End health inequality
Pushpa Babu Basnet
Marxist theory stipulates that economy shapes social orders. H. Waitzkin has explained that Marxism defines society in terms of two classes - the bourgeoisie, who possesses the means of production, and the working class that sells their labour to eke out a living. As two classes operate in the society, there exists not only economic disparity but also the medical one as Waitzkin puts it: “Marxist studies of medical care emphasise political power and economic dominance in capitalist society. Although historically the Marxist paradigm went into eclipse during the early twentieth century, the field has developed rapidly during recent years. The health system mirrors the society’s class structure through control over health institutions, stratification of health workers, and limited occupational mobility into health professions. Monopoly capital is manifest in the growth of medical centres, financial penetration by large corporations, and the “medical-industrial complex”.
Marx’s meanings of social class accentuated the social relations of economic production. Waitzkin noticed that the industrialist or bourgeoisie class controls the methods for generation of machines, the processing plants, land, and crude materials important to make items for the market. Neo-Marxists have conducted study on social classes and distribution of health facilities and concluded that there lie stark health imbalances.
Based on the Marxist perspective on health service, we can research on how and why there is economic inequality between upper and middle classes. Muntaner et al claimed that the term “social class” is widely used in health inequalities research. The pragmatic approach is ordinarily centred on straightforward stratification pointers, for example, salary, education and professional level may draw on a functionalist mode of humanism. The neo-Marxist approach can be outlined based on relations of financial creation through procedures of possession and work, mastery and abuse.
The low class that is subject to exploitation finds difficult to move social ladder and is forced to live in penury. They are likely succumbed to undesirable practices- smoking, liquor addiction and medication misuse. They can save money to be spent on healthy meal and hygienic life style. Matthews argued, “Poor diet, often portrayed as the result of a lack of education, is often the result of a lack of money to buy nutritious food”. They can scarcely live in good houses and are prone to organic health dangers. The government has not set up adequate number of medicinal centres and the poor people are deprived of legitimate restorative treatment.
For instance, in Nepal, in the absence of drugs for curing intestinal sickness and infection at the government health centres, the poor people are compelled to resort to self-remedy practice and buy drugs from shabby pharmacies. But those with resources can afford the expensive medicines and health services. Marxists stands for an elective society, which is progressively fair. Health researchers initiated using Wright’s neo-Marxist class indicators in population studies. It makes an inquiry into social classes and comes up with three theoretical premises - command over gainful resources possession, association, and aptitudes. The build of aptitude is associated with education utilised normally in the social inequalities in health field.
However, Gwatkin, (2000) argued health inequalities are the uncalled for and avoidable in the society. Social inequalities conflict with the standards of social equity. They don’t happen haphazardly or by some coincidence. They are socially constructed to a great extent. These conditions create hurdles for the commoners to have economic opportunities and live a healthy life. They are forced to remain outside any specialist’s medical procedure. Physicians possess the most astounding stratum among specialists in health foundations.
The state should ensure equal health service to the entire population. Health inequalities can be done away with the implementation of socialism-oriented approach. Marxist perspective insists that health inequalities contradict the spirit of social equity. Inequality is socially dictated to a great extent owing to the lopsided distribution of resources.
(Basnet is an ophthalmic officer at the Nepal Eye Programme)
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