Monday, December 20, 2004

Capitalism and Disease

Firestorm of blogging, eh? This is an interesting topic. On Z Sustainers Forums, we were discussing whether or not capitalism is net beneficial. It's obvious that the question begs so many semantical and methodological questions that it's not even worth it to delve into the topic in that way; rather, the question is "What's the best we can do?" One question is disease, and one Sustainer had this to say:
" >By and large, I tend to agree. However, I would like >to note something: >>Then again, some things, like>disease, have been >controlled much better, because of>medical advances etc. >closely linked to capitalist>industrial expansion. >This seems to be a widespread sentiment, but when you >assemble information concerning this, it just doesn't turn >out to be true. With a couple rare exceptions >(smallpox being the only one of which I'm aware), the modern >world and capitalism have seen diseases become stronger >and more uncontrollable. Many bacteria are now >super-resistant to antibiotics because of irresponsible >use, including tuberculosis, which has strains that do not >respond at all to antibiotics. Many viruses have >similarly adapted. >Actually, the most significant contributing factors of >improved health and longer lifespan are basic sanitation and >escape from poverty. So... here's another argument >against capitalism and for parecon. >If you're curious, I could direct you to relevant studies on >this.
OK, I've gotten some queries for more information on this. I'll send individual emails soon, but for now, I thought I'd post here:
((FYI, For the sake of speed and brevity, I've paraphrased below some of what's in Chapter 2 of The Sociology of Health, Illness and Health Care by Rose Weitz.))
The shift in a society characterized by infectious and parasitic diseases and low life expectancy to one characterized by degenerative and chronic illnesses and high life expectancy is called the epidemiological transition. This transition seems to occur once a nation’s mean per capita income reaches about $6,400 (Wilkinson, Richard G. 1996 Unhealthy Societies: The Afflictions of Inequality. London: Routledge.).
There’s more -- which supports a lot of what progressives call for. Let me quote Rose Weitz in The Sociology of Health, Illness, and Health Care: “Increases in average income above about $6,400 (in 1999) bring only modest increases in life expectancy. Instead, further increases in life expectancy appear to occur not when absolute incomes increase but only when the relative income differential within a country narrows. In other words, if the gap in income between rich and poor narrows, as it has in Costa Rica, for example, average life expectancy increases (especially among poorer citizens). Conversely, if the income gap widens, as happened following the collapse of the Soviet Union, average life expectancy declines. As a result, life expectancy is greatest within countries that have experienced epidemiological transition and have the smallest income gap between rich and poor, like Sweden and Japan, rather than in countries like the United States, which despite its great wealth has the widest income gap among the industrialized nations, (Bradsher, 1995).”
Bradsher, Keith. 1995. “Gap in wealth in U.S. called widest in west.” New York Times, April 17:A1+
Note that medical interventions like vaccinations, new drugs, new surgical techniques, etc. played little role in the epidemiological transition, which began more than 200 years ago in western societies.
For this, see:
Leavitt, Judith Walzer, and Ronald L. Numbers. 1985. Sickness and Health in America.
Madison: University of Wisconsin Press.
McKeown, Thomas. 1979. The Role of Medicine: Dream, Mirage, or Nemesis?
Princeton, NJ: Princeton University Press.
McKinlay, John B., and Sonja J. McKinlay. 1977. “The questionable effect of medical
measures on the decline of mortality in the United States in the twentieth
century.” Millbank Memorial Fund Quarterly 55:405-428.
The McKinlay & McKinlay study is especially revealing through the use of some graphs, which show the decline of mortality from several important diseases over time. The graphs show that these declines actually PRECEDED the introduction of effective medical interventions. They estimate that medical measures account for no more than 3.5 percent of the total decline in mortality since 1900. Other, more recent studies conclude that medical care can explain no more than one-sixth of the increase in life expectancy during the twentieth century. See:
Bunker, John P., Howard S. Frazier, and Frederick Mosteller. 1994. “Improving health: Measuring effects of medical care.” Milbank Quarterly 72:225-258.
"Only polio and smallpox declined substantially after the introduction of medical interventions. Of these two, only the decline in polio can be confidently attributed to medical intervention, as we cannot separate the possible impact of inoculation on the rate of smallpox from the impact of the myriad other changes that occurred since inoculation was first widely adopted 200 years ago."
McKinlay and McKinlay’s studies suggest the delclines in infectious diseases and such are associated primarily with changes in the social environment. As nutrition and living conditions improved, so did individuals’ ability to resist infection and survive if they were affected. Public health improvements like clean water supplies also played a less important role.
Even though infectious diseases continued to run rampant in the poorer regions of the world, Americans in the second half of the 20th century had grown to believe infectious diseases were under control. Then AIDS was discovered, and scientists have identified other diseases previously unknown in western societies, such as hemorrhagic fevers, and new deadly strains of cholera and streptococcus. Previously harmless microbes have become deadly – for example, the water-borne parasite cryptospoidium seemed unable to harm humans until recently, when in 1993 sickened 400,000 Milwaukee residents. See:
Altman, Lawrence K. 1994. “Infectious diseases on the rebound in the U.S., a report
says.” New York Times May 10:B7.
Drug Resistant Diseases
The re-emergence of Tuberculosis is probably the most important development in the appearance of drug-resistant germs, because TB kills more people yearly than any other infectious disease. See:
Donnelly, John, and Dave Montgomery. 1999. “TB from ex-Soviet states resists most
drugs.” Arizona Republic March 21:A27+.
Let me quote again from Weitz:
“The incidence rate of tuberculosis in the United states declined steadily from the late nineteenth century to the 1980s but then rose steadily until 1992, especially among immigrants and minorities. According to the [CDC] . . . the current tuberculosis epidemic reflects the increases in (1) AIDS; (2) homelessness, poverty, and substance abuse; (3) persons lacking health care; and (4) drug-resistant strains of the disease (Morbidity and Mortality Weekly Report, 1993). The increase in AIDS, homeless ness, and poverty beginning in the 1980s and the continued high rates of substance abuse has left more Americans with weakened immune systems, making them more likely to become infected with tuberculosis and to develop active symptoms if infected. During the same perios, the numbers of persons without health insurance or access to health care have increased. As a result of these factors, those who develop active [TB] often do not receive consistent medical care and stop treatment once their symptoms abate rather than continuing until the bacilli are all killed.
By definition, the bacilli strains that survive are those most resistant to the drugs. Thus, a vicious cycle develops in which difficulties in treatment lead to the evolution of more resistant strains of the bacilli, which in turn makes treatment more difficult. Currently, treatment costs about $250,000 per person, takes six to eight months, and often fails (Donnelly and Montgomery, 1999). As of 1999, only 1.3 percent of U.S. cases were drug resistant, but these numbers are growing, and drug-resistant cases have been identified in all fifty states.
Other drug-resistant strains of gonorrhea, pneumonia, meningitis, and more have also appeared. "
(Sorry for the formatting, it's late). Not only are questions about technology's effect on health vs. inequity's effect on health important (and the evidence is just overwhelming that inequity is far more important), capitalism's case is made worse by the fact that the innovations against disease overwhelmingly come from the public sector, from universities, and are then purloined by the private sector, with at best minimal investment in terms of donations to colleges... These statistics, while amazing, don't even touch on the corrosive effect of capitalism's tendencies to assault the public sector in very selective ways: encouraging war (with a massive Pentagon budget, for example) as a way of scaring people/insuring a market for waste goods/funding R&D while assaulting the "bleeding-heart" sector of policy: roads, hospitals, preventive health care programs, sewer systems, schools (including health classes), etc. You also get increased world trade and jet setters carrying diseases, which leads to everyone being more scared of SARS than the flu... You also get stress caused by the huge inequity and job insecurity of capitalism, and mental disorder caused by capitalism operating with ridiculous cultural norms of beauty to sell more products women (and now men) don't need. Add onto that the nation-state, blowing everything up in its path and threatening health possibilities for who knows how many billions of lives, and being used to open markets for capital, and you have a smorgasbord of problems. Oh, and good old racism too: Not only does racism and sexism siphon productivity, it also leads people to not make investments in preventive health care, like making sure that hospitals are ready to speak whatever language somebody speaks so they can provide the proper care...


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