This article is part of a series; find the second part here
FB, Corcaigh
Introduction
Capitalism and health make for strange bed-fellows. Terms associated with health usually revolve around those of moderation and balance or attempts at finding harmony between an arrangement of variables. As an economic system capitalism has instead committed itself to constructing an environment dominated by a class that is obsessed with extraction and growth, the scale of which has now surpassed anything that can be called sustainable. It has left us with a society which hardly resembles anything that can be called healthy. The individuals who make up our societies, their perception of themselves, the foods they consume and how they view this metabolic connection to nature not only all contribute to public health, but also the public’s ability and desire to make better choices. It is this fact or rather this relationship between man, nature and society that is exploited so key industries can be kept intact. Healthcare, or the Health industry, has become a trap in many ways and represents a grotesque contradiction. The public is simply preyed upon for the benefit of a collection of companies in a space where transparency is essentially non-existent.
Elaborate sales mechanisms steal people’s money and sell them garbage. Disease rates, especially in the developing world, are obscene and mental health has not yet received the proper care it deserves with many individuals who continue to suffer from archaic social stigmas and a lack of resources. Health encompasses a broad spectrum and is a complex topic but it is time to stand up and say we can and should do better. Capitalism has a monopoly on health which needs to be acknowledged, but how it might become incorporated as part of a targeted political approach by the reformist left is still lacking. A more radical interpretation of health remains underdeveloped as well. When we consider the typical working environment and the effect it has on our bodies coupled with the culture capitalism fosters it seems a programme or set of aims is badly needed now more than ever. Capitalism has reduced many of us to basic units in the cost of production and has transformed our existence and our bodies into commodities on the assembly line.
The damage done to countless lives is nothing less than a crime in itself. Modern work conditions malform our physiology, produce endless mental health issues and has left vast numbers of individuals overweight and sick, which coupled with unending increases in productivity has inculcated a deeply fractured relationship between many of us and the basic routines which make up our lives. This extends far beyond simple matters like dietary choices.. With more and more time being spent trying to manage a life which seems to be spiralling out of control, thoughts of health and routine inevitably turn to how I can keep my head above water. Economic priorities that overwhelmingly affect the working class take over. Thoughts of rent, utility bills, living pay cheque to pay cheque and never seeming to have enough to feel truly secure push our motivation and aspirations to the side and put in its place depression, fatigue and mental exhaustion.
How do the vast majority of us cope with all of this? Many of us turn to substance abuse in order to sedate our worried minds, to help get us to the end of the week and to make these difficult times seem a little less so, the exhaustion of recovering from the week is replaced by the exhaustion of recovering from the weekend. Burn out culture has managed to increase the likelihood of sending many of us to an early grave and these issues have to be addressed. Capitalism disguises social murder in many ways but here what will be discussed is the need for a left adopted programme promoting health. This article hopes to create the right type of dialogue by breaking down and discussing various aspects regarding capitalist society and our health with the connections established being used to offer a new perspective. One aspect of which should be that of protection, essentially how you can shield yourself from the harmful effects wrought upon us by capitalism If successful, health can become an anti-capitalist slogan and a weapon wielded by those who wish to use it against an economic system that seeks to exploit and dispose of them once finished. The need for a more radical and explicitly Marxist programme encouraging health is long overdue.
The Workplace
In his seminal work Conditions of the Working Class Friedrich Engels lays bare for us the horrors which confronted the early industrial proletariat. Workplaces so foul and decrepit that those who were forced to work and endure in conditions of squalor suffered effects so devastating that they were ultimately transformed by them. Cramped workhouses, back breaking labour, noxious fumes and toiling through 16 hour days, the workers were turned into a destitute bunch who received only contempt from the bourgeois class. The book doesn’t shy away from describing the many harsh realities of their existence and in chapter 6 – Single Branches of Industry – Engels spends a great deal of effort detailing the damage being done to the minds and bodies of men, women and children.
The worst situation is that of those workers who have to compete against a machine that is making its way…And when one reflects that, with all this, not one single muscle of the body is really exercised, really called into activity, that nothing whatsoever counteracts the enervating, relaxing tendency of all these conditions; that every influence is wanting which might give the muscles strength, the fibres elasticity and consistency; that from youth up, the operative is deprived of all fresh-air recreation, it is impossible to wonder at the almost unanimous testimony of the physicians in the Factories’ Report, that they find a great lack of ability to resist disease, a general depression in vital activity, a constant relaxation of the mental and physical powers
A lot of progress has been made from when that book was written in terms of health and safety regulations in the workplace but are they really at a position that we should be satisfied with? Conditions are definitely better (thanks to trade union agitation) but after a half century of neo-liberal setbacks and decline in trade union density, workers are beginning to pay the price as conditions have started to deteriorate once again. In the various sectors I’ve worked in I have seen countless workers who suffer from a large variety of injuries and afflictions most of which could be traced back to how they were forced to position themselves in the workplace. Bent over posture, carpal tunnel syndrome, excessive weight gain, anxiety, depression, colleagues who had visibly sunk into their own frames and widespread insomnia to name a few. Conditions serious enough that those same workers will be paying for them well into their later years. The modern workplace still manages to do harm to many of us, maybe more so than is understood. Going to work knowing that your health is being slowly worn away can be a daunting realisation.
Burnout
The most damaging feature of modern work is burnout. The fact that exhausted workers are being run into the ground is now commonplace and part of a culture capitalism has adopted is almost that of a glorious self-sacrifice in order to hit targets and to maintain high levels of productivity. Values like these alongside poor work conditions are fated to produce issues. In a 2016 report produced by the ERSI titled “Work-related Musculoskeletal Disorders, and Stress, Anxiety and Depression in Ireland: Evidence from the QNHS 2002–2013” the damage being done was revealed. Musculoskeletal disorders (MSD) and stress, anxiety and depression (SAD) were the most common self-reported work-related illnesses and between 2002-2013 accounted for 68 percent of work-related illnesses in Ireland. With variables taken into account such as the different sectors, the age groups and out of work commitments, the report still conclusively shows that modern work is making us sick. And who are the most likely to be affected? When it comes to risking your health at work it is shift workers who will most likely suffer, with one of the findings stating an increased risk for both SAD and MSD found among those who do shift and night work. Something worth noting is that in 2007 the WHO categorized night shift work as a “probable carcinogen” due to disruptions in the circadian rhythm. This, combined with out of hours emails and deadlines following people home, has created a new work environment that is “always on”.
In 2016 the online news source, the Journal, published an article titled “Irish shift workers struggle with a poor diet, a lack of sleep and higher smoking rates”. Examined is the impact of shift work on the overall health of Irish workers and some of the figures related to the decline in workers’ health are shocking. With over 1000 individuals taking part in the study conducted by Safefood 67% report having skipped meals, 8 out of 10 said they were not getting enough sleep and overall younger shift workers are more likely to consume more alcohol and suffer from weight gain. With shift patterns and a lack of breaks becoming a concern Safefood CEO Ryan Nolan was quoted as saying “shift work… increases the risk of chronic diseases like heart disease and cancer”. Two years later in 2018 an article was published by the Irish Times with the title “Shift Work: bad for your diet and sleep, and raises your cancer risk”. Discussed in it are many of the same issues. With findings similar to those reported two years previous the Safefood study is again cited as being a major contributor to raising awareness on the subject. The American Nurses Study is also cited as a source to analyse shift work. Of the 75,000 participants studied over a 22-year period, shift work was again associated with an “increase in mortality from all causes”.
The difficulty experienced by young people in particular while trying to navigate capitalism’s economic terrain is no secret. “Youth Labour in Transition” published by Oxford University Press does an excellent job highlighting this. Chapter 4 “Stressed Economics” discusses how labour flexibility was an attractive option to produce short-term market stability during the 2008 capitalist crisis but in the long run has no basis in labour sustainability. Precarious youth employment “may have persistent effects on psychological well being and health”. Also included are studies which find that “reduced life satisfaction is also observed among those who believe their job is insecure compared to those who feel secure” and most worryingly of all the findings cited is that “a number of studies have established a relationship between unemployment and increased suicide”. Young people are finding it difficult to gain a sense of security in their lives due to the economic conditions capitalism utilised as a way to rebound after the financial crash of 2008. To suggest that these types of behaviour have no connection to a crisis ridden economic base is just dishonesty. Looking back over capitalism’s history and traversing the booms and busts which accompany it, what is repeated every 7-10 years is the inevitable and systemic crisis of overproduction. The basis of capitalism is to produce insecurity,to squash any attempt to fight for better conditions and to have labour as weak as possible so it can be exploited for profit. The consequences of these radical changes in the labour market have been stark and its workers both young and old who are paying for it.
What is becoming clear is that under capitalism the stability of the market takes priority over the stability of people’s lives. It is a matter of sacrificing one for the other and the capitalist class has again and again chosen the market. It is hard to describe how many times I have heard people I have worked with say that they would like to lead more healthy lives, only for those aspirations to be crushed upon entering the workplace. I have met so many workers who say they want to give up smoking or lose weight but then become so overwhelmed with stress that the first thing they reach for is a cigarette during a hectic shift or after working for 7 days in a row to struggle while sticking to a desired eating pattern. It is hard to be surprised when numerous individuals just give up altogether on their goals or new year’s resolutions, especially when their work-life tension forbids them from introducing any positive and consistent change. One of the worst aspects is the guilt that accompanies this. Workers begin to believe that there is something wrong with them and it crushes their self-esteem. These points of reflection do not tell us anything new about capitalism, though, as for workers it has always been a race to the bottom in every aspect of their lives with health being no exception. As with most issues, what we are experiencing are the symptoms of the problem rather than the problem itself. And instead of trying to target the actions of groups and situate them within a social/economic context the easier short-term answer is to posit theories about how our generation is just lazy or how we don’t possess the right attitude.
The Misappropriation of Mental Health
While trying to find fault within the system itself one aspect worth exploring is how businesses respond to the health problems they help foster in individuals. As with most industrial issues, they try and solve the matter by internalising any treatment of it pursue a solution by actively individualizing our health as a personal issue rather than something that may be a by-product of how business operations are conducted. This is a powerful way of avoiding being implicated in ruining our health on a much larger scale and also avoids having to make structural changes that allow employees more time off and better wages to pursue a healthier lifestyle simply because it will become a “company expense”. In that same Irish Times article advice is given on ways to cope with the difficulties arising from shift work. As you can imagine much of the onus lies on the side of the worker. The author tries to offer help by asking a question Is there anything shift workers can do to ameliorate these negative effects? with a bullet point follow up to reassure. A study from the British Medical Journal is used to offer some suggestions. Among these are napping during your shift for 30 minutes. Another is wearing sunglasses if working a night shift or on the way home and other suggestions based around minimizing your sleep debt before a shift. That’s it. In that original Irish Examiner article where the ERSI study was reported solutions are offered but again still leave much to be desired. Try not to take your work home with you, take breaks, speak to the other workers, do more exercise and talk to management. No mention of the employer or restructuring the workplace in a significant way. No mention of collective action such as the employees trying to work out a better way to arrange times between them. If modern work is ruining your health, why not try taking a nap? It is a defensive approach to a serious issue granting workers no real power over their lives.
Mindfulness is just another tactic adopted by employers more recently and this can include doing yoga or even trying to get employees to meditate while at work. The idea of performing meditation during a stressful or hectic shift is laughable but even more so is the initial suggestion of adopting aspects of eastern philosophy to enhance work life. Trying to sanitize and repackage the teachings and reflections of eastern philosophers which centre around harmony and balance are bizarre suggestions by themselves and completely ill-fitting within a corporate environment. It echoes Mark Fisher’s Capitalist Realism especially when we think about capitalism’s ability to absorb and reproduce ideas regardless of what they are. What it does reveal is that young people are longing for conditions with stability and structure embedded within them where those same ideas of harmony and balance become part of their lives. Inner peace will be a hard thing to find while meditating on your low wages, risk of disease, lack of breaks and mind-numbing tasks. Many of the therapeutic solutions offered through health schemes in Ireland also focus on “adjusting your thought processes” rather than attempting to change or improve the external world.
Other matters to be considered along with this are how businesses promote or reproduce certain work cultures and behaviour. This can seem harmless or normal but in actuality could reinforce potentially dangerous habits such as giving out alcohol for hitting targets. It is easier for employers to promise a pizza night over real change. In work environments that have a high likelihood of fostering a whole host of health problems, both physical and mental, giving out alcohol seems like a seriously negligent thing to do. While it is a perfect way to sedate the workforce due to its numbing effects, coupled with a reinforced and easily reproducible mentality of deeds for rewards, companies are inviting sickness and addiction into the lives of their workers. With what has been discussed ideas like these can only be described as disturbing. Companies will suggest anything no matter how ridiculous or dangerous as long as it pulls the conversation away from collective action and better wages.
Formulating a Left Response
A question worth asking is how should the left respond to all of this? Can we ignore what is happening now without suggesting other ways that might help workers protect their own health? I would say that we we cannot. Conditions that can become serious or life threatening cannot be ignored but must also be incorporated into a deeper political analysis where workers and the general public are made to understand what exactly these companies are doing to us and what we can do to fight it. Companies must be held to account without question, not just for the damage done to the health of their workers but how it puts an economic strain on all of us. When the ERSI report was published no information or estimation was given on how much it is costing the Irish state but figures for the UK were given. The report states that “MSD could be costing their economy about £10 billion (€11.2 billion) every year, and SAD between £7 – £13 billion (€7.8 – €14.5 billion) every year”. In Ireland with most economic issues it is the community which is footing the bill. With a market that allows companies to enjoy the fact that they can extract wealth from the economy uninterrupted, bolstered by a disorganised labour movement, and the opportunity to dodge paying tax on profits, simply put, cutting corners with our health cannot further subsidise greedy multinationals.
Industrial issues are never straightforward but if any ground is going to be made trade unions will have to get involved. Trade Unions must take a more active role in encouraging health in the workers they represent, especially in those sectors where health risks are most likely to occur. If any success is going to be had workers must be assisted and helped to understand how much their health is worth in order to learn to fully value it. A few examples can be used to illustrate this. Most workers do not get sick pay and if someone does have to take time off work for an illness, for example, 3 days of that period can be worth 200 euros to that worker. On top of that a visit to the GP for a sick note is likely to set a worker back another 60 euros and this is just to hand it in so the employer has it on file. This can also include expenses within work as some workplaces have canteens providing food. When it comes to basic nutrition most workplaces are fairlyaverage. Considering the negative impact on workers’ health, food choices that help prevent illness and that are rich in nutrients are lacking. Having to fork out more for these foods outside of work can also be costly. Where these facilities are provided workers should be collectively agitating so that safe, healthy and protective foods are available during shifts. If the option for a reduced healthier alternative were available, I believe most would take it.
Companies should be forced to make room in their budgets for their workers’ health. This should cover decent food, sick pay and GP visits if it is demanded from an employer. A stronger trade union presence should ensure workers are being given their required breaks, time between shifts and a mechanism which gives workers a way to report and discuss any problems they see in a collective way rather than everything being funnelled into HR. Stricter legislation also needs to be passed and enforced so that workers are being protected during work hours. Going to businesses, speaking to the workers and giving them the skills they need to organize will be a crucial part of this. Workplace inspections are fairly poor with workers being left to fend for themselves, and employers are prone to “game” inspections when there is no union to call them out. This will have to change. The modern and half disturbed family culture pushed by modern employers needs to be replaced by something real. They must be transformed into places where workers are offered something more substantial with a real choice and real democracy.
Recently the idea of a four day work week is becoming an attractive option and this is something Trade Unions must get behind. To allow workers more time to enjoy life and pursue their health outside of work will be crucial. Having a shorter work week will facilitate having more time to cook your meals and will provide an adequate amount of time to address health concerns. Finland has been receiving a lot of attention recently over their new Prime Minister’s comments regarding how such a plan might be implemented. Something to note about Finland is that almost three quarters of employees are members of Trade Unions and according to an Independent article “91 percent of employees are covered by collective agreements”. What this means is that whatever changes do occur the views of the workers will be represented, rather than it being just an employer led decision. Regardless, studies on a shorter work week are already producing some positive results with workers being more productive and feeling happier in general.
Conclusion: A better workplace is possible
The workplace is only one aspect of this issue but still poses some of the most difficult challenges. It is high time to start viewing workplaces for what they really are, a place where many go to sacrifice their lives. To give up their free time in a space where they really have no control, moreover, where every technique utilised by post-Fordist models of the workplace are designed to control workers’ and measure their output. The damage done represents the outcome of an economic system where the people who work and who run the businesses have little to no say but are dictated to by a class that benefits from the fruits of that labour effort which they have not contributed to. If workers owned the industry they worked in, would they choose these horrific shifts, low pay, bad food, cutbacks on health policies and stressful environments? The answer should be fairly obvious. Capitalism is an economic system that seeks to ensure its own survival by reproducing ideas that are favourable to the economic system and that bolster the hegemonic control of the ruling class. How these two interact, the base and the superstructure, and what implications this has had on health as a cultural phenomenon will be elaborated on further in part two. Our health is under attack again from the bourgeois classes. They want to refuse us decent healthcare and the ability to properly sustain ourselves. Alternatives need to be looked at as the ability to access proper healthcare and to live a healthy lifestyle is a matter of life and death for many on the brink of poverty. In a total transformation of society which seeks to move past this predatory phase under capitalism, health can become what it was always supposed to be, caring, humane, part of our everyday lives and available to all.
