In early December 2018, tenants at Stonybrook Village, along with organizers from Boston DSA, assembled for the first official meeting of their tenants’ union. At that first meeting, crowded into the living room of a first-floor apartment, members discussed housing issues they had previously endured alone. Rising rents were certainly a concern for residents of the sprawling Hyde Park apartment complex, but even more pressing was the mold growing in their bathrooms, poorly sealed doors and windows letting in frigid winter air, and air vents that, having been left neglected for years, circulated dirty air that exacerbated the respiratory issues many tenants already suffered. This point was driven home during the meeting, when one organizer suffered an asthma attack caused by mold in the apartment—mold the landlord had chosen to paint over rather than eradicate. One thing that’s become abundantly clear in our organizing at Stonybrook Village is that, thanks to capitalist indifference, people’s homes often fail to serve as sites of rest and recuperation and instead do serious harm to their inhabitants’ health.
Marxist analysis of the social and political causes of illness
This is not a new observation. Marxist analysis of deleterious housing conditions dates back to Friedrich Engels. In 1842, Engels moved to Manchester to manage his father’s cotton-spinning factory. Through his relationship to Mary Burns, a working-class Irish radical, he spoke with workers and identified the roots of endemic illness and early death in economic production and in the social environment. British capitalism, Engels argued in The Condition of the Working Class in England (1845), forced working-class people to live and work under circumstances that inevitably made them sick. In particular, he linked poorly ventilated housing in working-class districts to dramatically increased transmission and subsequent death rates from infectious diseases like smallpox, measles and whooping cough.
The connection between housing and poor health has remained a major theme in Marxist discourse ever since. In La Realidad Medico-Social Chilena (1939), Chilean socialist Salvador Allende reaffirmed the social origins of ill health and again identified housing as a critical factor. Chile had some of the densest conditions in the world, and overcrowding fostered the spread of infectious diseases. Allende cited data that showed an association between population density and overall mortality. As he put it:
“The individual in society is not an abstract entity; one is born, develops, lives, works, reproduces, falls ill, and dies in strict subjection to the surrounding environment, whose different modalities create diverse modes of reaction, in the face of the etiologic agents of disease. This material environment is determined by wages, nutrition, housing, clothing, culture, and additional concrete and historical factors.”
In Boston and elsewhere, poor housing acts as structural violence
The conditions in which people live and work are no accident. They are acts of structural violence that landlords inflict to extract as much profit as possible from tenants. The real cost of mold and bad air quality is far greater than the price of bare-minimum building maintenance. Its cost is realized in a lifetime of respiratory issues and other chronic health conditions. But these costs never come to visit the landlords (who, in the case of Stonybrook Village, are billionaires living in one of Manhattan’s most expensive penthouses). They accumulate wealth by imposing these costs on others, and especially by inflicting them on the most exploited and marginalized among us. A tenant at Stonybrook put it best at our last meeting: “They think they can get away with it because we are immigrants, and because we are people of color, and they think that we can’t defend ourselves. That’s why they think they can exploit us.”
The extraction of higher and higher rents also naturally affects people’s ability to look after themselves. A tenant at an apartment complex in Mattapan, where Boston DSA is organizing a second tenants’ union, explained that skyrocketing rent has led her to start rationing her insulin. These examples are not isolated: The structural racism and violence of housing is borne out in disease data. Rates of respiratory infections, asthma, and injuries are markedly higher in poor neighborhoods and in communities of color. A 2012 report from the National Center for Health Statistics described a 75% higher death rate from asthma (per 1000 people) among black people compared to white, and a 53% higher prevalence of asthma among people with incomes below the poverty level than those with incomes at least 200% of the poverty level.
Toward healthy living conditions for all
While contemporary public health literature echoes the findings of early Marxist analyses, it generally dilutes or disregards their revolutionary origins and implications. The rise of genetic medicine, for example, over-emphasises the genetic factors in disease and thereby shifts attention away from social and environmental causes. A stark example of this phenomenon in Boston is the one hundred million dollar investment by the Koch brothers in the Koch Institute at MIT, which studies molecular causes of cancer and effectively de-emphasizes environmental causes, such as carcinogenic contamination of air and water. Koch Industries is among the largest producers of these toxins: A 2018 study by the University of Massachusetts found they are the only US company ranked in the top twenty global sources of air and water pollution and greenhouse gases.
Emphasis on healthcare can also obscure the health effects of the capitalist mode of production—particularly those developed within the constructed environments of our homes and workplaces. While access to healthcare is, of course, critical, compelling evidence from the Oregon Experiment (in which Medicaid was expanded by random lottery and researchers followed lottery “losers” and “winners”) suggests that health insurance mainly protects against medical debt, rather than making people physically healthier. The push for Medicare for All is therefore a reform that will likely benefit the economic interests of the working class and help alleviate the devastating consequences of healthcare costs here in the US. However, to build a society where everyone is free from the slow violence of toxic living and working conditions, socialists must emphasise that healthy living goes beyond healthcare, and that we need an economic system capable of providing clean, healthy, and comfortable environments for all.