Morbid Symptoms: Health under Capitalism

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Leo Panitch and Colin Leys, Merlin Press, £15.95

The editors of this year's Socialist Register describe their goal as seeking to develop a historical materialist analysis of health under capitalism. They aim to focus on what has happened in the current neoliberal period, looking at healthcare as an object of struggle between commercial forces seeking to make it a profitable commodity and popular forces trying to keep it a public service.

One could not fail to be impressed by the breadth of articles in this collection, covering both health and healthcare, both developed and Third World countries.

The earlier articles concentrate on the developed world. Colin Leys sets the tone for the book in his first article, looking at the fall in mortality that has occurred under capitalism. He argues that improvements have come as part of the struggle against capitalism, rather than because of it, pointing to the sanitation movement and the struggle for public health. He contrasts the principle of solidarity born out of the labour movement with the increasing re-commodification of healthcare taking place, a theme taken up and developed by Hans-Ulrich Deppe.

Christopher Hermann describes in detail how healthcare is becoming increasingly marketised across Europe in a whole series of reactionary reforms: public hospitals being sold to the private sector, the expansion of private insurance, the introduction of internal markets and the outsourcing of labour. Marie Gottschalk describes the tragic watering down of all Democrat proposals for US healthcare reform, including what is happening now with the originally weak Obama proposals.

Moving on to the Third World, there is a series of articles describing the shifts occurring as neoliberal health policies were rammed through in the 1990s. In 1978 the World Health Organisation introduced its "Health for All" strategy at Alma Ata, promising fundamental improvements in health and healthcare based on a strategy of investing in primary care to reduce health inequalities. Meri Koivusalo and other contributors describe how in the 1990s the World Bank sank that strategy to introduce a new world health policy driven by structural adjustment programmes, the promotion of the private sector and disinvestment in public services.

Case studies are given of how this played out in Africa, China and India. Julie Feinsilver describes what has happened in Cuba in response to the "special period" and how Cuba uses the export of doctors to promote Cuban diplomacy. But health is not just influenced by healthcare. Robert Albritton describes how capitalism is responsible both for obesity causing death in developed countries and starvation occurring in the Third World.

Does this year's Register succeed in meeting the editors' goals? My verdict is yes. But its weakness is that it gives little feel for what forces are out there challenging neoliberalism, or, where there is little challenge, where those forces could be found.