Historical and Economic Forces Surrounding Health from a Marxist Perspective - Essay Example

?Historical and economic forces as the key determining factors of contemporary debates surrounding health from a Marxist perspective Introduction Economic development has helped industrialised nations to cross the border of poverty and related illnesses. Herein observations reveal that the traditional or older forms of infectious reasons for death are still prevalent as diseases of the poor in developing or underdeveloped nations, while degenerative diseases related to adulthood or old age form the main reason behind death in developed nations (Wilkinson, 2005, p.10). Thus, here it is evident that in developed nations people die from old age or from other degenerative diseases generally associated with adulthood, like cancer or cardiovascular problems, instead of dying from childhood related simple illnesses like gastroenteritis, once deemed historically as fatal (Marmot and Wilkinson, 1999, pp. 1-16). Besides the strong health disparities that exist in the people between nations, there are evident disparities amongst citizens living within the social framework of single nation. This is evident in a recent health report that states that in terms of mortality rates, the mean difference between the upper and lower social classes, in terms of life expectancy vary anywhere between ten to four years (Siegrist and Marmot, 2006, p. 1). Considering the various technological innovations within the arena of medical sciences, and the persistently increasing amount of funds allocated for providing public healthcare services, especially in developed nations, it is difficult to comprehend class related disparities (arising from economic and historical factors) still exist within 21st century societies that create heath inequalities (Bartley, 2003, p. 5-8). Such class-based disparities or social stratification emulates a specific ‘social gradient’ as regards health, which takes into consideration the entire society. From the various reviews it is evident that a higher social status or a position higher up in the socioeconomic hierarchy, is inversely proportional to poverty related ill heath, mortality rates, morbidity, death frequencies, frequency of outbreak of diseases (Marmot, 2004, pp. 10-43). This implies that at an average count, higher social status allows an individual to lead a healthier life and a greater life span (Siegrist and Marmot 2006, pp. 4-5). Social stratification, which refers to structured inequality, is historically derived, starting with feudalism and its later transition to modern capitalism, is present within the society for many centuries. This has led to the formation of a hierarchy, based on many socially created inequality factors. From the theories of Marxism, we can derive that a society is generally distinguished by its mode of production, and the various relationships forged within a society on means of production form the basis of class division and subsequent class struggle. In such a scenario, social stratification that created hierarchical classes is composed of three multidimensional aspects, like “economic standing (wealth and income), prestige, and power” (Zanden, 1986, p. 156). Thus, one can assume that a minority group controlling the means of production, which has economic standing, power and wealth, would automatically be at the topmost level of this social stratification. Therefore, the study of social stratification is important, as it stands out to be an important factor in determining health and life style of an average person, residing within a state. While analysing social class it can be defined as “empirical investigation of the consequences and corollaries of the existence of a class structure defined ex-ante” (Breen & Rottman, 1995, p. 453). Even though the concept of social classes had always been present in UK, studies show that this issue was strongly highlighted in 1980, after publication of the Black Report, which showed that there were health inequalities within British society based on various historical and socio-economic factors. It highlighted the fact that class inequalities (created largely by the historically based social stratification system) within UK social structure were very relevant even to this day and formed to be one of the key determining factors of health inequality (Wilkinson, and Marmot, 2003, pp. 15-26). In this context, the paper will explore and review the concept that historical and economic forces are the key determining factors of contemporary debates surrounding health and will study it from a Marxist perspective. Discussion According to Marx, society is based on the nature of production, with economic power resting in hands of the few that control these means of production. This is evident in the theory conceptualised by Marx where he stated, “the extent to which a person or a social group has control over the means of production” (Marx, cited in Pompa, 2002, p. 5). Furthermore, he added that changes within the framework of a society are inevitable, and these changes are determined by various historical events that act as exemplars. Therefore, we find that it becomes imperative for the researchers and the policy makers to view all social processes within the framework of economic and historical development of that specific society/State. Therefore, health and disease patterns, as observed within a society/state, can be seen as being specific to that society/state, as they are the natural outcome of historical and economic forces prevalent within that particular society or state. The Marxist concept of social stratification thus pertains to relationship with means of production, which in turn is related to property, labour and capital. This automatically leads to the formation of two main social classes. The first one is the capitalist class that holds the capital and property, while the second one is the worker class that gives labour. From this stratification it is evident that the capitalist class has an upper hand, owing to the power it yields from its superior position, in terms of capitol and property, and is thus in a position to exploit the economically weaker (that is lacking capital and property) worker classes. According to Marx, this class division is evident in all forms of social stratifications, and manifests itself through the formation of social where there occurs a transfer of the extra output produced due to the labour put in by the working classes, to the capitalist groups (Stack, 2002, p. 2). Thus, the basic notion that underlies Marxism is the fact that poverty did not result as an outcome of the laws of nature, but came into existence as consequences of a specific manner in which of our social institutions function. Poverty, which is an important factor when viewing health from the Marxist perspective, is ascertainable within a framework of history and socio-economics factors, and is mainly a characteristic of capitalist society. Prior to the modern capitalist societies, UK was under feudal rule, where worker classes were seen as properties of their lords (the ruling or capitalist class), tied to their lands for farming and raising livestock. The transition from feudalism to capitalism took place owing to agricultural revolution brought in by technological innovation, which in turn created a separate production market and the issue of common land that turned many of the farmers homeless. It led to the Enclosure Movement that brought in freedom for labourers, and broke down the British feudal system. However, for many this freedom led to cutting away from their lands, which had once been their chief mode of production, and it often led them become destitute, or in other words, the worker class starting facing extreme poverty (Novak, 1988, p.7). After the feudal system was over, capitalism came into existence, which was based on the concept of exchange of manufactured products for the sole purpose of generating profits. This system came into prominence with the advent of industrialisation, where labour became necessary to accrue profits for the industries. Here the industries were owned by a powerful few who yielded socio-economic power, while the labourers or the worker classes owned nothing that were of material value. The workers remained free to sell their labour for a salary, but stiff competition at the worker class level helped industries to optimise profits while paying minimum salaries to the workers. This served to separate workers from enjoying the outcome of their labour, which in turn helped industries to rake in further profits (Blane, 1987, p. 8-36). Here it is evident that within a capitalist system the worker class has been systematically suppressed and manoeuvred in a manner where they have not been allowed to improve their standard of living. Marxism portrays capitalist society as “vampire-like, [which] only lives by sucking living labour, and lives the more, the more labour it sucks” (Marx, 1976, p. 342). Under such a situation, Marx contended, the worker’s role was systematically debased, and after forcing the worker to come down to the level of the factory machines, the latter is then used to compete with the former, thus making the former’s position even more insecure (Marx, 1988, p.24). This way, workers finally find themselves in a situation where they are obliged to take work that is unpleasant, unsatisfactory, and often dangerous. In this context, the incident of the plastic workers’ exposure to rare form of liver cancer in B.F. Goodrich’s PVC plant in Louisville (Kentucky) shows how the workers must choose between saving their livelihood and occupational safety. In a news report published by the ‘News and Courier’ in May 1974, we find mention of a case that involved 17 workers from the US plastic factory, who were found to have developed a rare form of liver carcinoma (angiosarcoma). Scientists while investigating the case found a strong connection between liver cancer and vinyl chloride (a chemical widely used for plastic production) (News and Courier, Plastic workers may be exposed to rare cancer, 1974). Despite the connection between vinyl chloride and liver cancer scientifically proven in the 1960s, and despite the fact that link between the two was widely acknowledged amongst medical fraternity, this evidence was suppressed by the powerful plastic industry (Freinkel, 2011, pp. 85- 88). Even after the scandal, where the news of the 17 workers who had developed liver cancer were published in various newspapers, the plastic industry refused to take any affirmative action towards protecting its workers and alleviating occupational exposure (ibid). After the guidelines set by the U.S. Occupational Safety and Health Administration, the exposure limits in plastic factories remained above safety limits. The plastic workers well aware of the danger to their health, posed by the chemical, had no option but to choose between employment safety and occupational safety, wherein most opted for continued employment under hazardous working conditions (Freinkel, 2011, 88-90). This incident clearly highlights the health disparity faced by the worker class in society and the lack of concern shown towards them by the richer segments and the ruling classes. In another similar incident that revealed complete negligence and apathy of the factory management towards workers and surrounding slum dwellers, was the Bhopal gas tragedy in 1984 that occurred in Union Carbide India Limited (UCIL) pesticide plant (a subsidiary of the US based Union Carbide Corporation or UCC) (BBC News, Bhopal trial: Eight convicted over India gas disaster, 2010). It involved leak of a poisonous gas, and is regarded as one of worst industrial/ man-made disasters. Despite previous warnings and various accidents within the plant where some workers had already died, the management chose to save money by overlooking the aspect of workers’ safety and maximising their own profits. The workers despite lukewarm protests did not carry on with their protests too far, in fear of losing their jobs. This shows the level of oppression faced by worker classes all over the world (the first incident took place in US, and the Bhopal incident took place in India). The gas leak occurred owing to the facts that the poisonous MIC (methyl isocyanate) gas were placed in tanks well beyond recommended limits, the plant in general was poorly maintained, the safety systems were not in place and in some cases even switched off to save money (The Palm Beach Post, Killing fog covered 25 miles; Assurances false: MIC worse than tear gas, 1987). Here it is evident that, capitalism in its ‘vampire’ like nature was at its best, where in order to optimise profits, it completely disregarded the safety aspects of the worker class and poorer segment of the society, causing thousands of violent deaths with even more people developing deformities over the years. The worst scenario took place after the leak, which was evident in the manner the Indian government mishandled the entire situation by refusing to make public all relevant data and allowing the criminals (top management of the company) to escape scot-free to US. The responses from the main Union Carbide Corporation (UCC) were also ‘vampire’ like in nature, where it refused to provide adequate compensation to the affected people and refused its management to be prosecuted under Indian courts (BBC News, Bhopal trial: Eight convicted over India gas disaster, 2010). The two incidents provide an insight where we find the worker classes faced bias from the ruling capitalist classes, which in turn proves Marx’s theories. Thus, we find that under capitalism, an environment is created where industry owners manipulate to force labourers to work hard under hazardous working conditions while keeping their salaries at a bare minimum. Here workers that find no employment live in abject poverty, while the ones that work, survive on subsistence salaries. In this context, Engels commented that there is nothing worse than being forced against one’s own will to something day after day and from morning till the night (Engels, 1999, p.129). As in the era of industrialisation, the modern capitalist society also functions in the same manner, where cash value is given supreme importance, over all other ‘real’ values, like product or labour, and in a capitalist society “increasing value of the world of things proceeds in direct proportion to the devaluation of the world of men… [causing]…complete domination of dead matter over men” (Marx, 1988, p.71). In a capitalist society, the ruling classes do not have the best interests of the society in their mind and only aim at increasing personal profits by deceiving the common citizens (Marx, 1988, p. 40). Whether in the feudal system or in the capitalist system, it is evident that the history human society is actually the history of class domination and related struggle (Engels and Marx, 1985, p. 35-36), where the workers always stood be dominated and oppressed by those holding the socio-economic reigns of a state. In context of a capitalist society, as is perceived in modern UK, societies have turned into production factories, while man functions as a machine only fit for production and consumption. Here it is seen that human life has turned into a form of capital, with the world being completely dominated by economic and commercial laws (Marx, 1988, p.48). From this, one can easily derive that with elevation in wealth that is enjoyed by the upper classes in the society; overall, there is an increase in poverty and ill health for the common people (Merton, 1957, pp. 360- 368). At the time of the industrial revolution, there had been widespread migration from the various rural regions of UK to the urban regions, in search of salaried labour. This led to a situation where cities became overcrowded, lacked proper system for sanitation, which in turn gave rise to health problems and an increase in crimes. Here the social structure, which was capitalist in nature, placed more importance on accruing profits instead of taking care of the public health system (Navarro, 2002, pp. 13- 30). Owing to such apathy on the part of ruling classes, the workers worked and lived under terrible conditions, where epidemic outbreaks were quite common and life expectancies were low (Engel, 1999, p. 107). In 1840, average life expectancies of those residing in Liverpool (UK) were: A resident belonging to the professional class- 35 years A resident belonging to the middle class = 22 years Worker class (day labourers) - 15 years (Leeder, 2003, p. 1). Such conditions prevailed until the two Great Wars, at the end of which the concept of Welfare State came into existence, from 1948 onward (Townsend, 1979, pp. 34- 51). In the context of social class stratification and issues of public health in UK, a mention must be made of the theory on social classes as advanced by Erik Olin Wright. He theorised that “variety of contradictory class locations were inhabited by groups having more control over the means of production than the working class, but less than the capitalist. Control achieved through higher skills and experience, and hence greater marketability” (Stack, 2002, p. 2). This control gave the worker class more power in their working areas, while also achieved to maintain a good working relationship with their employers. This theory is best suitable for the scenario pertaining to liberal modern countries like USA and UK, where we find that a large number of workers are on weak grounds with widely varying salaries and working conditions. Insecurity within the worker class is steadily rising, owing to a constant decrease in the number of workers union (denoting less power to the worker class), and rising form of contractual employment preferred by the employers, as we find that labour is being increasingly treated as a factor, amongst many others, necessary for market production (Hutton, 1996, p. 89-110). Despite the start of the welfare state in UK from 1948, there were growing concerns regarding the issue of public health, wherein the Labour government in 1977 decided to form a committee that would create a review report on this matter. This resulted in the Black Report published in 1980, which showed that the myth of a classless UK is nothing but a myth, and a look into this Report indicated that along with presence of class inequalities in Britain, the gap between the rich and the poor seemed to be increasing (Socialist Health Association, The Black Report 1980, 2005). The three classes that are prevalent in UK today are the upper class, middle class, and the lower class. Earlier, the Registrar General’s classification had based UK individuals according to their occupations and created a social class stratum with five tiers. These tiers comprised of Professional and higher managerial class (Lawyers, doctors, bank managers); Intermediate managerial, administrative, professional (social workers, teachers, nurses); Skilled non-manual (Secretary, technicians); Skilled manual (Electricians, bus-drivers); Semi-skilled (postal workers, agricultural workers); and unskilled (Window cleaner, labourer) (Llewellyn, Agu, and Mercer, 2006, p. 59). According to Marx, the semi-skilled and unskilled social classes that are at the bottom of the social hierarchy are more liable to face disparity in terms of health and access to health care facilities. Thus, it is necessary for the UK government to place more emphasis on these groups while making health related policies, in order to accord them fair and equitable healthcare. Recent empirical evidences prove that there are a large number of inequalities in the health of UK inhabitants within the different social classes (Platt, 2005, pp. 9-27). From these evidences, it is clear that income gap between the upper class and the lower class has widened, and achievements arising out of education and employment are dependent on the factor of social class, which makes class distinction an important factor, during framing of any public policy in UK (Devine, et al., 2004, pp. 24-45). A critical study of the Black Report (1980) showed that in UK there were increasing disparities in heath standards amongst the various occupational classes, even though poverty had decreased after the two Great wars. After this report, three more reports were published on the same subject: The Health Divide (1987), The Acheson Report in 1998, and most recently the 2010 report of Sir Michael Marmot. Examination of the three reports revealed that there is one point in common that has remained consistent throughout the years, which is the fact that the primary reason behind health related inequalities arise from poverty. This is clear when we examine the report by Sir Marmot where it is stated, “Inequalities are a matter of life and death, of health and sickness… in England today people from different socioeconomic groups experience avoidable differences in health, well-being and length of life” (Marmot, 2010, p. 37). Health disparities are evident when we find reports of people residing in wealthy sections of Chelsea or Kensington (where the upper class London reside) having life expectancies of an average 88 years. On the other hand, people residing in Tottenham Green, just a few kilometres from Chelsea, which comprises of the poorest section of London (residences of people belonging to the lower class social strata), have an average life expectancy of 71 years (ibid). This review supports the Marxist theory, which conceptualised that the worker classes, which are at the lowest rung of the social hierarchy, face heath disparity, while also proving that socio-economic and historical factors play a major part in determining health status of an individual in UK. In the fig 1 given below, the Marmot Report clearly indicates the inequality in the health factor that is based on social class. Fig 1: these figures from the Marmot report 2010 clearly indicates the social disparity (The Economist, In Sickness and Health, 2010). Those belonging to upper class live more, than the ones living in modest accommodations (middle class), while the middle class does better than the ones living in slums (lower class) (Strategic Review of Health Inequalities in England Post-2010, 2010, pp. 82- 84). The Economist reiterated this stand where it claimed that in UK, the poor have a shorter lifespan, which they spend coping with health related problems and various forms of disabilities (The Economist, In Sickness and Health, 2010). It further stated that in England, people who are placed lower in social hierarchy and reside in the poorest housing societies of the country, on an average, have a life span that is shorter by 7 years, than those residing in posh and upmarket areas. The poor people are more liable to face disabilities (physical or mental) almost 17 years earlier, than their counterpart richer people are (ibid). From this study, it is again quite evident that the poor people in UK face health related disparities that are based on socio-economic and historical factors, as distinguished by Marx in his theories. Marx, whose social class theory was based on exploitation of the worker classes, believed that the capitalist classes with their power and wealth also controlled the educational and intellectual world (Kettle, 1963, pp. 10-14). Thus, from this it can be easily derived that the capitalist class had strong control over the State where ideologies of the ruling capitalist class would dominate the ruling ideals of the state. In this context, it can be assumed that the class holding the production reigns also controlled the various processes of intellectual production; therefore, it would be natural to deduce that ruling ideologies are merely the model expressions, pertaining to the ruling capitalist class (Marx, cited in Kenny, 2002, p.4). From a Marxist perspective, within a capitalist society, medical profession also acts as a capitalist vessel used by ruling classes for controlling the worker classes (White, 2002, p. 8). The high treatment costs are aimed at making profits, and not at healing people, thus making access to health services (like NHS) also a symbol of social health disparity (Seedhouse, 2003, pp. 171- 175). From these representations, it can be derived that economic factors play an important role in determining health factor of an individual residing in UK, while historical factors help one to ascertain reasons behind social stratification that exist in UK and the health disparity that is evident between upper and lower classes of the society (Bartley, Blane, and Davey, 1998, pp. 193–216). Conclusion From The Black Report is it is evident that class inequalities, which started long back in history, exists in modern Britain and is showing a rise (Davey, and Morris, 1994, p. 1453–1454). Based on the economic inequality factor, there is a distinct health disparity within UK society. People belonging to the upper class (having higher social status or economic power) tend to enjoy better health with greater life expectancies and easy access to better treatment facilities (Shaw, Smith, and Dorling, 2005, p. 110- 115). People belonging to the lower social strata or the worker classes, face more health issues, have lower life expectancies and do not get easy access to good healthcare facilities (Blane, 2001, p. 292-293). The presence of such disparities, according to Marx, is due to the improper functioning of the current social institutions. In order to remove such disparities, poverty and associated suffering, Marx suggested the means of production to be kept in the hands of the state. 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