Think of two forty-year-olds. Both live in the same city. But one was born in a wealthy neighborhood, and the other in a poor one. The first will likely live ten to fifteen years longer than the second. Not because of better genetics or more exercise. But because the health system was not designed for both equally.
Today we’re going to talk about something that affects us all: health is not a universal right under capitalism. It is a commodity. We’ll see how it works globally and who gets the money, we’ll talk about austerity in Argentina, and we’ll imagine how it could be different.
A baby born in a poor country is 13 times more likely to die before age five than one born in a rich country. Annual health spending per person in high-income countries exceeds $3,000. In low-income countries, it’s less than $40. That difference is not just economic; it is historical. The health underdevelopment of the so-called Global South is not a starting point; it is the result. Centuries of colonialism and decades of financial dependence (foreign debt, IMF adjustments, resource flight) built that gap. Higher-income countries are rich, in large part, thanks to poor countries.
The COVID-19 pandemic showed it without anesthesia: rich countries hoarded 90% of vaccines in the first months of distribution. The rest of us had to wait. Thousands died while others already had their booster.
The data is brutal. According to the WHO, in low-income countries, between 5.7 and 8.4 million people die each year from lack of access to basic health services, most of them preventable deaths. In Latin America, maternal mortality is 7 times higher among the poorest 20% of the population than among the richest 20%. Out-of-pocket health spending (what you pay from your own salary when you get sick) pushes more than 30 million Latin Americans into poverty each year.
And what about the gap in imperialist countries? In the UK, life expectancy is 18 years lower if you live in a poor neighborhood than if you live in a rich one. In the United States, the richest country in the world, life expectancy for African American men is five years lower than for white men. A system where black lives don’t matter.
The United States, with 4% of the world’s population, accounts for 41% of global health spending. But that number must be read carefully: most of that spending is absorbed by insurers, laboratories, and private hospitals.
The underlying problem is that the system is designed on the logic of demand: there is no incentive for prevention, promotion, or health education, because that doesn’t generate revenue. The system waits for the patient to demand care, and only then does it act. The result is that millions of people, even middle-class, avoid going to the doctor until it’s too late, because a consultation, a test, a hospitalization can mean an unaffordable expense or a debt that consumes your life.
This leads to exhaustion and desperation, which are increasingly felt. In December 2024, Luigi Mangioni murdered Brian Thompson, CEO of UnitedHealth, one of the world’s largest insurers, known for systematically denying coverage to its members. And what was the reaction? Thousands of people expressed sympathy and support for Luigi, because they recognized in that act the accumulated rage of a society where people die because a company decided their treatment was not profitable.
There is a structural problem and also an active trend toward cuts. The IMF and World Bank have for decades promoted austerity policies that include reducing public health spending. Meanwhile, global military spending reached a historic record of $2.2 trillion in 2023. That year, the US spent over $900 billion on defense. In comparison, the WHO has an annual budget of just $6 billion to coordinate global health. There is money. The question is what it’s used for and who makes those decisions.
The official WHO definition says health is «a state of complete physical, mental and social well-being, and not merely the absence of disease.» Idealistic, isn’t it? Especially in this system… which makes it even more utopian for the majority.
Health cannot be understood separated from the material conditions of life. Friedrich Engels already stated it in 1845, in The Condition of the Working Class in England: disease does not come from heaven; it comes from working conditions, housing, hunger, exhaustion. He wrote: «These people have become so weak that certain cases, which under other circumstances would have evolved favorably, necessarily involve serious illness and death.»
Marx did not write a book on health. But he did develop something that allows us to understand this system in depth: the distinction between use value and exchange value. A vaccine has enormous use value: it prevents disease. But under capitalism, what matters is not whether the vaccine saves lives, but whether someone can pay for it and how much profit it generates. When exchange value dominates use value, health becomes a commodity. And commodities are distributed not by need but by purchasing power.
According to the WHO, more than 1 billion people worldwide live with some mental health issue. Depression is one of the leading causes of disability globally. These numbers don’t fall from the sky. Although we are often shown that they are individual problems, anxiety, depression, chronic exhaustion are partly consequences of concrete material conditions: endless workdays, precariousness, debt, loneliness, lack of future. Capitalism systematically produces mental suffering and then treats it as a personal problem. It tells you that you are broken, when in reality it is the system that breaks you.
And there the business appears. The pharmaceutical industry has found in mental health a permanently expanding market. Antidepressants and anxiolytics move billions of dollars globally each year. In many cases, medication may be necessary, but the problem arises when the first resort is the pill and the last is asking why so many people are unwell at the same time. Medicalizing social discomfort is a way of depoliticizing it.
Para mí esto huele a genocidio de clase: los ricos se compran la vida mientras nosotros nos pudrimos en la lista de espera. ¡Basura de sistema! La muerte es su negocio, la lucha es nuestra. Argentina, despertá, que acá el ajuste mata pobres.
Para mí, esto huele a lloriqueo de zurditos. Si no tenés guita, morite nomás, así se limpia la raza. Yo banco mis impuestos para mi salud, no para vagos. Viva la libertad, carajo!