The polycrisis of capital and the challenges for health systems in Latin America

a contribution from the social determination perspective of political economy critique.

Abstract

The world is going through turbulent times, which Marxist authors call the polycrisis of capital. This crisis expresses the confluence and intertwining of several crises when analyzed within the totality of the capitalist crisis: economic (inflation and depression), ecological (climate and pandemic), geopolitical (war and international divisions), and political with the rise of neofascism and attacks on the modern republican form of the capitalist state. In this context, we are witnessing the intensification of health inequalities, which is imposing constraints on health systems in Latin America, especially the Unified Health System (SUS). From a perspective of the critique of the political economy of health, highlighting the importance of the category of social determination of the health-disease process, we argue that the ongoing polycrisis has profound implications for global public health, shaping health inequalities now and for future generations, as well as for health systems, mainly in Latin America and, in particular, in Brazil. Thus, the objective of this work is to analyze the main characteristics of the polycrisis of capital and its implications for health systems in Latin America, with a particular focus on the Brazilian Unified Health System (SUS), based on the important category of social determination and Marx's critique of political economy. The work is organized into three parts. The first part presents general characteristics of the polycrisis of capital, with the intention of clarifying its relationship with the capitalist state – the 'state-form' – which stimulates the rise of extreme violence and increased health inequalities. The second part deals with the more general foundations of Marx's political theory, implicit in his critique of political economy and the category of social determination, which contribute to commenting on the capitalist state, or rather, the state-form that derives from the value-form. The third part analyzes the general effects of the polycrisis of capital on health systems in Latin America, with a special focus on the SUS. In the 21st century, humanity and the planet are facing a serious polycrisis of capitalism, which has been ongoing for some time and indicates that it is far from over. From a theoretical standpoint regarding the understanding of the capitalist crisis, it is interesting to highlight that, in the three volumes of Marx's *Capital*, an articulated and complete theory of crises is developed, based on a multidimensional conception of economic crises. Among the different dimensions, it is worth highlighting the factors associated with the "causality" of crises. In this sense, it is possible to understand the law of the tendency of the rate of profit to fall, the cycle of bubbles and panics in the financial market. Thus, the second trend of capitalist accumulation of the last 40 years is contemplated here, explaining its crisis through the vertiginous growth of fictitious capital, in the form of government bonds, shares traded on the secondary market, or as derivatives of all kinds. This multi-crisis and its effects allow us to open a radical critical dialogue about the future of Latin American health systems, their challenges, and the intensification of violence perpetrated by the capitalist state in contemporary capitalism. The policies of permanent austerity throughout the 1990s, 2000s, 2010s, and 2020s—and the growth of the privatization of healthcare in the countries of this continent, especially in Brazil—have transformed the state into a mere enterprise at the service of large capitalists, regardless of the social cost. We are witnessing a continuous process of expropriation of workers' social rights and an intensification of health inequalities, particularly in Brazil, which should be explained as counter-tendencies to the crisis of capital—its polycrisis—led by the anomic violence of the State and understood as a moment of capital movement. In this way, the State, as a ‘state-form’, guarantees its contribution to confronting and intensifying the super-exploitation of the working class and the health conditions of this class. We understand that our reflection must be firmly grounded in the idea that capital is a social relation of domination (power) and exploitation between human beings, a complex process that materializes as the politics of capital and the State. In reality, the essence of the capital process is truly in tune with the the logic of value, or, in very precise terms, the ‘value-form’. From this perspective, it is impossible to understand the State without a real understanding of the ‘State-form’, linked to the totality of the movement of capital. In this context of polycrisis, we witness the ‘State-form’, in line with the movement of capital, intensifying the significant reduction of social and health rights of the working class. Here too, we cannot forget that the way of life of capital is rational and operates within an imperial logic, in the ‘Empire-form’, a higher level of the State-form, derived from its ‘value-form’. Thus, in this context of capitalism in crisis, a situation arises of a diminished role of the State as a space of social cohesion guaranteed by a supreme authority, with greater emphasis on the verticality of power, highlighting the monopoly of legitimate physical violence and the adoption of counter-reforms that ensure the participation of private initiative in the State and openness to the privatization process, on the one hand, and, on the other, the excess of coercive and controlling power over the working class, with a notable rise of neo-fascism.