Promoting Health Equity in an Era of Growing Contradictions Between Capital Accumulation and Social Reproduction in Capitalist Economies.

Abstract

Background: Despite a robust literature on the importance of promoting health equity, actual progress in doing so is flagging and this is especially the case in Anglo-Saxon liberal welfare states such as Canada, the USA, and the United Kingdom. Purpose: In this paper we place these developments within the context of the political economy concepts of capital accumulation -- or profit making -- and social reproduction -- or the ongoing functioning of society. Research Design: We carefully reviewed the current state of theorization and research into the political economy of health to identify the main themes and findings in this literature in relation to the polycrisis of living and working conditions in Canada, the USA, and United Kingdom.Analysis: We drew upon critical materialist political economy thought to show how the growing contradictions between profit making and societal functioning in capitalist economies - and this especially so in liberal welfare states -- threaten both the quality and equitable distribution of the living and working conditions that shape health - the social determinants of health - and the organization and delivery of health care. Results: While there is increasing application of political economy approaches to understanding the adverse effects of capitalism, almost all of these are limited to critiquing capitalism without envisioning a post-capitalist society. Various ways of addressing these contradictions are provided that include 1) redistribution, social spending by governments, and managing the market economy within existing economic and political structures; 2) movement towards social democratic or conservative models of governance common to the Nordic and Continental nations respectively; or 3) building a post-capitalist socialist future.Conclusion: While we offer three paths forward towards achieving health equity, we conclude that the last path, building a post-capitalist socialist future, offers the most useful means of promoting health equity in both the short and long-term.