Three - Markets, profits and health care

Summary

Every society has had its way of dealing with impaired individual and community health, some more organised than others. While it has proved tempting to many modern Western observers to dismiss early healing systems as primitive, at least until the emergence of fully fledged agrarian states around 3000 BC, this is often to underestimate our predecessors (Graeber and Wengrow, 2021). History is in fact replete with modes of societal healing from which lessons might still be learned (see Stacey (1988) for a comprehensive but neglected sociological introduction from a feminist vantage point). Stacey defines ‘health work’ as embracing all those activities that involve the production and maintenance of health; the restoration of health; the care and control of birth, mating and death; and the amelioration of irreparable conditions and care of the dependent. While this is a useful reminder of the wide reach of factors that are pertinent to health and longevity and to interventions to address them, it is not necessary to explore the global trajectories of the multiple past and present forms of health work again here. Instead, I will preface an account of the emergence and travails currently facing the NHS with a few preliminary contextual remarks. The first is to approvingly note Stacey’s (1988: 10) assertion that:

Capitalism has developed from small- scale enterprise to monopoly capitalism and the associated development of international oligopolies. Contemporarily, consumer capitalism involves market control of demand, and the machinations of finance capitalists appear to render the governments of nominally sovereign states powerless to control their own affairs.

She goes on to insist that social structures as well as cultures change, and understanding this is critical for explaining the evolution of health care. Stacey’s stance here is consonant with the class/command dynamic – and by inference the GBH – though her focus is on gender as well as class.

A second comment is on the optimal definition of a modern ‘health system’. Mays (2018) suggests that the term typically refers to all organisations, people and activities undertaken in society in pursuit of the goals of protecting, improving or restoring the health of a population. This includes action taken in relation to social determinants of health.