Socialism is the Best Medicine

Socialism is the Best Medicine

Social Policy and Human Health

June 1, 1999


Book Review: Blane, Brunner & Wilkinson. (Eds), 1996, Health and Social Organization: Towards a Health Policy for the 21st Century. London: Routledge.

Health and Social Organization sets out to shatter “common sense” myths about health. At the same time it promotes another myth, that social policy is shaped by science, when it is actually shaped by the needs of the capitalist class.

The stated purpose of this book is

“to provide policy-makers and the public at large with a scientific understanding of the social, economic, and cultural determinants of a nation’s health status.”

The first chapter examines more than 50 years of public health policy in Britain, Canada, the United States, and other nations. This history shows that the post-war expansion of the ‘welfare State’ was accompanied by less inequality and a reduction in the gap between the lifespans of rich and poor.

Numerous studies have linked more generous social services with improved health and longer life spans. However, health policy began to shift in the later 1950s as efforts to reduce inequality at the social level gave way to campaigns to modify individual behaviors.

“As a recipe for health, the dos and don’ts of personal behaviour have a strong resonance with traditional morality: against drinking and smoking, in favour of sexual fidelity, and against sloth and gluttony.”

Many studies aimed to measure the benefits of changing health-damaging behaviors. The results were disappointing. The 361,662-person Multiple Risk Factor Intervention Trial in the US found that sustained behavioral change was difficult to achieve, even among highly-motivated individuals.

Class gradient

The first Whitehall study that began in Britain in the late 1960s, found that the risk of premature death increased from the top to the bottom grades of the civil service hierarchy and could not be explained by differences in smoking, blood pressure, obesity, or exercise. Both the first and the second Whitehall studies revealed that those near the top of the gradient (where there is no poverty) have worse health than those at the top, and this gradient continues all the way down.

Throughout the 1970s, widening differences in mortality were documented in Britain and France. These differences could not be accounted for by individual behaviors or specific occupational hazards. In the United States, major health-related differences were documented between Black and White Americans.

In Chapter 2, Leonard Syme discusses coronary artery disease, which has been studied extensively for over 50 years. Researchers agree that cigarette smoking, high blood pressure, and high cholesterol are risk factors for this disease, and other factors have been implicated including obesity, physical inactivity, diabetes, blood fat levels, clotting factors, stress, and various hormones. However, when all of these risk factors are considered together, they account for only 40 percent of all coronary artery disease. What is causing the remaining 60 percent?

In Chapter 5, Alvin Tarlov argues that the factors that most influence the health gradient are: having control over your work, having work that stimulates your creativity, having freedom from economic insecurity, having more education and a higher standard of living, being appreciated for your contributions, and having social support.

Tarlov disagrees with those who promote a genetic basis for sickness, arguing that “genes as a determinant of health account for 1-5 percent of the total disease burden of man.” Access to medical care is also a minor factor. Tarlov concludes,

“The chronic, persistent, inescapable dissonance between what a person would like to do or become and what seems accomplishable triggers biological signals that are antecedent of chronic disease development.”

In Chapter 3, Mildred Baxter cites a 1994 study that found that differences in survival from breast cancer were based more on socioeconomic status than on the type or malignancy of the tumor. She calculates that if class differences were eliminated, more lives would be saved than the number expected to be saved from a national breast cancer screening program. In the west of Scotland, an estimated 336 lives per year could be saved by breast cancer screening programs, compared with 475 lives that would be saved by eliminating social deprivation. Baxter concludes that medicine is

“unable to alter socioeconomic disadvantage, and equally unable, on the whole and despite an increasing involvement in health promotion, to change lifestyles. Thus it is little wonder that medicine may resign itself to treating whatever comes before it, defining socioeconomic differences as outside its sphere of influence.”

During the economic boom of the early 1980s, the income gap widened between the higher-paid and the lower-paid. Rising class inequality has been accompanied by an increase in health inequality, higher death rates for the lower strata, and the re-emergence of tuberculosis in the poorest sections of the population. Despite its National Health Service, Britain showed up to four-fold differences in mortality rates between the social classes.

We have enough evidence

This book convincingly demonstrates that excess mortality accompanies class inequality, yet the authors avoid discussing the need to eliminate class divisions. Instead, they argue for more evidence to prove what is already know. In Chapter 15, Eric Brunner suggests,

“The case for remedial action to reduce the burden of preventable ill health can be strengthened if the biological pathways connecting low social status with specific diseases are understood.”

This argument fits the agenda of policy-makers who would like to reduce the cost of poor health without eliminating the class structure that generates it. In the chapter devoted to work and health, Michael Marmot and Amanda Feeney suggest how this could be done.

“A major reason for exploring the links between social status and ill health is the search for ways to break the chain linking them. Work is potentially an important link in the chain binding social status to ill health that can potentially be modified without necessarily changing the fundamental nature of social stratification.”

One cannot preserve alienation, exploitation, and oppression and also eliminate their damaging impact on human health. On the other hand, efforts to adapt human beings to unhealthy social conditions by altering their chemistry, psychology, behavior, or genetics can advance professional careers.

Brunner does emphasize that social phenomena require social explanations and social solutions. However, funds are diminishing for research into social health and, more important, for social measures to improve health. The simple reason is that improving working and living conditions would cut into profits.

The general argument of this book, that national investment in human health pays economic dividends, has long been known. However, the nature of capitalist competition means that long-term interests are regularly sacrificed for short-term gain. Consider the Y2K crisis.

The prospect of global computer meltdown with its accompanying disruption of all computer-dependent systems (including nuclear launching systems) was disregarded for the sake of the immediate competitive edge granted by sacrificing the first two digits of the year. Because the consequences of this decision lay in the future, and there was no immediate financial gain for anyone who corrected it, the problem was deferred with no regard for the consequences.

A pathogenic system

Whenever capitalism goes into crisis, death, disease, and starvation follow because the system can regenerate only by driving down living standards. When the former Soviet Union disintegrated, government services were slashed in Eastern Europe, causing death rates to rise dramatically between 1989 and 1993.

The push to accumulate capital will continue to deepen class and health inequality unless workers fight for a larger proportion of the wealth they produce. Sadly, the working class exist for the authors of this book only as object, never as subject. In their view, policy-makers determine the degree of social inequality; the working class sickens and dies but never resists, demands, or transforms society.

Having excluded the working class as the agent of social change, the authors must resort to making moral arguments to policy-makers who are committed to an immoral system. Accepting capitalism’s prime directive – accumulate, accumulate – Fraser Mustard argues that,

“the dominant task will be how to sustain stable social environments (social capital) with diminished resources.”

Since this book was published, austerity policies have dramatically increased class inequality and the suffering that goes with it.

All the research linking the nurturing of pre-school children with improved intellectual and behavioral performance has been thrown out the window as working-class children are deprived of quality childcare, nutritious meals, affordable housing, employed parents, and access to social services. In the context of such lean and mean policies, we do not need more research, we need an organized fight back.

In 1844, Frederich Engels wrote The Condition of The Working Class in England, in which he documented the unnecessary death and disease generated by capitalist rule. Engels argued that the most effective way to prevent disease and premature death is to abolish class divisions. Since then, researchers have accumulated another 155 years of evidence to prove him correct.

Health and Social Organization lacks the political clarity of Engels’ ground-breaking work. As a guided tour through the field of social health, it a useful resource. Unlike Engels’ work, it offers no way forward.


1 Comment

  1. Us smokers, we start early on to put up a psychological barrier of denial between our smoking habit and the reality of the damage we’re inflicting on ourselves by smoking


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