How do we understand and analyze this? What concepts and frameworks help us see what is happening?
See the pedagogy document for what this lens does across all themes.
The concepts this lens builds are the surplus class (capitalism sorts people into those it can employ and those it cannot, and does something else with the second group), debility as extraction (being kept sick is profitable in a way that being cured is not), anti-fatness as a race technology (the standard was white before it was medical), and group-differentiated vulnerability to premature death, which is Ruth Wilson Gilmore’s definition of racism and is this theme’s whole argument compressed into eleven words.
Read Harrison first. Everything else in the theme is either evidence for their claim or an argument with it.
One strand of the book this theme does not yet carry, and a facilitator should know it is there. Harrison’s fourth chapter is about policing: when Eric Garner was killed, a congressman defended the officers on the grounds that they were taking down a 350-pound man, and at the disciplinary hearing the medical examiner offered that even a bear hug could have killed him, given his fragile health. The chokehold became a secondary detail. That is the theme’s whole claim happening in a single sentence, in public, on the record: the body was already priced, so the killing needed no defense beyond the body. Read chapter 4 alongside Anti-Blackness and Racial Capitalism.
Anchor questions
- Harrison says health is a framework in which no Black person can ever fit. What is the difference between being excluded from a category and being the thing the category was built to be defined against? What follows for what you demand?
- If a health system makes money from managing a condition and none from ending it, what is it for?
- The BMI was devised by a statistician measuring white Frenchmen and Scots. How did it become a diagnosis?
- Who is the surplus class, and what does a society do with people it cannot profitably employ?
- Gilmore defines racism as vulnerability to premature death, produced and exploited. Is that a definition of racism or a definition of the health system?
- If your body’s worth is what it can produce, what is a body worth that will never produce again?
Materials
Free unless marked otherwise. The two anchors are paywalled and both have free routes in: read the excerpts and you can run this lens without buying anything.
The spine
- Da’Shaun L. Harrison, Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness (2021). The book this theme is built on. Harrison’s claim is not that Black people receive worse health care, and not even that health was withheld from them, but that “health” was created as the antithesis of Blackness. The Black fat, they write, was “always already removed from the possibility of ‘good’ health,” which is a claim about how the category was built rather than about how it is handed out: the thing being distributed is defined as what you are not. “Because the Black always already fails in, or is removed from, morality, and as such never has access to care.” Anti-fatness is where that shows most plainly, because the fat Black body is treated as a diagnosis, a moral failure, and a threat at once. Harrison is Black, fat, trans, and disabled, and writes from all of it; they use they/them. Paywalled: northatlanticbooks.com. Their own free excerpt, reading the war on obesity as the war on drugs’ sibling: dashaunharrison.com
- Sabrina Strings, Fearing the Black Body (2019). The history under Harrison’s claim: fatphobia was invented to tell white women apart from Black women, and it did that job for a century before medicine adopted it and called it health. They are not simply allies, and the room should catch the split. Strings argues that the fear of fatness is not really about health at all, but a way to legitimize race, sex, and class hierarchy. Harrison agrees only halfway, and then turns it: precisely because anti-fatness is not about anyone’s wellbeing, it is about health, because the structure needed a Thing that Black fat people could never obtain, and health is that Thing. Strings makes health a pretext. Harrison makes it the mechanism. Paywalled: nyupress.org. Free: her essay The Racist Roots of Fighting Obesity, where the BMI turns out to have come from a statistician measuring the wrong people for the wrong reason. Read that essay with ASDAH’s accountability statement beside it: the co-author, Lindo Bacon, was held publicly accountable by the fat liberation community in 2022 for harm to fat Black activists, and a theme about whose body counts should not cite him as though that had not happened. It is also the best item here on Health At Every Size and its critics, because it is the movement auditing itself.
- Fat Underground, Fat Liberation Manifesto (1973). Seven demands, including the charge that the reducing industries profit from fat people’s deaths. Fifty years before a university press published the argument, this said it on a mimeograph. Free: fatlibarchive.org
Health under capitalism
- Beatrice Adler-Bolton and Artie Vierkant, Health Communism (2022). Capitalism sorts people into workers and surplus, and the health industry does not fail the surplus, it extracts from them: debility is a product line. Their argument is that universalizing this system is not the answer to it. Paywalled: versobooks.com; the archive.org copy is an unauthorized upload and is not linked. Free, authorized, and enough to argue from: thenewinquiry.com
- Philip Harvey, The Political Economy of Health: A Perspective on the Marxian Origins (2021). Where the analysis comes from, briefly and free: health is produced by how production is organized, and medicine arrives afterward to sort out the remainder. Free: pmc.ncbi.nlm.nih.gov
- Vicente Navarro, The Consequences of Neoliberalism in the Current Pandemic (2020). Navarro built this field. On COVID: the deaths were sorted by class, and the sorting mechanism was installed decades earlier. Free: pmc.ncbi.nlm.nih.gov
- Yea-Hung Chen and colleagues, Excess mortality by occupational sector during COVID-19 (2021). Who died, by job. Read it after Navarro and the argument stops being a position. Free: pmc.ncbi.nlm.nih.gov
The definition that is already in this school
- Ruth Wilson Gilmore, Golden Gulag (2007) and her free sixteen-minute film Geographies of Racial Capitalism (about 304,000 views). Racism is “the state-sanctioned or extralegal production and exploitation of group-differentiated vulnerability to premature death.” That is a sentence about health, written by a prison scholar, and it has been sitting in the anti-Blackness theme the whole time. If the room takes one line out of this theme, take that one. Book paywalled: ucpress.edu
A note on method
The temptation is to argue about health care and never about health. Financing is the easiest thing in this theme to discuss and the least important: you can nationalize an insurance system and leave every judgment in this lens exactly where it was. Harrison, Strings, and Adler-Bolton and Vierkant are all making a prior claim, that the system is doing what it was built to do, and a room that jumps to policy has skipped it.
Do not let the room diagnose anyone. This lens contains a lot of material about bodies, and participants have bodies, some of which the material is about. The argument is about a system’s judgment, not about anyone’s weight, and a facilitator should say so before it comes up rather than after.
Further reading
For resources behind a paywall, see the note on access.
- Paul Starr, The Social Transformation of American Medicine (1982). The standard history of how American medicine became a sovereign profession and then an industry. Liberal rather than Marxist, and the better for it here: it is the mainstream account of how the money got in. No borrowable copy exists. Not free: hachettebookgroup.com
Status
First pass, and it may be a while before there is a second. It is built around one claim. Its honest weaknesses: the anchors are paywalled, Harrison and Strings both, and the lens runs on excerpts to stay usable. Psychiatry and mad studies are absent entirely, which is a real hole in a theme about which bodies are judged unfit. So is health outside the United States and the global pharmaceutical order. Contributions welcome, especially from fat organizers and health workers.