Why The NHS Cannot Protect Our Health - Part 3

At the beginning of Part 1, I quoted Brecht's “Workers' Speech To A Doctor”. There are a number of reasons why it is particularly relevant to this discussion.

Firstly, it demonstrates the way in which within Capitalist Society, health is viewed in individualistic terms. The doctor does not see before him a member of society, whose health is largely determined by the society he lives in, but only sees an individual patient. Whilst, of course, the health of every patient is to a varying extent, a function of their individual physical make-up, to a much larger extent on average, health is not determined by that, or even by our own individual actions. To give, a stark example, of that I was told a long time ago by a scientist that the problems that the majority of people suffer from heroin addiction, are, in fact nothing to do with that addiction. There were, he told me, many doctors, for example, who used heroin recreationally, and who were able to do so throughout their lifetime. The reason was that firstly, they could obtain heroin that was not cut with all manner of harmful substances, which can occur with addicts who are forced to try to find it where they can, and at the lowest price they can. Secondly, as a result of being able to obtain it, and also knowing how to use it they were in less danger of doing themselves harm. Thirdly, as a result of that, and of their higher standard of living, their general health was better, whereas the normal addict forced to pay high prices, then ends up cutting their spending on other things such as food and so on, so that their general health deteriorates. It is usually from these other factors that the run of the mill heroin addict becomes ill.

But, we can see it in other ways. Every survey ever done, going back to the 19th Century, shows people who are more affluent living longer, and leading healthier lives.

Again, in survey after survey, including one done only a few years ago, it is demonstrated that a string of indicators, such as Educational Attainment, Housing, and Health are all related to the level of affluence, and all of these factors are reinforcing. That latest survey showed that children, from less affluent backgrounds, with above average levels of intelligence at the point they entered nursery had lost all of that advantage over less intelligent children from more affluent backgrounds, by the time they were just seven years old.

It does not take a great leap of understanding to see that contributing factors to that are indeed, missing school due to ill-health, or that like Brecht's worker that ill-health was in turn caused by poor housing conditions!

And, of course, again like Brecht's worker, it does not take a great leap of understanding to realise that asbestosis affected all of those workers who worked in the asbestos industry, or in industries where exposure to asbestos was common, whereas it was not at all prevalent amongst the Chief Executives of companies, including those in the aforementioned industries. It is no coincidence that coal miners suffered from pneumoconiosis whereas Bank Managers did not. Yet, in relation to asbestos, it was known for decades what the dangers were.

But, the industry, and the State Health and Factory Inspectors kept quiet, because for a long time it formed such an important part of the functioning of Capitalist industry, prior to the development of fire retardants and so on, that to have ceased production, or to have introduced the necessary safety measures would have been very expensive for Capital. On the other hand, the lives of the workers in the industry were considered expendable. The same is true with Coal Miners who could work for many years before the effects of the “dust” prevented them from being productive workers.

What Capitalism is concerned with, and what its Health system is there to achieve is not the Health of workers, but the reproduction of workers who are healthy enough, for long enough to be capable of working productively for Capital, and thereby of creating profits. Exactly, what that level of health is is itself determined by the needs of Capital at any particular time. At the beginning of the 19th Century, for example, life expectancy for the majority of people fell in half. Just a generation before the parents and grandparents of those factory workers, were peasants who enjoyed by comparison a reasonably healthy lifestyle. Marx quotes the relevant information in Capital.

The anonymous author of “An Essay on Trade and Commerce, containing Observations on Taxes etc.” 1770, comments,

”That mankind in general are naturally inclined to ease and indolence, we fatally experience to be true, from the conduct of our manufacturing populace, who do not labour, upon an average, above four days in a week, unless provisions happen to be very dear.”

The degree to which the workers were better off even in the 15th century compared to the 19th century is given by J. Wade in his “History of the Middle and Working Classes" . He remarks,

“From the statement above it appears that in 1496 the diet was considered equivalent to one third of the income of an artificer and one half the income of a labourer, which indicates a greater degree of independence among the working classes than prevails at present; for the board both of labourers and artificers, would now be reckoned at a much higher proportion of their wages.” (Pp 24,25, and 577)

As the peasants were expropriated and a growing number of landless labourers and paupers were created, Britain created its own version of the slave trade that was being carried on within the borders of the US at the time. People forced into the Poor Houses were gathered together and put on canal boats having been sold by the Poor Houses to the textile manufacturers in Manchester who could not recruit enough workers. This speech by a Member of Parliament gives a flavour of the time.

“This system had grown up unto a regular trade. This House will hardly believe it, but I tell them, that this traffic in human flesh was as well kept up, they were in effect as regularly sold to the (Manchester) manufacturers as slaves are sold to the cotton grower in the United States….

In 1860, the cotton trade was at its zenith…. The manufacturers again found that they were short of hands…. They applied to the ‘flesh agents’ as they are called. Those agents sent to the Southern downs of England, to the pastures of Dorsetshire, to the glades of Devonshire, to the people tending kine in Wiltshire, but they sought in vain. The surplus population was ‘absorbed’.”
William Ferrand’s speech in the House of Commons 27th April 1863.)

This last reference to “absorbed” relates to comments made by the cotton manufacturers in 1834. Ferrand in his speech gives details of the way in which the intolerable conditions of the workers was affecting their life expectancy. He commented,

“The cotton trade has existed for ninety years…It has existed for three generations of the English race, and I believe I may safely say that during that period it has destroyed nine generations of factory operatives.” (ibid.

Faced with this shortage of labour the manufacturers had applied to the Poor Law Commissioners that they should send the “surplus population” to them with the explanation that they would “absorb and use it up” to use their own words. Hence Ferrand’s reference.

The devastation that capitalism was wreaking on the population, in a period of just 90 years, was so great that even enlightened capitalists and their representatives were appalled at what happens when you let free market forces and laissez-faire run riot as the free marketeers would have us do.

This fact is shown by the actions of capitalists like Josiah Wedgwood, and his analysis alongside those of his fellow manufacturers is illustrative.

The condition of the Staffordshire potters was appalling. The life expectancy had been slashed, and disease was rampant amongst them. Had it not been for the intermarrying of the potters in North Staffordshire with members of the surrounding rural population the population of North Staffordshire would have died out. Faced with these circumstances, as much out of self-interest as anything else, (though Wedgwood having himself been originally a working man had some social conscience) they resolved to act. In 1863 26 firms owning extensive potbanks in Staffordshire, including Wedgwood, petitioned the government for legislative action to limit working time. And why did they need such legislation rather than voluntary agreement.

“Much as we deplore the evils before mentioned, (i.e. the length of the working day and poor conditions) it would not be possible to prevent them by any scheme of agreement between the manufacturers…Taking all these points into consideration, we have come to the conviction that some legislative enactment is wanted.” (Children’s Employment Commission Report 1. 1863 p 322)

The reason no voluntary agreement could be reached was precisely because free market competition would force each to cheat in order to gain an advantage.

As Engels was to describe these developments.

“The competition of manufacturer against manufacturer by means of petty thefts upon the workpeople did no longer pay. Trade had outgrown such low means of making money; they were not worth while practising for the manufacturing millionaire, and served merely to keep alive the competition of smaller traders, thankful to pick up a penny wherever they could.

Thus the truck system was suppressed, the Ten Hours’ Bill [2] was enacted, and a number of other secondary reforms introduced — much against the spirit of Free Trade and unbridled competition, but quite as much in favour of the giant-capitalist in his competition with his less favoured brother. Moreover, the larger the concern, and with it the number of hands, the greater the loss and inconvenience caused by every conflict between master and men; and thus a new spirit came over the masters, especially the large ones, which taught them to avoid unnecessary squabbles, to acquiesce in the existence and power of Trades’ Unions, and finally even to discover in strikes — at opportune times — a powerful means to serve their own ends. The largest manufacturers, formerly the leaders of the war against the working-class, were now the foremost to preach peace and harmony. And for a very good reason. The fact is that all these concessions to justice and philanthropy were nothing else but means to accelerate the concentration of capital in the hands of the few, for whom the niggardly extra extortions of former years had lost all importance and had become actual nuisances; and to crush all the quicker and all the safer their smaller competitors, who could not make both ends meet without such perquisites.”

Preface to the English Edition of “The Condition of the Working Class in England"

In fact, by the end of the 19th Century in England, the Long Wave Boom that lasted from the late 1880's to 1914, swallowed up the Reserve Army of Labour, and laid the basis for the development of mass Trades Unions, and the raising of workers real living standards. If Capital wanted to extract more Surplus Value from workers now it had essentially two options.

It could extract a greater amount of relative surplus value i.e. increase labour productivity by the introduction of more and better machinery, or it could extend the useful working-life of every worker. The first option entailed raising the educational level of workers, both in order to obtain the skilled workers capable of producing the more sophisticated machines, and also to a large extent, for example in engineering to be able to use those machines. The second required improving workers health, a need that was brought to light even more starkly during the Boer War, and First World War, when it was found that the workers recruited into the Army were not even fit to fight, and had to be fed and given physical training to raise their level of health and fitness! Associated with that drive was the idea of “Homes Fit For Heroes”, adopted by Capital after WWI, which along with Capital's further programmes for the introduction of a Welfare State developed at the turn of the Century, and particularly by Neville Chamberlain in the 1920's, were intended to learn the lessons of the War in order to create an effective Industrial Army, for the new more technological industries that were being introduced. In fact, the introduction of the Welfare State is an example of the way combined and uneven development works.

The establishment of the Welfare State in Britain, really followed the example that Bismark had set in establishing such a system in Germany in the 1880's, to meet the needs of a much younger German Capitalism. And, in fact, the analysis that has been done more recently has shown that the improvements in health and mortality that have arisen during the 20th Century, have almost all been attributed to improvements in general living standards, improvements in diet, in housing provision and so on rather than improvements in actual healthcare.

Yet, billions of pounds continues to be spent on healthcare rather than on further advancing these other aspects of worker's health and environment, and that is because Health is provided to workers as a commodity, it is sold to them by a State Monopoly, paid for by a compulsory deduction from their wages and via other taxes, and in turn huge, powerful, vested interests lie behind the continuation of that industry, from the State Bureaucrats in the upper reaches of the Department of Health, to their counterparts in the NHS itself, to the top Consultants paid huge salaries, and often with extremely beneficial links to private companies in the pharmaceutical industry, to those pharmaceutical companies themselves alongside all of the other companies from construction to ICT, to transport who also make huge profits out of the continued provision of Health as a commodity sold to workers, via a State Monopoly, and whose Supply can be adjusted up or down accordingly to meet the needs of Capital.

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