Determinantes sociales de la salud y el pensamiento de Lukács: una contribución

uma contribuição

Resumen

The approach of the social determination of health, based on the Marxist framework, has significant implications for understanding the health-disease-care process. The aim of this paper is to present some theoretical elements of György Lukács’s thought that may contribute to this reflection. Lukács’s project sought to promote the revival of Marxism, grounded in Marx’s writings, after the reductionist distortions of certain strands of Marxism. Karl Marx established a social theory aimed at analyzing the structure and dynamics of the capitalist mode of production, structured around three central pillars—capital, labor, and the state—and governed by a permanent process of capital valorization through the production of commodities. It is a revolutionary praxis, a theoretical-practical activity aimed at transforming social reality and overcoming the oppression and exploitation resulting from the dynamics of capital. Lukács maintains that human beings emerge from a historical process in which the inorganic gave rise to the organic, and the organic to the human species, so that the social being depends both on organic and inorganic nature. Biological reproduction is the ontological foundation of the various vital manifestations of human individuals, in such a way that the former can occur without the latter, whereas the reverse is impossible. Labor occupies a central role in this process, as it marks the ontological leap from organic being to social being, through the exercise of a specifically human vital activity, which establishes a metabolism with nature to produce the goods necessary to meet human needs. A “removal of natural barriers” occurs, so that the human species does not establish an immediate relationship with organic nature, nor even with itself as a biological being, but through a system of social mediations that displaces human reproduction from mere biological reproduction. Labor has ontological priority over all other social practices, insofar as it is through labor that human beings produce the material conditions for their individual and collective reproduction, and therefore for the performance of the totality of their activities. The human species is characterized by three fundamental ontological complexes—the natural, the social, and the historical—integrating a totality in which they are interrelated. Humans are natural beings, that is, corporeal, objective, and active. They are corporeal because endowed with vital capacities, objectively externalizing themselves in the world as these capacities are developed and exercised. They are objective because they depend on external objects while being independent of them, which are essential for the realization of their existence. They are active because they realize themselves both objectively and subjectively through their actions, particularly the exercise of their vital activity. Humans are social beings, constituted by social relations in which society produces individuals, and individuals create society. They are historical beings, encompassing a natural and social history that are mutually subordinated, in a process where human relations with nature and with each other are mutually conditioned. To understand society, Lukács works with the categories of totality and mediation. He conceives human reality as a concrete totality composed of a “complex of complexes,” encompassing various spheres of human practice, such as the economy and politics. It is a social totality where multiple interactions occur through a system of dynamic mediations between various partial complexes and between these and the total complex, with each complex operating with its own organization and functioning to satisfy specific needs. This reality is realized in a historical-social process, in which partial complexes and the social totality are continuously reproduced and transformed, resulting from their contradictory dynamics. However, the totality assumes a predominant moment that drives a particular general movement of the whole, while maintaining the relative autonomy of the partial complexes. In the process of social reproduction, the ontological priority of the economy must be highlighted, upon which, on the one hand, the various complexes are based and, on the other hand, react to its influences, considering that without material production the physical reproduction of human beings and society as a whole is impossible. From a methodological point of view, it should be emphasized that Marx adopts an ontological approach to the object and subject that precedes epistemological treatment, providing the foundation for the problematics of knowledge production. The capacity to think is a property of human individuals as active beings, confirmed in their activity and their knowledge of the world. In the activity of thought, the theoretical reproduction of the object’s internal structure and dynamics takes place. Human relations with objects are practical in nature, so that the subject-object complex is understood as sensory activity. Through the mediation of practice, subjective interiority—the ideal activity aimed at establishing goals—and objective exteriority—the real activity of shaping objects—are fused as necessary moments of social being. The criterion of truth is ontopractical, as it is in practice that human beings demonstrate the reality of their thought. Lukács's elaborations can contribute to a deeper understanding of the social determinants of health in three fundamental aspects. First, the view of the human species as natural, social, and historical, such that the biological being ontologically presupposes the social being, and human reproduction constitutes a dialectical unity of biological and social reproduction, realized through a set of social mediations between these two poles. Second, the ontological priority of labor within human practices, due to its centrality in producing the material conditions for human reproduction, emphasizing the precedence of the economy over other complexes. Third, the conception of human reality as composed of multiple complexes, including health, establishing a system of mediations between this complex and other specific complexes, particularly with the economy, and between health and the social totality, impacting living conditions and enabling both collective and individual reproduction.