Lesley Thulin reviews Health Communism

Beatrice Adler-Bolton and Artie Vierkant. Health Communism. New York: Verso Books, 2022. 222 pp.

Review by Lesley Thulin

28 September 2023

In Health Communism, Beatrice Adler-Bolton and Artie Vierkant offer a trenchant critique of the political economy of health, arguing that the only way to attain “all care for all people” is to remove health entirely from capital’s grasp (p. xiii). This means that our politics must center the so-called surplus populations—a diverse range of bodies that are characterized as economically unproductive yet are paradoxically exploited for profit by the very system that deems them unproductive in a process that the authors call “extractive abandonment” (p. xvi). Adler-Bolton and Vierkant zero in on one segment of these surplus populations that illustrates capital’s parasitic relationship to health with particular lucidity: the disabled/chronically ill.

Defined by the Social Security Administration as “the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment,” disability names an embodied state that is antithetical to capitalism’s logic of unrelenting productivity.[1] Because disability challenges this merciless injunction to work, capital plants disabled people squarely on the latter side of its worker/surplus binary and judiciously polices which bodies are deemed deserving of state relief through processes of certification predicated on distrust and artificial scarcity. (For example, the Social Security Administration stipulates that beneficiaries must meet its “strict definition of disability.”[2]) Figured as an inconvenient remainder of the productive population, disabled people conjoin eugenic burden and debt burden: on the one hand, they pose a “demographic” or “reproductive threat” to the body politic; on the other, they risk draining the economy (p. 21).

As Adler-Bolton and Vierkant show, capital’s sneaky solution is to cordon off this population while simultaneously turning a profit on it through rehabilitation—a process that aims to restore patients to health in order for them to return to the workforce—and medicalization. Institutions such as private nursing homes, hospitals, and prisons coconspire with the private insurance industry and the state in extractive abandonment—an idea that traces its genealogy to Marta Russell and Ruth Wilson Gilmore. This is Adler-Bolton and Vierkant’s main intervention in Marxist disability studies, a subfield that identifies capital as the primary social determinant of health. Their concept of extractive abandonment deftly synthesizes Russell’s “‘money model of disability’”—capital’s commodification of the disabled body and the privatization of welfare—with Gilmore’s theory of “‘organized abandonment,’” or the racial capitalist state’s deliberate neglect of marginalized communities (p. 13). As the authors point out, extractive abandonment names not only a relationship between a state and its own population but also its relationship to international populations; it is for this reason, they argue, that health communism requires an internationalist effort.

Divided into nine chapters organized around topics like “LABOR,” “MADNESS,” and “PHARMACOLOGY,” Health Communism moves at a fast clip, but skillfully and accessibly weaves its animated polemic with scholarship from disability studies, the history of medicine, and the social sciences. Adler-Bolton and Vierkant also recover the history of the Sozialistisches Patientenkollektiv (SPK or Socialist Patients’ Collective), a Heidelberg-based collective of patients and doctors who resisted the West German capitalist state in the 1970s. In doing so, the authors, who describe themselves as SPK’s ideological heirs, reclaim a history that is essential to understanding materialist disability studies: SPK was among the first to expand the concept of the surplus populations beyond Marx’s designation of the general “reserve army,” or people who are unemployed but nevertheless able to work, to include the disabled.[3]

In its insistence that “social-infrastructural aspects of life—not just housing and clean air, but food, clean water, public sanitation, social supports, in-home aid, a planet not burned and destroyed by capital” are part of healthcare, Health Communism calls to mind Rupa Marya and Raj Patel’s Inflamed: Deep Medicine and the Anatomy of Injustice (2021), which addresses, through a decolonial lens, the profound interconnection between the human body and the environment (pp. xv–xvi). Whereas Marya and Patel have a clear idea of what, exactly, health means (the absence of inflammation, ranging in scale from the human cell to the troposphere), Adler-Bolton and Vierkant are less sure. They readily acknowledge the difficulty of defining “health,” which, they argue, “has no fixed meaning” (p. xi). As they explain, their uncertainty is a product of the historical-material conditions under which we currently live: under capitalism and the attendant “medical model” of disability that locates disability in the individual body rather than in one’s immediate environmental circumstances, health is individualized as “always a possession, not an ontology,” remaining a fantasy (pp. 13, xi). Health under communism, on the other hand, looks something like meeting “the social and material needs of all” (p. 23).

Health Communism is an exciting contribution to materialist disability studies, which has grown increasingly dissatisfied with the so-called social model of disability, from its limitations in accounting for bodily impairment to its reluctance (until recently, with the work of scholars such as Jasbir Puar and Sami Schalk) to address traumatic processes of debilitation. Although Russell and the subject of political economy have been largely overlooked in disability studies, Adler-Bolton and Vierkant make a strong case for their relevance. As they remind us in a riff on the old adage in the field that we will all eventually become disabled if we live long enough: “In the eyes of capital, we are all surplus” (p. 183).

[1] Basic Definition of Disability, Code of Federal Regulations § 404.1505

[2] “Disability Benefits: How You Qualify,” Social Security Administration website, www.ssa.gov/benefits/disability/qualify.html

[3] See Karl Marx, “The Progressive Production of a Relative Surplus Population or Industrial Reserve Army,” trans. Ben Fowkes, Capital: A Critique of Political Economy, trans. Fowkes and David Fernback, 3 vols. (1867–94; New York, 1976), 1:781–94.