Until healthcare policy addresses the capitalist elephant in the room, health research will forever be trying to treat the symptoms rather than tackling the root causes.
‘One to three drinks a day for most men… women are more sensitive to alcohol, so they are advised to drink less—one to two drinks.’ These words were spoken in 2016, during the Nigerian ‘Beer and Health’ conference, an annual one-day symposium, sponsored by Heineken-Nigerian Breweries. The symposium was introduced to create awareness of the ‘health and nutritional benefits of beer consumption’. Despite the claims of beer preventing cancer, reducing the incidence of kidney stones, enhancing vitality and cardiovascular health, and facilitating longevity and cognition among the elderly, it is difficult to ignore the clear tensions between the health benefits argued by presenters and fears people have around the health impacts of overconsumption of beer.
In the company’s own words, Heineken is the most trusted international beer brand in the world. In 2020, according to its annual reports, while Heineken saw a marginal decline in revenues by 0.4 per cent globally, only 25 markets grew in double digits, including Brazil, China, the UK, Singapore, Poland and Nigeria. The marketing strategies of a global alcohol industry is expanding across the continent, and Nigeria is no exception. At 13 litres of alcohol per capita as of 2019, Nigeria is the highest beer-consuming country in Africa. Health consequences come second in the face of ever-increasing pro-drinking strategies. In Nigeria, the absence of national-level alcohol control policies means self-regulation is the only tool available against over-consumption.
Symposiums like this make clear the foothold multinational corporations have on the conditions of our lives as Africans. Oliver van Beemen in Heineken in Africa: A Multinational Unleashed goes into further detail about Heineken’s role in perpetuating continued inequality in Africa. Brewing companies are not alone in the dichotomy between the need to increase profits and adverse health consequences. Famously, in the 2000s, Purdue Pharma sponsored various medical conferences in the United States as a way to gain influence at prestigious academic medical centres, and boost revenues by encouraging doctors to prescribe OxyContin and other opioids to more patients, often at higher doses and for longer. Both cases highlight the continuing conflict between the incentives of capitalism and establishing a world in which we all have the right to health.
A RECURRING TREND
On the eastern side of the Kwa Ibo River about a few kilometres from the river mouth, Ibeno is one of the largest fishing settlements on the Nigerian coast. In November 2021, Ijaw youths blocked the ExxonMobil company headquarters, demanding the clean-up of Ibeno. The Kwa Ibo (Qua Iboe) River finds the Atlantic Ocean in Akwa Ibom State. The river feeds a zone of mangrove swamps linked by creeks and lagoons that is separated from the sea by a low and narrow ridge of sand.
Today, the fishing community is plagued by oil spills from the nearby refineries which large oil companies such as Exxon Mobil use in processing extracted oil from the numerous offshore fields. The first documented oil spill in Ibeno was in 1998. Since then, further spills have not received the same attention so as to be immediately cleaned up by the oil corporation. Oil spills are a clear and present danger to the health of those living there and future generations. Locals in the community have reported that even the rainwater is no longer safe to drink due to the petroleum flares from the refineries overhead. Further, life expectancy is reported to have gone down from 80 to 60 years of age. In 2019, Nigeria’s oil and gas sector accounted for about 5.8 per cent of Gross Domestic Product and was responsible for 95 per cent of Nigeria’s foreign exchange earnings and 80 per cent of its budget revenues. There is a need to fuel global energy needs and, at times, this comes at the cost to health and livelihoods. In 2021, President Muhammadu Buhari signed the Petroleum Industry Bill (PIB), which aims to safeguard growth while addressing legitimate grievances of communities most impacted by extractive industries. We are yet to see if the policy will make a difference to those communities living in the shadow of extractive industries.
HOW CAPITALISM MAKES US SICKER
Having penetrated every aspect of society, numerous scholars have named capitalism as the fundamental cause of today’s apocalypses, as well as yesterday’s and tomorrow’s public health disasters. The capitalist economies that dominate nation states operate to promote market incentives. Capitalism rewards and prioritizes profit-motivated behaviours above all else. This not only defines the ‘economy’ but bleeds into society and how we talk about issues and the challenges that face us.
Where the economy ends and society begins is not evidently distinct. What we consider aspects of modern society are as a direct result of a capitalistic economy. Capitalism is a system of social relations that seeks to commodify everything. These social relations to be commodified are not confined to the relation between workers and capitalists or confined to the economic system but pervade the social and political forms of society. In a capitalist society, profit seeking is rational. As such, commodities, in order to maintain profit, can be rationed. These can be goods and services—and this can even be the delivery of health.
The societal and systemic factors that determine the health of an individual, so called ‘social determinants of health’ that lie outside the purview of an individual’s control, somewhat obscure the mechanism through which individuals secure the necessities of life in a capitalist economy—and that is through the market. The simplest example is how a lack of income impedes how the individual can access basic health care. In this light, it is no surprise that research has shown how basic income support has significantly positive effects on birth outcomes, early childhood development, education attainment, housing security, and mental health.
In his recent book, At What Cost: Modern Capitalism and the Future of Health, Nicholas Freudenberg faces the health research community, who often prove reluctant to use the word capitalism when analysing the world’s current health problems and proposing solutions. Until healthcare policy addresses the capitalist elephant in the room, health research will forever be trying to treat the symptoms rather than tackling the root causes.
THE PANDEMIC: RENEWED OPTIMISM WITH OLD CHALLENGES
Fast-forward to a COVID-19 pandemic that called into question how states responded to the crises. In the face of the pandemic, governments found political will whether they liked it or not. Many governments acted to minimize the economic impact of the pandemic first and foremost. All of a sudden, the role of governments went beyond simply being a tool to correct the market failures of the economic system.
The pandemic shows that new approaches to health interventions are needed, not just in rich countries. Containment and mitigation are two responses to an infectious outbreak. The containment phase involves isolating and treating identified cases with effective contact tracing while mitigation focuses on ‘social distancing’, ‘lockdowns’ and other measures that ensure the population is at a reduced risk. As the pandemic continues, establishes, and ultimately becomes endemic, another third option avails itself. One that will rely on these upstream interventions to safely manage people and livelihoods.
However, under capitalism, the global inequality that drives profit-making markets must be maintained even at the expense of public health. This was evident in the global distribution of COVID-19 vaccines where we witnessed lower-income countries at the end of the line to receive vital lifesaving vaccine shots, even as richer countries rolled out second, third, and even fourth doses. At first, it was a problem of supply and surplus demand. Everyone in the world would need to be vaccinated to combat this pandemic; yet, initially, there were only few countries with capacities to manufacture the vaccine. Countries like South Africa and India proposed a solution—the so-called ‘TRIPS waiver’. The World Trade Organisation Doha Declaration on the TRIPS Agreement and Public Health, agreed by World Trade Organisation members in 2001 helped to frame the health policy context of the intellectual property system. A TRIPS waiver would allow for the suspension of rules that protect intellectual property monopolies over the technology and allow other countries to make generic versions of COVID-19 vaccines. To date, such a waiver has not yet been granted.
What makes the inequality even more stark is the fact that the technology at the heart of the COVID-19 vaccine was developed with a combination of private and public money. Companies relied on publicly funded research, but it was also the reliance on private investment that provided the rationale for pursuing a profit motive when the vaccines were developed. The choice was clear when the promise of a vaccine started to become a reality—maximize profits or prioritize global access. To date, campaigners are still advocating for intellectual property waivers to bring the vaccine to some of the poorest areas of the world.
AN IMPORTANT STEP
Dominant neoliberal economics and its emphasis on individual and not collective responsibility, go against public health efforts that need to target the collective good. As capitalism trends towards the immense concentration of wealth in the control of a diminishing few, the most important thing nation states can do to protect individual health is collective actions for health.
The issue goes further than a once-in-a-hundred-year pandemic event. As climate chaos envelops Africa, the opposing forces of health versus capitalism comes into clearer focus. Nation states, in their relationship with global corporate entities, have a responsibility to safeguard the right to health as a fundamental part of our human rights and of our understanding of a life in dignity⎈
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