Health in a capitalist system: a common good?

 » It is the society that multiplies the causes of physical, mental and social maladjustment and that makes it necessary to spend fantastic sums of money to care for, rehabilitate or keep alive the maladjusted .

 » Citizens are increasingly aware of their dependence on the medical enterprise, but they believe that this is an irreversible phenomenon. They identify this dependence on progress  »

Ivan Illich, Medical Nemesis, complete work, vol.1, Fayard, p.657 and 681. 

What is health in a world where profit is the ultimate value? To this question, the answer seems simple enough: a bureaucratic system of disease management in which the patient’s well-being is no longer the ultimate goal — even if it is a consequence it can achieve. To all the other questions that this theme raises, we do not pretend to answer in a few pages of this file, but hope that it will raise some doubts, certainties, disagreements or not. 

We open this one with a meeting with Dr. Anne-Lise Ducanda (10–11), who works in France (Evry) at the Direction de la protection maternelle infantile et de la santé. In fifteen years, she has seen the progressive ravages of the generalization of screens on the development of children. She speaks of nothing less than « the greatest public health challenge « , adding that « it is the entire future of our society that is at stake « . Bathed in an advertising environment, the injunction to consume more so that the GDP grows is in total opposition to this major challenge that Dr. Ducanda identifies. 

Outside, we continue to produce sickness: stale air, indoor pollution due to the components of manufactured products, junk food, stress, a society that establishes detachment and therefore solitude… all this makes people sick, and it would be a lie to say that it doesn’t do some good, financially, to a minority. At the same time, medicine is gaining the control power of new technologies, ushering in the era of « connected medicine » (12–13), which is not unrelated to the first topic of this dossier… A gold mine for multinationals, these projects signal the future of a robotized and over-medicalized subject, who, far from being autonomous, will henceforth be totally dependent on technology for his survival. 

The meeting with two doctors who are passionate about their work takes us into the mysteries of the hospital, a bureaucratic territory where people classify, sort, categorize, measure and quantify (14–15). We manage. No time, or little, for the most lucid, to think to act. Where for many, studies and their forgotten social cost, one takes the highest bidding employer, for others one tries to survive in a competitive universe where new colleagues are imported from the East, ready to accept less and tolerate more. No time then, when you have to eat, when you are surrounded by young department heads who see their job as a business, that you have to make figures, no time to get out of the matrix… In this context, does the Belgian model of medical centres constitute a bulwark against the privatization of health and the loss of autonomy of the subject in this field (16–17)?

Will we throw the stone at those who try? No ! They already have the merit of lucidity. Are they not in the same situation as many workers, who participate in spite of themselves in the functioning of the society that refuses to act on the causes of the problems. No doubt, if nothing changes, they will witness the collapse of the world with an anguish that allows us to see a small twitch of the lips, the beginning of a sneer, silently saying:  » But how could it have been otherwise?

This reminds us of what Ivan Illich said in Medical Nemesis: « The analysis of morbidity trends shows that the general environment (which includes lifestyle) is the primary determinant of the overall health status of any population. Food, housing and working conditions, the cohesion of the social fabric and the cultural mechanisms that stabilize the population play the decisive role in determining the health status of adults and the age at which they tend to die.⁽¹⁾.

In these areas, however, can we pretend that everything is going well? 

File coordinated by Alexandre Penasse