• Open Access

A view from beside the elephant


Correspondence to: Dr David Coburn, 3161 Henderson Road, Victoria, BC Canada V8P 5A3; e-mail: david.coburn@utoronto.ca

inline image

People terrified to death, falling and jumping from doomed towers. Televised live. 9/11 has had huge consequences simply because the dominant world power was publicly attacked on its own territory. The health effects on such nations as Iraq and Afghanistan have been horrific. However, both before and after 9/11 the world was dramatically divergent in health. Given the social determinants of health, today's unprecedented wealth, along with poverty and starvation, means there are stark and dramatic contrasts in health. ‘Epidemics’ of obesity confront millions suffering from undernutrition and premature death.

Neo-liberalism, characterised by the hegemony of capital, has been associated with massive inequalities in standards of life, including health, and with frequent crises which show as utopian the promise that neo-liberalism will bring prosperity for all. These economic crises, within the past thirty years the stock market crash of 1987, the South American crises, the East Asian crisis and the recent global crisis, all grind down the poor while others are enriched.

There are emerging supra-national global capitalist classes, reaching across nations with the result that American imperialism, national and global structures act in concert. But such global classes are partly based on nation-based class structures. In fact, many of the suppressions, exploitations, and health consequences experienced are due to national class structures, reinforced by global class dominance.

Capital is appropriating an inordinate amount of social power and the social surplus. Representative democracy has become a convenient curtain for the hegemony of corporate interests. Ironically, this overwhelming dominance is not even in the long-term interest of capitalist ‘stability’. The sub-prime crisis is a classical ‘underconsumption crisis’ in which the mass of the people can no longer purchase the goods they are so good at producing.

While the chief health victims are the developing nations poor they are not the only ones. The United States now has to prop up militarily its world-wide interests through exploitation of the American people themselves. The American rich propagate a fantasy economics in which the only policies are lower taxes, ‘small government’ and cutbacks in services. Such policies have produced the greatest income and social inequality, in the US, Britain, and elsewhere, since before World War II. The health of Americans, and others, has suffered. If, since World War II, the United States had had the same infant mortality and life expectancy rates as Sweden, for example, there would be millions more Americans alive today than there are.

The dominance of the rich, the ideological hegemony of a business dominated media, the crushing of the power of oppositional movements, were greatly reinforced by the events of 9/11. Attention was diverted from domestic problems to foreign enemies in a socially constructed ‘war’– of civilizations or of religions. How convenient for the rich. However, in a finite world, hegemonic neo-liberal forms of capitalism will have to face their own trends and contradictions as the increasing inequalities and economic crises demonstrate. Whether this will lead to a deepening of the neoliberal dream or an awakening from it* remains in question.


  • Paraphrased from p.20. Slavoj Zizek. First as tragedy, then as farce. Verso, London and New York, 2009.