In The Social Sources of Sickness: What I Learned From 50 Years in Medicine, I explain that there are no ‘social determinants of health’ under capitalism. Nothing about this society generates health for people or their environments. Inequality, racism, sexism, war – these social sources of sickness are essential for capital accumulation.
From the onset of the pandemic to the end of 2020, the wealth of the world’s billionaires increased by $540 billion. OXFAM estimates it would cost $18 billion to deliver a COVID-19 vaccine to every person on the planet. That won’t happen because it would not be profitable.
The failure to use accumulated capital to protect human health is commonly attributed to a ‘broken system’ that needs fixing. This is mistaken.
Capitalism cannot be fixed because it’s not broken
Capitalism has been wildly successful at achieving its purpose: to extract capital from human labor and concentrate it in ever-fewer hands. In 2010, 388 billionaires commanded as much wealth as the poorest half of humanity. By 2021, that number had dropped to just 20 billionaires.
What is broken are the minds and bodies of people trapped in health-destroying conditions that would never be tolerated in a sharing society. What is broken are the social bonds that would enable us to unite against our oppressors. What is broken is our relationship with the natural world that sustains our existence.
Climate change, environmental destruction, gross inequality, pandemics, and endless war are the necessary price of a system that floats the few by drowning the many.
The capitalist class take no responsibility for the harm they do. This is not a matter of ignorance; they have been warned, in detail, repeatedly. They are locked in a deadly competition for capital and cannot change course.
The rest of us have a choice: Do we allow the capitalists to destroy everything that humanity has accomplished over millennia? Or do we fight for a sustainable future? Undoubtedly, the majority choose to survive. The question is how.
Capitalists sustain their rule by dividing us against each other and creating confusion over who are our enemies, who are our allies, what should be done, and who should do it. They do this through the mass media, social institutions, and the use of police and military forces.
Some point to the power of the capitalist class and despair that we could ever defeat them. In reality, capitalist power is built on sand.
Capitalism has never been more vulnerable. Globalization has transformed the entire world into a giant factory for extracting capital from workers who are linked in production and distribution chains that span the globe.
Rising productivity has magnified workers’ power. Just 25 workers crew modern cargo ships the size of small cities. When one of these ships accidentally blocked the Suez Canal, more than ten percent of global shipping came to a halt.
The power of the international working class presents an existential threat to capitalist rule, which explains their increasing use of authoritarian measures to stay in power.
This is a turbulent time of crisis and revolt, war and revolution. The majority want a society that meets their needs and the ruling elite refuse to change their ways. Increasingly, youth are rebelling, workers are striking, and nations are shaken by mass demonstrations.
We have a window of opportunity to unite on a global basis, end thousands of years of class rule, and chart a new course for humanity.
I cannot think of a single major problem that can be solved under capitalist rule: not inequality, not oppression, not environmental destruction, not global warming, not war, and not this pandemic. On the other hand, there is no problem we could not solve if workers removed the capitalist class from power.
The social sources of health already exist in embryonic form. Health is generated when people take care of each other, stand up for each other, and refuse to be divided. Together, we can end capitalist rule, eliminate the social sources of sickness, and construct the cooperative, health-promoting society we need and deserve.
Does this make me a communist? That depends on what you mean.
If communism means that a few impose their will on the many, then I want nothing to do with it. That’s what we have now.
If communism means that everyone is treated as equally worthy to contribute to society and equally worthy to get their needs met, then I am all in.
Susan Rosenthal, MD