The usual way to talk about health is disparity: some people get worse care, live shorter lives, die of things that were treatable. All true, and all framed as a gap, a failure, a thing the system did not manage to do. This theme starts somewhere else. Health under capitalism is not a service unevenly delivered. It is a judgment about which bodies hold value and which do not, and the delivery follows the judgment exactly.
Da’Shaun Harrison puts the sharpest version of it, and it is sharper than it first sounds. Not that Black people were denied health, but that “health is a framework in which no Black person can ever fit.” Harrison’s argument is that for race to be constructed at all, the Slave had to exist and had to exist as the antithesis of health, so that European physicians and eugenicists had something to define the Caucasian against. Health, on this account, “had a job to do. That job was to ensure that the Black, which is, too, the fat, was always fixed to be something that Black fat subjects could not be.” That is not a complaint about distribution. It says the category was built to be unreachable, so you are outside it by construction, before any doctor is involved, and the denial is the category working rather than a system failing. Once you hold that, the pieces stop looking like separate scandals. The Supreme Court authorized sterilizing people it called unfit, and said so out loud, and that ruling has never been overturned. A third of Puerto Rican women were sterilized. Fannie Lou Hamer went in for a tumor and came out unable to have children. California was still sterilizing women in its prisons in 2010. None of that is medicine going wrong. It is medicine doing what it was asked to do, to bodies a system had already priced.
The same logic runs through the food. Supermarkets left, and the leaving is called a desert, as though it were weather. Processed calories are cheaper because they are subsidized to be cheaper. The people who pick the food get heat and pesticides, and the people who eat it get blamed for their bodies. Who gets fed, and whose body is worth poisoning, is the same question this theme asks about medicine, which is why food lives here rather than in a theme of its own.
This is also the theme where several of the school’s other arguments arrive at once. Ruth Wilson Gilmore defines racism as the production and exploitation of group-differentiated vulnerability to premature death, which is a definition of racism written in the vocabulary of health, and it is already in this library twice. The eugenic logic that this theme traces is the same logic disability justice was built to answer. The bodies that capital wanted, it wore out; the bodies it did not want, it warehoused or sterilized. Both are decisions about value.
How to use this theme
This folder organizes resources by lens. See the Pedagogy document for what the lenses do and why they are structured this way.
- Experiential: What is your experience with this? What does the room already know?
- Historical: How did this come to be?
- Theoretical: How do we understand and analyze it?
- Practical: What is happening on the ground and what are people doing about it?
- Liberatory: What would it mean to overcome or transform this?
A session does not need to use all five lenses. Unlike most themes in this school, the experiential lens here is not a warm-up: everyone in the room has a body, has been treated or refused, and probably has a story about being disbelieved. Start there and the theory has somewhere to land.
Anchor questions
These questions have proven useful for opening up this theme. They are starting points, not a script.
- Have you ever been disbelieved by a doctor? What were you disbelieved about, and what happened next?
- Have you avoided care because of what it would cost? What did you do instead?
- What does your body have to do for you to keep your health coverage? What happens if it stops?
- Buck v. Bell has never been overturned. What is that ruling still doing there?
- Cheap food is engineered to be cheap and then people are blamed for eating it. Who is that arrangement for?
- If a health system exists to return people to work, what is it for when someone will never work again?
- Whose death counts as a tragedy, and whose counts as a statistic, and who decides?
Recommended sequences
Suggested arcs for groups new to this theme. Adapt freely. Every session opens with a check-in and closes with reflection (see the pedagogy document).
Single-session entry point (2 hours). Open experiential: has anyone here been disbelieved about their own body? Let that run; it will run. Then read the Buck v. Bell holding aloud, in the Court’s own words, and note the date it was overturned, which is never. Close on the question the room will already be forming: if that is the law, what is the health system for? See the single-session template.
Six-week study circle. Week 1 experiential: our own bodies, our own refusals. Week 2 historical: eugenics, from Buck v. Bell to the sterilizations, and the American money that funded the German programme. Week 3 historical: medical racism, from Sims through Tuskegee to the algorithms still running. Week 4 theoretical: Harrison and Strings on anti-fatness, and the food system that manufactures the bodies it punishes. Week 5 theoretical and practical: health under capitalism, the surplus class, and who the system is actually for. Week 6 liberatory: stage the argument between Medicare for All, health communism, and disability justice, and do not resolve it. See the six-week template.
Weekend intensive. Friday: the experiential lens and a screening. Saturday: eugenics and medical racism, which is heavy and should end early. Sunday: food, fatness, and the strategy argument. See the weekend-intensive template.
A note on this theme
This one lands on bodies in the room. Every other theme in this school can be studied at some distance. Here, participants are fat, or sick, or disabled, or have been sterilized, or have been refused, or have buried someone the system decided not to spend money on. That is not a hazard to manage, it is the theme’s best material, and it is also a reason to be careful about how the room is set up and who is asked to perform their own suffering for the group’s education. Nobody owes the room a story. See the facilitator guide.
Do not let it become a list. Capitalism, eugenics, fatness, food, disability, medical racism, COVID: six good subjects and no argument, if the spine is not doing work. Every strand here earns its place by making the same claim, that health is a judgment about whose bodies are worth keeping alive. Anything that does not make that claim belongs in a theme that already has one.
Related themes
- Anti-Blackness and Racial Capitalism holds Gilmore’s definition of racism, which is this theme’s thesis stated in one sentence, and the property-and-labor mechanism that decided which bodies were worth working to death.
- Gender, Reproduction, and the Household holds Angela Davis on birth control and eugenics, SisterSong on reproductive justice, and the care work that keeps bodies alive without being counted as work.
- Ecology and the Climate Crisis holds Bullard on environmental racism, which is the same question as this theme’s, asked about where the poison goes, and the food sovereignty movements that answer the food strand.
- Labor, Work, and Organizing holds the farmworker organizing; this theme holds what the work does to the worker’s body.
- Critical Pedagogy and the Practice of Liberation holds the disability justice material, because a school had to ask who could get in the room before it could ask anything else.
- Settler Colonialism, Land, and Indigenous Sovereignty holds the elimination logic that ran through the Indian Health Service sterilizations and the commodity foods.
Status
First pass across all five lenses, and it may be a while before there is a second. It is built around one claim, and its risk is dilution: it touches six literatures and could easily become a reading list about health instead of an argument about value. Contributions welcome, especially from health workers, disabled organizers, and fat organizers, and especially where this first pass is thin: psychiatry and mad studies, health outside the United States, and the global pharmaceutical order. If you have run a session on this theme, consider contributing back what you used and what you learned.