Health Communism offers an analysis of capitalism and health that provides insights, but neglects the need for solidarity, argues Caitlin Southern

The aim of this book is to examine the links between capitalism and ill health, with the goal of unpicking the reasons why it can seem impossible to become or remain physically and mentally well in a society that is geared towards the maximum extraction of profit. It establishes that the supposed divide between workers and those deemed unable to work, and thereby contribute to the economy, is a false one due to capitalism’s need to extract some form of worth from every body.

The institutionalisation of those deemed incurable, whether physically or mentally, is likened to imprisonment, particularly as similar sections of the population are overrepresented in both systems. Beginning with a detailed description of the ways that some of the population is classed as surplus and how this is used to ‘other’ them, Adler-Bolton and Vierkant establish their case for the need to separate what they describe as the parasite of capitalism from the host of health.

The examination of the commodification of ill health is interesting as it shines a light on the need to divide the proletariat into ‘workers’ and ‘surplus population’. A poignant point is that eventually we all become ‘surplus’ either through illness, injury, changing economic conditions or old age, so distinguishing between ‘worker’ and ‘surplus’ does not help in the struggle for a better world. There is clearly a need under capitalism to keep those designated as useful healthy enough to be exploited, but not well enough to build a meaningful rebellion. This is a major focus of the book. Arbitrary divisions between ‘well’ and ‘unwell’ mirror earlier attitudes towards the ‘deserving’ and ‘undeserving’ poor to determine which sections of the population receive any form of relief from the conditions under which capitalism forces people to live.

There is a close examination of the actions and goals of the West German Socialist Patients’ Collective (SPK) active in the early 1970s, and the events leading up to the group being targeted as a terrorist organisation. The book is, in fact, dedicated to this group. This theme, as well as mention of the actions and failures of American AIDS activist groups in the 1980s, is explored throughout, and the authors’ admiration for the SPK is clearly stated. This dedication to a very controversial group, whose ultra-leftism led some of its members to the Baader-Meinhof group, does limit the audience for the book, and thereby the reach of the arguments contained within. Rejecting the terrorist characterisation of the SPK as ableist, indeed stating that it doesn’t matter whether the definition is legitimate or not, the authors make a clear statement on the need for unity between the ‘sick’ and the ‘well’ in order to challenge what they (and the SPK) describe as the ‘biological, fascist fantasy’ that is health.

Capitalism as the disease

The view of the authors is that capitalism is a ‘parasite’ on health, unable to function unless it can control, codify and exploit both diagnosis and treatment. They see the export of American-style private health provision and insurance through forced trade deals as a form of imperialism that undermines social-welfare systems globally. Even so, they do not view social welfare as necessarily good when it must operate under a capitalist framework that seeks to provide the greatest ‘value for money’ by dehumanising the poor. There is a call for the greater participation of patients in their own care in order to create a more collaborative type of medical care that would help to break down barriers between doctors and patients. These barriers can hinder care if they cause doctors to ignore patient concerns due to what the authors feel is classism.

The language used throughout is fairly dense and directed towards a particular audience, indeed some of the glowing reviews are provided by people quoted in the text. This may be in part due to the somewhat niche nature of the academic community to which it is aimed. The language can obscure the argument at times, making it difficult to concentrate on the links between capital and illness, and the need to create a revolution in society that would also make for a revolutionary change in how illness is identified and treated.

Adler-Bolton and Vierkant make some good points about artificial scarcity under capitalism to control populations and borders by creating and maintaining fears over migrants and malingerers, who can be portrayed as consuming resources to which they have no ‘right’. The authors see current medicine and medical practitioners as part of the problem faced by patients, placing them in a position whereby they perpetuate ableist norms that discriminate against those classed as disabled. This somewhat undermines the call for unity, despite quoting the SPK line that even these medical professionals can be classed as sick while having to live and practice under capitalism.

Overall, Health Communism is an interesting if at times flawed read that presents some fascinating insights into the links between capitalism, health and control. The ways that definitions of health and illness are used to ‘other’ people and widen divisions is examined extensively throughout the text and do provide some useful points for discussion. That these divisions exacerbate exploitation, particularly in the global South, needs to be stressed. This exploitation does not stop in those countries, and the immorality of its existence should be at the forefront of discussion. The agenda spreads quietly to allow for not only the prevention of social health systems developing in some countries, but also to dismantle those already in existence.