At the turn of the 20th century, the average lifespan in western nations was around 50 years. At the same time, the three leading causes of death in the US were related to infectious diseases (tuberculosis, pneumonia, gastrointestinal infections). What has happened since the late1800s is remarkable; deaths due to infectious diseases have become rare (see panel on the right, slide 1). With fewer people dying in childhood, the average person now lives longer than ever before. The classic explanation is that scientific advances, namely vaccines and antibiotics, saved humankind from the indignity of microbial death. But a causal connection is not borne out in the data. Deaths due to infectious disease began decreasing long before vaccines or antibiotics for those illnesses became available. This is clear with tuberculosis (see slide 2). In a number of western countries and cities, tuberculosis deaths decreased for decades before streptomycin, one of the first antibiotics, entered clinical practice in 1946. By that point, mortality from tuberculosis had already decreased 90% from its peak in the mid-1800s. The same trend exists for most vanquished foes. Measles mortality fell many years before the introduction of a vaccine decreased measles incidence (slide 3). I do not bring up these data to argue that vaccines are unnecessary (although some do make such bad faith arguments). Vaccines remain a great human innovation that prevents suffering. Rather, it is misguided to attribute all improvements in public health to scientific research alone. To better understand the role of science and capitalism in our society, we need to grapple with what underlies the precipitous decrease in death due to microbial disease.

It is undeniable that health outcomes have improved in the absence of medical and scientific intervention. An uncontroversial corollary is that the health of a society is affected by a combination of medicine, work conditions, nutrition, sanitation, and environment. Academics have tried to tease apart the impact of these different aspects of society on human health. Once the project is undertaken, it is hard to ignore the positive benefits of socialist forces on lifespan. One prominent example is Cuba. Before the Cuban revolution in 1958, life expectancy on the island was only 60 years and lower than a number of other Latin American countries.[i] In the following years, life expectancy surged to over 75 years. As of 2015, Cuba has the third highest life expectancy in Latin America and lags USA by only 0.2 years. This is despite being an impoverished island nation that faces intense American pressure (Cuba is one of the biggest outliers when comparing GDP per capita and life expectancy). A more equitable distribution of scarce resources has decreased infant malnutrition and mortality and increased access to flush toilets and running water.[i] Another example are the nordic countries of Denmark, Sweden, and Norway that achieved some of the greatest health indicators in the world after several decades of socialist democracy and high union involvement.[i] However, we started by speaking about infectious disease and the 1800/early-1900s in Western Europe and North America. What was happening then and there?

In general, a decrease in infectious disease deaths could arise from the development of effective treatments/preventatives, a change in the microbe and/or host immunity, or a change in the standard of living. When looking at the decline in tuberculosis mortality in England and Wales, the most logical explanation is an increase in nutrition and other socioeconomic improvements in the mid 1800s.[ii] What else was happening in England at this time? The industrial revolution was just coming to an end. Some argue that capitalism, emblemized by the industrial revolution, was the impetus behind an increase in standard of living. But what else was happening in England? Socialism. The Chartist Movement was the first mass worker’s movement in English history. By the mid-1800s, they achieved a reduction in the work day to ten hours. Direct action, including general strikes, was common. Now, it is true that industrialization lead to increased wealth. But, the funny thing about capitalism is that wealth concentrates in the hands of the few. Did a factory owner ever increase wages in industrial England, or America, or Canada? Of course. However, increases in wage and improvements in work conditions were the result of organized strike action. Capitalism unfettered does not improve conditions for the labouring class. Rather, the organization of labour, often under the banner of socialism, brings about reforms that improve socioeconomic conditions and improve resilience to pestilence.

Even if the importance of poverty in health is accepted, I can imagine that people might hesitate to give up the medical advances we have come to enjoy. After all, technology can also prevent and cure illnesses and even compensate for unhealthy lifestyles and environmental conditions brought about by capitalist exploitation. It is important to recognize that this either/or thinking is artificial. It is not a choice between socialism or technology. Hear me out. Karl Marx took a historical approach to political economy. He described the transition from feudalism to capitalism as a natural progression. In the same way, Marx recognized that the capitalist ideology would result in increased inequality until the working class revolted. In the process, workers would not abandon the factories but rather operate them as a collective. In this way, the wealth generated by an industrial society can be shared. So far, this has only happened on a small scale with the labour movement winning concessions from the capitalist class; as illustrated, even these reforms have had a profound impact on the quality of life for the proles. Now imagine what would happen if the entirety of the biotech industry was brought under social control? Scientists, doctors, and other ancillary workers would collectively make decisions about the research they pursue and the conditions under which they labour, all while sharing the wealth generated. The redistribution of wealth will improve the health of the workers. The direct democratic control will also enable scientists to better help improve societal health by pursuing the projects that are most needed rather than those that are profitable (like new antibiotics). In this way, we enjoy the full bounty of this planet and the creativity of all people. For those who are still sceptical that scientific progress will continue unabated in the absence of a profit motive, remember that the most important medications in history have been developed by publicly-funded scientists. Medications like penicillin and insulin were first created in university labs. Only after the initial discovery and development were these drugs patented and sold for profit. Capitalism is more parasitic than mutualistic. With this in mind, there is no reason why we cannot socialize the pharmaceutical and medical industries.