From the August 1985 issue of the Socialist Standard
Illnesses are commonly, and mistakenly, believed to strike at random and are often considered to be the result of the “affluent” life-style of advanced countries. Ulcers and heart attacks, for example, are viewed as the price of success for executives although unskilled workers are four times more likely to die from ulcers than the wealthy and also more prone to develop heart disease.
Health trends, with the exception of hereditary diseases and some genetic disorders, are determined to a considerable extent by economic factors. The general health and types of diseases prevalent in population groups vary according to historical development; class differences; stages of the economic cycle; and relationships between developed and underdeveloped countries.
Life expectancy in Anglo-Saxon Britain was about 31 years, increasing to 35 in the Middle Ages, 48 in 1840 and 69 years for men and 75 years for women today. In modern Britain about 15% of the population are over 65 compared with only 5 per cent at the beginning of this century, reflecting improved survival rates in childhood and early adulthood.
The advantages of wealth in maintaining health can be seen in pre-capitalist Europe where the aristocracy were, on average, almost a foot taller than the peasants and lived nearly twenty years longer. Capitalism, by applying modern productive processes to agriculture, has revolutionised food supplies and made it possible to sustain over four thousand million people — a number far in excess of the capabilities of pre-capitalist societies.
Before the industrial revolution infectious and parasitical diseases were the major causes of deaths in Britain. Town dwellers formed only a small proportion of the total population but had higher mortality rates than the rural poor due to pollution and poor sanitary facilities. The invention of the jenny in 1764 and the spinning throstle in 1767 radically changed production methods. The farming weavers and smallholders abandoned the land to work in factories, and land enclosures and the increasing use of agricultural machinery “assisted” the migration of smallholders and yeomen to the towns.
At first mortality rates fell as the rural poor increased their earning power in the factories. But the manufacturing centres expanded rapidly: the populations of Leeds and Bradford nearly trebled and that of Glasgow increased from 30,000 to 300,000 in the first three decades of the nineteenth century. The cities became notorious for their back-to-back slum houses and open sewers. Factory work was exhausting, dirty and often dangerous. Capitalist competition, in the absence of workers’ organisations, gradually forced wages down, while the invention of new machines reduced the demand for craftsmen.
From about 1816 mortality rates rose sharply as a result of the overcrowding and poverty endured by the new industrial working class. Although smallpox became less prevalent after about 1800 with the widespread use of Jenner’s vaccine, typhus, cholera, tuberculosis and gastro-intestinal infections exacted a terrible toll. Typhus has been aptly called “the poor man’s disease” while tuberculosis, which spreads rapidly among malnourished, overcrowded populations, caused about one third of all deaths in the nineteenth century. Such was the toll of life in infancy, childhood and young adulthood among the working poor that the average age of death was 17 years in Manchester and 15 years in Liverpool.
A series of public health measures beginning with the 1848 Public Health Act, resulted in improved sanitation. These changes were spurred on by working class unrest and the fear that cholera epidemics might spread to engulf affluent as well as working class districts. The living standards of workers began to improve from about 1860 and led to improved nutrition, particularly in the consumption of meat and fruit imported cheaply from abroad. Although fluctuations in wages occurred, by 1900 “real wages” were nearly double those of 1850.
The last decades of the nineteenth century saw the need for a fitter, more reliable and skilful workforce as machines became more complex. Good business, not altruism, was the motive behind the public health legislation of the 1870s and 1880s, and with improved living conditions the death rate from tuberculosis halved from 1850 to 1900 and typhus and cholera declined dramatically. But considerable ill health remained the fate of workers during the early decades of the twentieth century. Although mortality rates improved they remained considerably higher for the poor than for the wealthy; in fact, they are only part of the picture because they do not show the chronic ill health and misery of debilitating, but not necessarily fatal, diseases.
The economic recession of the 1920s and 1930s saw a considerable hardship for the working class, who were continually afflicted by rickets, juvenile rheumatism, rheumatic heart disease and bronchitis. (Juvenile rheumatism, for example, was thirty times more common among the children of the poor in industrial towns as among the wealthy.) These diseases of poverty, which reached a peak before the second world war and dwindled after it, have started to reappear with the present economic recession. With 15 million people now living below the official poverty line, rickets has been reported in a number of British cities.
It was assumed that the National Health Service would progressively improve the people’s health, but such a view failed to recognise that poverty, bad housing, pollution, stressful, repetitive, alienating factory work and the insecurity of capitalism’s economic system are the causes of physical and mental ill health. In the United States tuberculosis, cholera, dysentery, typhoid, scarlet fever, diphtheria, whooping cough and measles all declined considerably before the introduction of antibiotics and widespread immunisation. Even underdeveloped countries find that improved food distribution and public health campaigns have a greater impact in improving mortality rates than sophisticated medical care systems. But profits, not human needs, are the driving force of capitalism, and thus food production is actually cut back in developed countries despite widespread malnutrition in other parts of the world.
Although reductions in infectious and parasitical diseases have occurred in advanced capitalist countries there has been an increase in cardiovascular diseases, road and industrial accidents, diabetes, cancers, respiratory diseases, mental illness, suicide and alcohol-related diseases — to mention only a few. Health trends are affected by booms and slumps in the economy. The higher wages gained during a boom lead to better housing and nutrition while the need for a fitter, more reliable workforce results in the provision of improved medical care, although this has a more marginal effect in producing a healthy population. During a slump the fall in wages leads to a deterioration in housing conditions and poorer nutrition. Medical care deteriorates as the capitalists’ profits are squeezed and they have less need to maintain a healthy workforce, although some firms selectively protect the health of skilled workers and executives through the provision of private insurance schemes.
However, the complexity of health trends in advanced capitalism make it difficult to evaluate whether booms or slumps are more harmful. Although better housing, nutrition and health care in booms are beneficial they must be weighed against an increase in smoking and alcohol consumption, more pollution, more accidents due to increased overtime and travel, and the spread of epidemics and break up of families due to migration. During slumps smoking and alcohol consumption decreases, pollution lessens and there are less accidents. Short term unemployment appears to have little effect on health but long term unemployment causes feelings of hopelessness and depression.
Mortality rates may have improved considerably, but the stressful, alienating nature of factory work and the insecurity, poverty and pollution inherent in capitalism’s organisation of society prevents the workers from achieving the health at present enjoyed only by the wealthy.