{"id":50203,"date":"2021-05-06T16:23:19","date_gmt":"2021-05-06T15:23:19","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50203"},"modified":"2021-05-11T10:40:35","modified_gmt":"2021-05-11T09:40:35","slug":"why-do-we-ignore-capitalism-when-we-examine-the-health-crises-of-our-time","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/06\/why-do-we-ignore-capitalism-when-we-examine-the-health-crises-of-our-time\/","title":{"rendered":"Why do we ignore capitalism when we examine the health crises of our time?"},"content":{"rendered":"<p class=\"standfirst\"><span style=\"font-weight: 400\">Our reluctance to look at capitalism when we investigate global patterns of health and disease has a cost, writes Nicholas Freudenberg<\/span><\/p>\n<p><!--more--><span style=\"font-weight: 400\">A cascade of health crises\u2014from the covid-19 pandemic, to our climate emergency, and a rise in \u201c<\/span><a href=\"https:\/\/press.princeton.edu\/books\/hardcover\/9780691190785\/deaths-of-despair-and-the-future-of-capitalism\"><span style=\"font-weight: 400\">deaths of despair<\/span><\/a><span style=\"font-weight: 400\">\u201d<\/span><span style=\"font-weight: 400\">\u2014are 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 21<\/span><span style=\"font-weight: 400\">st<\/span><span style=\"font-weight: 400\"> century capitalism <\/span><a href=\"https:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/09692290.2019.1659842\"><span style=\"font-weight: 400\">add to the global burden of disease<\/span><\/a><span style=\"font-weight: 400\"> and to health inequities within and among nations. <\/span><a href=\"https:\/\/global.oup.com\/academic\/product\/at-what-cost-9780190078621?cc=us&amp;lang=en&amp;\"><span style=\"font-weight: 400\">Corporate managed globalization<\/span><\/a><span style=\"font-weight: 400\"> spreads viruses, unhealthy products, and pollution across borders. <\/span><a href=\"https:\/\/www.semanticscholar.org\/paper\/Financialization-of-the-Economy-Davis-Kim\/a98acaeb0f95a217010f3da5b19eda552a32c6bd?p2df\"><span style=\"font-weight: 400\">Financialization<\/span><\/a><span style=\"font-weight: 400\"> 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.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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\u2019s 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 <\/span><a href=\"https:\/\/link.springer.com\/chapter\/10.1007\/978-3-030-41239-5_5\"><span style=\"font-weight: 400\">reductionist biomedical model<\/span><\/a><span style=\"font-weight: 400\"> to the <\/span><a href=\"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1363459317695630\"><span style=\"font-weight: 400\">behavioral focus of public health practice<\/span><\/a><span style=\"font-weight: 400\">, can further discourage use of complex terms like capitalism.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 <\/span><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/obr.12107\"><span style=\"font-weight: 400\">contributes to a suboptimal diet<\/span><\/a><span style=\"font-weight: 400\">, now the <\/span><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0140673619300418\"><span style=\"font-weight: 400\">leading risk factor for premature death and preventable illness<\/span><\/a><span style=\"font-weight: 400\">. The fossil fuel industry is a <\/span><a href=\"https:\/\/link.springer.com\/article\/10.1007\/s10584-015-1472-5\"><span style=\"font-weight: 400\">driving force for the world\u2019s climate emergency<\/span><\/a><span style=\"font-weight: 400\"> and the pollution that now sickens so many. The <\/span><a href=\"https:\/\/movendi.ngo\/wp-content\/uploads\/2017\/04\/13-02-The-Lancet-Monteiro-et-al.pdf\"><span style=\"font-weight: 400\">marketing practices<\/span><\/a><span style=\"font-weight: 400\"> 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 <\/span><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0140673617305718\"><span style=\"font-weight: 400\">growing concentration of wealth<\/span><\/a><span style=\"font-weight: 400\"> in the world\u2019s largest corporations and richest individuals worsens the living conditions, health, and family lives of an increasing proportion of the world\u2019s workers. Ignoring the system that has led to these declines would be like physicians seeking to treat illnesses without considering the human body.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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,\u00a0 food, and other industries, or can they devise new governance mechanisms that de-normalize corporate practices that undermine public health?\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">So what might a health science centered on capitalism look like? First, it would need to be grounded in the <\/span><a href=\"https:\/\/muse.jhu.edu\/article\/776001\/pdf?casa_token=ZgUDuhY8oAIAAAAA:fHkXXfTMIXNkqB1553-ayoojdalxsBIY8m71TleictdSIkscthGBRHketfXffqtED0p-3zvIYq4\"><span style=\"font-weight: 400\">intersections of medicine, history, political economy, and public health<\/span><\/a><span style=\"font-weight: 400\">. 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 <\/span><a href=\"https:\/\/www.inderscienceonline.com\/doi\/abs\/10.1504\/IJPP.2019.099056\"><span style=\"font-weight: 400\">heterogeneity of the varieties of capitalism <\/span><\/a><span style=\"font-weight: 400\">\u00a0and their influence on health will avoid oversimplification and enable identification of structures less damaging to health.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 21<\/span><span style=\"font-weight: 400\">st<\/span><span style=\"font-weight: 400\"> century capitalism on global and individual health can clarify what paths will lead to improvements in the decades to come.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 21<\/span><span style=\"font-weight: 400\">st <\/span><span style=\"font-weight: 400\">century capitalism, we can contribute to the next chapter of improving human and planetary health.\u00a0\u00a0<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Nicholas Freudenberg<\/strong> is distinguished professor of public health at the City University of New York School of Public Health and author of <\/span><\/em><span style=\"font-weight: 400\">At What Cost Modern Capitalism and the Future of Health<\/span><em><span style=\"font-weight: 400\">.\u00a0<\/span><\/em><\/p>\n<p><strong>Competing interests:<\/strong> none declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Our reluctance to look at capitalism when we investigate global patterns of health and disease has a cost, writes Nicholas Freudenberg [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/06\/why-do-we-ignore-capitalism-when-we-examine-the-health-crises-of-our-time\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":419,"featured_media":50206,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-50203","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Why do we ignore capitalism when we examine the health crises of our time? 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