By Daniel Tarade
Even for individuals that acknowledge capitalism’s misdeeds, some are willing to bite the bullet. Why? Because even if capitalism results in gross inequality, it also has prompted the technological innovations that have trickled down and helped everyone. In this way, capitalism is the utilitarian choice. I want to tackle this assertion head on. To do so, I want to talk about one metric that is brought up in political and scientific circles: lifespan. One of the biggest developments in the past hundred or so years is that human lifespan has become longer. A lot longer. Despite lifespan being affected by many variables, scientists and science advocates often point to advances in medication and vaccination. I call this the myth of heroic science, that all modern advances are the outcome of science. Intrinsic to this veneration is that scientific process requires a profit motive. Lies. A look at historical trends reveals that major killers, like tuberculosis, began killing fewer and fewer people before major scientific innovations. Rather, socialist and labour movements brought about improved conditions for the common labourer. Social progress, not profit-driven science, is responsible for a new era of human longevity.
At the turn of the 20th century, the average lifespan in western nations was around 50 years. At the same time, the three leading causes of death in the US were related to infectious diseases (tuberculosis, pneumonia, gastrointestinal infections). What has happened since the late 1800s is remarkable; deaths due to infectious diseases have become rare (see panel on the right, slide 1). With fewer people dying in childhood, the average person now lives longer than ever before. The classic explanation is that scientific advances, namely vaccines and antibiotics, saved humankind from the indignity of microbial death. But a causal connection is not borne out in the data. Deaths due to infectious disease began decreasing long before vaccines or antibiotics for those illnesses became available. This is clear with tuberculosis (see slide 2). In a number of western countries and cities, tuberculosis deaths decreased for decades before streptomycin, one of the first antibiotics, entered clinical practice in 1946. By that point, mortality from tuberculosis had already decreased 90% from its peak in the mid-1800s. The same trend exists for most vanquished foes. Measles mortality fell many years before the introduction of a vaccine decreased measles incidence (slide 3). I do not bring up these data to argue that vaccines are unnecessary (although some do make such bad faith arguments). Vaccines remain a great human innovation that prevents suffering. Rather, it is misguided to attribute all improvements in public health to scientific research alone. To better understand the role of science and capitalism in our society, we need to grapple with what underlies the precipitous decrease in death due to microbial disease.
It is undeniable that health outcomes have improved in the absence of medical and scientific intervention. An uncontroversial corollary is that the health of a society is affected by a combination of medicine, work conditions, nutrition, sanitation, and environment. And academics try to tease apart the impact of these different aspects of society on human health. Once the project is undertaken, it is hard to ignore the positive benefits of socialist forces on lifespan. One prominent example is Cuba. Before the Cuban revolution in 1958, life expectancy on the island was only 60 years and lower than a number of other Latin American countries.[i] In the following years, life expectancy surged to over 75 years. As of 2015, Cuba boasts the third highest life expectancy in Latin America and lags USA by only 0.2 years. This is despite being an impoverished island nation that faces intense American pressure (Cuba is one of the biggest outliers when comparing GDP per capita and life expectancy). In Cuba, a more equitable distribution of scarce resources decreased infant malnutrition and mortality and increased access to flush toilets and running water.[i] Another example are the nordic countries of Denmark, Sweden, and Norway that achieved some of the greatest health indicators in the world after several decades of socialist democracy and high union involvement.[i]
We started by speaking about infectious disease and the 1800/early-1900s in Western Europe and North America. What was happening then and there?
In general, a decrease in infectious disease deaths could arise from the development of effective treatments/preventatives, a change in the microbe and/or host immunity, or a change in the standard of living. When looking at the decline in tuberculosis mortality in England and Wales, the most logical explanation is an increase in nutrition and other socioeconomic improvements in the mid 1800s.[ii] What else was happening in England at this time? The industrial revolution was just coming to an end. Some argue that capitalism, emblemized by the industrial revolution, was the impetus behind an increase in standard of living. But what else was happening in England? Socialism. The Chartist Movement was the first mass worker’s movement in English history. By the mid-1800s, they achieved a reduction in the work day to ten hours. Direct action, including general strikes, was common. Now, it is true that industrialization lead to increased wealth. But the funny thing about capitalism is that wealth concentrates in the hands of the few. Did a factory owner ever increase wages in industrial England, or America, or Canada? Of course. Increases in wage and improvements in work conditions, however, resulted from organized strike action. Capitalism unfettered does not improve conditions for the labouring class. Rather, the organization of labour, often under the banner of socialism, brings about reforms that improve socioeconomic conditions and improve resilience to pestilence.
Even if the importance of poverty in health is accepted, I can imagine that people might hesitate to give up the medical advances we have come to enjoy. After all, technology can also prevent and cure illnesses and even compensate for unhealthy lifestyles and environmental conditions brought about by capitalist exploitation. It is important to recognize that this either/or thinking is artificial. We do not need to choose between socialism or technology. Hear me out. Karl Marx took a historical approach to political economy. He described the transition from feudalism to capitalism as a natural progression. In the same way, Marx recognized that the capitalist ideology would result in increased inequality until the working class revolted. In the process, workers would not abandon the factories but rather operate them as a collective. In this way, the wealth generated by an industrial society can be shared. So far, this has only happened on a small scale with the labour movement winning concessions from the capitalist class; as illustrated, even these reforms have had a profound impact on the quality of life for the proles.
Now imagine what would happen if the entirety of the biotech industry was brought under social control? Scientists, doctors, and other ancillary workers would collectively make decisions about the research they pursue and the conditions under which they labour, all while sharing the wealth generated. The redistribution of wealth will improve the health of the workers. The direct democratic control will also enable scientists to better improve societal health by pursuing the projects that are most needed rather than those that are profitable (like new antibiotics). In this way, we enjoy the full bounty of this planet and the creativity of all people. For those who are still sceptical that scientific progress will continue unabated in the absence of a profit motive, remember that the most important medications in history have been developed by publicly-funded scientists. Medications like penicillin and insulin were first created in university labs. Only after the initial discovery and development were these drugs patented and sold for profit. Capitalism is more parasitic than mutualistic. With this in mind, there is no reason why we cannot socialize the pharmaceutical and medical industries.
My supervisor once told me an anecdote about interviewing potential candidates for the MD/PhD program at the University of Toronto. They were asked what they thought was the greatest medical advance in the past century. Many answered that CRISPR, the emergent gene editing technology, stood above the rest. The response elicited shock from my supervisor, who instead felt that vaccines and antibiotics were the obvious answer. Whether one thinks old-school microbial management or futuristic gene therapy is more important, both betray the ideological supposition that science alone can promote the health of our citizenry. When combined with the truism that capitalism is necessary for technological advance, we begin to feel that we have no choice but to accept an exploitive and unequal system. However, two pieces of evidence liberate us from this conclusion. One, dramatic decreases in infectious disease mortality precede relevant scientific discoveries and instead are the result of concessions won by the labour movement. Two, medical knowledge has been accumulated for millenia before the dawn of capitalism, and many major discoveries are made by government-funded scientists. We need to remind ourselves that socialism does not mean abandoning medical research but liberating scientists and doctors from a profit motive. By redistributing wealth, socialism allows for improved quality of life AND democratic control of scientific institutions. Truly a win-win.
Post-Script on Anti-Vaxxers
I believe that the anti-vaccine movement is dangerous. But I also see the anti-anti-vax rhetoric as reactionary. By arguing that an unvaccinated children is guaranteed (or even likely) to die, we become alienated from the role that societal structure plays in human heath. Instead, science becomes an almost godlike monolith that one must worship. Science is capable of promoting great change but only if it is under our control. Otherwise, it is susceptible to exploitation for profit.
[i] Navarro, V. (1993). Has socialism failed? An analysis of health indicators under capitalism and socialism. Science & Society, 6-30.
[ii] McKeown, T., & Record, R. G. (1962). Reasons for the decline of mortality in England and Wales during the nineteenth century. Population studies, 16(2), 94-122.