Health Communism

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AV: In the introduction to the book, we write, “Health is a vulgar phenomenon.” What we mean is that health has become inextricably linked to capital and capitalism. Furthermore, the definitions and metrics by which we judge health are fundamentally seen through a capitalist, political economic lens. For example, ill health is the threat that disciplines the labor force. When you think of the term “health” as something abstracted—as physical and cognitive capacity—it can be and is used to define who is and isn’t allowed to identify as part of society. Health in this sense can disqualify people from participating in civic and political life. It’s similar to how a term like “citizen” constitutes the boundaries of who is able to engage in social and political life, and the degree to which people are able to exercise autonomy over their own lives. Written by co-hosts of the hit “Death Panel” podcast and longtime disability justice and healthcare activists Adler-Bolton and Vierkant, Health Communism first examines how capital has instrumentalized health, disability, madness, and illness to create a class seen as “surplus,” regarded as a fiscal and social burden. Demarcating the healthy from the surplus, the worker from the “unfit” to work, the authors argue, serves not only to undermine solidarity but to mark whole populations for extraction by the industries that have emerged to manage and contain this “surplus” population. Health Communism then looks to the grave threat capital poses to global public health, and at the rare movements around the world that have successfully challenged the extractive economy of health. The NHS is often wielded uncritically on the left, reproducing a fetishised, nostalgic notion of its existence. Further, the NHS is intertwined with the left’s nostalgic fetishisation of the Labour tradition and post-war social democracy; Bevan standing over us as a great statue of socialism’s past, as someone we hope to emulate again one day. All of this is understood from an ahistorical, immaterial perspective that erases the way the NHS was birthed through the bloody exploits of the empire. Welfare and warfare coming together. El-Enany highlights how welfare ‘embodied the assertion of white entitlement to the spoils of colonial conquest.’ [20] Alfie Hancox provides a devastatingly lucid account of this in his essay, Lieutenants of imperialism: social democracy’s imperialist soul . Reforming the NHS within the confines of methodological nationalism would leave ongoing imperialist exploitation intact. Just as Bevan ignored this when he proclaimed that Attlees’s Britain had ‘ assumed the moral leadership of the world’, despite how his government spent several years violently repressing communist and anti-colonial uprisings in some of the bloodiest years of British imperialism. We must, as Shafi and Nagdee demand, ‘refuse the British left’s historical dereliction of duty: its compromise with imperialism and its rejection of radical internationalism.’ [21] Anti-Imperialist Health Communism Why should we spend money for a fool, for a hopeless ill person, if I can do with the same money so much good for a poor peasant's kid..."

The SPK produced a manifesto “To Make an Army out of Illness” along with other writings. Their critique of psychiatry was pro-illness. They saw capitalist production as destroying life. It is made up of destructive industry that creates ill health, and rehabilitative industry that then cures ill health. This is “not a collective regime of population health, but instead systems of wealth transfer generating surplus profit from the system of care.” The SPK model of inclusion meant embracing the “spoiled identity” (as a member of a surplus population). Rather than trying to “fix” the symptoms brought on by capitalism, the goal was abolishing it to undercut the causes of those symptoms (149-150). The core project of health communism is thus to ensure that nobody is ever deemed surplus, a situation that ultimately requires dismantling capitalism. This would see the convergence of patient-controlled healthcare and the equal distribution of health’s social determinants such as food, housing and education. Another example of resistance is the campaigning to close Manston detention camp where people seeking asylum were detained in the most horrendous conditions and subjected to violence. In response to pressure people were moved on, however there are reports of it still being used and the camp hasn’t yet been closed. In December 2022, an Iraqi man died of diphtheria whilst being detained. The struggle to close detention centres and stop deportations is paramount to health justice.

Coopting the language of the left at the pro-life march on Washington

In short, this seamless book fills an urgent void in leftist theories of illness: a conception of health that is possible to work toward within the capitalist system but which is mutually exclusive with this system’s model of health (along a spectrum of capacity to work and, barring this, to be an institutional subject of extractive abandonment). Health Communism is a slim book, and its argument is tight. However, it is so tight between mutually informing threads of class analysis, early modern categorizations of disability, the decline and fall of asylum systems, and international pharmaceutical policy that the achievement of such a concise yet cogent framework (aided by the fact that the past years have only confirmed its conclusion) is a marvel. This fiery, theoretical tour-de-force, offers an overview of life and death under capitalism and argue for a new global left politics aimed at severing the ties between capital and one of its primary tools: health.

The authors claim that they offer one of the most comprehensive accounts of the SPK in the English language. Indeed, their historical account of the SPK, and their revival of the group’s relevance and political concepts, is one of the book’s greatest strengths. Though the SPK originated as a collective of psychiatric patients and doctor collaborators, the authors emphasise their unitary theory of health, making no differentiation between the physical and mental, rather seeing all illness as the result of social and political determinants.For too long, socialized medicine has been billed as a humane concession to be made by the capitalist state, while those in power have recognized it as the threat it is” (26).

Artie Vierkant points out that “this could have been the new normal for medicaid or the beginning of something much bigger or better...” While he sees the necessity of fighting against these massive cuts, he reminds the listeners that “Just like everything else with Covid, this is a signal for the importance of a movement to totally sever health from capital.” Written by cohosts of the hit Death Panel podcast and longtime disability justice and healthcare activists Beatrice Adler-Bolton and Artie, Health Communism first examines how capital has instrumentalized health, disability, madness, and illness to create a class seen as "surplus," regarded as a fiscal and social burden. Demarcating the healthy from the surplus, the worker from the "unfit" to work, the authors argue, serves not only to undermine solidarity but to mark whole populations for extraction by the industries that have emerged to manage and contain this "surplus" population. Health Communism then looks to the grave threat capital poses to global public health, and at the rare movements around the world that have successfully challenged the extractive economy of health.

The Dead Don't Die: who makes the zombies?

I’m grateful for the way you resist exceptionalizing COVID. And I think the show is key for looking at how pandemic discourse is produced and to what ends, and how this fits into a longer history of health capitalism. In Health Communism, you write that “health functions as capitalism’s host body.” Could you elaborate? What is “health”?

Building on this is their concept of ‘extractive abandonment’. This is a synthesis of Marta Russell’s ‘money model of disability’ and Ruth Wilson Gilmore’s ‘ organised abandonment’. Adler-Bolton and Vierkant define extractive abandonment as: ‘the process by which [surplus populations] are made profitable to capital’. [11] Or as they put it otherwise: ‘In a political economy built on systems of extractive abandonment, the state exists to facilitate a capacity for profit, balanced always against the amount of extractable capital or health of the individual subject’. [12] Des Fitzgerald et al, ‘Brexit as heredity reduce: Imperialism, biomedicine and the NHS in Britain, Sociological Review, no. 68 (2020): 6, 1170. BEATRICE ADLER-BOLTON: One of the things that we were working on before the pandemic was developing a lens of looking at how policy affects people’s lives in material ways. How do we economically and materially feel the impact of laws that dictate what care is and how care is supposed to be paid for? What are we entitled to in terms of housing or clean air or clean water? As soon as COVID began, it was obvious that these kinds of questions were indicative of the direction the pandemic was going to take. You didn’t need to be clairvoyant to see how bad this was going to be. At any rate, the authors explain that drug companies capitalized on national sentiments during the Cold War to tell “the drug story” in which only capitalist economies could advance pharmaceutical science, while “communist” economies could not (39). Given the sad state of US healthcare, the massive inefficiency and cost redundancies, the stranglehold of private insurance companies able to crush political attempts at socialized medicine, these Cold War statements that only capitalism brings medical advancement are absurd.Health Communism first examines how capital has instrumentalized health, disability, madness, and illness to create a class seen as “surplus,” regarded as a fiscal and social burden. Demarcating the healthy from the surplus, the worker from the “unfit” to work, the authors argue, serves not only to undermine solidarity but to mark whole populations for extraction by the industries that have emerged to manage and contain this “surplus” population. Health Communism then looks to the grave threat capital poses to global public health, and at the rare movements around the world that have successfully challenged the extractive economy of health. We are obviously living in a time when defending basic welfare state care programs is vital to our survival, but we also know they are not enough. To go beyond mere welfare schemes as found under capitalism, the authors want to deepen the meaning of what is called “the social determinants of health.” As defined by activists, the idea that health is socially determined means that housing, clean air, food, clean water, public sanitation, social supports, etc. are all forms of healthcare. Capitalist welfare systems contain the kernel of revolutionary care if “we can imagine the reformation of the political economy around the social determinants of health.” To do that will require centering the surplus populations with the goal of meeting “the social needs of all” (22-23). The current pandemic, during which Health Communism was written, is wholly and deliberately excluded. None of the Covid pandemic’s “lessons” were unknown, and none of its effects (save for the most menial) were unforeseen. They have only affirmed the authors’ socially determined view of health: housing is healthcare, working conditions are healthcare, food is healthcare, and clean air is healthcare. To attain it is to center on our demands of the current system and the surplus population that it creates and extracts.