Why is it that, the world over, people’s health is so poor, despite large amounts of money being spent on healthcare, and in every country large differences remain between the health of the rich and of the poor? This big question is tackled comprehensively in this short book that ranges over a number of themes relating to health and healthcare.
But healthcare is a small part of the picture in determining our poor health and the health inequalities in society. Humber makes the case for the traditional social determinants of health that are much more important in determining what illnesses we get than the healthcare we receive; air pollution, bad housing, our poor diet, and the employment that capitalism forces us into. The details of the links between these factors and our health are made clear, with fewer homes being built to lower standards, and rising homelessness; the food we eat being produced by 10 major companies; insecure and stressful work. These factors dominate our poor health and the inequalities between different social classes.
Important authors such as Kate Picket, Richard Wilkinson and Danny Dorling have argued that these social determinants, though important, are not as important as the levels of inequality in society, and it is the inequality itself that lowers social cohesion, producing poorer health to differing degrees for both poor and rich. Humber takes issue with this approach arguing that the problem starts with neoliberalism causing the dominance of the market. The dominance of the market in turn causes income inequalities on the one hand, but also directly causes a worsening of the traditional social determinants of health for all classes. The problem is correctly relocated back into the structure of capitalism and the class society it generates.
I liked the chapter on health paradigms. Here Humber charts how revolutions caused major changes in thinking that resulted in new paradigms of health and healthcare. He charts the effects of the English and French revolutions, and more latterly the Russian Revolution and how they changed medicine but also the social determinants of health. In the course of this chapter, Humber deals with thinkers such as Thomas Kuhn, Michel Foucault, Alfons Labisch and Ivan Illich.
The book ends by describing the changes in healthcare and the social determinants of health in Britain, and how this was shaped by the reforms introduced due to the pressure caused by Chartism, the Great Labour Unrest 1910-14, and the Second World War strike waves.
The book finishes by describing the NHS as a revolution half made, never fully living up to the ideal set by the French Revolution of a service grounded in the public health with a more preventive than curative foundation. He paraphrases Rosa Luxembourg describing the NHS as “a surface modification of the old order” that failed to realise the full potential of that historical moment. It is our task as revolutionaries to pick up the fight to do more than that and create a world where all can be healthy. This book is essential reading for all those fighting in health campaigns or working in the NHS.