Contradictions and the Contemporary Polycrisis

The concept of polycrisis characterizes an array of linked crises that are not simply contemporaneous but also interconnected. Many consider the polycrisis as incorporating ecology, democracy, digitalization as well as economic challenges.129–131 In our work we focus on the skewing of living and working conditions – or social determinants of health – and see all of these and the broader issues noted above as growing from the ongoing contradictions of contemporary neoliberal global capitalism. In such a situation, conventional public policy management methods are ineffective as the polycrisis extends beyond any single policy area and reflects the overall structures and processes of a society’s political economy. 14 We see the polycrisis as driven by private sector need for capital accumulation which threatens social reproduction. The importance of capital accumulation to health is not a novel insight: Doyal and Pennell identified capital accumulation as being the core of why governing authorities frequently fail to meet the health and health care needs of their citizens. 56 The contemporary polycrisis is now finally directing public health attention to its effects.

The depth of the social determinants of health polycrisis is seen in the similarities of health threatening Victorian-era capitalist practices of the mid-1850s and contemporary Canadian society in income and wealth inequalities, employment security and working conditions, and access to food, housing, and health services, deaths of despair in the USA, and declining life expectancy in the UK.21,80,132 In Canada, the relentless quest for capital accumulation has resulted in precarious work and stagnating wages for many as the profits of the companies they work for grow, housing unaffordability as private realty companies buy up currently affordable housing and carry out renovictions and raise rents, and increasing food insecurity as the major food distributors record growing profits. 19 Similar processes are taking place in the USA and UK.133,134

The second component of health equity is access to health care. Health care has always been a site for private sector capital accumulation through investment and growing commodification in Canada and other countries with public health care systems.56,82,135 Commodification through private for-profit investment undermines access to health care with special impact on the health of those in the lowest income groups. 136 Health care became commodified as governments shifted away from the post-World War II commitment to provide health care and public health to their populations. 34

Countries vary in their investments in these programs, especially health care. The USA is the only wealthy country without a public health care system yet consistently outspends all other rich nations on health. 137 USA health care is costly as a result of amalgamation of hospitals and providers in which the growth of private monopolies exact higher prices from insurance payers. 82 This leads to adverse financial and health impacts for users. For example, a 2016 study found that cancer treatment can result in bankruptcies and increased the risk of mortality from treatable cancers. 138

Growing private sector involvement is apparent in Canada and the UK public health care systems with adverse consequences for health.139–143 These impacts reflect the impact of commodification and contribute to a growing health care crisis as countries with public health care systems privatize health services as a cost-saving measure which may lead to preventable illness and deaths, increasing infant mortality and declining life expectancy, some of which have already occurred.