Tobacco smoking: the end of the road? (1962)

From the August 1962 issue of the Socialist Standard

Tobacco has been known to us for quite a long time, cigarettes not nearly so long, but long enough for the smoking habit to be very well established by the time the Royal College of Physicians issued their report on lung cancer earlier this year. Although it is probably true to say that medicos have never been really happy about the effect of smoking on health, it is only in recent years that they have felt able to pin some of the blame on it at least for stomach irritation, chronic bronchitis, heart attacks, coronary thrombosis, and last but not least—lung cancer.

The Royal College’s report Smoking and Health, published last March launches a swinging attack on the smoking habit—cigarettes mainly—but it is not the first of its kind. In 1950, Professor Hill and Dr. Doll published results of their first investigation into the incidence of lung cancer in relation to men’s smoking habits. Then at the beginning of 1952 the American Cancer Society began a survey of nearly two hundred thousand men between the ages of fifty and seventy. Its grim findings were announced to the American Medical Association convention in 1954.

Tobacco shares fell at the news, but Alistair Cooke, writing in The Manchester Guardian at the time, was a little hasty when he assumed that it would “. . . induce profound melancholia or even penury in the American cigarette manufacturers.” Sales of tobacco have continued to rise since then, with cigarettes reaching an all time high in 1961. In that year also, there were 22,000 deaths from lung cancer in Great Britain alone.

In the twelve years since the Hill and Doll report there have been similar independent surveys conducted in at least eight countries. All have reached the same broad conclusions, so that the R.C.P. report this year only set the seal really on the impressive weight of evidence which has been building up in the meantime. It is difficult to say at this stage how seriously this latest report will be taken; there is still a very strong social habit to be taken into account. But that is not the whole story. It is really only the fag end.

The tobacco firms are rich and very well established. Some idea can be gained of the persistent money spinner that tobacco is, when it is realised that in this country alone last year £825 million went to the Government in revenue from this source. Almost exactly the cost of the National Health Service, as one noble Lord put it. Which gives us a glimpse of the dilemma facing our rulers—powerful tobacco interests and a huge tax income on the one hand and a rising lung cancer rate on the other.

Maybe they can take some solace from the fact that others before them have had to tread a similar path. Over the centuries since its discovery and the beginning of its use in England, tobacco has been violently attacked and just as stoutly defended, but its consumption has increased and with it the tax yield. Even James I, who campaigned vigorously against the weed in such works as A Counterblast to Tobacco (1604) was not slow to slap on an import duty of 6s. 8d. a pound the following year. Some say that James’ antagonism toward tobacco was really an expression of his hatred of Sir Walter Raleigh. Be that as it may, and whatever his original motives for imposing the tax, he was cute enough to realise its possibilities. By 1613, he had rescinded his earlier tax and in 1624 made tobacco a Royal Monopoly.

Nicotiana Tabacum — common tobacco — native of Central and South America, is now grown the world over and accounts for about three-quarters of all that is smoked. It was introduced into Europe about 1530. There is still some dispute over which of the colonists in the time of Hawkins and Drake brought the plant to England. What we can say is that smoking slowly took hold here between 1565 and 1590. Ironic that today it should come under such heavy medical fire, when in those days it was thought to have great curative powers and in many places took root because of this belief.

The first cigarettes known to be manufactured in England were by Robert Gloag in 1856. He opened a factory in Walworth, London. This form of smoking gained rapid popularity (probably because of its comparative cheapness) and the various cigarette firms, familiar to us all, were well established by the turn of the century. Seventeen of them combined in 1902 to form The Imperial Tobacco Company Ltd., as a counter to the threat of American competition. They were strong enough to win the “tobacco war” with the American manufacturer James Buchanan Duke, and secured his withdrawal from the English market.

As the market for tobacco, and particularly cigarettes, expanded, so did the government’s interest in it as a course of taxation. This applied even more in times of war. During the first world war, for example, the duty was raised enormously and eventually reached 8s. 2d. a lb., where it remained until 1927 when there was another jump to 8s. 10d. Again, the second world war gave a tremendous fillip to taxation and at the end of it, the duty had reached 35s. 6d. per Ib. Successive governments have continued the practice since then.

Which is just about where we came in. All governments have to levy taxes to finance their administration of capitalism’s economy, and they are not particularly worried about where they get them from. Tobacco has been a sure source of income up to now and cigarettes take the brunt of this because they form at least 4/5ths of the tobacco consumed in Britain today. So although strong medical suspicions have been voiced for over ten years, cigarette consumption has continued to rise and the government has continued to cream off some of the profits.

It must be a bit perplexing for our politicians to have to set about discouraging a widespread habit which they have themselves helped to foster in the past. Remember the huge quantities of “fags” distributed free to the forces during the last war, and how they were considered vital in boosting morale? But 22,000 deaths in one year and the rate still rising cannot be ignored. Let the tobacco companies gripe if they like. The more astute capitalist politician will have his eye on the threat to production if the incidence continues to rise. And remember that it is not uncommon in the younger age groups now, the ones who matter so much in the productive scheme of things. That is why the anti-smoking propaganda has been directed so conspicuously at school children, and not old age pensioners.

Just how successful the government’s campaign will be is anybody’s guess. The smoking habit is certainly well established, but if it threatens the overall interests of the capitalist class they will try to do something about it. What will happen to the tobacco firms then? Some may go broke, but there will be other fields of profitable investment. Labour will be transferred elsewhere, and the government will start looking in other directions for its taxes.

But by then we shall probably have other problems to worry us anyway. Poor health, after all, is not something for which smoking is solely to blame. Inferior diet, poor working conditions and the sheer strain of modern living are constantly wearing workers down. Add only three of the factors which are to that the fact that medical research itself is never very high on the priority list of expenditure, and you have an idea of the magnitude of this problem. To say that it is social is to stress the obvious, and despite the best intentions of the medical profession the task of tackling it can hardly begin until capitalism is well on the way out.

Eddie Critchfield

SPGB Snippets: Unhealthy Living (2026)

From the Socialist Party of Great Britain website

March 11, 2026

The ONS recently reported that there had been small increases in life expectancy in the UK since the 2019–21 period. However, it also revealed that in 2022–24 there had been decreases in healthy life expectancy (HLE) since the previous period.

HLE is the number of years that people can expect to spend in ‘good’ general health. In the more recent period, HLE at birth was 60.7 years for males and 60.9 years for females. The reductions here are 1.8 and 2.5 years, respectively.

So the chances are that at least a fifth of a person’s life will not be spent in decent health, a situation which is deteriorating. That’s life and health under capitalism!

Not so glorious food (2007)

Book Review from the January 2007 issue of the Socialist Standard

Joanna Blythman: Bad Food Britain. (Fourth Estate £7.99.)

Essentially this is an extended rant about the eating habits of the British, especially in contrast to countries with a proper food culture such as France and Italy. Recipe books and TV cookery programmes abound, yet fewer and fewer people actually cook food from scratch or sit down to eat with their family.

Instead more and more ready meals are consumed, mostly in front of the television rather than at a table. Less time is spent on food shopping and less money spent on food. Children are astonishingly ignorant about food, often being unable to identify common fruit and veg. The population are subject to food scare after food scare and gradually become desensitised to them. Junk food and snacks combine to make people fat, in what is apparently called an obesogenic environment.

The reaction at this point may be that Blythman doesn’t think much of the food consumed by people in Britain, but that people are after all free to eat what they want. Nothing forces people to eat a ready-made shepherds’ pie rather than peel and mash the potatoes, cook the mince, and so on. But of course this freedom is found in a particular context, and people often say they are too tired to do much in the evenings, especially cook. The pressures of capitalism are such that workers really do have insufficient energy (though maybe enough time) to cook properly.

We also have to look at the pressure exerted by the food industry. Snacks mean big profits (‘mini bites for maxi profits’, according to Proctor and Gamble), and fast food and ready meals are big profit-earners too, much more so than fresh fruit and vegetables. The food manufacturers also resist any government efforts to to rein them in a little, and are becoming increasingly involved with sports sponsorship in order to foster a healthy image.

Mind you, if living under capitalism is what makes the British diet so bad, one wonders how workers in other capitalist countries manage to fare rather better. Blythman’s final message is, ‘Eat as little processed food as possible and base your diet on home-cooked meals, made from scratch from raw ingredients.’ Advice to be borne in mind in Socialism, perhaps, when people really will be free to eat as they wish.

Paul Bennett

Voice From The Back: The wasteland (1999)

The Voice From The Back Column from the July 1999 issue of the Socialist Standard

The Wasteland

Derelict land in England now covers an area equivalent to a city twice the size of Birmingham, according to the country’s most detailed survey of vacant sites and buildings. The so-called national land use Data Base, due to be released shortly, finds that almost 130,000 acres are idle—in theory enough for 2.5 million medium-density homes. Guardian, 20 May.

How are the mighty?

The world’s biggest personal computer maker was thrown into crisis today as two of its top chiefs dramatically quit following a dire profits warning and plummeting share price . . . Compaq stunned Wall Street two weeks ago by announcing its first-quarter earnings would be half of what analysts expected, leading to a 23 percent tumble in its shares. Evening Mail, 19 April.

Russian capitalism 

Fifty-three percent of the Russian people are said to be living below the “official” poverty line; 2 percent own 57 percent of the country’s wealth (land, means of production, etc). the super-rich have, since 1991, managed, largely illegally, to transfer between 200 and 250 billion dollars out of the country. In 1997, 27 percent of the workers’ salaries had not been paid. The economy will contract by 6 percent this year. Source: The Centre of Studies for Living Standards, Moscow.

Capitalism is depressing

“There are more people suffering from depression in Britain today than asthma and diabetes combined. It is a major problem,” said Dr [Chris] Manning. One in four of the population suffered depression at some point in their lives. Four thousand people suffering depression committed suicide each year . . . According to the survey, money worries are the most likely trigger of depression, cited by 88 percent of people, followed closely by death and illness in the family, work worries and marriage or relationship problems. Guardian, 22 April.

Great expectations die again

Former freedom fighters and militant unionists who spent decades struggling to topple South African capitalism have become instant millionaires as the directors of new black-run companies or white-owned firms keen to get a few black faces on the board. Trade unions, the Communist Party and a slew of other organisations that once campaigned for the nationalisation of the gold mines and other “commanding heights” of the economy have joined the scramble to buy into private business. But critics say that black-owned firms treat workers little better than the white companies that financed apartheid . . . When a former Robben Island prisoner, Mzi Khumalo, took over a major company, JCI he was asked whether he would be sympathetic to the unions. “I have spoken to the unions at JCI and made it clear: we are here to run a business. I’m not for any of this brotherhood stuff.” Guardian, 22 April.

Winning the war

The world’s estimated 6m millionaires have shrugged off the effects of last year’s financial turmoil and are getting richer by the day. New research by Merrill Lynch, the investment bank, with Gemini Consulting, a management consultancy, found the wealth held by high net worth individuals with more than $1m of financial assets grew last year by 12 percent to $21,600bn. The World Wealth Report produced by the two firms projects a steady rise to $32,700bn by the end of 2003—a growth rate which is expected to attract more firms into the lucrative market for private banking and wealth management services. Financial Times, 17 May.

Class war casualties

More than 1m people are killed at work every year—including 12,000 children—and 250m suffer workplace injuries which force them to take time off, according to International Labour Organisation estimates. The worldwide annual workplace death tally of 1.1m outstrips the numbers killed in road accidents, war, violence and Aids and costs 4 percent of the world’s gross domestic product in terms of absence from work, treatment, disability and survivor benefits. Guardian, 28 April.

Losing the war 

Our Health Challenge:

• Thirty percent more men [in the area] die from lung cancer than the national average.
• Sixty-eight percent more people die from heart attacks.
• Eleven percent more people die from strokes.
• We are among the country’s ten worst places for deaths of babies at or just after birth.
• We have one of the country’s highest teenage conception rates.
• Thirty percent of households have someone with a long-term illness.

Our Social Challenge:

• Thirty-five percent of households have no central heating.
• Twenty-three percent of public housing and 17 percent of private housing are unfit for human habitation.
• Four percent of privately rented accommodation have no exclusive use of bath/shower or inside toilet.
• Ninety-five percent of Sandwell people have no qualifications beyond school.
• Fifty percent more people are unemployed than the national average.

Better Health for Sandwell People.

The long and the short of it (2022)

From the June 2022 issue of the Socialist Standard

One of the great advances in the course of human history has been the increase in life expectancy. It may be argued that life was never quite as nasty, brutish and short as Thomas Hobbes once claimed, but the average human lifespan has clearly increased over the millennia and centuries, having more than doubled in the last two hundred years or so. Moreover, it is a matter of not just living longer but of doing so in a better condition too: people who reach the age of sixty now are likely to be healthier and fitter than their parents, and especially their grandparents, were at the same age. Nevertheless, there is a great deal to be said about the determinants and limits on lifespans under capitalism.

Many figures could be cited to demonstrate the improvements. For instance, in 1820 life expectancy at birth was around 29 globally, and 36 in Europe. By 1970 the averages were up to 60 and over 70 respectively. The global chances of a child dying in their first five years are down from 18 percent in the 1960s to 4 percent now. Improved health care and sanitary conditions have clearly been one of the main reasons for these changes. The germ theory of disease led to big reductions in cholera, for instance, in the nineteenth century, when proper sewage systems also resulted in far fewer deaths from typhoid. Infectious diseases have in the ‘rich world’ become less important as causes of death, while chronic conditions such as heart disease and cancer have become more crucial. In some countries, the improvements have been more recent: life expectancy in India rose from 32 to 51 between 1950 and 1968, partly caused by decline in deaths from cholera (and the figure now is 70).

Yet things are not quite as bright and wonderful as is sometimes suggested. Life expectancy varies greatly across nations, and within countries on the basis of such characteristics as skin colour, education and poverty. In some cases, lifespans have been stagnating or even getting shorter. For instance, between 1990 and 2008, life expectancy for white US men without a college degree fell by three years. In general, better educational qualifications imply more years of life, and poverty of course shortens lives. In the US again, black people live on average fewer years than white people, though the gap is narrowing. Unemployment leads to earlier deaths, even when factors such as smoking and previous health conditions are taken into account.

However, in developed countries there is no simple correlation between life expectancy and average income. The US has a high average income but is near the bottom for life expectancy. People in Sweden are less well-off than those in Norway, but have slightly longer lifespans. In The Spirit Level, Richard Wilkinson and Kate Pickett argue that the determining factor is inequality, which is associated with lower life expectancy, lower birth-weights and higher rates of infant mortality: more unequal countries have worse outcomes in these (and many other) areas.

In 2006–08, life expectancy at birth was far higher in Kensington & Chelsea than in Glasgow: thirteen years in the case of men and eleven years for women. This figure is taken from Danny Dorling’s So You Think You Know About Britain? where it is suggested that premature death was in 2010 ‘the great measurer of the North-South divide’, which involved a line drawn from just north of the Wash to the Bristol Channel, with Grimsby on the northern side and Lincoln on the southern. Dorling argues that other contributory factors to a longer life include occupation, height, periods of unemployment, sleeping rough, eating fruit every day, amount of exercise, and weight. Personal lifestyle can make a difference, but a person’s social situation is clearly of great importance too.

Of course the largest differences in lifespan on a global scale do depend on how ‘developed’ a country is. According to worldometers.info, the two countries with the highest life expectancy are Hong Kong and Japan, with over 85 years each. Figures descend via the UK (over 81) and the US (over 79) to Afghanistan (just below 66), Haiti (just under 65) to the Central African Republic (54). Countries in Africa cluster towards the bottom of the list. It is hardly controversial to say that living standards, health care and access to adequate food are crucial here.

One point that applies in every country is that women on average live longer than men (just over three extra years in the UK). Quite why this should be the case is not clear. It did not hold in rich countries in the nineteenth century, and the difference in Russia is now a remarkable ten years. Various reasons have been suggested, but probably it is the combination of various factors. More men than women smoke; differences in child mortality between girls and boys may make a small contribution; biological factors can apply, such as men having more fat surrounding their organs, which increases the extent of cardiovascular disease. One interesting suggestion is that ‘women do not live longer than men only because they age more slowly, but also because they are more robust when they get sick at any age’: women spend more time in hospital than men but still live longer (article by Esteban Ortiz-Ospina and Diana Beltekian at ourworldindata.org).

There can be no doubt that capitalism impacts people’s lives in one of the most fundamental ways, namely how long you will live for. From impoverished countries with short lifespans to places where poverty and living conditions affect a person’s likely years of life, capitalism is simply bad for you. We cannot predict what will happen to life expectancy in socialism, or just what the consequences would be of increasing numbers of elderly people. But we can say that the massive global inequalities will, after a while, cease to exist. Society will be concerned to ensure that everyone leads as long, healthy and rewarding a life as possible.

Paul Bennett

Blogger's Notes:

• Danny Dorling’s So You Think You Know About Britain? was reviewed in the August 2011 issue of the Socialist Standard.
• Richard Wilkinson and Kate Pickett's The Inner Level was reviewed in the October 2019 issue of the Socialist Standard.

The N.H.S.—Was it worth it? (1975)

From the May 1975 issue of the Socialist Standard

There are still many people who will tell you that the British NHS offers the best medical attention, for patients of all social strata, in the world. In fact, nearly all its original claims have proved to be miserably false.

When discussing the “welfare state” one still often hears the completely false claim that “nobody starves to death in Britain any more.” Thousands of people die here every year from lack of food, clothing, blankets and fuel. The respectable term for this starvation is ‘hypothermia”. Strictly translated this means “low heat” and indicates that the victims suffer from an insufficiency of calories to support their basic vital metabolic needs. They starve from lack of calories.

An article in the November 8th 1974 issue of the periodical General Practitioner reads as follows:

Dr. Geoffrey Taylor, of Ilminster, near Taunton, retired Professor of Medicine in Lahore, India, and a leading campaigner in the nutrition and problems of old people, plans to ask local health officials and Somerset County Council to help him set up a team of volunteer street wardens.

These wardens, armed with room thermometers, will check the homes of old people to make sure the rooms they are living in have a temperature of at least 70°F. If necessary, they will block draughts, check insulation and advise the old people to live entirely in one room. “Very large numbers of old people suffer heart attacks as a result of extreme cold”, he said.

“About 700,000 have core temperatures of 95.5°F, and are on the verge of hypothermia in mild winters. In cold winters there must be three or four times that number. It is a question of action now. Our problem is getting volunteers”.

But the warden scheme is only a short-term answer. Dr. Taylor is hoping to persuade councils to back his long term scheme for district heating. He explained: "District heating uses waste material now thrown away to boil water which can heat homes.

Elderly invalids living alone are often victims of loneliness and depression. Rightly, they should have constant nursing attention and company. They often need frequent cleaning and changing and assistance with feeding and using the toilet. In the enormous numbers of homes that have no fixed bath or inside lavatory this is very difficult. Relatives with their own family responsibilities often just cannot properly cope with these cases. Yet there is a great shortage of hospitals for the frail and old — with waiting lists which will become even longer — since Mrs. Barbara Castle has intimated not only will there be no increased expenditure in this field but expenditure will have to be less for some years to come. An article in the General Practitioner of July 13th 1973, reads:

Strongly associated with chronic disability were low income, age, widowhood and living alone. More than a third of all persons living alone were chronically limited by disability and this proportion rose to 44% in the over sixties.

The proportion of chronic sick varied between 35% and 41% in families with a total income of £5 to £12.50 a week.

So much for the Welfare State. Did we really “never have it so good?”

It was once boasted that the NHS would provide free specialist treatment for all, and that the needy would not have to suffer ill health any more because of their poverty. But now, with waiting periods of months for specialist appointments and years for routine operations, this is an empty promise. When told of these waiting lists workers often ask how much it would cost to “go private” and so have their case dealt with much sooner. When told the probable fee, some struggle to find it and others turn away amazed and disappointed. Yet another example of the broken promises and boasts of the NHS was that patients would be able to receive treatment without having to pay the monstrous prices of drugs. Yet now, being handed a prescription, poor patients sometimes ask if one or more of the items prescribed for their health can be deleted because finding the extra 20p is beyond them.

The profits of drug manufacturers are enormous but they claim that these are necessary, to plough funds back into research for new drugs. But it is well-known that many drug companies manufacture and sell products introduced by other firms under different proprietary names. Their subsequent propaganda often points out that their product is more than just a pharmacological equivalent because, say, it is better absorbed or has less side effects. This one drug may be bought at different prices, in different make-up and under different proprietary names. Admittedly some companies spend a lot on research and introduction of completely new drugs. Nevertheless, far more of their returns are spent on advertizing their own brands in opposition to the pharmaceutical equivalents made by others. Figures vary, but it has been said that in certain cases five times as much is spent on advertising them as on research.

In a sane order of society research would be made finding the most efficacious and side-effect-free product and this alone would be manufactured and used. Such massive duplication with its attendant wastage would then be pointless.

R. B. Gill

The Knowledge (2011)

Book Review from the August 2011 issue of the Socialist Standard

‘So You Think You Know about Britain?’ By Danny Dorling. (Constable £8.99)

 

It is often argued that there are too many old people or too many immigrants in Britain, or simply too many people. In this informative and enlightening book, Danny Dorling subjects these and many other commonly-held beliefs to a thorough examination, with frequently-surprising conclusions.

 

The north–south divide has been moving gradually southwards, with more and more areas being categorised as part of the less well-off ‘north’; the dividing line in fact runs diagonally from the Humber to the Severn estuary. On average, if you live on the London side of the line your life expectancy is two years greater than otherwise. Life expectancy is also influenced by many other factors (extra years likely if your father worked in a non-manual occupation, if you have never smoked, if you eat fruit daily, if you have sex at least twice a week, for instance). The north–south divide is now wider than at any time since the 1920s, and is most graphically illustrated by the difference between how long a child born in the most affluent part of London is likely to live as opposed to one born in the poorest part of Glasgow (86.7 versus 74.3 years).

 

Women on average live longer than men, which is why Eastbourne, a popular retirement destination, has 87 men for every 100 women. In other cases, such as Glasgow, a comparable imbalance is caused by men either leaving the area or else dying before they reach retirement age. But women in their late twenties are the most likely to get into debt. And a recession leads to both an increase in emigration and a drop in birth rates, as people are less willing to start a family. 

 

Inequality has increased in various ways, with the incomes of the richest fifth of the population having grown at eight times the rate of the bottom fifth. By 2005, 27 percent of households could be classified as poor, living below the breadline. This poverty is largely geographically-based, but there are no ghettos, in the sense of districts almost exclusively the preserve of one ethnic or cultural group. Yet in England most children who live above the fourth floor in tower blocks are black or Asian.

 

Dorling is well aware that measuring things in terms of profit is not always sensible:

 “British roads, pavements and railway carriages could be far more comfortable places to travel on (and in) if we did not so often judge an activity as worthy only if it makes a profit. We don’t always do this, we don’t always seek only profit, otherwise none of us would have children.”

 This is reinforced by the discovery of the large numbers of unpaid carers, who ‘often visited others’ homes simply to help, for no monetary reward, and often for reasons other than family ties’. There are more carers in places with more people in need of care. So the view, often put forward by supporters of capitalism, that people will not work without being paid in return, is simply untrue. This book not only shows that many beliefs about Britain are wrong – it also discredits a common argument against socialism. 

Paul Bennett

The health divide (1987)

From the May 1987 issue of the Socialist Standard

In March the Health Education Council brought out its latest — and final — report. The Health Divide: Inequalities in Health in the 1980s. It was released amid a storm of controversy and accusations of an attempted government cover-up. The Council's chairman. Brian Bailey, cancelled a press conference to announce the report, at short notice, saying that the full council had not had time to consider it. He said that its findings could be political dynamite in an election year.

The report illustrates how the poor, especially the unemployed, are more likely to suffer from bad health. The death rate for unemployed men is 36 per cent higher and their wives also die earlier. They are more likely to suffer from deteriorating mental health and lung cancer and suicides are more frequent. There is a substantially higher death rate for children among the poorest 25 per cent of the population. The rate of stillbirths among the top 25 per cent is four per thousand while it is nearly twice that for children in the bottom quarter.

Although people's lifestyles — for instance smoking and drinking — do influence the figures, by far the biggest impact is caused by material deprivation. Bad housing, "low and inadequate income", overcrowded conditions. pollution and high-rise living are among the main factors which affect people's health. Areas of high unemployment coincide with areas with the worst health records. There are more areas in the north with severe poverty. But there are pockets of prosperity in the north, as well as areas of severe poverty in the south where the health statistics are just as bad. Clearly it is class, not geographical location, which determines people's health.

These figures certainly should be political dynamite in an election year or indeed in any other year. But predictably the response from concerned reformers was as pathetic as the government's claims to be tackling the problem. Douglas Black, the former president of the Royal College of Surgeons, was involved in compiling the report. He advocated more help for mothers-to-be, better child benefit, good school meals, better housing and improved employment. These suggestions fail to confront the cause of the problem and the last one in particular fails to recognise the findings of other reports which show the detrimental effects that employment can have on workers. To suggest that people should kill themselves at work rather than on the dole is not a sensible solution, although it's one the capitalist class and their apologists would welcome.

The most hypocritical response to the report came from Labour's spokesperson on health, Frank Dobson. He said, "The report shows bluntly that poverty kills. Thousands of people would still be alive today if the Tories pursued policies to tackle poverty rather than worsen it”. He concluded. "Our ultimate slogan for the next election will be 'Vote Labour, Live Longer'". But Labour's cries of anguish and horror should be seen in the light of the fact that the gap between the health of the rich and that of the poor also widened during the period of the last Labour government. Poverty was not invented by Thatcher although since the Tories have been in power, and with the increase in unemployment, the gap between rich and poor has widened still further.

The report, and those who commented on it, all stressed that being poor, or as they put it, being part of a "lower social class", was the main factor in bad health. Yet the solutions they offered were various reforms which ignore the cause of this problem and which have failed in the past. The obvious answer would be to put an end to class-divided society in which a small minority live in ease and luxury while many of the rest of us have to endanger our health to make them rich. Capitalism is the real cause of poverty and the poor health that goes with it. It is a diseased, cancerous system that needs revolutionary surgery, not useless elasto-plast reforms.

Ian Ratcliffe

Running Commentary: Junk society (1988)

The Running Commentary Column from the July 1988 issue of the Socialist Standard

Junk society

It's not often that I find myself in half agreement with a lackey of capitalism, in this case Edwina Currie, junior Health Minister. When she made her headline-grabbing remarks that Northerners are more overweight than Southerners, eat too many crisps and drink too much. I could only concur with her. While aware that Southerners eat junk food too, Mrs Currie raised a question to which any socialist could have given her the answer: diet is related to economic circumstances.

Two years on medical "experts” have reached the same conclusion and are taking Mrs Currie to task for omitting this explanation from her previous comments. The Henley Centre's director of health. Mr Kreitzman. told a BUPA conference in Leeds that by the early part of the next century life expectancy in the South would be longer than in the North. "We are talking about four to five years, which is quite significant", he said. "Just as we are developing an economy with affluence and poverty living cheek by jowl, so it is the case with health" (Guardian, 2 June). Currie was also attacked by Dr Colin Waine, chairman of the Clinical Research Division of the Royal College of Practitioners, who said that she had failed to understand that a northern diet is based on a tradition of low wage levels and heavy manual work.

One explanation for the northern predilection for "comfort" food may be that offered by George Orwell in The Road to Wigan Pier:

 Would it not be better if they spent more money on wholesome things like oranges and wholemeal bread? Yes, it would, but the point is that no ordinary human being is ever going to do such a thing. The ordinary human being would rather starve than live on brown bread and raw carrots. And the peculiar evil is this, that the less money you have, the less you feel inclined to spend it on wholesome food. A millionaire may enjoy breakfasting off orange juice and Ryvita; an unemployed man doesn't. When you are unemployed, which is to say when you are underfed, harassed, bored and miserable, you don't want to eat dull wholesome food. You want something a little "tasty".

As long as capitalism exists, if you have caviar tastes but a fish and chip budget then your choice of food will be restricted by the amount of money you get for selling your labour-power to a minority ruling class. If you really want to improve both your health and your happiness then abolish this junk system of society. Abolish capitalism.

Sheep’s brain

Tucked away on the back page of the Guardian of 7 June was a hundred and fifty word report headlined "Howe insists on the beneficence of the capitalist system". In a speech in the City of London the day before Sir Geoffrey Howe had defended the social responsibility of the capitalist economy by claiming that those acting in their own interest in the market were promoting an increase in others' well-being. (Those readers who haven’t at this point fallen off their seats, and are rolling about consumed with hollow laughter, read on.) Replying to recent criticism by the Church of England, Sir Geoffrey said. “Where people are able to respond to the signals of the market place, they are responding to the preferences of their citizens. In effect, in seeking to increase their own well being, they are often helping to promote an increase in other people’s well being." He concluded that the welfare state, by promoting rights rather than responsibilities, had undermined traditional obligations.

Assuming that all readers aren’t curled up on the floor at this point, screaming "Please, Sir Geoffrey, no more. Have you ever thought of auditioning for Bob Monkhouse's Opportunity Knocks?', let me remind you that Denis Healey compared being criticised by Howe to being savaged by a dead sheep. This is a mistake. One must never under-estimate the power and influence of a member of the executive of the modern state, the committee for managing the common affairs of the ruling class, no matter how inane or ineffectual he or she may appear to be.

Dave Coggan

Life Support (2019)

Book Review from the October 2019 issue of the Socialist Standard

Lee Humber: Vital Signs: The Deadly Costs of Health Inequality. Pluto Press £17.99.

What determines the health of an individual or of a whole population? Is it the healthcare they receive, or is it more to do with the conditions in which they live? Humber’s answer is that it is very much the ‘social determinants of health’ that affect a person’s wellbeing and life expectancy. Biomedical models focus on a person’s relationship with disease and the expertise of the medical profession, but a more multifaceted approach also looks at factors such as polluted air, overcrowded households, diet, and the pressures of employment.

Of course this does not mean that the kind of healthcare received is beside the point. One claim is that cuts in UK government health spending resulted in 45,000 more deaths among those over sixty between 2010 and 2014. In the US almost twice as much as a proportion of GDP is spent on healthcare than in the UK, yet life expectancy is several years less. About half of Americans can only afford the most basic health insurance, and 45,000 die each year because they lack health coverage. In spite of the importance of diet, GPs rarely ask patients about it.

One chapter is a critique of the ‘inequality thesis’ as set out by various authors. Humber claims that they rely too much on subjective notions such as status and social trust, and pay insufficient attention to social factors such as the quality of food. This overlooks the fact that Wilkinson and Pickett in particular rely on inequality of income as the crucial point, and there is no reason why an inequality-based approach and one looking at other societal factors cannot be combined.

It lacks an overall theme, and does not emphasis inequality as much as the subtitle might suggest, but Humber’s book gives a good picture of the deleterious effects of what others have termed the ‘medical–industrial complex’.

Paul Bennett

Tiny Tips (2011)

The Tiny Tips column from the November 2011 issue of the Socialist Standard

Jenny Nicholson is tired of hearing how the poor are poor because they make poor choices. Let’s see what kind of choices you make when it’s your turn to be flattened by the economy. That’s the idea behind Spent, an online game Nicholson created to challenge popular misconceptions about poverty. Play it at www.playspent.org.

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Some children in the North [of China] live ferally: they are known as kotjebi, or “fluttering swallows”, and roam in packs. When they cannot steal in the markets, they eat dead dogs and rotten food (reportedly chewing toothpaste in the belief that it prevents food poisoning).

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A typical prize for a children’s contest might be a backpack, a lunchbox or maybe some toys. But not in Somalia. Over the weekend, a Somali radio station run by the Shabab, the most powerful Islamist  militant group in the war-ravaged country, held an awards ceremony to honor children who were experts at Shabab trivia and at reciting the Koran . The prizes? Fully automatic assault rifles and live hand grenades.

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What makes individual stockbrokers blow billions in financial markets with criminal trading schemes? According to a new study conducted at a Swiss university, it may be because share traders behave  more recklessly and are more manipulative than psychopaths:

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A Saudi Arabian ministry statement carried by the state news agency, SPA, stated that Abdul Hamid al-Fakki “practiced witchcraft and sorcery,” which are illegal under Saudi Arabia’s Islamic sharia law. Al-Fakki was beheaded in the western city of Medina on Monday, the interior ministry announced:

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Mr. Daisey’s trip to Shenzhen, China, where he posed as a wealthy businessman to infiltrate factories where Apple products and other electronics are made. He says he witnessed inhumane conditions and interviewed workers outside of factories who said they were as young as 12.

   ‘What was shocking to me was the level of dehumanization built into the systems that have been put into place by American corporations in collusion with suppliers…… There’s a hunger in very controlling companies like Apple to create planned obsolescences sooner rather than later, so it will become more and more difficult to stay functional’:

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Eight in 10 British workers are overweight or living with long-term illnesses that limit their productivity, according to early findings of a 25-year study of people’s wellbeing:

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Tobacco companies knew that cigarettes contained a radioactive substance called polonium-210, but hid that knowledge from the public for over four decades, a new study of historical documents revealed:

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“Uneconomic” hospitals to close (1992)

From the July 1992 issue of the Socialist Standard

Less than a week after winning the general election the new Conservative Secretary of State for Health, Virginia Bottomley, indicated that “uneconomic” National Health Service hospitals will be closed. It is believed that a special commission, under the chairmanship of Sir Bernard Tomlinson, will recommend the closure of one of London's 14 teaching hospitals. Speaking about this possibility Virginia Bottomley stated:

  Hospitals have always closed. At the end of the war there were 300,000 TB beds in this country. Now there are about 300. So there must be change (Independent, 17 April).

This is a blatantly dishonest comparison. TB hospitals have closed because tuberculosis has been practically eradicated due to improved living standards since the end of the Second World War, greater natural resistance to the disease, and immunisation. To close beds because they are expensive to maintain in spite of the need for them is an entirely different proposition.

Bottomley added:

  It is too early to say what the recommendation of Tomlinson will be, but I will not hesitate to take whatever decisions arc necessary to ensure that further generations of Londoners can have the best possible health service.

This example of Orwellian “doublespeak” claims that health care can be improved by reducing its provision. Already the closure of small hospitals, with loss of beds, and the concentration of most of the remainder into large district general hospitals, has led to many people in rural districts living considerable distances from the nearest hospital.

The reduction of hospital beds over the last 25 years led to record waiting lists of over a million people needing treatment by 1991. Political expediency prompted by an impending general election this year has led to patients waiting for treatment for more than two years being attended to. But there have been claims that this attempt to clear the back-log of politically embarrassing long-term problems has sometimes been at the expense of patients with more serious problems of a shorter duration.

Waiting lists
Some health authorities have reduced their waiting lists by the simple expedient of not carrying out certain categories of operations unless the patient opts for private treatment.

The closure of beds in psychiatric hospitals has led to long-term mentally ill people swelling the number of the homeless in Britain's major towns and cities. And Lord Justice Mustill has attacked the lack of provision for mentally ill offenders who move between prison and the community without anyone taking proper responsibility for their care (Guardian, 21 March).

The pressure on hospital beds has led to hospitals having to be “closed" to acute admissions on occasions because there are no beds available. Family doctors and medical staff in casualty departments are obliged to waste valuable time in telephoning other hospitals to find out if there is a vacant bed. This involves considerable delay in getting an ill patient admitted for treatment; can remove patients considerable distances from their families; and taxes the resources of the over-stretched ambulance service because of having to make longer journeys.

The ambulance service is already struggling because of the effects of the government’s economies without these added problems: in Greater Manchester there has been a reduction of 40 posts since August 1991 and further redundancies announced recently (Manchester Evening News, 28 April).

A consequence of the shortage of hospital beds and the need to be seen to be “economic" leads to the premature discharge of patients from hospital to convalescence at home. This has led to higher rates of re-admission in the last few years. But as turnover of patients is seen to be the barometer of efficiency irrespective of whether death or discharge is the reason for leaving hospital, the reduction of hospital beds can only aggravate matters.

There have been attacks on health care provisions in other ways: prescription charges have been increased several times more than the rate of inflation, and the charge for sight-testing have deterred some workers from having their eyesight tested as frequently as they should. Dental charges have increased considerably and in some areas it is difficult to find a dentist prepared to undertake NHS work.

It is expected that most health authorities will become self-governing trusts within the next two years and more family doctors will become budget holders to buy treatment for their patients.

Buying treatment
But an internal market does not provide more money for the NHS; it merely shuffles existing money between hospitals at greatly increased administrative costs. And with doctors being obliged to keep costs down, because of the risk of being labelled "uneconomic”, there is the likelihood that patients will get the cheapest rather than the most appropriate treatment. Because doctors can incur financial penalties for over-prescribing but may use money that they save on treatments to improve their practices some people in high-risk groups (diabetics, the elderly and the long-term mentally ill) have greater difficulty in registering with a doctor.

The debates over the numbers of patients treated and on the waiting list misses the point that poverty is the main cause of ill health. Unskilled workers are four times more likely to die from ulcers than the wealthy and are also more prone to develop heart disease. The Health Education Council’s 1987 report The Health Divide found that there was a difference in life expectancy of more than eight years for men in the most affluent parts of Sheffield compared with the poorest areas.

The large number of patients requiring medical treatment under capitalism (rather than being a matter for congratulation) is an indication of how poor the workers’ health is. Capitalism with its poverty, stress, alienation and pollution is unable to remedy this.

Nevertheless, the NHS, despite its shortcomings, does ameliorate some of the misery of illness caused by capitalism. But because health care “free at the point of use" represents a cost against production it is vulnerable to attack in a recession when there are a larger number of workers than are needed to meet the capitalists' requirements.

But poverty is not an inevitable part of the human condition. A socialist society producing goods for human needs and not for the market; a society of co-operation instead of the competitiveness, hostility and suspiciousness of capitalism could make the high levels of ill health and the long waiting lists for treatment a thing of the past.

Carl Pinel

The Economics of Health (1959)

From the February 1959 issue of the Socialist Standard

1. A Survey of the Problem

It has long been known that economic factors have an immense amount to do with health, although opinions vary on "why" and "how" health is so influenced. Frederick Engels, in his Conditions of the Working Class in England in 1844 wrote: "Society in England daily and hourly commits social murder; it has placed the workers under conditions in which they neither retain health nor live long; it undermines the vital force of these workers gradually, little by little, and so hurries them to their grave before their time.” If conditions in this country have changed somewhat since 1844, in many parts of the world these things still apply. It has been stated by Lord Boyd Orr that two-thirds of the world’s population are still living below the standards of normal nutrition—in other words, they are suffering from malnutrition, and are destined to die of malnutrition if they don’t first succumb from some other condition.

In 1938 Dr. Scott Williamson and Dr. Innes Pearce, of the Peckham Health Centre, examined 1,530 men, women and children, and in only 9 per cent. did they find nothing wrong. Eight per cent. were diseased and were under treatment. Eighty-three per cent. had something wrong and were doing nothing about it—and this was only twenty years ago and in a large town where every help should be obtainable. It constitutes a great indictment that something appalling is wrong, and whatever it be that is wrong, it has a causative factor behind it.

In a Board of Education Survey (1927) of an unselected group of 1,638 London Elementary School children aged 5 (i.e., at the age when they first come under the eye of the School Medical Officer) 83 per cent. showed one or more signs of bony rickets; 66 per cent. showed two or more signs of bony rickets; 83 per cent. showed some abnormality of nose and throat; 67 per cent. had some degree of adenoids; 94 per cent. had decayed teeth ; 88 per cent. had a certain degree of bad development of the teeth. A great proportion of such defects are attributable to inadequate food.

This report did not suggest in what way the food was inadequate, for it might well have been inadequate in quality, i.e., deficient in nutritional value, or insufficient in quantity, or both.

It can be observed quite easily that there is a considerable difference in the distribution of illnesses between the rich and the poor. Dr. Spence (Medical Officer of Health for Newcastle-on-Tyne), in his annual Report for 1933, declared, “Since the high incidence of apparent malnutrition is not found in the children of the better class families, it is due to preventable causes. Ill-health, therefore, is not only very widespread, it is unevenly distributed, the poor being much more prone to illness than the rich.” The late Dr. Drysdale, Physician to the Metropolitan Free Hospital, London, many years ago said that, “while 8 per cent. of the infants of the rich died, the death rate among the very poor was often 40 per cent.” According to this, full health is an idle dream so long as poverty persists. Quotations of this kind are unfortunately conspicuously lacking as the authorities have the knack of recording very few of them, and don’t seem to encourage research along these lines. They have the idea (or seem to) that it is not too healthy (politically) to paint the picture too black against their own administration. Yet, Sir George Newman more than once declared, “Health is a purchasable commodity.”

When Sir George Newman was Chief Medical Officer to the Ministry of Health and the Board of Education, he stated in 1920 that not less than a million children of school age were so physically or mentally retarded, defective or diseased as to be unable to derive benefit from the State Education provided.

Public Opinion in Preventative Medicine

An article appeared in the Lancet (organ of the British Medical Profession), for 5th December, 1942, and in commenting on the Beveridge Report—the forerunner of the National Health Service—declared : “The greatest single cause of ill-health and sub-optimal health, mental and physical, is not a virus or a bacterium, but poverty. So it is the doctor’s duty to fight poverty with even greater vigour than He fights the diphtheria bacillus.”

If we look at the maternal mortality figures for different districts of London we notice that the maternal mortality for Bermondsey and Paddington (industrial districts), is four times as high as Westminster, and six times as high as Kensington, and twice as high as the average for Greater London. Letchworth, a relatively prosperous garden city with 10,000 insured workers in 1938 out of a total of 17,000. had no maternal deaths in the five years prior to that date. 

Another very striking quotation: “During the period 1935 to 1937 more than 10,000 expectant mothers in the poorer districts of South Wales were given special food supplements during pregnancy. As a result the death rate in this group was only about a quarter as great as that in 18,000 who received no food supplements.” There are a host of similar figures to prove this.

An interesting experiment has been tried which shows beyond any shadow of doubt the tremendous influence of economic factors on health. In the Papworth Village Settlement for sufferers from tuberculosis, the children living with their tuberculous parents do not develop the disease in spite of this close contact. Sir Pendril Varries Jones, the founder of the Settlement, gives the following reasons for this immunity, reasons which are, in themselves, a striking comment on our society; 1. Adequate food supply. 2. Adequate and prolonged parental income. 3. Freedom from anxiety. 4. No risk of unemployment after breakdown. 5. Proper housing. 6. Public opinion which makes it possible to observe the necessary hygienic conditions without being laughed at. He sums up with the remark, “Economic conditions determine the spread or otherwise of the disease.”

Horace Jarvis

Link to Part 2

The Economics of Health (1959)

From the April 1959 issue of the Socialist Standard

Link to Part 1

2. Food and Profits

Sir Jack Drummond, the nutritional expert who was murdered in the South of France a few years ago, declared that if we were to put the nation's diet right we could close half our hospitals. Drummond was well aware of the extent of food sophistication, that most of our foods are adulterated, preserved, coloured with dyes, treated with' anti-oxidants and anti-staling agents (not anti-Stalin agents), sprayed with poisonous concoctions and grown in soil which has been treated with chemicals. A lot of our foods have gone through all these processes—in fact, any food that comes from a factory and is canned or packed up in some way, has had most of these mysterious treatments. For what purpose is all this done to our food? Who has demanded that food should be grown artificially, have its vitamins removed, have chalk mixed with it, have it bleached with poisonous gases, and various chemicals added so that it will keep twice as long in a soft condition than it otherwise would? Whoever made such requests to food manufacturers? The answer is that nobody has ever asked that any of these things shall be done to his or her food—they are all done without our wishes and in many cases without our knowledge.

There are about 700 chemicals used in the manufacture of foodstuffs and most of this delightful list has not been sufficiently tested to determine precisely its toxicological effects upon the human body, This fact was referred to in an address given by Sir Edward Mellanby as President of the Medical Research Council, But let us ask again why are these foods tampered with in such a way? The answer is that it enables products to be sold and hence a profit made—which is the prime object. Caviar is not used to adulterate sausages nor brandy to sophisticate beer, because this would be unprofitable.

Why does the farmer grow wheat? Because there are people who want bread? No fear; so far as he is concerned they can starve if they have not the money to pay for it. there are people wanting all sorts of things, but nobody is going to try to provide them because there is no profit to be made. Yes, profit! The farmer grows wheat with a view to making profit, on which he lives. The miller grinds the corn to flour for the self-same delightful purpose—that of making profit, the baker bakes bread for no other purpose than profit. If it is profitable to use artificial fertilisers to grow more wheat. and barley, potatoes and sugar-beet then the farmer employs artificial fertilisers. If the miller discovers that by bleaching flour he can sell more of it, then it is bleached white, or if required, he would colour it purple to aid his sales. When he finds that by extracting vitamins from his flour he can keep it longer and so prevent germination, which would prejudice sales, then the germ of the wheat is extracted, if the baker finds that people want bread that does not go stale in 24 hours, and are prepared to pay for a loaf that is more like a pudding, then who can blame him if he makes it so? So long as society is run in this way we will have the present state of affairs—the factor that is wrong is neither the farmer, the miller nor the baker, nor even the public, but the social set-up that produces these idiotic and harmful phenomena. Fancy selling foods by colour. Not only are sweets made in all the colours of the rainbow with aniline dyes, but so are jams, confectionery and tinned foods. In older days, in order to adulterate a sack of flour a miller, if sufficiently unscrupulous, would put a heavy stone in it. The size of the stone was usually proportional to his scruples. To-day it is necessary to be a little more scientific and grind the stone down to powder and mix it carefully with the flour. Perhaps to-day’s process is the most dangerous for it cannot be so easily extracted as the former stone could. But the motive is precisely the same. Of course, ordinary stones are not used, but special ones- chalk and various powders functioning as anti-oxidants and anti-staling agents, and substances to soak up water, which makes a loaf more like a sponge, or causes water to stand up on end. All these chemical treatments masquerade under the name of “improvers,” meaning that they improve the profits of the baker.

Horace Jarvis

Editorial: The Cost of Living Farce (1937)

Editorial from the November 1937 issue of the Socialist Standard

The Government is conducting an inquiry among 30,000 families to discover how they spend their wages. The resulting figures will be used as the basis of a new cost of living index to show from month to month whether and by how much the cost of living has increased or decreased. The old index, which dates back to 1904, is considered out of date, but the new one will be just as farcical as the other. The inquiry is not designed to discover how much good food a human being needs to maintain health and how much money that food costs, but simply to discover how the worker spends his wages. Whether the wages are too low to maintain health is not regarded by the Government as being its business.

Three things show the Government’s attitude in its true colours. The first is the fact that though Government employees for years had a cost of living bonus system, the bonus was never more than part of the full increase in the cost of living. The Government flatly refused to grant the full amount. The second is that at all times thousands of Government employees have been receiving wages which were shown by authoritative estimates to be too low to provide the necessities of life.

The third thing is that the Government, which is spending an extra £1,500 million pounds on armaments, has just refused a request by the Trade Union Congress that the pay of the unemployed should be increased in keeping with the rise in prices (Daily Telegraph, October 18th, 1937).

How inadequate is the level of wages, whether in Government employment or outside, has just been demonstrated again by the issue of a revised edition of Mr. Seebohm Rowntree’s “Human Needs of Labour” (Longmans, 1937, 2s. 6d.).

In it he estimates that at 1936 prices the minimum amount needed to keep a family of man, wife and three dependent children living in a town is 53s. a week. It is assumed for this purpose that the wage is paid for 52 weeks a year (i.e., that the worker has paid holidays) and that he receives 53s. all the time, not only at the time when he actually has three children; because he has got to get his home together, and no allowance is made for this in calculating the 53s. Moreover, the 53s. does not apply to London or to any place where rents and traveling expenses are unusually high. Mr. Rowntree allows only 9s. 6d. for rent and rates and 1s. for travelling to and from work, both of which are absurdly low for London. Mr. Rowntree admits that in London rents may range up to 20s. or 25s. (p. 89) and that his 53s. must be increased accordingly. It would in such cases be in the region of 70s., apart from the inadequacy of the allowance for food, referred to below. The dietary, costing 20s. 6d. a week for the family of five, is based on a minimum estimate of what adults and children need to maintain health drawn up by a committee appointed by the British Medical Association. But whereas that committee specified 14 pints of fresh milk a week, Rowntree substitutes 12 tins of skimmed milk, condensed (p. 84). If fresh milk were allowed for, the weekly cost would be 1s. 9d. greater, i.e., 3s. 9d. a week throughout the year instead of 2s.

Mr. Rowntree admits, too, that if he adopted the diet drawn up by the Health Committee of the League of Nations, a diet designed to secure perfect health—and not merely to prevent malnutrition—it would cost another 6s. a week (p. 160).

For expenditure for the family of five after paying for rent and rates (9s. 6d.), food (20s. 6d.), clothing (8s.), fuel and light (4s. 4d.) and household sundries (1s. 8d.) Mr. Rowntree allows only 9s. to cover everything else, including travel to and from work, entertainment, holidays, books, beer, tobacco, etc., etc. He has the grace to admit (p. 101) that he is “almost ashamed to put forward so low an estimate.” As he says elsewhere (p. 12), out of this 9s., the amount expected to cover "holidays, beer and tobacco, amusements . . . travelling, other than fares to and from work, or contingencies of any kind,” is 3s. 4d. a week, or ” little more than the cost of a cocktail.” Mr. Rowntree’s standard of 53s. (with an additional 15s. or more in London owing to high rents and the cost of travel to and from work, and more still for families with over three children) is, therefore, plainly far below a reasonable or even a minimum  standard for health. Yet everybody knows, and Mr. Rowntree admits (p. 125), that our wonderful capitalism fails to provide even that standard for millions of workers. When Mr. Rowntree defends the deliberate choice of a standard so low that he is almost ashamed of it because “I want to make my figure . . . one which is unassailable " (p. 101) he is only saying in a roundabout way that capitalism never will give the workers a standard that is fit for human beings.

Sickness and Wealth (1988)

Book Review from the August 1988 issue of the Socialist Standard

Inequalities of Health: The Black Report edited by Peter Townsend and Nick Davidson; The Health Divide by Margaret Whitehead. Penguin Books. £4.95

This book brings together the 1980 Report of the Working Group on Inequalities in Health (the Black Report) and the 1987 Health Education Council's report. "The Health Divide". The controversy caused by the Government's heavy-handed attempts to restrict the distribution and influence of both will probably guarantee that Inequalities in Health will be much more widely read than publications of this type usually are, the Black Report having been available in only 260 duplicated copies when submitted to the Secretary of State. "The Health Divide" was published in March 1987 just after the government had announced the Council's dissolution.

The Black Report examines inequalities in health up to the late 1970s. with international comparisons; regional differences in mortality; housing tenure and mortality; race and health; the influence of gender on health; and occupational differences in health A wealth of statistical data demonstrates conclusively that “At any age people in occupational class five have a higher rate of death than their better off counterparts" and "At birth and during the first month of life the risk of death in families of unskilled workers is double that of professional families" (p43). From the first month to the first year of life the gap widens still further, with deaths of male infants of unskilled manual workers three times higher than those of professional workers, and the ratio for female infants is higher still. The part played by bad housing, poor environments and poverty can be seen by the fact that accidents and respiratory diseases are responsible for the excess of deaths in infancy.

A fundamental principle of the National Health Service purports to be the provision of equal access to health care regardless of personal means, but the Black Report found clear evidence that people in higher income groups make better use of available facilities. Data Collected from other countries confirm the link between poverty and ill health: although greater resources allocated to maternity services and infant welfare have succeeded in reducing infant mortality rates in Denmark and Finland, a class bias remains.

A comparison between health inequalities today and in Victorian Britain prompts the Report to state:

 Poverty is also a relative concept, and those who are unable to share the amenities or facilities provided within a rich society, or who are unable to fulfil the social and occupational obligations placed upon them by virtue of their limited resources, can properly be regarded as poor. They may also be relatively disadvantaged in relation to the risks of illness or accident or the factors positively promoting ill health (p107).

And even in old age:

 To have secure employment and an above-average income when one is at work is to be better able to provide for one's retirement. It is in this way that continuity in the distribution of material welfare is sustained. and inequalities in health perpetuated, from the cradle to the grave (p 125).

In setting out plans for improving health the Black Report is at its weakest because it fails to appreciate that capitalism functions by exploiting workers' labour power and cannot be made to work in our interests.

"The Health Divide" is a shorter report that confirms and updates the evidence collected in the Black Report. It looks at the much publicised "North-South divide" and finds that, while there are higher rates of chronic disease in the North of England. Scotland and Wales, there are also marked regional variations: "In Sheffield, for instance, there was a difference in men's life expectancy of over eight years between the most affluent and the most deprived wards' (p247). It examines "life-styles" more closely than the Black Report and concludes that behaviour is less important than poverty in accounting for health inequalities. Smoking, for example, may help some working class women cope with their stressful workload.

In the years between the appearance of the Black Report and "The Health Divide" the problems of poverty and bad housing persisted, and grew even more severe for large numbers of workers. Research in the future will be more difficult because the Registrar General's Office stopped analysing mortality rates for different occupational groups in 1986. to avoid the embarrassing conclusion that the health gap between rich and poor is widening The solutions put forward to eliminate health differences are similar in both studies and have no prospect of success whatsoever. The reforms of the past have eased some of the misery at the margins of poverty while allowing the system of exploitation to function intact; this book provides proof that capitalism is bad for our health without even considering its replacement.

Carl Pinel

Pathfinders: Missionary Positions (2019)

The Pathfinders Column from the January 2019 issue of the Socialist Standard

“Lord, is this island Satan’s last stronghold where none have heard or even had the chance to hear your name?” So wrote John Allen Chau, the 26-year-old Christian missionary, just before his last visit to North Sentinel Island in the Andaman chain in November last year. His death at the hands of the Sentineli islanders made world headlines, largely because it was like something out of the eighteenth century. The pious missionary rows his canoe to the shore, brandishes a Bible and starts singing hymns, and the Stone Age natives shoot him full of arrows.

Interestingly, all the media blame for this fateful encounter fell on Chau himself, who was visiting illegally and in defiance of the island’s special protection status. The Sentineli have a history of killing intruders, and Chau himself had already been shot at with arrows on a previous visit, so he knew very well what might happen. The Indian police arrested seven fishermen who had helped Chau get to the island, though no arrests on the island itself were made or even mooted. Some blame should also fall on the organisation that sent him, the All Nations Church of St Louis, Missouri, whose stated mission ‘to do whatever it takes so as many people as possible can see Jesus’ is what got Chau killed. The fact that imported viral or bacterial diseases are the number one killer among newly-contacted tribes does not seem to have occurred to the moronic bible-bashers. What’s worrying is the thought that other church groups will now view the Sentineli as the ultimate challenge.

Billed as ‘the last uncontacted tribe on Earth’, the Sentineli have in fact been contacted off and on since 1867, and received tools and cooking implements as gifts, but encounters have frequently gone badly. Not much is known about them except that they use fire and know how to rework scavenged iron for arrowheads. What can be speculated is that, like most ‘isolated’ tribes the world over, they know far more about the outside world than the outside world suspects. Their hostility is almost certainly due to fear than to some supposed innate aggression.

Inverting the usual colonial assumptions about what such people could gain from the modern world, the BBC instead approached various anthropologists to ask what we might learn from the tribes (BBC Online, 24 November). Apart, that is, from stealing their local medicinal plants and patenting them for the pharmaceutical industry.

Thus we learn that the 14,000-strong Piaroa of Venezuela are egalitarians who practise individualistic autonomy without hierarchies or private ownership. They see competition as evil and don’t play any competitive sports, and anyone who gets above themselves is treated with pity as being immature. Wikipedia also attests to this ‘functioning anarchist society’ and notes that they are ‘opposed to the hoarding of resources, which they see as giving members the power to constrain their freedom.’

Well quite, and what we’ve been saying all along. Not that every remote tribe is so enlightened, of course, and the BBC article warns us not to ‘over-romanticise’ how they live. But socialists can easily relate to groups like the Piaroa, who seem to have hit on the principles of common ownership and equality as a successful survival strategy and would presumably look askance at modern capitalism and its habit of pursuing the exact opposite of a successful survival strategy. Maybe the Piaroa should send out missionaries to the capitalist world. But the world would probably tell them their society is logically impossible because of human nature. Or shoot them full of arrows.

What’s cooking?

‘When we’re confronted with abundance, we’re hardwired to take what we can, and it’s difficult to overcome that impulse’, says the founder of a UK food-waste reduction organisation in a recent article about how to reduce the approximately 30 percent of food that is wasted every year (New Scientist, 8 December). The blame for this apparently lies with supermarkets, which pile high and sell cheap, leading to runaway overconsumption and waste in fresh perishable goods. But this makes it sound as if consumers are mindlessly greedy, when the reality is they’re having to pay for all this waste and many are hard-pressed to afford it. The more likely explanation for such waste is that, despite endless food-porn TV shows, people are not very good at managing the business of domestic cooking. It’s not taught effectively in schools because they don’t have the time or the facilities to achieve more than a tokenistic effort. And parents who can’t cook are not going to pass the skills on either. No wonder poor people resort to expensive and environmentally wasteful takeaways and TV dinners.

The article discusses a new business model which aims to supply meal ‘kits’, comprising the exact proportions of ingredients in compostable packaging, however the take-up rate is slow and the value for money questionable. What has not occurred to anyone is the idea of socialising the process. In socialism it would be deemed sheer lunacy for each individual to do their own cooking in their own kitchen with their own larders and fridges full of their own food stores, when most people would be happy to share the job communally and thereby only need to help cook once a month or so. Think of the savings in space, storage, waste, time, effort, and indeed safety, given the huge potential for burns, cuts and fires. You might call that plain old common sense, but capitalism doesn’t have an abundance of that.

Brave New CRISPR World

In December a Chinese researcher achieved a historic landmark but earned general condemnation including from Chinese regulators by announcing the world’s first IVF twins born after modification with the CRISPR gene-editing process (New Scientist, 8 December). The researcher is widely considered a renegade for ignoring international ethical standards, employing an experimental technique for no valid medical reason, and including clauses in his test agreement that compelled participants to continue or else pay a large forfeiture. The targeted gene coded for HIV resistance, however it would only ever be partially effective at best. Meanwhile nobody can tell what side-effect damage may have been caused, and it will be years before this can be known. Ethical oversight aside, designer babies are where the smart capitalist money is. Huxley’s famous dystopia just came a step closer.

Paddy Shannon