If we view the health care delivery system as a social system, it becomes amenable to sociological analysis. In analyzing social systems, it is very important to understand the world view or belief system that guides their behaviour and tends to determine roles, norms, status hierarchy, rewards and values.
I am basing my analysis on the U.S., a dominant power in the world and one which strongly influences Canada. We can discern three distinct social complexes in the U.S.: the military-industrial, the automobile-petroleum-highway, and the medical-pharmaceutical-insurance complex. These terms identify the major social actors or members of the complex.
It is important to describe the larger context in which the medical-pharmaceutical-insurance complex has evolved. The context is the current process of globalization which imprints its values on all dominant social systems. It is no accident that the U.S. is the only country in the economically developed world which does not have a national universal health care plan. Not surprisingly, the U.S. also has the highest infant mortality, lowest life expectancy, and highest incidence of cancer--as well as the highest per capita consumption of beef and fatty foods. It also has the highest per capita production of all major pollutants and industrial waste. Given the nature and profit-making priority of the medical-pharmaceutical complex, it is no wonder its leaders view cancer as a growth industry.
Cancer is the plague of “progress”—largely the result of the millions of chemicals in our air, food, and water, including known and suspected carcinogens, exposure to ionizing radiation and tobacco smoke. Theoretically, all of the cancers induced by environmental factors are preventable by the exercise of political will. The basic reason they are permitted is patently obvious. In our social system, economic values supersede and transcend human values. In the U.S. alone, there are over one million cases of cancer currently, and the death rate is over 50%. Mortality and morbidity rates continued to climb, bringing us closer to epidemic levels. Like the Vietnam War, the cancer war is a lost one, despite billions of dollars spent on costly unproductive treatments.
In fact, if we compare the total social cost of over one million cases of cancer, it is clear that prevention would be far less costly. The trouble is that cancer treatment is a business in which public costs are discounted in favour of private profits. And this is done with government collusion. In a truly just and democratic society, our governments would be laying criminal charges against the CEOs whose companies are spewing carcinogens into our environment. Instead, these business leaders are extolled for raising dividends and profits regardless of the enormous toll in preventable human suffering their methods entail. It is a system in which profits are made only if people become sick, so the sicker they become the better for the bottom line. Billions are reaped from expensive treatments and diagnostic procedures—treatments that, in the case of cancer, are often useless and sometimes do more harm than good.
In the allocation of causes between lifestyle (e.g., diet and smoking) and environmental, the exact numbers are still uncertain. But the downgrading of environmental causes is a perfect example of biopolitics--i.e., arguing that a biological hazard is of minimal significance.
A special class of cancer-causing chemicals are xenoestrogens, found in some pesticides, cosmetics, and plastics, which can behave in our bodies like hormones, mimicking estrogen or blocking testosterone. These are all hormone-disrupting pollutants. There is little argument about their impact on various animal populations, destroying their ability to reproduce and reducing immunity to disease. Some investigators are now arguing, with considerable scientific merit, that these same xenoestrogens can activate natural forms of estrogen in human females, increasing the risk of breast cancer.
Underlying all of this is a more fundamental distortion of our health system, in that it is really a disease system with exclusive concern with treatment and cure, and a profound neglect of prevention. This follows naturally from the power of the economic imperative. Since the treatment of disease is a business venture, only those patients who can generate profit will tend to be treated or given preference in treatment. In fact, the insurance companies have a name for these patients: “revenue generators.” This, of course, leads to the neglect of health care for the majority of the poor, and many of the aged and disabled. These people are simply sacrificed at the altar of organized greed.
This is a system of functional inhumanity which views social services generally as subversive to free enterprise, and thus in need of deregulation. But it is also a system that belatedly is at last being questioned. Some physicians and scientists are reappraising the preventive and therapeutic value of vitamins, minerals, and herbal supplements. Studies are exposing the cancer-causing toxins in the environment.
An awareness is growing that prevention and the preservation of health is far less costly to society as a whole than the treatment of the sick and the search for elusive cures. But a switch from treatment to prevention would be very costly for the corporations whose profits rise with the incidence of sickness and fall with the rise in overall well-being.
Unfortunately, we live in a world in which corporate health trumps human health. Unless we succeed in our efforts to have this twisted set of values and priorities reversed, the toll of needless deaths and suffering from cancer and other preventable ills will continue to rise.
(Fred Knelman is a long-time peace activist and writer on international affairs.)