Has capitalism led to increased life and vitality for humans? Let’s delve up to our elbows into history to see if that is the case. To fully comprehend any progress in improvement of the living conditions of humans since capitalism, let’s look at times before capitalism. A lot of capitalists will have you believe it was a world of harsh conditions, barter, early death and constant warring between individuals and groups. This Hobbesian1 world constructed in capitalists minds is one that has been found to be increasingly unlikely to have ever occurred for a significant duration2.
People increasingly live longer lives than before, according to Professor Statistics of the University of Statistical Statistics. While this coincided with the advancement of capitalism, the public grossly overestimates how much of our increased life expectancy should be attributed to paid-for medical care and is largely unaware of the critical role played by public health and improved social conditions. Public health historians and epidemiologists calculate that the majority of the life expectancy increase during the last 200 years resulted from control of infectious diseases, more abundant and safer foods, better sanitary conditions, and other non-medical social improvements3.
The greatest increase in life expectancy, referred to as the ‘First Public Health Revolution’, occurred between 1880 and 1920 (at least 50 years after capitalism emerged as a distinct economic/political entity), before the advent of antibiotics and advanced surgical techniques. Improved sanitation in the form of public water treatment, sewage management, food inspection and municipal waste collection nearly eliminated the diseases of cholera, dysentery and typhoid. New methods of agricultural production, food transportation, and preservation greatly improved the average diet eradicating many nutritional deficiency-caused diseases and improving immune function against infectious diseases. Though many poor had no safety net to help them in times of need and suffered from a lack of proper nutrition and medical care.
Unintentional injury and occupational deaths rates were significantly reduced through regulations, education and engineering changes. Air quality has improved with the elimination of coal burning furnaces, leaded gasoline and better industrial emissions regulation. More education, higher literacy rates, child labour laws, and increased economic prosperity also greatly improved life expectancy and health. All these are costly in a capitalist set-up and could be removed in a truly unfettered free market.
To get an insight of capitalism’s involvement in health matters, we can look at what life was like for people during the Industrial Revolution, in the UK. For many skilled workers, the quality of life decreased a great deal in the first 60 years of the Industrial Revolution4.
Historians have estimated that in the 17th century average life expectancy at birth was around 35 with about 25% of people dying before they were 5 years old. However if you could survive childhood you had a good chance of living to your 50s or your early 60s5,6. During the Industrial Revolution, the life expectancy of a poor person, such as a factory worker was only seventeen years7. The industrial cities such as Manchester, Liverpool or any other large city with factories were unhealthy to live in, especially for the factory workers. The cities were over–crowded, streets were small, lack of a clean water supply and bad sanitation as there were no building laws. The Registrar General reported in 1841 that the average life expectancy in rural areas of England was 45 years of age but was only 37 in London and 26 in Liverpool (Haley). These are life-long averages that highlight a very high infant mortality rate; in the first half of the 19th century, 25 to 33% of children in England died before their 5th birthday8.
James P. Kay-Shuttleworth was a doctor in Manchester and in 1832 he reported9:
‘Frequently, the inspectors found two or more families crowded into one small house and often one family lived in a damp cellar where twelve or sixteen persons were crowded. Children are ill-fed, dirty, ill-clothed, exposed to cold and neglect; and in consequence, more than one-half of the off-spring die before they have completed their fifth year. The strongest survive; but the same causes which destroy the weakest, impair the vigour of the more robust; and hence the children of our manufacturing population are proverbially pale and sallow.‘
It was only with Parliamentary legislation such as the Municipal Reform Act10, public health reports such as the 1842 Report on the Sanitary Condition of the Labouring Population of Great Britain11,12 and the eventual 1848 Public Health Act13, which improved the living conditions of most working people. Edwin Chadwick14 was instrumental in these improvements, though his motives were influenced by economic considerations. That if the health of the poor were improved, it would result in less people seeking poor relief; much poor relief was given to the families of men who had died from infectious diseases. Money spent on improving public health was therefore cost effective, as it would save money in the long term.
Using this economic line of thought, then perhaps capitalism can be seen as a progressive force in healthcare and life expectancy. Economic circumstances15 have an affect on life expectancy, as they may reflect factors such as diet and lifestyle, as well as access to medical care. It may also reflect a selective effect: people with chronic life-threatening illnesses are less likely to become wealthy or to reside in affluent areas16. Though as its a complex issue17 involving non-linear living systems, the inverse relation can also be detected. For example, during the Great Depression within the USA, life expectancy actually increased by 6.2 years18. People during prosperous economic times, often undergo more stress, exposure to pollution, and the likelihood of injury among other longevity-limiting factors.
Throughout the world, what we consider ‘public health’ is usually an apparatus of publicly funded and administered registration and census systems, without which we could have no intelligence as to the changing and variable state of the public’s health. Without the intellectual disciplines of public health medicine, epidemiology, and demography, we would have precious little understanding of the meaning of all the data these formidable bureaucratic structures accumulate. We literally create our public health, our understanding of it, and our capacities to monitor and improve it through a continuous historical practice of acts of political will to bring about, fund, and support this area of knowledge and to act on what we learn about it. This is all backed by the humble employees of local government and health boards such as sanitary inspectors, housing officers, health visitors, trained midwives, and school medical officers19,20. There is no need for any benevolent ‘invisible hand’.
As noted, the main contributor to extension of life expectancy comes from child mortality improvement. This statistic, is a recent invention of English-speaking societies (other historical languages and cultures are outside the scope of this blog). In 1857 the number of deaths under the age of one year old were provided for the whole country and in subsequent years an annual breakdown of infant deaths by various causes was published21, but it was not until 1877 that infant deaths were specifically reported as the infant mortality rate. It was still possible, retrospectively, to calculate the infant mortality rate for the years preceding 1875 so that changes in the rate in both earlier and subsequent years could be identified and compared.
During the years 1890-1915, infant mortality rates declined significantly. This is particularly true for gastroenteritis. It can be demonstrated that the shift in opinions about hygiene was responsible for saving countless infant lives from diarrhoea22. As much as capitalism was involved advertising the commodity of soap in the early 20th Century, it didn’t invent it23.
Another improvement concerning childbirth, is the falling maternal mortality24. Again, it was not until about 1870, when the registration of cause of death was made mandatory, that rates became reasonably accurate. Conquering infection with chemotherapy and antibiotics was the principal reason for a large reduction in mortality after the 1930’s. Other notable factors include legalising abortion by trained personnel, better education of women and antenatal care, at a younger age and wider use of contraception has probably allowed better spacing of births and smaller families. Although these factors pertain in North America, Europe and Australasia, this is not true in the other parts of the world, where maternal mortality still accounts for just under a million deaths a year, often from unnecessary and potentially curable causes.
Most nations have some sort of publicly funded or administered healthcare system25, whereby the government ensures a large percentage of the population has readily available access to healthcare. This has helped increase life-expectancy throughout the world. When comparing the amount spent on healthcare versus life expectancy, we can see that the USA has the most spend but not the overall highest life-expectancy26. Due to their capitalist ideology, the USA runs its health services as a businesses. Their high costs can largely be attributed to obesity, chronic disease prevalence and healthcare provider market power (ability to set high prices via their monopolization of the healthcare market or lobbying). This is deleterious to the health of a lot of poor people and is evident in the lower life-expectancy outcomes. Wider social and economic ramifications of using a capitalist-based healthcare regime are present throughout the USA. One study has claimed that 62.1% of bankruptcies were caused by medical issues29.
Being the unproductive recording of production, capital has led societies to value health and longevity as a measure of vitality (even if only to ensure reproducible work is done consistently) and assumes this is a reflection of it’s worth and validity. But as we can see, the extent of improvement on life expectancy that capitalism has directly impacted is marginal or fortuitous. At its extreme, people working within a pure capitalist society would lead short unhealthy lives. This is why most public health institutions were set up to restrict its damage. Although at the other extreme, there is a possibility that capitalism would find a way to extend people’s lives indefinitely; by submerging people’s brains in vats and harnessing their neuron power to click through online advertisements.
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