Melbourne Forum talks Health versus Capitalism

Last night, Melbourne's Plan B collective hosted a panel discussion and forum at the Victorian Trades Hall on the topic of “Health vs. Capitalism”. The panel's four speakers were selected to present a range of academic, professional and activist views on the intersection and impact of capitalism upon modern healthcare and global well-being.

The first speaker, J. C. Coggo of the Melbourne Street Medic Collective, explained that capitalism's effect on health is very visible in his work and that it was becoming increasingly clear that, “capitalism makes us sick, [and] we're sick of capitalism.” During the last 18 years of working as a nurse and nurse educator it had become clear that the purpose and motivations driving healthcare have changed and, as healthcare has become more business focused, the ability of nurses and other professionals to articulate traditional values has been forced out of the picture.

As was discussed later in the evening, the practical result of this shift is the dehumanisation of nursing labour and the reduction of workers to “productive time units” and the prioritisation of time management over good health objectives.

As well as engaging with peers in the workplace and more widely with the community through union structures, Coggo said that he had found a useful form of resistance in Street Medicine. Street Medicine, he explained, is most interested in discovering and promoting post-revolutionary values that will replace those of the current capitalist paradigm. At the core of the movement is building and strengthening community and Street Medics have traditionally situated themselves in anti-capitalist movements in order to help activists look after themselves while resisting capitalism.

Following Coggo was the University of Melbourne's Associate Professor Hans Baer. Professor Baer is a Medical Anthropologist of considerable standing with some 200 articles and 19 books under his belt who became interested in the political economy of health when reading for his post-doctoral fellowship at Michigan State University in the late 1970s.

Baer sees capitalism as “the elephant in the room” and accused capitalism of being the main driver of ill health and climate change in the world today. This is because capitalism is interested in “functional health” rather than “experiential health” (which requires a greater focus on holistic and social well-being) and as a result people fall through the cracks and become ill.

He also drew a comparison between the US and Cuban healthcare systems, which share a similar level of GDP expenditure but enjoy very different health outcomes, to make the point that expenditure is not necessarily the primary indicator of good health outcomes. Moreover, the failure of WHO to adequately respond to the Ebola outbreak in West Africa (and to the HIV/AIDS epidemic in Africa and Asia) clearly demonstrates the extent and impact of economic disparity upon health and well-being.

This being said, social systems do not last forever and with capitalism being committed to “the sort of growth model leading to the destruction of the global ecology and environment” Professor Baer argued that we are at an historical junction where we must move past capitalism. His ideal form of social organisation would be some sort of Democratic Eco-Socialism but, in any case, “we must create the vision”. The real question is how we might get from our current situation to the ideal, and in this aim we will need to see and create new ideas, organisations and even parties to drive and refine this vision.

The third speaker for the night was the People's Health Movement's David Legge. Legge began by coming back to and building on two points raised by Coggo: firstly, that we must appreciate information left to us by indigenous cultures, particularly the role of spirituality in their social systems for encouraging well-being.

Secondly, he agreed wholeheartedly that disillusionment is common amongst health professionals. Just as Coggo had, Legge found the experience of educating health professionals alienating and this experience led him to begin reading on the political economy of health.

In order to understand the global health crisis Legge argued that we need to consider the direct impact of capitalism upon health and well-being (i.e., the extent of inequality and waste) and understand that the political governance of the global economy faces terrible instabilities: economic, financial, ecological and social. Global economic leaders seek to protect transnational capitalism but their solutions often, if not inherently, lead to further instabilities.

The primary instability identified by Legge is the massive overhang of productive capacity compared to consumption capacity, which leads to the stagnation of profits. With this threat in mind, capitalists may react by attempting to monopolise their industries (for a greater share of profits) or else to privatise public services, externalise costs to the environment, drive down wages and replace wage labour with technology. The latter option is potentially most dangerous for its ability to alienate, marginalise and otherwise exclude labour. This point is particularly important for acknowledging that the problem is not simply about institutions like the IMF or global superpowers but is also about class relations. Any potential solutions must take this into consideration.

Legge's organisation, the People's Health Movement, has a presence in more than 70 countries around the world and has two main aims: to confront neoliberalism; and, to link with activist groups who are working to shift the current economic system. He believes that the popularity of the Communist Party of Australia following the Second World War was because its members believed they had answers and solutions to move beyond capitalism. For a successful challenge to be mounted against current-day capitalism, a similar capacity to inspire and offer solutions is necessary.

To this end, activists and health professionals need to consider what the instabilities of the global economy are and what potential corrections that could be made while also drawing links between the local and the global. By linking global campaigns and concerns with local struggles the former will be kept relevant and accurate to the situation on the ground. Meanwhile, a link to the global context would help to inform local struggles of their place and significance within the global picture.

The final speaker for the night was Dr. Deborah Gleeson of La Trobe University's School of Public Health and Human Biosciences. Given the closeness of her and David Legge's academic and activist work, Dr. Gleeson opted to focus her portion of the panel discussion on the impact of trade agreements upon health.

Gleeson's interest in this particular subject was peaked after discovering that trade negotiations between Australia, New Zealand and Pacific Island nations were having a negative impact upon the health of Pacific islanders. In an exchange with a Fijian woman Gleeson discovered that trade agreements had seen the importation of fatty meats that would not be eaten in Australia or New Zealand but could be sold cheaply to Pacific Island nations.

Shortly after this incident came the revelation of the Trans-Pacific Partnership Agreement (TPPA). Negotiations for this agreement commenced in 2010 but it was not until draft chapters were leaked in 2011 that the implications for global health began to be revealed. The draft chapters showed that the US had plans to challenge Australia's Pharmaceutical Benefits Scheme (PBS) and health services, as well as to introduce the ability for foreign corporations to sue signatory governments through an Investor-State Dispute Settlement (ISDS) clause.

The documents also went a long way to demonstrating the extent to which transnational capital advances its own policy via trade negotiations: despite there only being 12 countries engaged in negotiations at the time, around 600 negotiators were engaged in the process of drawing up the provisions of the TPPA. These included corporate representatives and members of trade advisory committees sponsored and staffed by transnational corporations and it was clear that these groups were allowed direct input into the form and substance of the draft policies. This revelation is all the more galling with the understanding that the public is actively barred from knowing the contents of negotiations, with information only being released as a result of leaks.

Of the chapters that have currently been leaked, those concerning Intellectual Property and Transparency are most worrying. Policy advanced as part of the IP chapter includes the lengthening of patents of medicines and copyright, while an annex to the Transparency chapter poses a threat to the functioning of the PBS by advocating longer patents, preventing regulation that aims to lower costs (and thus profits) and introducing a form of ISDS currently being used by pharmaceutical company Eli Lilly to sue the Canadian government.

The US pharmaceutical industry has been pushing for longer patents on biologic drugs in order to prevent generic companies from accessing clinical trial data that would enable the production of cheaper, more accessible medications. Gleeson also argued that pharmaceutical companies have been trying to use trade deals to prevent regulation designed to promote health due to their potential threat to profit.

Last, but certainly not least, it is known that there are two draft chapters in the TPPA concerned with health services and it is feared that if services such as Medibank and Medicare are privatised the provisions of the TPPA may prevent future governments from bringing them under public control again.

At the conclusion of the panel discussion the evening moved into more of a Q&A format. One talking point that was repeatedly raised in discussion was the need to combat the hyper-individualism of modern capitalism and its pervasive presence in nearly all forms of social and economic interaction. It was acknowledged that the demonisation of the concept of “connectiveness”, usually pejoratively associated with hippies, reflected the dangerousness of the idea that we are not all separate individuals but instead are part of a greater whole. The failure to appreciate our interconnection with ecology and the environment, not to mention spirituality and emotional well-being, is a potent explanation for the current health crisis and here again the point was made that more must be done to learn from indigenous cultures.

One audience member argued that the dehumanisation of nurse and health professional labour and the dehumanising language of management in these workplaces seeks to combat the strong social capital of healthcare workers and asked the panel to suggest ways that workers and activists might seek to leverage this capital. Following on from this question it was also asked how healthcare workers might fightback against ironic attacks on industrial actions (that seek to claim that strikes will harm patients when, in fact, cuts and privatisation will have a more dire effect).

Coggo responded by acknowledging that during EBA negotiations in 2011 nurses had been told they couldn't fully exercise their industrial power because the healthcare industry is too complex and valuable to weather such a shock, even though the actions proposed involved temporarily lowering staffing levels to those proposed by the state government as part of their EBA negotiations contributions. One way to address both issues (the utilisation of social capital and the need to repudiate ironic criticism) might be for nurses and unionists to draw the argument back to the harm and violence caused to society by capitalism and very firmly frame the discussion around this point.

Another person asked the panel what practical things could be done by people during their interactions with the health system, and whether there were any extant campaigns linking ill-health to capitalism as with recent climate change activism highlighting the impact of climate change upon health.

To the first question the panel responded by advising that patients should educate themselves or, where this was not possible, seek out others who could educate them about the health system. On the point of gathering information and recommendations about “safe” practitioners the panel advised that this information would have to come from specific communities and that broad campaigns are needed to raise awareness of sensitivities amongst health professionals that could limit their ability to practice safely.

On the second point David Legge suggested it would be a good idea to go back to the Declaration of Alma-Ata, which was designed to ensure adequate provision of health to all people and to incorporate the consideration of social and political issues into assessments and management of health and well-being. Professor Baer also mentioned that patient advocacy has been growing in strength recently and may be a useful area for activists to engage with.

In keeping with the theme of practical responses, one person asked the panel what might be able to be done against the real and imminent threat of things like the TPPA. To this the panel responded by encouraging further resistance: recent leaks of draft chapters from the TPPA have shown that even though the final agreement will likely be devastating, continued resistance and advocacy have produced a watering down of some elements and the final agreement will be much less worse than the original proposals.

The final question put to the panel was to do with integrating mental health activism into wider health activism. It was agreed that this is an important element of anti-capitalist approaches to health as the individualisation of capitalism forces us to approach issues as individuals, placing an often unbearable strain upon our mental, as well as physical, health. Professor Baer recommended the book "Sociological Imagination" by C. Wright Mills, which recognises that “personal struggles are related to social struggles,” and might prove a useful theoretical inspiration to health activists.

To finish the evening a few closing statements were offered by each of the panel members.

Dr. Gleeson stated that there are big threats to the public ownership of Medicare and access on the horizon, with the outsourcing of claims processing and the increasing prevalence of insurance companies moving into primary health being evidence of the government's intense privatisation agenda.

David Legge endorsed Global Health Watch as a good resource for activists, as it is anti-neoliberal and has a strong globalisation analysis. He also stated that the big challenge, in his view, is to keep the global perspective in mind as capitalism is itself global. Finally, he suggested that those attending should read the recent BBC report on profit margins in the global pharmaceutical industry, which showed that the industry is spending significantly more money on marketing than on research and development. This is undoubtedly contributing to the inappropriate and over use of medications and the death of anti-biotics.

Professor Baer kept his focus on questions of how activists might achieve change and stated that regardless of whether we tweak or fix the system we must move beyond the current system as gaps in health and well-being are widening internationally and intranationally. He praised Occupy Everywhere for its attempt to link health activism with global social justice but added that all global justice movements need a focus on health as it incorporates larger questions around poverty, equality and the environment.

Coggo was the final speaker and he took the opportunity to note that this is a discussion that should not end just because the meeting had finished. Those present last night (and those reading this article) are the people who will fight and bring change, so these discussions must continue.