Talk given by David McCoy at the Medact Relaunch Conference on - PDF document

Talk given by David McCoy at the Medact Relaunch Conference on November 9. NB. Some small changes and additions have been made to provide greater clarity. Andy Haines has presented a set of three inter- connected threats to global health: climate change and ecological degradation; war and militarisation; and enduring poverty and growing economic inequalities. These threats require a response from the health community that must include reacting to their negative health effects; and mitigating the scale of the health effects. But for Medact, we also see a need to for the health community to address the underlying root causes. The underlying social and political failings that drive war, violence and ecological destruction; and which allows such widespread immiseration and injustice. Many of the root causes can be summarised as a set of three inter-connected social pathologies. Inequality is not just a moral or ethical issue. Nor is it just a consequence of social or political processes. It is also a cause of social and political dysfunction. An unprecedented concentration of wealth and power underlies a raft of policies and laws across a whole range of sectors that are simply bad for the planet and for much of the world’s population. But these laws and policies continue because they serve a wealthy and powerful minority. I don’t know of Richard Wilkinson or Kate Pickett are here today – but the empirical evidence and theories that they and others have generated to show and explain how inequality – in and of itself – is a cause for social dysfunction and poor health, needs to be understood as a serious and tangible scientific issue.

This is a picture I use when teaching the social determinants of health to students. I ask them to consider not just the health and social effects of such visible and stark disparities, but also the ecological effects. Whether we consider inequality at the local or international level, we need to understand it as a social pathology which, among other things, erodes trust, undermines peaceful cooperation and creates insecurity. Inequality and in particular, the concentration of immense wealth and unchecked power, has reached a state of crisis. And running alongside this crisis is a crisis of democracy – in spite of the worldwide growth in the number of representative democracies. Why is this? One reason is because individual and corporate elites have developed a number of ways to circumvent democracy. Among them are:  The financing of politicians and politicians  The creation of a vast and extensive lobbying industry  Indirect influence over the political process through the control of news and information  The capture of public debate through the financing of pro-corporate think-tanks as well as the part capture of science and academia Where this doesn’t work, dissent is controlled. Either through the use or threat of force; or through the more indirect means of personal ‘debt’ and job insecurity; or through the strategic use of charity and philanthropy. The circumvention of democracy has been facilitated further by a form of uneven globalisation that has empowered Trans-National Corporations at the expense of ordinary citizens and national parliaments worldwide.

If inequality is a structural pathology; and the circumvention of democracy a political pathology, then neoliberalism is the ideological pathology that we must confront. Neoliberal theories and ideas promote a fundamental belief in free markets and small government, fuelled by strong private property rights. But whatever we might think (theoretically and philosophically) about the optimum balance between free markets and regulation; or between private property and public ownership; or between individual freedoms and the common good. And whatever we might think about the optimum role of the state in society – we need to understand neoliberalism as a political programme that has sought to undermine democracy; and enable the accumulation and concentration of vast wealth. The structural pathology of inequality; the political pathology of false weak democracies; and the ideological pathology of neoliberalism are thus synergistic in their effect. How else does one explain the absurd and ludicrous situation represented by these two images? Neoliberalism has also gone from being a set of theories and ideas to being a meta-ideology – one that supersedes and rejects even the possibility of other alternatives. And one that dulled us into thinking that there are no other choices. Indeed, to paraphrase Mark Fisher, it feels as if it is easier to imagine the end of the world than it is to imagine the end of neoliberal capitalism. I hope I don’t sound like a “radical” (a label which invites instant dismissal in polite society and the corridors of power). I know I hav e been labelled as such. I’m actually a mild and moderate person who is merely reacting to the facts on the ground. So if these are the social pathologies we face, what then are the corresponding social vaccines and treatments?

In the face of the enormity of the challenges, we need lots of hope and courage. It is easy to feel hopeless and disempowered; and confronting powerful and malign governments and corporations can invite threats of all kinds. Greater public knowledge and understanding is another important ingredient if we are to deny the power of spin, propaganda and lies. We also need imagination – to believe that another world is possible; and that alternatives exist. If we are to be effective in making change happen, we need also to be better organised. And finally, I would say we need a lot of public health science – so we can harness the critical contributions of epidemiology, rigorous analysis and evidence. All of which brings me to Medact – an organisation that grew out of the medical peace movement from as far back as 1952. But which subsequently developed a broader public health agenda. It has a strong and proud legacy as an organisation that has consistently ‘punched above’ its own weight. But it is undeniably, a small organisation. It has a small office and limited though largely independent income. So why relaunch Medact? Why seek to ‘revitalise’ Medact?

The answer is that there is a need for an organisation that is able to harness the voice, professional mandate, expertise and social standing of health professionals, and the wider health community, to act on the upstream social and political determinants of health. There is a need for an organisation that can champion the fact that health is inherently social and political; and with equity and human rights at its heart. There is also a need for an organisation that is willing to see the big picture – and cover a wide area of ground that includes economics; climate change and ecology; war and militarisation; and human rights medicine and health policy. These are Medact’s four broad programmatic areas – but most importantly, Medact recognises the inter-connections between these areas, and the various issues and factors that cut across them. But we want to grow the organisation. Seek the required resources to have an office with five, maybe even ten staff. We want to increase our membership to at least 3000; whilst harnessing the voice and support of tens of thousands of health workers around specific campaigns and actions. There are over a million health workers of various kinds in the UK – a lot of them will share the same values and objectives that we do. Medact will need to also raise project-based funding from grant-making bodies – to enable it to fund research, analytical and educational activities. There are many existing health-based organisations and initiatives that work on similar issues. So Medact wants to also provide a platform – some infrastructure – to support and enable such groups and initiatives. In this way Medact would act as an ‘enabler’ or ‘force multiplier’ for others. This is important because many health professionals are already doing working hard on issues to do with climate change, human rights and violence – but too much work is atomised, fragmented and under-powered. Medact co uld act as either an ‘umbrella’ or ‘platform’ to enable, for example, existing groups and initiatives to share a pool of common resources (for example, a press officer or a research intern).