Two recent books, Health Communism and Inflamed: Deep Medicine and the Anatomy of Injustice, offer counterarguments to the abandonment of public health, calling for more expansive understandings of human well-being and its interconnection with all of our social and environmental conditions.
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The Biden Administration's plans to end the pandemic emergency declaration
and related programs means not only the end to free vaccines and tests and the chance for Big Pharma to raise vaccine prices exorbitantly. It also means ending telehealth options and depriving some 15 million Americans of access to Medicaid--including nearly seven million who will still be poor enough to qualify but are unlikely to be able to meet the paperwork requirements. It means ending supplemental food support programs, even though food banks have been hard pressed to meet people's needs even with the additional federal support.
It continues a process of abandoning the spirit of public health that has been under attack from officials at least since the CDC told us that those who are vaccinated need not wear a mask and that one-way masking will protect individuals.
To be clear, the end of the emergency declaration does not mean the end of the pandemic, which is likely to become even more damaging, as it continues to spread with even fewer checks, and thus to evolve ever more variants of unpredictable severity. What we can predict is that the effects of this pandemic--and the next ones sure to come--will inflict most damage on those already disadvantaged.
As is well known, people of color have experienced higher levels of infection and death from Covid-19. Women and trans people have been more likely to experience long covid--the persistent symptoms that can last week, months, or years after the initial infection. These disparities are not the effects of some inherent weakness or failure in oppressed groups (despite what fascist health supremacists might suggest), but the cumulative impact of suffering that oppression.
In their 2021 book Inflamed: Deep Medicine and the Anatomy of Injustice, authors Rupa Marya and Raj Patel draw a series of analogies between the body and the planet as they explore the systemic inflammation resulting from capitalism and colonialism. The book explains that when tissues are damaged or threatened, our immune system sends cells and molecular messengers that attack invaders, repair damage, and restore the body to health. Sometimes, “the response doesn’t switch off, and the result is a chronic inflammatory state. When that happens, the body’s healing mechanism is transformed into a smoldering fire that creates ongoing harm.” Leading causes of this chronic inflammation include malnutrition, environmental toxins, and stress. That is, lack of adequate food; proximity to toxins, for instance, because of dangerous workplaces or the siting of toxic dumps near black, brown, indigenous homes; and stress--the result of suffering the effects of structural, institutional, and interpersonal racism, sexism, and other oppressions--lead to chronic inflammation, which contributes to cancer, heart disease, diabetes, colitis, asthma, and other illness. Marya and Patel argue that individuals can be healthy “only when the entire community is also healthy…this is achievable only through social, economic, political, ecological, and cosmological spheres working in an integrated fashion for the benefit of all.”
As the pandemic has continued, some have suggested that the impact on the labor market and the increasing difficulty of reliably staffing any business with an ever-more debilitated population will eventually cause a shift in public policy toward ensuring a healthy workforce.
That argument might have stronger historical basis if we look at the military, since, for instance,
some of the nutrition programs in western nations resulted from the
discovery of how much of the population was too malnourished from the Great Depression to fight World War II.
But I think a more persuasive account of the current political economy of healthcare can be found in Health Communism, the recent book by Beatrice Adler-Bolton and Arnie Vierkant, co-hosts of the Death Panel podcast. Adler-Bolton and Vierkant argue that capitalism makes a fuzzy and unstable but crucial distinction between two populations: the workers and the surplus, and capitalist healthcare is the system of managing the surplus, the “unwanted, discarded bodies viewed as waste.” We can see this division being made in the way that disability is defined, for instance, when Social Security Disability Insurance uses the simplified metric of how a particular illness or condition impacts an individual’s capacity to work.
Moreover, those in the “worker” category constantly face the threat of falling into the latter category, as they will, since the surplus includes ex-workers who are no longer able to produce capital, whether because of age or other factors. But while this system treats certain populations as surplus, as waste, it also depends on these populations to exist. The surplus also become a source of extraction and profit, with various industries developing to extract value from them, whether through policing or through care.
In April 2020 as the pandemic took hold in the US, as hospitals were overwhelmed with covid patients and health workers were hailed as essential and heroic, 1.4 million hospital workers were laid off. As the New York Times put it at the time, "plunging revenues from canceled nonemergency medical appointments have forced hospitals to furlough or cut the pay of doctors, nurses and other staff" (and I note that "forced" is the language of the Times) tossing many of those workers into the surplus category. Meanwhile, as Eric Reinhart recently noted in a Times opinion piece about the demoralization of medical workers, "ostensibly nonprofit charity hospitals have illegally saddled poor patients with debt for receiving care to which they were entitled without cost and have turned large profits by exploiting tax incentives meant to promote care for poor communities. Hospitals are deliberately understaffing themselves and undercutting patient care while sitting on billions of dollars in cash reserves."
Adler-Bolton and Vierkant describe this process as "extractive abandonment," a concept they develop by drawing on Ruth Wilson Gilmore's work on imprisonment and the notion of "organized state abandonment" and Marta Russell's work on Capitalism and Disability. For Wilson Gilmore, this abandonment appears as a withdrawal of the state but is actually a strategy of racial capitalist state formation to exploit vulnerable communities, and it signals the process of governing populations through callous yet purposeful neglect, framing many humans and other lifeforms as surplus to the contemporary political economic order.
Health Communism also draws on “Marta Russell’s money model of disability" which "theorizes that while the disabled—the surplus population—are widely regarded as a “drain” on the economy, in truth over time capital and the state have constructed systems to reclaim this lost population as a source of financial production. Russell situates these systems as manifesting through charity fundraising, the prioritization of care aimed toward the “repair” of disabled people to become workers, and through policies that grow the private sector through for-profit private nursing home care paid for by publicly funded, means-tested state health care programs.”
Ultimately, the authors of Health Communism call for left projects to center the "waste," because “deviants, the surplus, and the sick form the central class that can bring about the fall of capital.” They argue that “It is not necessarily the case that we are all sick. But none of us is well." "Health" is "a biological fascist fantasy" "a subjective dream of an unattenuated 'wellness,' a body state [they] deny any being has ever known." "Capital has emphasized and corrupted the delineations between surplus classes for its convenience; it is immeasurably threatening to capital to see a group of those it has deemed to be waste come together in solidarity. ” "The truth of the distinction that capitalist states draw in their demarcations of worker/surplus is that in the eyes of capital, we are all surplus."
