Health as autonomy

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It is more important to know what sort of person has a disease than to know what sort of disease a person has.

Hippocrates

I believe it is time to state clearly that specific situations and circumstances are sickening, rather than that people are sick. The symptoms which modern medicine attempts to treat often have little to do with the condition of our bodies; they are, rather, signals pointing to the disorders and presumptions of modern ways of working, playing and living.

Ivan Illich

The government of Mariano Rajoy made law, on the 20th of April, the exclusion of all residents in spain without citizenship or proper documentation from the country’s public health care system.  The public justification was austerity, an austerity necessary to defend a good that should be the exclusive privilege of the properly spanish.  The underlying argumentation was racist.  The intimate relation of the welfare state, the supposed embodiment of the realisation of social rights, with nationalism was in this way exposed; an intimacy that was in fact present from its beginnings.  Today, europe’s “extreme” right finds company among social democrats.

If the new law has left close to a million people without health care, it itself comes in the wake of severe budget cuts to public health, paralleled by extensive privatisations of health centres, hospitals and support services.  The medical apartheid that the government has introduced thereby helps to cover over the dismantling and selling off of public wealth.  The illegal immigrant is held up scapegoat, while the good spaniard is fleeced.

 The resistance to these measures in spain have been impressive.  Protests by health care workers against budget restrictions and privatisation have been numerous, and this outside of the frame of the official labour unions and organisation of the professions involved (e.g. the marea blanca).  More significantly, many medical professionals have simply refused to obey the new, and in acts of widespread civil disobedience continue to treat those in need.  (e.g. Yo Sí, Sanidad Universal).

Yet beyond civil disobedience lie more profound questions about the welfare state, the relation of the nation state and human well being and health itself.  In Barcelona, in the neighbourhood of Raval, a collective of doctors, nurses and activists, under the name of Espacio del Inmigrante, have tried to create an alternative health service.  Unable to ignore completely the state’s public services, they nevertheless offer first aid services, freely.  This is complimented by legal counselling, accompaniment to existing health centres and hospitals, and other activities (e.g. a food kitchen, workshops and lectures, protests, etc.).

Working through the 15M inspired neighbourhood assembly of Raval, in an occupied building, the project is essentially political. 

“What we’ve been talking about until now is a social health intervention, with a set of technical tasks carried out by professionals we work with.  But there is another dimension, a social one, which consists of weaving a social fabric and a network of common people who are marginalised or excluded.  With humility, we try to align ourselves in this task with the autonomy of the Zapatistas. … Beyond abolishing apartheid in the health care system, our ultimate goal is to generate autonomous processes among the people affected by this situation, processes of empowerment, so that it it’s not just us doing this all the time. …What we want to do is remove barriers to solidarity, such as fear, and strengthen the links between equals.” (Roarmag)

Health and health care are thus conceived as something that may be autonomously self-managed.  Freed from technocratic control, as well as from national political sovereignty, health is placed within, and is central to, a politics of freedom.  In such a process, the very nature of health becomes political.

“Heath, whether public or private, is an institution that is based on medicine conceived of as scientific and technological.  It tends to see the body and mind as two more machines, susceptible to repairs using other non-human machines, or specific medication.  Such a conception feeds the enormous medical and pharmaceutical industry, for decades now transformed into a highly lucrative business, for the benefit of a few.  Health also presupposes the specialization and compartementalisation of medical knowledge, increasingly less accessible to “the patients”, whose knowledge of their own bodies and minds and health is ever poorer; patients are thus delegated to the experts.” (Política a largo plazo).

The politics of autonomy is also a politics of appropriation of our being as living creatures; a re-appropriation of our bios, and finding/making from within life, a free way of being in the world.    

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