Our reluctance to look at capitalism when we investigate global patterns of health and disease has a cost, writes Nicholas Freudenberg
A cascade of health crises—from the covid-19 pandemic, to our climate emergency, and a rise in “deaths of despair”—are contributing to growing global health burdens, making this the time for health professionals to seek the common causes of these catastrophes. Mounting evidence suggests that key features of 21st century capitalism add to the global burden of disease and to health inequities within and among nations. Corporate managed globalization spreads viruses, unhealthy products, and pollution across borders. Financialization leads to privatization of healthcare, reductions in worker compensation, and less attention to product safety and pollution controls. Corporate appropriation of science and technology leads to the use of discoveries in pharmaceuticals, food, and transportation not to improve wellbeing, but to increase profits.
Despite these links between dominant political and economic structures and health, health professionals are often reluctant to use the word capitalism when analyzing the world’s current health problems and proposing solutions. Some fear that use of the word will brand them as relics caught up in the conflicts of another century or immature rebels, or make them targets for career damaging reprisals. Leading scientific paradigms, from the reductionist biomedical model to the behavioral focus of public health practice, can further discourage use of complex terms like capitalism.
But this reluctance to look through the prism of capitalism to investigate global patterns of health and disease and identify more effective approaches for preventing global health crises has a cost. First, it ignores growing evidence that, for example, the global food and agriculture system contributes to a suboptimal diet, now the leading risk factor for premature death and preventable illness. The fossil fuel industry is a driving force for the world’s climate emergency and the pollution that now sickens so many. The marketing practices of the food, alcohol, tobacco, pharmaceutical, and firearms industries play key roles in exacerbating the rise of deaths of despair and from non-communicable diseases. The growing concentration of wealth in the world’s largest corporations and richest individuals worsens the living conditions, health, and family lives of an increasing proportion of the world’s workers. Ignoring the system that has led to these declines would be like physicians seeking to treat illnesses without considering the human body.
Second, reluctance to make capitalism itself a subject of investigation reinforces the siloization of health problems and our responses to it. Do researchers have to study separately for decades the business and political practices of the food, tobacco, financial, and Big Tech sectors before they can identify common causes of health problems and recommend changes to ameliorate these harmful influences? Do health professionals have to examine separately the disease process in each organ system when these conditions share common pathways and solutions? Do health organizations need to confront each disinformation campaign designed to discredit relevant science by the fossil fuel, tobacco, alcohol, food, and other industries, or can they devise new governance mechanisms that de-normalize corporate practices that undermine public health?
So what might a health science centered on capitalism look like? First, it would need to be grounded in the intersections of medicine, history, political economy, and public health. Capitalism has changed over time and place and will continue to do so. Understanding the shifting drivers of these changes and their influence on health will enable researchers to identify specific opportunities for intervention. Recognizing the heterogeneity of the varieties of capitalism and their influence on health will avoid oversimplification and enable identification of structures less damaging to health.
Second, developing a body of evidence on the health impact of capitalism does not require anyone to declare allegiance to any specific brand of capitalism or socialism. Health professionals have always included those who embrace, detest, or want to reform capitalism. Explicit and robust discussion of the impact of 21st century capitalism on global and individual health can clarify what paths will lead to improvements in the decades to come.
A health practice and research agenda on capitalism could seek to help our patients and communities connect their daily life experiences with deeper political and economic structures in order to identify more powerful strategies for improving health. It would seek common ground among medical and public health organizations; movements fighting for the rights of labor, women, ethnic minority communities, and immigrants; and those that seek to stop climate change, gun violence, and promotion of alcohol, tobacco, unhealthy food, and firearms. With a clear policy agenda and a commitment to reduce the current siloization among these movements and organizations, such an alliance could begin to compete with the power of corporations and investors to shape health and social policy for their purposes.
In previous centuries, the efforts of health professionals, reformers, and social movements led to advances that improved human and planetary health. By focusing on reducing the costs of 21st century capitalism, we can contribute to the next chapter of improving human and planetary health.
Nicholas Freudenberg is distinguished professor of public health at the City University of New York School of Public Health and author of At What Cost Modern Capitalism and the Future of Health.
Competing interests: none declared.