the poor prospects, low wage, part time, zero hours contract economy, to become the ‘precariat‘.

 

 

 

Thus, Higher Education is increasingly a commodity to be sold in a market aimed at the reproduction of the relations of production in a global competitive marketplace. This how the Corporate Class Executive and the Political Power Elite (CCE/PPE) under financial capitalism requires it to be. They inhabit, own and run this market place and compete to reap the rewards that they enjoy. To continue to do so, their vested interests in the current system has to be supported by reproducing the current conditions of production.

 

 

 

In ‘On Ideology’ Louis Althusser outlined a theory of the reproduction of labour power through a mechanism of ideology, as well as repression when required.  This operates in the following way:

 

As stated above there is a requirement to reproduce the ‘conditions of production’:  every social formation arises from a dominant mode of production and in doing so, and to survive, that social formation must reproduce the productive forces and the social relations of production. These sound very technical. What this means is that society has to ensure the next generation engages in the world of work and the social relationships that make up how we work together. So far, so what? Hunter gatherer societies had a very sustainable ‘mode of production’ – they hunted and gathered! Their conditions of production were their small group kin relationships and the natural environment they found themselves in, with property rights, if they had them, manifested in their cultural practices. The next generation had to learn the skills and knowledge required to reproduce the conditions of production they grew up in. Or die. However, even in these so called ‘primitive’ societies there was room for art, as expressed in the cave paintings that survive to this die. All their educational practices were not only to reproduce the way of life and the goods and services they required. As far as we know, early human groups also seemed to engage in ‘art for art’s sake’.

 

So, a mode of production is the way a society organises the provision of goods and services (hunter-gather, feudal, mercantile/industrial/financial/state capitalism). This ‘mode’ describes how we go about making things, growing things, distributing and exchanging things that we all want. This of course involves social relationships, which includes in the modern era communities or workers all focused on producing certain goods. This also involves the relationships these workers have with the owners of any land they work on. Another social relationship is that of ‘contract’, we promise each other to do or provide something and the terms that surround that promise. Productive forces might include the availability and bringing together infrastructures such as railways or information technologies to those with goods or services to sell. Together the forces and social relations of production are the ‘conditions of production’. The ‘means of production’ include land, capital, factories, call centres, railways, the internet.

 

Productive forces must reproduce the means of production and reproduce labour power. In order to smoothly reproduce labour power, Labour (workers/students) must learn the skills needed in the economy, and the rules that govern Labour’s place in the social relationships of production.

 

This where higher, and other forms, of education and training comes in. To ensure the smooth running of the capitalist system, Labour must accept its place and preferably not question the social relations of production. Education that focuses only on providing skills and knowledge for a job will not equip students with critical tools. The system of rewards and incentives can then be reproduced without query. In a capitalist mode of production, wages must also reproduce labour power otherwise the next generation can’t pay their bills to eat and pay rent. Competence also reproduces labour power otherwise the next generation can’t undertake the work that is required. Ideology also reproduces labour power, the work ethic must be passed on while the system of rewards for work has to be seen as legitimate and as serving the needs of all fairly rather than serving the needs of the few unfairly. Not to do this will lead to a ‘crisis of legitimation’ in which the citizenry cry ‘enough!”

 

So, the reproduction of labour power also requires the reproduction of it’s submission to the rules of the established order, to the ruling ideology, and a reproduction of the ability to manipulate the ruling ideology for the benefit of the agents of exploitation and repression so that they too will provide for the domination of the ruling class in words.

 

Ruling class interests requires that labour/students submit to the dominant rules, and that this submission is reproduced. Ruling class ideology must be seen as being the ‘normal rules’ which are required to ensure the system functions efficiently for all and not just for the ruling class. Class interests must be covered up by an ideology that masks the exploitative social relationships of production. Ruling ideas must become ‘common sense’ that everyone in society accepts.

 

Thus it is becoming common sense that one is required to pay for education on the basis that she or he who pays also is the one who benefits from education. Common sense argues that middle class beneficiaries of education must not benefit from the tax contributions of working class people who do not go to University. It is also common sense that if one has to pay for education then this should lead to paid employment, that the course above all other objectives must lead to skills for the workplace. Currently this means a focus on STEM subjects in order to prepare the UK workforce to compete in a global marketplace. Why waste an education on the Arts and Humanities when what is required is skills in the sciences, maths and technology?

 

Philosophy and Critical Sociology are luxuries we can longer afford.

 

Thus for the current system of capital to continue as a mode of production, the CCE/PPE need to ensure that Labour (students) accepts the tenets of this brand (neoliberalism) as serving not only or just the ruling elite or class but also that it serves Labour’s own interest.

 

To do that it needs an ideological apparatus, backed up by a repressive apparatus when required, i.e. when labour/students no longer accepts the ideology. The disciplinary techniques mentioned above are part of the repressive apparatus used to keep students in line. The paradox is that the more repression is required over and above the ideological, the less acceptance of the ideology there is. Repression may actually highlight that ‘the rules’ are not legitimate, but are self serving rules for the ruling class. This is evidenced by the Occupy movement, the ‘Indignados’ and what Paul Mason has called the ‘graduate with no future’ who increasingly argue that the current system is unjust.

 

The ideology supporting tuition fees is that of neoliberalism: Unfettered markets, deregulation of capital, the withering away and de-legitimisation of state provision, control of Labour and its immasculation as a force in politics, and the primacy of individualism. This is supported by a materialist culture that values consumption as an end in itself. Other social goals are relegated as useless in meeting the demands of markets and consumption. Globalisation backs this up through threats of undercutting wages and moving production to where Labour is weaker.

 

This ideology supported the development of Finance Capital as it replaces Industrial capital as a dominant mode of production in developed countries. Finance capital provides fabulous rewards for those that access and control financial assets, but it produces nothing concrete. It may provide capital for investment for actual production of goods and services but even this base function has been overshadowed by its overreach into speculation, trading on credit default swaps, hedging and betting on futures markets.

 

The promise of material rewards, the manufacture of demand for consumer products, fear of precarious work, the collapse of the structure of opportunities, fear of migrant workers, the powerlessness of social democratic control, and the loss of collective social solidarity in a liquid modern world, leads many students to accept fees and experience its disciplinary nature.

 

Students therefore get trapped into a higher education system that reproduces the social relationship of production that suits the needs of the CCE/PPE. Unless there are liberated territories for critical thinking that are not linked to ‘getting a job’, a generation of students will find it hard to articulate against power, to organise against power, to speak truth to power and will resort to credit fuelled consumption locked onto the treadmill of mortgages they can neither afford, or not to afford to have. They’ll be damned if they do, and damned if they don’t. Not getting into mortgage debt means facing a lifetime of rent and that could take an increasing share of their income. Getting into mortgage debt, on top of the fees debt, ensures they keep compliant or lose risking their home as well as the loss of their critical faculties as disciplined consumers. The other way to ‘escape’ fees debt is not too earn too much and wait for 30 years.

 

Finally, there is a small group of ‘elite’ universities who are particularly complicit in all of this. Supported by long established histories, nobel prize winners, wealthy benefactors and  huge corporate and state funding for research they provide the instrumentally based education that supplies and supports the next generation of the CCE/PPE. They get prestige, power and funding, they provide a compliant uncritical graduate whose only goals are their ‘discipline’ and naked self aggrandisement as members of an ‘elite’ group. Their failure to forecast economic collapse indicates the level of their paradigm bound understanding. Just at a time when the modern university should have been critiquing ideological policies, they capitulated, unable to analyse the systemic risk that resulted in the collapse of Lehmann’s and nearly the entire global financial system, an error that students are now also paying for.

 

The riposte to this is that the system is inevitable, that society has to reproduce a workforce that can do the ‘work’ and that someone has to pay for that education. This misses the point. It is a given that this is so, but it is the form of that education and the nature of work itself as well as the social relationships which direct reward and incentives that can be critiqued. However, while education trains for skills for the workplace it cannot focus on the ideological reasons that underpin the current system.

 

It does not have to be this way.  For the student working in a burger bar who will graduate to a precariat ‘non job’, they have little choice and little voice, in this Hobbesian educational and social environment.

 

 

 

The Rich List

The Rich List.

 

Micheal Meacher posted the following on his blog site:

“The Sunday Times Rich List, published today and compulsory reading for anybody who wants to understand Britain’s power structure today, holds three extremely significant conclusions.   One is that the 1,000 richest persons in the UK have increased their wealth by so much in the last 3 years – £155bn – that they themselves alone could pay off the entire UK budget deficit and still leave themselves with £30bn to spare which should be enough to keep the wolf from the door.   The second, even more staggering, is that whilst the rest of the country is being crippled by the biggest public expenditure and benefits squeeze for a century, these 1,000 persons, containing many of the bankers and hedge fund and private equity operators who caused the financial crash in the first place, have not been made subject to any tax payback whatever commensurate to their gains.   This is truly a government of the rich, by the rich, and for the rich.

The third is that despite the biggest slump for nearly a century, the slowest and most anaemic recovery, and prolonged austerity stretching to a decade or more, this ultra-rich clique are now sitting on wealth even greater than what they had amassed at the height of the boom just before the crash.   Their combined wealth is now estimated at more than £414bn, equivalent to more than a third of Britain’s entire GDP.    They include 77 billionaires and 23 others whose wealth exceeds £750m.  

Despite these massive repositories of wealth, these are some of the very people to whom Osborne gifted £3bn in his recent budget by cutting the 50p tax rate.   That measure alone gave 40,000 UK millionaires an extra average £14,000 a week, at the same time as those on very low incomes in receipt of working tax credits who couldn’t find an employer to increase their hours of work from 16 to 24 a week were being deprived in the same budget of £77 a week, around a third of their income, through their tax credits being withdrawn.

In 1997 the wealth of the richest 1,000 amounted to £99bn.   The increase in their wealth over the last 15 years has therefore been £315bn.   If this increase in wealth were subject to capital gains tax at the current 28% rate, it would yield £88bn, and that alone would pay off more than 70% of the total budget deficit.   However Osborne seems to share the notorious view of the New York heiress, Leonora Helmsley: “taxes are only for the little people”.”

 

Now, to make the conclusion that all we need to do is tax the rich to solve the deficit problem is misguided and is not actually the point of this article. Meacher well knows the difference between the annual deficit (about £125 bn) and the national debt which he says is about £1tn. The main point to draw from this is to illustrate just how staggeringly wealthy the top 1000 people are. The trend is an ever increasing wealth gap and rising inequalities in the UK which Danny Dorling so clearly outlines. Does this matter? Well, yes. Inequalities on this scale directly lead to health inequalities and that means a social gradient in death to you and me.

Coupled with ‘where do I stand’ data and this ‘UK pay: winners and Losers’  published by the Resolution Foundation, the ‘rich list’ paints a sorry picture indeed.

So, you can justify this position by arguing that the risk deserve their wealth because they are risk takers, wealth creators, gifted, very intelligent, talented and hard working people. However, even if you accept this line of reasoning (and it has more than just a whiff of self justificatory ideology about it), does that still justify the ever increasing gap and the huge amounts of wealth they accumulate?

There are two reasons for thinking not. One is the political threat of social unrest and the other is the unequal patterns of the distribution of disease and death that result.

Danny Dorling argues that democracy works when the gap is acceptable by the people and also when they have hope of betterment themselves. I think the gap is increasingly being seen to be unacceptable and, for far too many in the UK, hope for a better and secure future is also vanishing. Inequality on this scale threatens democracy because it distorts our political system as men of wealth are buying men of power.

Inequality is also directly linked to health inequalities. The ‘little people’ are literally paying with their lives and ill health, as the WHO recognises:

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries”  The World Health Organisation. 

The British are said to have a sense of fair play which if true will be sorely tested by this sort of information. The public may have been hoodwinked into believing that the last Labour government was responsible for the current plight of public finances, and indeed in not challenging or restructuring the neo-liberal experiment, they are culpable. However, let us not forget that it was the economic policies adopted by Thatcher/Reagan which gave free rein to finance capital to wreck the global financial system for which ‘the little people’ are paying in lost jobs, benefit cuts, pay freezes and dashed hopes.

Given the trillions of dollars that financial and economic mismanagement, no lets call it ‘gambling’,  has caused the global economy, remind me how many of those responsible are languishing in prisons rather than merely resigning/hiding with their pensions and payoffs intact? Where is ‘Fred the Shred’ now? What price at the bookies for seeing him in the queue for a pay day loan?  Well in 2010 it was reported that he was back in the UK paying £3.5m for a home. Back in 2009 the Royal Bank of Scotland (RBS) stated that following negotiation an agreement was reached to reduce his pension to £342,500 a year from the £555,000 and after he took out an estimated £2.7 million tax-free lump sum. It is should be pointed out that The RBS undertook an internal inquiry into Goodwin’s conduct, which found no wrongdoing. Remind me, who now owns RBS and why?

The, understandably, financially illiterate British public prior to 2008 were sold a pup. The British economy was built upon cheap credit and a housing boom financed by the ‘Masters of the Universe’ hedge fund managers in the City of London. British families in the period running up to the finacial crash did not earn enough to buy the goods and services that also provided the jobs. Henry Ford, certainly no Marxist, understood that he needed to pay his workers enough so that they could buy the cars they produced.   Those who ran our politics and financial institutions either forgot this maxim or recklessly ignored it preferring instead to ensure the gap between income and expenditures was filled by easy come easy go credit. While the champagne kept flowing,  no one cared.

The system stinks and people should know it.

Cameron today again said there is no alternative.

Twat.

Secret funding by Billionaires against progressive causes

 

George Monbiot is a well known left leaning environmentalist. He writes for the Guardian. So you may dismiss his views or accept them according to your prejudices. “Comment is free but facts are sacred” – make of this what you will. However uncovering secret funding by vested interests should be of interest to those who think democracy should be exercised on the basis of truth. What George reveals in the article is a list of organisations funding right wing, anti progressivist positions. You may check the sources, you may think that this activity is a good thing. You should however at least know what is going on. One example is the Institute for Economic Affairs (IEA). This organisation has charitable status and is often quoted on the BBC as if it was independent of right wing funding and policy making. Democracy becomes debased when powerful groups, who can spend billions supporting their cause and often in secret, can set the agenda and the frame of reference for debate for billions of citizens. Like mushrooms, we are being fed shit and kept in the dark.

 

 

Plucking Imaginary Flowers

“Criticism has plucked the imaginary flowers on the chain not in order that man shall continue to bear that chain without fantasy or consolation, but so that he shall throw off the chain and pluck the living flower. The criticism of religion disillusions man, so that he will think, act, and fashion his reality like a man who has discarded his illusions and regained his senses, so that he will move around himself as his own true Sun. Religion is only the illusory Sun which revolves around man as long as he does not revolve around himself.” (Marx Critique of Hegel’s Philosophy of Right)

This quote from Marx has always been a favourite of mine because it clarifies a fundamental truth: that many social practices obscure the actual nature of social relationships resulting in imbalances of power and exploitation which because of self delusion are not challenged. The subject here may be religion as an obfuscatory belief system but it equally applies to the tenets of consumer capitalism as an obfuscatory belief system.

Religion says “I am the way, the truth and the life, no one comes to the father but through me” (John 3:16). Without going into too much interpretation the message here is that Christ is the only path to enlightenment and knowledge of God, of course accepting that there is a God to know in the first place. Thus is established the first hierachy which was then extended into the human realm by such notions as the Divine Right of kings and the established practices of organised christianity. “Rich man at his castle, poor man at his gate, God made them high and lowly and ordered their estate”.

The flower: Believe in God (and his ordained ministers on earth) and your reward will be in heaven. The chain: your lowly social position.

The apologists for consumer capitalism use the public sector deficit as an ideological cover for their brand of neoliberalism. They say “We are all in this together” and that there is no alternative to slashing public spending to head off becoming Greece. Public sector pensions are also “unaffordable”:

The flower: Cut public spending and we will prosper. The chain: the inability of labour to break free from wage slavery and to organise an alternative relationship to wealth creation, distribution and exchange.

Illusions abound: It is argued that governments do not make money, they only spend it, and that it is the private sector, and importantly, global corporations that provide jobs and wealth. Note the words ‘government’ ‘private sector’ and ‘corporation’. These are illusory abstractions (flowers). They exist in discourse only to explain how a system works. In concrete reality there are human beings engaged in productive processes arranged in particular social relationships (chains).

Thus Marx calls for an examination of actual social relationships as they exist in concrete reality to reveal that it is labour creating surplus value for capital as the basis for wealth creation. Bright, ambitious individuals prosper partly through their own efforts but also because the system they prosper in has been constructed to reward certain types of effort disproportionately. This is now happening to the extent that a financial global elite are making sums of money most ordinary mortals cannot even concieve of for creating things like Credit default swaps (http://tinyurl.com/negativeCDS) which are basically bets on firms or countries failing in a market worth an estimate $45 trillion. That is to say people are working on abstractions in financial markets (which are numbers in a computer software programme) which bear little relationship to actual houses, food and energy. Let’s return to ‘affordability’ – read that number above again. That is in trillions (1 trillion = 1,000 billion). How much is the financial sector worth in trade each year? How much money sloshes around the global sytem, who earns it,  who keeps it? Affordability is another abstraction. These questions need concret answers before we talk about affordability.

The flowers include buying your own home, owning a new car, a holiday in the sun, a new kitchen…the chains were the loans you have to take out to get these things and the length of time you need to spend in work to pay it all back. You (labour) work in a system which promises you illusory heaven now to cover the the actual hell experienced while capital reaps the rewards. The system is just not sustainable. 

 

Setting private sector workers against the public sector lets the elite off the hook.

First the strike: it may be premature and it risks public reaction against it, and also playing into Daily Mail type rants. However, negotiations have not been handled well and of course this expresses depth of feeling. At least the issues are being discussed. We had one day off for the Royal wedding and no one complained. 

The government has described  strikes over pension changes as “regrettable, unnecessary and premature”, based on and following Lord Hutton’s report, it argues that the current system is not affordable (http://tinyurl.com/6xt4ska).

However, Carl Emmerson of the Institute of Fiscal Studies argues  “affordability is not a very good argument for making these schemes [public sector pensions] less generous” : http://www.bbc.co.uk/podcasts/series/today

Anything is affordable if you wish it…this is about values and fairness.

Comparing the private sector and public sector is a nonsense, many jobs do not equate and in any case this should not be a race to the bottom. Private sector workers have had to face pay cuts and higher pension contributions and reductions in benefits, so (the argument runs) the public sector should do the same. This is a turkeys voting for christmas argument. This also lets the wealthy power elite off the hook.

If you wish to compare (and you really shouldn’t) the median pension for private and public sector are broadly the same. According to Lord Hutton’s report: http://cdn.hm-treasury.gov.uk/hutton_final_100311.pdf, the median pension for the public sector is £5600 (don’t bother with average figure is this is skewed by higher earners, but for your interest it is £7800). Private sector workers in defined benefit schemes median pension is £5860, but these schemes are fading fast and those in defined contribution schemes will not get anywhere near this (Peter Worrall 2011http://tinyurl.com/6xt4ska).

Private sector workers are to be encouraged and supported in their fight to get increased benefits. Their pension contributions from employers are nowhere near as good as in the public sector but that is not an argument for pulling the public sector down.

However, and sadly, many workers who voted for ‘Blatcherism’ are gettiing the pensions they voted for, they swallowed whole the neoliberal agenda that over three decades attacked the position of workers in the attempt to bring flexibility and restructuring to the job market.

We are in danger of divide and rule here, the private/public divide is a chimera, all working people deserve a better slice of the pie. Actually (and excuse the analogy) the way the pie is baked needs restructuring as well as how it is sliced. Huge slices have unfortunataly been taken more and more by the already rich. Taking inflation into account wages have flatlined while wealth increased. The % of the increase in wealth taken by the top has increased. Ordinary people are paying the price for the continuing crisis of capitalism (Harvey 2010), a crisis they are not responsbile for, except in the sense of not understanding that the political class in the US and UK were sleepwalking us into a nightmare.

The cost of the ‘subsidy’ by the public is according to Paul Lewis of moneybox (BBC) on the TV this am is £4bn pa. It is legitimate to ask whether this is this good use of public money but this is a political question based on values, not a simple “we can’t afford it” question. In addition, a financial levy of 0.01% would raise £20bn per year (http://robinhoodtax.org/)


How much does the two aircraft carrier project cost for example…do you know? According to the BBC: £5bn, (http://www.bbc.co.uk/news/uk-11274060) of course that is a one off figure to build them, but before we get into affordability questions we need to know the structure of budgets and understand what it is we are signing up for as a country. 

See David Harvey’s ‘The enigma of capital and the crises of capitalism (2010) for why it is the system itself that is crisis prone that needs fixing.

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