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Public Health Care and Democratic Eco-socialism

“Medicare for All Rally” by mollyktadams

By Natalya Dinat

  1. Universal health care is a hard-fought right

Health care services are embedded in the political economy of the state and reflect the demands of the states’ needs (Wei Zhang 2023) be it the production of the barefoot doctors of China, or the mining hospitals of South Africa, working to keep the black workers just healthy enough to maximise profits for the mines.

But equitable health care has also been a core demand of the working classes and oppressed peoples’ struggles and incorporated into their political programmes. These struggles led to great victories, especially from 1948 up until the 1970s. Many countries, including newly liberated ex-colonies, socialist countries and European countries, started to provide universal access to health care in that period. As articulated by socialist Minister Aneurin Bevan, by launching the National Health Service (NHS) in the UK, as a health care service providing freedom from fear of falling ill. Locally, people have provided exciting models of health care, including the community clinics run by the Black Panther Movement. Globally, the Alma Ata declaration of 1978 emphasised primary health care and health for all. This idea of a publicly-owned, universal health care, free at the point of delivery, also generated improved health outcomes, relevant research breakthroughs, and an emphasis on preventative care.

  1. The rise of the “industry”

By the late 1970’s, however, the neoliberal project of free marketeering began the privatization and commoditization of health care services, amongst other commons and public services. The commoditization of health care services became a commonplace idea, now even wellness and happiness are for sale. The increasingly deregulated health care service became the accurately named Health care ‘industry’.  The pharmaceutical industry rose to the largest profit-making industry sector and has remained in the top three. Research funds were allocated to diseases of the rich, whilst research into the biggest killers on the planet, malaria and TB, were woefully neglected. 

In the UK, the NHS has been captured and sold off to biscuit manufacturers and the leisure industry as described by Allyson Pollack (2005). The World Health Organisation now accepts funding from the private sector – who are not without influence on the WHO agenda. Privatisation has been done, as John Pilger remarked in his documentary “The dirty war on the NHS” (2019), by stealth while measures to misinform were often dressed up as “raising efficiency”.

In South Africa, the government emphasises universal access, which remains policy, but ignores the important central issue, that is, that health care should not be a commodity. Services are deliberately run down, blaming migrants, far away wars, epidemics, floods; as Naomi Klein (2007) describes, whilst populations are in shock, services are sold off – leaving intact the misleading idea of health care being free at the point of delivery. 

  1. Profits are incompatible with good healthcare

Commoditised health care is inefficient and does not suit the health needs of individuals, since profit for shareholders is the primary concern, not health. This results in inappropriate and harmful care – for example, in the South African private sector, the cesarian section rate is above 90%. The WHO recommends that it be between 10-15%. High CS rates are correlated to higher rates of postnatal depression (PND) and so more antidepressants. Patents on drugs, like the lifesaving ARV drugs, also prevent access.

Privately owned health care is also wasteful and further draining or destroying planetary eco-systems. Economies of scale are not attained, while overprescribing of drugs, besides fostering a potential disaster with resistance to antibiotics, has trumped an emphasis on preventative health care, nutrition, and safeguarding mental health. Overprescribing and lack of accountability for the harmful metabolites of anti-depressants, in turn, have meant that these toxic chemicals have found their way into the water systems, affecting fish and food chains. Breast feeding attempts are stymied by companies producing formula “milk”, which in turn are contributing to an increase in allergies, obesity, dental issues, asthma, earache and malnutrition.  

In his paper on China’s health care Wei Zhang (2023) asserts that profit also degrades trust between the patients and their families, and the providers. He states that “unnecessary medical care has increasingly become standard practice across the country, driving up health care costs and ruining the patient-physician relationship. This explains why, despite growing government health spending, patients’ out-of-pocket expenditures – both absolute and relative to total consumption – have kept scaling up”.

What has become clear is that commodified health care is detrimental for the health of individuals, communities and of the planet.

  1. The capitalist market cannot accommodate a holistic approach to health

There is growing recognition that healthcare is only one component in achieving well-being and health, and indeed human flourishing. Others include the social, political and economic determinants of health. Richard Horton has identified modern trends in medicine and public health: “privatised health economies, the power of conservative professional elites; […] philanthrocapitalism; […] global health’s neoimperialist tendencies; product-driven definitions of disease; and the exclusion of stigmatised communities from our societies” (2017, 2026). Thus, perpetuating a system that is inadequate and destructive for its own benefit.

A recent editorial in The Lancet (March 23th 2023) has stressed “that the products and practices of some commercial actors – notably the largest transnational corporations – are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie., tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem.”

Capitalist alienation of the workers and especially unemployed youth have, along these lines, led to increased levels of anxiety and feelings of worthlessness and despair, mental health issues and increasing levels of drug use as people are left to their own devices to manage their mental health.

  1. Our health and the health of the planet are inseparable

Our health is inextricably linked to the health of the planet’s ecological systems.  An understanding that all life, and planetary systems are interconnected and in a delicate state of balance, requires action to place demands for publicly-owned, publicly-run health care providing universal and appropriate access. Campaigns for this, as well as linked issues of education, housing, access to food and water and jobs are an essential part of the demand for democratic eco-socialism. The way we run our health care systems today currently affects both the planet’s health and ours. Market-based health care is a significant contributor to carbon emissions. A market driven system is chaotic and thus cannot respond to changing health needs; nor can it provide the coordinated response required for sudden and evolving emergencies. It is also severely constrained in what it can offer, since it works for profit and not public good.

  1. We need democratic eco-socialism for our health and wellbeing

In the Global South, we need to counter the view that somehow capitalist extractivism is unproblematic when serving an emerging national bourgeoisie. We also need to develop the idea of all of us being stewards and protectors of the Earth. It is definitely not our time to eat, as is often heard in South African ruling circles. We know that whichever capitalists are in charge the poor are left to go hungry on poisoned land. The bourgeois democrats’ disdain for the Earth and for the poor requires us to reject this type of democracy and fight for another one, for democratic eco-socialism.

It is a call for us to work and act collectively – this is not the same as bourgeois democracy’s call to “vote every 4 years”. Our democracy is richer, more dynamic and demands all voices being heard. We have it in our hands to have people-owned and people-run local health care.

Our real health and wellbeing  is linked to food struggles (as the issue of ultra-processed food makes clear), to preservation of water, soil, biodiversity and the climate, alongside the promotion of safe motherhood and freedom from wars and violence. The idea that access to healthcare, education and housing are not rights follow the same logic as “ownership” and commoditization of land; the next targets for profit-making industry are soil and seed, water (even rainwater), food, electricity, the internet and public transport, with privatization initiatives in various parts of the world. Jason Hickel (2023) rightly argues that we must achieve democratic control not only over finance and production, but around the double goal of wellbeing and ecology.

John Bellamy Foster (2000) and others, in turn, eloquently argue that understanding ecology is central to Marxist thought. Indeed, as Marxists we need to have an eco-socialist programme at the heart of what we do. From a practical standpoint, devising plans for a degrowth, circular economy that is locally and nationally appropriate and includes a people’s health care should all be integral parts of that programme.

The content of HKWM-Blog publications is the responsibility of its authors and of InkriT e.V. and does not necessarily reflect the position of the Rosa Luxemburg Foundation.


Natalya Dinat is a medical specialist and a homeopath. She lives and works in Johannesburg South Africa and is active in Science for the People.



Editorial “Unravelling the commercial determinants of health”, in: The Lancet, vol. 401, Issue 1083 (2023), 1131, available at: https://doi.org/10.1016/s0140-6736(23)00590-1.

J. B. Foster, Marx’s Ecology: Materialism and Nature, New York, 2000.

J. Hickel, “The Double Objective of Democratic Ecosocialism”, in: Monthly Review, vol. 75, n° 4 (September 2023), available at: https://monthlyreview.org/2023/09/01/the-double-objective-of-democratic-ecosocialism/

R. Horton, “Offline: Medicine and Marx”, in: The Lancet, vol. 390 (November 4th 2017), available at: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32805-2.pdf.

N. Klein, The Shock Doctrine: The Rise of Disaster Capitalism, London 2007.

A. M. Pollack, NHS plc: the Privatisation of Our Health Care, London 2005.

Wei Zhang, “China’s Health and Health Care in the ‘New Era’”, in: Monthly Review, vol. 75, n° 6 (October 2023), available at: https://monthlyreview.org/2023/10/01/chinas-health-and-health-care-in-the-new-era/.