Morbid Symptoms: Health Under Capitalism (review)

The 46th volume of the Socialist Register, Morbid Symptoms, brings together an eclectic set of papers to investigate health care and capitalism from a “systematically critical standpoint.” (ix) In 17 wide-ranging chapters, such disparate topics as medical TV dramas, pharmaceutical industry practices, obesity and the food industry, and maternal mortality in Africa are explored. “Our goal in preparing this volume,” write the editors, Leo Panitch and Colin Leys, “was to help develop the historical materialist analysis of health under capitalism.” (ix) They note, moreover, that it is imperative to address the “marketisation of public health services, and the way the pharmaceutical, insurance, medical technology and healthcare corporations push to make health care everywhere into a field of capital accumulation and expand the consumption of medical commodities.” (x) The book is an informative piece of work and generally successful in addressing major medical debates.

Morbid Symptoms focuses explicitly on “the economic, social, and political determinants of health” in an era of neoliberalism and globalization. (ix) It is an important topic, one justifying further discussion, and the editors duly offer a brief overview of their field. They argue that despite significant and pioneering research by Lesley Doyal, Julian Tudor Hart, and Vicente Navarro in the 1970s, scholars have subsequently failed to build on this line of inquiry. Therefore, Morbid Symptoms acts as a corrective and aims to galvanize not only debate in the field but also amongst members of “the Left.” According to Panitch and Leys, it is necessary to shift attention away from the affluent North (especially the United States), where the relationship between capitalism and health produces perverse outcomes, and they also point toward developing countries and economies as constructive categories of analysis. Africa, Cuba, China, Europe and India receive scrutiny and ‘Americanization’ emerges as a predominant theme.

The opening article, written by Colin Leys, establishes many of the book’s governing principles and charts the steady growth of, as the title of this collection suggests, health under capitalism. In an ambitious analysis that connects the recent financial crisis of 2007–2008 with over a hundred of years of history, Leys seeks to explode one core myth: that capitalism promotes health. The myth had its genesis, he suggests, in England’s mortality revolution in the late 19th century. As sanitation, nutrition, and medical knowledge improved so too did life expectancy and physical stature. Thereafter, Leys provides the basic structural frameworks and narratives for many of the subsequent articles; in sections called “After the Mortality Revolution,” “Public Health,” “Health Care Since the Therapeutic Revolution,” “Health Care and Legitimation: Ideology,” and “The Re-Commodification of Health Care,” Leys chronicles the inexorable rise of capitalism in health care policy-making.

A significant highlight of the book is its emphasis on Africa, as well as such countries as China, India, and Cuba. According to Paula Tibandebage and Maureen Mackintosh, maternal mortality in Sub-Saharan Africa requires further evaluation in the future but also offers a lens – a “gender lens” – to understand the gendered structure of health systems and health policy. Shaouang Wang presents an arresting view of the “double movement” in Chinese health care. In Wang’s estimation, during Mao’s era the health of the population was one of the country’s proudest boasts; with economic reform in the late 1970s, however, a widening gap between regions, between urban and rural populations, and between rich and poor households, invariably harmed the nation’s health. This in turn produced a backlash – a protective counter-movement – that has seen the government allocate more money for health care. Similarly, in a well-researched and compelling overview of health care and policy-making in India, Mohan Rao offers an incisive perspective on the struggle between the public and private models of health care in the context of neoliberal globalization. Rao’s gloomy conclusion holds that at least since the early 1990s the gulf between the two health systems has widened. Consequently, health inequalities have increased. Finally, Julie Feinsilver offers an illuminating and comprehensive account of Cuba’s...