Communia

This week, the WHO reported that global working hours keep lengthening and that excess working hours kill nearly three-quarters of a million people a year worldwide. Late last month it was also reported that excess mortality -not taking into account covid- has multiplied in recent decades in the US.

The overall health of the population keeps getting worse as GDPs and accumulation keep growing, but this wasn't always the case. There was a period when the health of the economy and the health of the general population were aligned, but that ended a century ago and there is no going back. What happened and what is left for us to do to reverse this trend?

The health of the masses was not improved by industrialization, but by the class struggle

Weavers in Manchester in the 1920s. Industrialization did not improve workplace sanitation and general health conditions, the struggle of the workers did

Early modern economic theorists - overwhelmingly medical doctors and chemists - worked from an analogy between the social body and the human body, claiming that the health of the economy and its members could be improved by imposing private property, reorganizing the country, and boosting industry. In the end this improvement in economic and social health did ultimately occur, but neither in the manner envisioned by the economists nor for the reasons expected.

It is true that the adoption of the new knowledge and methods of chemistry and the new technology led to great advances in anatomy and the theoretical side of medicine, but as can be seen from the data, this did not have an impact on general health. The reasons for high mortality and poor general health had little to do with the direct concerns of 17th- and 18th-century physicians.

The ills that plagued the population were a far cry from the anatomy and the circulatory and organ systems that had kept physicians fixated. Merely to be able to establish effective ways of treating infectious diseases, it was necessary to fight hard against immobile and conservative medical guilds and faculties. There were few things less original in the 19th century than the idea and theory that infectious diseases were caused by microscopic transmissible agents and not by the theories of environmental toxic vapors and fluids so dear to the medical profession.

But it was all the same to the medical authorities. Countless authors since antiquity had argued that a large number of diseases were caused by transmissible agents, and a whole series of physicians from the 16th to the 18th century had defended it anew and even observed infectious agents under the microscope. It was never enough.

When, in the mid-19th century, Semmelweis abruptly lowered his hospital's infant mortality rate by having doctors wash their hands with disinfectant before assisting a delivery, the medical community looked the other way. Today it is difficult to convey the gravity of the situation back then, but, to provide a glimpse, up to a quarter of Europe's adult population died of tuberculosis in the 19th century. Meanwhile, one set of doctors believed it was a hereditary disease and the other engaged in bloodletting as treatment.

Life Expectancy 1543-2015

On the other hand, there is a gap of almost a century between the beginnings of the much-touted industrial revolution and the take-off of life expectancy in the most industrialized countries. The aggregate economic data are, once again, misleading.

For instance, in 1830s Britain, 60 years after the onset of industrialization, at least half of national textile production occurred not in factories, but at home. Under these domestic conditions and with antiquated machinery, the only way to keep producing more to keep eking out a poor living was to speed up work rates and lengthen working hours.

In many of the factories - whose workers lived in overcrowded, unsanitary quarters - the conditions and priorities were the same, to seize more time from the workers, to produce more, and not to stop the machines even when a worker was trapped under them. An improvement in health conditions could hardly be expected only from a massive industrialization... which had actually worsened them.

However, something unexpected was born out of this industrialization: a massive organized proletariat and its struggles. It was these struggles which, coupled with a [specific global situation of internal and external markets available in quantity (including through colonization)](http://dictionary.marxismo.school/Rising capitalism/), pushed towards a new industrial reorganization.

The struggles for shorter working hours, the struggles for hygienic living conditions for the proletariat, but also the emergence of various sectors of the bourgeoisie who saw in the development of productivity a way to wipe out their competitors, led to a change of focus.

From the atrocious living conditions of the proletariat resulting from increasing exploitation in absolute terms, the focus shifted to increasing exploitation in relative terms, to increasing productivity and the weight of machinery on the total invested capital. As long as the external markets to which to sell remain solvent, national capital and the conditions of the workers can be improved. For a relatively short period, the needs of capital and the needs of Humanity overlapped partially but significantly.

As was almost to be expected, the beginning of the end for the prevailing medical theories came in no small part from outside the medical profession itself, because of the consequences of this turn toward greater industrial productivity. A whole host of chemists were put to work to improve the industrial production of alcohol and fermented products.

Louis Pasteur is the most famous of them, but not the only one. Put in charge of the Lille science faculty by the government to improve the situation of what the minister himself dubbed the major industrial center of northern France, it would be his studies on alcoholic fermentation which would put an end to the theories of spontaneous generation and lead him from his speculations on the cosmic importance of symmetry towards the path of the germ theory of disease and the importance of vaccination campaigns.

After several external blows, part of the medical establishment began to rescue the past work of Semmelweis and John Snow, as well as the theories of great Renaissance atomist physicians such as Fracastoro, until today, when the whole thing is presented as a linear march of Western medicine (whatever that is) towards the truth.

It was neither the industrialists with their worker-grinding plants nor the artisan Luddites bent on preventing machinization who achieved this milestone, it was the struggles of a third contender -the organized working class - all but invisible in the early 19th century.

At the end of the 19th century, capitalism was in its full progressive stage, living conditions were improving, working hours were being fought for and shortened, infectious diseases had gone from killing 30% to 4% of the population, and through industrial concentration and the development of technology, solutions would soon be found for the worldwide fertilizer shortage and other pressing problems.

However, the partial overlap of the interests of the bourgeoisie and human needs imposed some tension on the organized labor movement. It was quite possible for a part of it to lose its class independence and end up passing with arms and baggage to the other side.

When the capacity of the external markets began to run out and the countries that had once been the locomotives of progress decided to go on a great slaughter to save their profits, the workers' movement definitely split in two. One part betrayed internationalism and ran off to support the slaughter in support of their national capitals, while the other continued [pushing for internationalism](http://dictionary.marxismo.school/Revolutionary defeatism/) and the satisfaction of universal needs, triggering the world revolution as a response to the end of the progressive period of capitalism.

Health and the "welfare state"

After the two great imperialist world slaughters, several of the most developed states will try, with the notorious exception of the USA, to pursue a revamped version of the merger within the state of what were once class organizations and ended up creating what is known as the welfare state.

They were industrialized societies, highly capitalized and focused on exploitation in relative terms, so guaranteeing a minimum level of health and education to their workforce was a requirement for the economy and national capital. That is to say, these were part of the general conditions of exploitation guaranteed by the state to national capital.

But all this could only be sustained as long as it remained profitable - that is, as long as there remained solvent external markets and as long as the profits generated by the industrial park justified it. The economic boost caused by the massive destruction of capital during World War II and reconstruction began to run into the water in the 1970s, leading to a series of serial closures and the offshoring of almost entire large industrial parks to countries where lower operating costs allowed profitability to be maintained.

Evolution of hospital beds for every 1000 inhabitans.

This meant economic depression, unemployment and the worsening of working conditions in large regions in the same countries that until then had been industrial locomotives. The industrial belts of the USA, the north and east of France, regions of Germany, Spain, the list would be endless...

The attempts at redevelopment failed for the most part and even the unions and organizations which were the scions of that part of the labor movement which went over to the side of the bourgeoisie fell into a long decline, steadily losing membership and weight.

The health of the population at large depends on the vitality of society, rather than on last-minute hospital interventions

The situation in the working-class neighborhoods and environments kept deteriorating, with epidemic after epidemic of drug addiction, depression and suicides in many of them, there is a reason why some of the best-known examples of mass hysteria occurred in cities or neighborhoods with sky-high rates of unemployment. Moreover, with the industrial base overseas and no resistance in front of them, nothing prevented the states and the bourgeoisie to start their continual erosion of public health systems for several decades.

The development of new antibiotics was held back because the huge masses of investment required were not justified by small or dubious returns, and in the end if they moved forward at all it was thanks to military funding in anticipation of further imperialist slaughter.

Excess mortality rising in the US compared to mortality in Europe

But not everything were passive effects or lack of funding, capitalism went on to profit directly and to a greater extent from the worsening of general health. Trying to scrape profits from wherever they could, companies poisoned and addicted millions of workers with synthetic (and not so synthetic) opiates and other drugs.

In the face of declining profitability in the agricultural and food sector, companies expanded the entire processing chain for these same products, flooding the market with ultra-processed flours, convenience foods and gigantic portions. The effects on general health were swift. The food industry's new strategy, coupled with the collapse of the community aspect of working-class neighborhoods - where families stopped eating at the same table and precariousness led to the replacement of family cooking with precooked meals - triggered [a new epidemic of metabolic syndrome from the 1980s-1990s first in the USA and then throughout much of the rest of the developed world](https://www. cambridge.org/core/books/western-diseases/2DB8074F99CE69BE8964EA85129B2FEB).

Life expectancy in the USA by racial group and educational attainment

After several decades of deteriorating health, national aggregate data began to reflect the anti-historical and anti-human character of capitalism today. One of the greatest successes of the progressive period of capitalism, the increase in life expectancy of the population at large, is in decline.

In a class-based society, life expectancy is a matter of class

This happened first broadly in the country with the worst health system among those with the most concentrated national capital, the US, and then in working-class neighborhoods and regions of countries with supposedly good health systems such as Britain. In the US, scientists warn that up to 59% of lung cancer cases are related to socioeconomic causes - a euphemism for class and precariousness- and that improvements in treatment have a marginal effect on mortality and morbidity.

Also in the US, the fact that former large industrial concentrations on the west coast and in the north of the country are populated by black precarious workers and their descendants drives ideological propaganda to dismiss the obvious class character of this decline in life expectancy and push the umpteenth racialist campaign. However, studies where life expectancy is broken down by race and educational attainment show unambiguously that the drop in life expectancy is a matter of class.

And thereupon arrived the Covid

Massive teachers' strike aside from the unions in Algeria

Naturally, the Covid pandemic has only made the situation worse. Not only did most countries refuse to close borders and establish quarantines when there was still time (unlike South Korea and China, for example), but they have kept imposing the needs of the economy (=capital accumulation) over the health of the population, often with counterproductive effects in the short and medium term for the national capital itself.

But this pandemic also comes in the midst of a global trade war, and several countries have decided to take the worsening of global health one step further, cynically using the pandemic to promote their domestic alternative medicine industries, from China to Iran via India. Juicy multi-billion dollar markets for these medicines are expected in developing countries. It doesn't matter if they are not tested for effectiveness or quality. There will once again be one completely different medicine for the rich and another for the poor, as in the good old days.

Read also: The Pandemic and the Working Class: What We've Learned So Far (6/2/2021), communiqué from Emancipation.

Individual health is indeed a reflection of the health of social metabolism and activity as a whole. However, there is a crucial difference between this assertion and what the ideology of the bourgeoisie and its economic theory say:

It is neither capital accumulation nor the generalization of mercantile relations which improves general health, but the coordination of human activity on a large scale to satisfy the generic needs of Humanity.

There was an era during which the development of capital partially overlapped with that satisfaction, and yet that partial satisfaction would not have occurred without the active struggle of the working class.

However, that era is long over and there is no turning back, there are no virgin markets left to flood and only general devastation can bring the world economy back to life.

No cooperation with the bourgeoisie, its nation states or its factions, however rebellious or alternative they pretend to be, is worth at a time when the vitality of the economy thrives at the expense of vampirizing society's health.

The working class must fight independently in order to impose the satisfaction of universal human needs and stop the deterioration of general health conditions. It will not be done by others - not by unions, not by governments - on our behalf.