Health, illness and the world .docx

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Dalhousie University
Soc & Social Anthropology
SOSA 3143
Robin Oakley

NOTES Morbid Symptoms: Health under capitalism Neoliberal era: A political movement beginning in the 1960s that blends traditional liberal concerns for social justice with an emphasis on economic growth Preface:  All the elements of public health, from a balanced diet to decent housing, job security and job satisfaction are crucial in determining how well and how long people live.  Health care as an object struggle, between commercial forces trying to make (or keep) it a public service and to reduce current gross inequalities of access. o The marketization of public health services, and the way the pharmaceutical, insurance, medical technology and healthcare corporations push to make health care everywhere into a field of capital accumulation.  Corporate control of medical research and training, the misuse of scientific data for commercial gain, the generation and mistreatment of an epidemic of mental illness, and the newest frontier of capitalist accumulation turning of genes into commodities.  Capitalist society works to create fear, but look like the hero with the breakthrough research, new ‘wonder’ drugs.  The corporation: Capitalists are psychopaths.  Everything comes down to profit. Health, Health Care and Capitalism  Capitalism is seen as the supreme engine of growth, and growth is seen as the crucial condition for health improvement. (i.e. malnutrition is present in both developed and third world countries: over-nourished vs. under- nourished; flu vaccine- could make you more prone to the flu virus)  Epidemiological transition- from infectious disease to chronic disease mortality.  The sanitation drive was resisted by capitalists  Page 4: important on prevention  Moreover the gain over time has been the greatest where incomes are most equally distributed, not where they are highest. Yet the only thing capitalism tends to do without fail is to produce and reproduce inequality.  Julian Tudor Hart’s famous ‘inverse care law’ tends to hold  the amount of health care given is inversely related to the need for it. September 19: Capitalism, Imperialism and Neoliberalisation (search: capitalism 101) Class Notes Capitalism:  Private ownership of productive forces (industries, mining sector)  People sell their labour power (it is an extremely unequal transaction to sell your labour to someone else/industry)  Adam Smith - Wealth of Nations, classic ‘liberal’ text; wage slavery  Labour is a commodity on the market; exploited by nature in a capitalist society.  Use value and exchange value (has a price tag and is in the system): health care (shouldn’t be a commodity but is shoved down our throats as one), food (i.e. Halifax/Nova Scotia: central privatized laundry facility for all the hospitals [to reduce costs] but could spread disease)  Circulation of capital becomes the reason d’être and logic of the society; circulation of capital is the lifeblood of capitalism. Marx’s humanism: Marx wanted to see more leisure time for human beings for self-development and self-realization.  A socialized economy would allow for more leisure time, time for self-development rather than spending ones life-producing value to benefit the capitalist class who extracts surplus value.  “The saving of labour time is the equivalent to the increase of free time i.e. time for the full development of the individual, which itself, as the greatest productive force, in turn reacts upon the productive power of labour” (Critique of Political Economy 97)  Marx was thrown out of country after country in Europe for his political views and call to action. As he noted “The bourgeois economists only see that production is carried on better with modern police than, e.g. under the law of the cudgel…” (Critique Introduction 1976)  The state has legitimate use of force  He envisioned the possibility of a society based on socialized economy whereby the surplus value goes back to the people who produced that value, rather than into the hands of capitalists as profit.  He notes: “…when material production is no longer limited by exchange value, but solely by its relation to the overall development of the individual, all this business, with its convulsions and pains, comes to an end” (Critique 12) He also noted socialized production had the potential to save labour time “…not for the purpose of increasing the capitalists profit, but for the benefit of society as a whole” (Critique 49)  Surplus value (Smith and Marx agreed: i.e. manufacturing pens for 10 cents/ea. Then sold for $3)  He also was very clear about the ways that this situated affected children and women (both vulnerable in terms of social reproduction) and the ways that colonial contexts such as India, African continent etc. (see Leacock, Ward Gailey)  “Gary Larson’s Depiction of Alienation” What is Imperialism (1870s – WWI and II?):  Formation of Global Trade Blocks, started in 1870s (USA, Britain, France, Belgium, Japan), which were competing against one another. (Trade blocks like NAFTA [i.e. water- converted into an important commodity; water started to have a price tag in Canada], EU, BRICS)  Formation of Monopolies—elimination of free competition (i.e. start own business freely and compete)  Financial Oligarchy  Finance capital (abstract) becomes more important than the capital produced from commodity production - - eliminating the borders and boundaries that would prevent the circulation of capital.  Wars over competition for markets  Foremost Imperialist of the 19 Century: Cecil Rhodes (in a society of buying and selling of land in Africa) What is Neoliberalism?  Leys and Panitch, in their preface note the significance of Vincent Navarro in critiquing capitalist-based health systems.  “Neoliberalism holds to a theory (though not necessarily a practice) that posits the following: 1. The state (or what is wrongly referred to in popular parlance as “the government”) needs to reduce its interventionism in economic and social activities. 2. Labour and financial markets need to be deregulated to liberate the enormous creative energy of the markets. 3. Commerce and investments need to be stimulated by eliminating borders and barriers to allow for the full mobility of labour, capital, goods and services (Navarro 2007:9). Globalisation: the internationalisation of economic activity according to neoliberal tenants.  A purportedly “new” process  Which states are losing power and are being replaced by a worldwide market centered in multinational corporations, which are the main units of economic activity in the world today.  Navarro challenges the idea that the state is backing away from policy making – from the idea that neoliberalism means a weakening of the state  BRICS summit concludes in china Impacts “The culture of capitalism is devoted to encouraging the production and sale of commodities. For capitalists, it encourages the accumulation of profit; for labourers, it encourages the accumulation of wages; for consumers, it encourages accumulation of goods. In other worlds, capitalism defines a set of people who, behaving according to a set of rules, act, as they must. There is nothing natural about this behaviour. People are not naturally driven to accumulate wealth. There are societies where such accumulation is discouraged” {Problematizes the seeming a priori, primordial, natural, common-sense} – Robbins Global Problems and the Culture of Capitalism Nancy Scheper Hughes Primacy of the Ethical  We live in a context of the state of emergency created by global capitalism in ‘making the world and social science safe for ‘low intensity democracy’ backed by World Bank capital” Scheper-Hughes Introduction to her ethnography Thesis of Book: “It is about culture and scarcity, both material and psychological, and their effects on moral thinking and practice, particularly on “maternal thinking”… what are the effects of chronic hunger, sickness, death, and loss of the ability to love, trust, have faith… Quick Write 1 – Group 3 Refresher on themes of course: 1. Critical Political Economy 2. History 3. Analysis and Action—Praxis Class Notes: INEQUALITY AND HEALTH September 26, 2012 Heroic Poets and Affirming the Collective In a number of parts of the old world, 2000 years ago, in the so called “heroic age” – people’s poets (bards, poets) commented and compared the societies and peoples they came into contact. I.e. Bards of Tamil Nadu, India (Kalaisapathy 2002 Tamil Heroic Poetry); from Maylasia, Tamil scholar, teaching Jaffna Sri Lanka, Cambridge o Poets lived among the people, observing them o Fluent in a number of languages, cultural conventions o Could easily move between societies and cultures o Orally transmitted o Women and men o Part of and yet separate society o “Know” emic dimension of life meanings, values, emotional and cultural content o Powerful, feared by leaders (feudal kings and queens, princes, etc); curse i.e. King Pulikesi o Poetry was systematized  Oral “Elements of production”  Skilfully used rich symbolism; dual meanings (classical languages “huge lexicon to draw from” like Tamil, Telegu, Greek, Arabic)  In Tamil Nadu, conveyed the concepts of “ollukum” (proper conduct) and “katan” (virtue) of leaders; “shame”  Leaders measured by the condition of the population  “An unjust leader ought to be killed like a wild dog” This leads us to Scheper Hughes and the three readings on inequality by Albritton, Coburn and Deppe… (week 3) Introduction that we read last week: “Anthropologists have tended to understand morality as always contingent on, and embedded within, specific, cultural assumptions about human life. Bit there is another existential philosophical position that posits the inverse by suggesting that the ethical is always prior to culture because the ethical presupposes all sense of meaning and therefore makes culture possible. ‘Morality’ does not belong to culture: it enables one to judge it.’ Accountability, answerability to ‘the other’ – the ethical as I am defining it here is ‘precultural’ in that human existence always presupposes the presence of another…” (p. 23) “…writing can be a site of resistance. This approach bears the resemblances to what Michael Taussig and others called ‘writing against terror’” ~23 Nancy Scheper Hughes Forgot to mention last week: P. 26-29 : Scheper Hughes writes about the potential of ethnography as a tool for human liberation.  She highlights the role of ethnography to “bear witness” to people’s struggles (28).  To “…speak truth to power…”  “…on our ability to listen and observe carefully, empathetically and compassionately….seeing, listening, touching, recording, can be, if done with care and sensitivity, acts of fraternity and sisterhood, acts of solidarity. Above all, they are the work of recognition. Not to look, not to touch, not to record, can be the hostile act, the act of indifference and of turning away.  I.e. in Halifax : Africville, forced removal “public health issue” – yet forgetting to mention that the city itself did not provide basic services to the Africville tax payers such as a decent road, sanitation, garbage removal, public water supplies… (ignoring is an act)  “The ethnographer, like the country doctor, knows the personal history of the community… a keeper of records, a minor historian of ordinary lives of people presumed to have no history…” (29) o And this could potentially be even more powerful if drawn from the local people themselves Paulo Frere – Pedagogy of the Oppressed; Henry Giroux – critical pedagogy: organic intellectual Lizards and Female Poets: soothsayers, prophetic and dangerous  Structural violence: Paul Farmer he endorsed the nomination of a Medical Anthropologist to be the current president of the World Bank. Scheper Hughes Chapter 1: O Nordeste: Sweetness and Death Re-emergence of infectious diseases—preventable; capitalism and imperialism (this is happening in India right now because of the huge industrial) o Typhoid o Malaria o Polio o TB o Leprosy o Bubonic plague “Although we think of these diseases pestilences as tropical diseases arising from the more or less ‘natural’ interactions of climate, geography, and human ecology, we might do better to think of them as poverty diseases…” (31) Naturalised public discourse Scheper Hughes next reinforces the points being made in Coburn, Albrittion and Deppe readings from morbid symptoms about inequality and health. – Inequality creates a ripe context for disease  The “promise” of the Brazil’s intense industrialization in 60s and 70s: “…the economic ‘miracle’ failed to filter down to the millions of workers and migrants of the Nordeste…” (32) Two theorists she notes: Manual Moreno Fraginals 1976 Gilbert Frere – The Masters and the Slaves 1986 Gilbert Frere drew on concept of Bagaceira (left over sugar cane husks – not used for anythings) – also refers to junk, throw-away people  Plantation culture in general Sugar and Death  Europe sold in terms of grams (more valuable than gold)  Mintz exposed the “perversity of capitalist relations”  Ireland shortage (16 pounds per week)  Major additive and preservative in foods ---- good for people on ships. o Biscuits and tea with sugar “food” o British working class replaced their beer and bread with cheaper biscuits and tea o “White death” – copious amounts that pass through our system o Now in grocery stores: used to be “sugar”: high fructose corn syrup which is highly toxic to our system. o Land is being used to plant corn (GMO) –corn syrup industrial foods (toxic)  Fuels  Cash crop o 1980s Ronald Reagan; advocate ketchup US schools cafeterias as a “nutritional supplement” Colonial Landgrant system – favoured Europeans over Indigenous people o Indians made poor plantation workers – even suicides over conditions (37) o African slaves imported (38) Frere’s observation: “ The slave on the Brazilian plantation… was generally well trated and his lot was really less wretched than many European labourers who were not called slaves” (39) Adam Smith Wealth of Nations: Wage Slavery more profitable than slavery (i.e. see p. 41 why slavery was expensive in Brazil) o Overwork led to high mortality rate o Escape  In other words, you need to invest in a slave if you want it to be profitable…wage slavery frees that capitalist from this worry  But Scheper Hughes attributes it to the benevolence (paternalism) of Portuguese’s Catholicism. (39) South Africa – Apartheid (legal racism) Domestic service – Jacklyn Cock ; paternalism  Slave/employee as a junior kin member or a junior people  Unhealthy kind of “ism” – racism, sexism, ethnocentrism, paternalism, euro centrism  Creates a toxic social environment Rise of the Modern Sugar Factory th  Before the turn of the 20 Century and with state and private help  State hoped the traditional land tenure system and subsistence cropping would die out (43)  Locals evicted of land started in 1950s (45) Amartya Sen Indian economist: three types of entitlements that people have in regard to food: 1. Land to grow food 2. A job to earn money so as to buy food 3. If both of these fail, some form of social entitlements (welfare system, or subsidy provided by the society to help people when the other entitlements failed) to provide food to people. –Without stigma “Cut loose from the paternalistic bonds to a particular landowner, plantation, or sugar mill, these workers became ‘free agents’ who sold their labour for wages on a temporary basis. In effect, they formed a ready reserve army of rural day labourers” (46) 1945-64 The Peasant Leagues Transition of peasant consciousness and organization (46-49) Privatisation/liberalisation/deregulation does not save money, is not more efficient –but rather that the economic and social costs are very high “Where is the life we lost in living” TS Elliot Readings in Panitch and Leys: Loeppky, Applbaum, Tudor Hart, Scheper Hughes ch. 2 Vincent Navarro “The water that harms one class harms the others as well” Scheper-Hughes (72) Robert Hunter Wade, a colleague of Vincent Navarro, challenges the liberal view that inequality is a necessary outcome of the risks taken by capitalist entrepreneurs. Wade notes the tendency for liberal scholars to promote the idea that “…inequalities are the result of differences in effort and talent and just plain luck…” He notes that this is the “…moral case for greater inequality” (95) Social Darwinian: survival of the fittest--- the organisms in the environment that had adaptable traits that function well in a given environment will be more fit than those with less adaptable traits -social Darwinians is also at the root of eugenics movement – up until the 1970s; mentally inferior: poor, Washington consensus was applied to low and middle income countries (“developing”): o A set of rules to make the market work better by strengthening property rights  Liberalising domestic markets  Privatising state-owned enterprises  Opening the economy to free trade…  Financialising the economy: giving stock markets a more central roles in the economy (96) Many of the low and middle income countries that were targeting, were countries that after the 1960s—post colonial period, i.e. India (became independent); they actually created public healthcare systems with plenty of free clinics, …social medicine: rooted in providing preventative care such as the basics of food, shelter and the means to get them. . . create conditions where people can maximize their “health” (wellness)  Washington consensus (world bank) changed it to operationalize it. Wade notes that scholars and intellectuals play a huge role in both promoting these tendencies and concealing their negative effects. (the tendencies outlined in regard to Washington consensus) For example: WB researchers go through rigorous article approval for The Economist (huge influence on public opinion— “impact factor”) and alternate views are not published.  A strict control of the knowledge that is circulated in society o As a result a number of “alternative” presses, publishing venues have emerged over the past 20 years. He also notes the emergence of “faith based science” (98) i.e. “…I don’t have a crystal ball…” nothing is certain… Biomedical hospital in India Profit becomes the primary motive for “healthcare” rather than the “human factor” Training of physicians ---ethical and legal as opposed to “treatment” issues (legal risk)  Along with faith based science, is also the tendency to focus on ethical or legal issues  When a market logic is applied to healthcare (Loeppky) Loeppky highlights the growing incursions of market logic into healthcare and the resulting “disquiet” about it (59)  The hospital becomes a competitor as much as any other industry “In instances where market competition or some reasonable facsimile is the objective, dismemberment or dissolution of (particularly state) institutional control over specific “Rather than seeing this industry’s fortunes as a mere response to populations’ ‘natural’ demands, it is the health industry’s self expanding accumulation strategies that much be examined as candidates for the prime movers of growth…as pharmaceutical profits took off in the early 1980s, much of it occurred in the guise of an innovation-led ‘biotechnology revolution’ – a ‘revolution’ which has, in turn, laid the basis for new industry claims to be enhancing health outcomes” (63)—in the absence of social medicine; in the context of a decline of social medicine “The liberal argument carries the prophetic clout: provided we hold steady to the central thrust towards free markets and private property and lower taxes, extreme poverty will be eliminated, income gaps between countries will be eliminated, income gaps within countries will also level up as the poor become better off “: SICKO (documentary on US healthcare) The tendency is to have pockets where this happens but always on the backs of someone else’s suffering… While Canada has been embarked on a full fledges process of liberalisation privatisation, and deregulation and so on it has led to:  Homelessness as a national disaster (declared a national disaster by a public health nurse named Cathy Crow) –housing crisis in the US  Chronic food insecurity  Functional illiteracy among Canadians (puts people in a vulnerable position)  Increase in mental illness  Increase of wait times for health services  Increase of life expectancy but simultaneous increase in chronic illness for half of one’s life “Bad lifestyle choices…” – “Hobson’s choice” 2006 Toxic nation While economies of BRICS countries have economically “developed” and are “developing” how about inequality and poverty?  Re-emergence of infectious diseases in India  Social movements trying to keep lands  Farmer suicides  Morbid symptoms and social movements who are trying to stop deregulation, privatisation… Imperialism  An advance on early capitalism based on Free Competition. With the development of Monopolies, Free competition ceases leading to the development of finance capital.  According to critic
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