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<p class="m_535924193500748062gmail-BodyA" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria;color:black;border:medium none"><b><span style="font-family:Arial"><font size="1">Sent as a letter to The Lancet, but got no response.     Claudio</font><br></span></b></p><p class="m_535924193500748062gmail-BodyA" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria;color:black;border:medium none"><b><span style="font-family:Arial">Moving Beyond Capitalism for Our
Health</span></b><b><span style="font-family:Arial"><span></span></span></b></p>

<p class="m_535924193500748062gmail-BodyA" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria;color:black;border:medium none"><b><span style="font-family:Arial"><span> </span></span></b></p>

<p class="m_535924193500748062gmail-BodyA" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria;color:black;border:medium none"><span style="font-family:Arial"><span>            </span></span><span style="font-family:Arial" lang="DE">Richard Horton</span><span style="font-family:Arial">’s ‘offline’ articles capture the
essence of why capitalism continues to hinder equitable health access and
outcomes worldwide. His piece ‘Medicine and Marx’ centers on Marx’s visionary
explanation of the key problems of capitalism that continue to afflict today’s
public health.</span><a href="#m_535924193500748062__edn1" name="m_535924193500748062__ednref1" title="">^{<span style="font-family:Arial"><span>^{<span style="font-size:12pt;font-family:Arial;color:black;border:medium none">[1]</span>}</span></span>}</a><span style="font-family:Arial"> Fittingly,
among other sources, Horton </span><span style="font-family:Arial" lang="IT">quote</span><span style="font-family:Arial">s from Howard
Waitzkin’</span><span style="font-family:Arial" lang="FR">s 1978 </span><span style="font-family:Arial">article in the <i>Annals of
Internal Medicine, ‘</i>A Marxist View of Medical Care’: “The Marxist viewpoint
questions whether major improvements in the health system can occur without
fundamental changes in the broad social order.”</span><a href="#m_535924193500748062__edn2" name="m_535924193500748062__ednref2" title="">^{<span style="font-family:Arial"><span>^{<span style="font-size:12pt;font-family:Arial;color:black;border:medium none">[2]</span>}</span></span>}</a><span style="font-family:Arial"> Horton concludes,
“…we might agree that medicine has a great deal to learn from Marx.”¹
</span><span style="font-family:Arial"><span></span></span></p>

<p class="m_535924193500748062gmail-BodyA" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria;color:black;border:medium none"><span style="font-family:Arial"><span>            </span>Horton
also </span><span style="font-family:Arial">reminds
his readers of another great theorist and revolutionary in the Marxist
tradition, Rosa Luxemburg.</span><a href="#m_535924193500748062__edn3" name="m_535924193500748062__ednref3" title="">^{<span style="font-family:Arial"><span>^{<span style="font-size:12pt;font-family:Arial;color:black;border:medium none">[3]</span>}</span></span>}</a><span style="font-family:Arial"> Murdered a
century ago, Luxemburg focused on the accumulation of capital and on capitalist
imperialism as fundamental problems that called for revolutionary
transformation. Considering Luxemburg’s theses relevance to medicine, Horton
describes key work by my colleagues in the People’s Health Movement (PHM), i.e.,
work by Amit Sengupta, Chiara Bodini, and Sebastian Franco (‘<i>The Struggle
for Health’</i>), that emphasizes the deepening threats to health brought about
by contemporary global capitalism.</span><a href="#m_535924193500748062__edn4" name="m_535924193500748062__ednref4" title="">^{<span style="font-family:Arial"><span>^{<span style="font-size:12pt;font-family:Arial;color:black;border:medium none">[4]</span>}</span></span>}</a><span style="font-family:Arial"> Sengupta
died on Nov 28, 2018, in a tragic drowning accident.</span><a href="#m_535924193500748062__edn5" name="m_535924193500748062__ednref5" title="">^{<span style="font-family:Arial"><span>^{<span style="font-size:12pt;font-family:Arial;color:black;border:medium none">[5]</span>}</span></span>}</a><span style="font-family:Arial"> To honor
Amit’s memory, I focus this brief article on ‘moving beyond capitalism for our
health’.</span><span style="font-family:Arial"><span></span></span></p>

<p class="m_535924193500748062gmail-BodyA" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria;color:black;border:medium none"><span style="font-family:Arial"><span>            </span>The
transformation that this move requires is powerfully portrayed in Howard
Waitzkin and the Working Group on Health Beyond Capitalism</span><span style="font-family:Arial">’s new book
that points to capitalism as the central threat to the health of people
worldwide. Consequently, it identifies moving beyond capitalism as the only
long-term solution.</span><a href="#m_535924193500748062__edn6" name="m_535924193500748062__ednref6" title="">^{<span style="font-family:Arial"><span>^{<span style="font-size:12pt;font-family:Arial;color:black;border:medium none">[6]</span>}</span></span>}</a><span style="font-family:Arial"> The book
rightfully argues that we can no longer defer the urgently needed
transformation of global capitalism until future generations; humanity and
other life forms depend on our embracing the needed revolutionary changes --here
and now.</span><span style="font-family:Arial"><span></span></span></p>

<p class="m_535924193500748062gmail-Default" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><span style="font-size:12pt;line-height:200%;font-family:Arial"><span>            </span>The book</span><span style="font-size:12pt;line-height:200%;font-family:Arial">’s subtitle, ‘Moving Beyond Capitalism for Our Health’,</span><span style="font-size:12pt;line-height:200%;font-family:Arial"> <span lang="FR">points to the authors’
intention </span></span><span style="font-size:12pt;line-height:200%;font-family:Arial">to clarify the true determinants
of preventable ill-health and early deaths ultimately due to the prevailing
global political-economic system. Moving beyond capitalism also points toward a
roadmap to transform this system --and in this aim the book fully delivers. The
struggle that the book calls for was embraced by Sengupta and has, for years,
been at the core of PHM’s and other social movements’ struggle. This moment of
our planet’s history deserves no less.</span><span style="font-size:12pt;line-height:200%;font-family:Arial"><span></span></span></p>

<p class="m_535924193500748062gmail-Default" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><span style="font-size:12pt;line-height:200%;font-family:Arial"><span>            </span>Smoothly written and provocative,
the book contains no caricatures, no stereotypes. Even though the book</span><span style="font-size:12pt;line-height:200%;font-family:Arial" lang="PT"> expos</span><span style="font-size:12pt;line-height:200%;font-family:Arial">es
the troubling guts of neoliberalism and how it affects health globally, the
writing is not depressing. It walks the reader through the complex geopolitical
and economic challenges we face and does so with informative and engaging
prose. I do not know any analysis that better explains the ravages of
capitalism on health and health services; it complements the views expressed in
Horton’s pieces.</span><span style="font-size:12pt;line-height:200%;font-family:Arial"><span></span></span></p>

<p class="m_535924193500748062gmail-Default" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><span style="font-size:12pt;line-height:200%;font-family:Arial"><span>            </span>The </span><span style="font-size:12pt;line-height:200%;font-family:Arial">book’s
optimistic closing is welcome. Let me give you a flavor here. </span><span style="font-size:12pt;line-height:200%;font-family:Arial"><span></span></span></p>

<p class="m_535924193500748062gmail-Default" style="margin:0in 0in 0.0001pt 39.25pt;line-height:200%;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><span style="font-size:12pt;line-height:200%;font-family:Arial">“We recognize”, it says “… that we hold no corner on a strategic
truth.… Still, we see four main priorities for action”, namely:</span><span style="font-size:12pt;line-height:200%;font-family:Arial"><span></span></span></p>

<p class="m_535924193500748062gmail-Default" style="margin:0in 0in 0.0001pt 57.25pt;line-height:200%;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><span style="font-size:12pt;line-height:200%;font-family:Symbol"><span>·<span style="font:7pt "Times New Roman"">     
</span></span></span><span style="font-size:12pt;line-height:200%;font-family:Arial">Fostering a sustained,
broad-based movement for single-payer national health programs that reduces the
role of corporations and private profit. <span></span></span></p>

<p class="m_535924193500748062gmail-Default" style="margin:0in 0in 0.0001pt 57.25pt;line-height:200%;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><span style="font-size:12pt;line-height:200%;font-family:Symbol"><span>·<span style="font:7pt "Times New Roman"">     
</span></span></span><span style="font-size:12pt;line-height:200%;font-family:Arial">Working towards an activated
labor movement that includes health professionals such as physicians whose
deteriorated social-class position and a proletarianized condition of their
medical practice have made them ripe for activism and change. <span></span></span></p>

<p class="m_535924193500748062gmail-Default" style="margin:0in 0in 0.0001pt 57.25pt;line-height:200%;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><span style="font-size:12pt;line-height:200%;font-family:Symbol"><span>·<span style="font:7pt "Times New Roman"">     
</span></span></span><span style="font-size:12pt;line-height:200%;font-family:Arial">Calling for greater
emphasis on communal organizations that participate in the revolutionary
process of moving ‘beyond capital’.<span></span></span></p>

<p class="m_535924193500748062gmail-Default" style="margin:0in 0in 0.0001pt 57.25pt;line-height:200%;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><span style="font-size:12pt;line-height:200%;font-family:Symbol"><span>·<span style="font:7pt "Times New Roman"">     
</span></span></span><span style="font-size:12pt;line-height:200%;font-family:Arial">Promoting the
understanding that the importance of party building goes far beyond electoral
campaigns to more fundamental social transformation. <span></span></span></p><span style="font-size:12pt;line-height:200%;font-family:Arial">All these priorities emphasize the urgency of creating
bridges that link health activism with social movements that focus on
social-class oppression including poverty and inequality, racism, sexism,
environmental degradation, militarism and imperialism, as well as the dominant
ideologies that lead women and men to accept pathological social conditions as
being ‘normal’. </span><span style="font-size:12pt;line-height:200%;font-family:Arial"><span></span></span>

<p class="m_535924193500748062gmail-Default" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><span style="font-size:12pt;line-height:200%;font-family:Arial">Before
us is a path to revolutionary transformation of the social conditions that
distort our best efforts in medicine and public health. This vision reinforces
Sengupta’s and many others’ understanding that PHM and similar social movements
worldwide must now move beyond capitalism to achieve health.</span><span style="font-size:12pt;line-height:200%;font-family:Arial"><span></span></span></p>

<p class="m_535924193500748062gmail-BodyA" style="margin:0in 0in 0.0001pt 1in;line-height:200%;font-size:12pt;font-family:Cambria;color:black;border:medium none"><i><span style="font-family:Arial">Claudio
Schuftan</span></i><i><span style="font-family:Arial"><span></span></span></i></p>

<p class="m_535924193500748062gmail-BodyA" style="margin:0in 0in 0.0001pt 1in;line-height:200%;font-size:12pt;font-family:Cambria;color:black;border:medium none"><i><span style="font-family:Arial"><a href="mailto:cschuftan@phmovement.org" target="_blank">cschuftan@phmovement.org</a></span></i><span></span></p>

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<p class="m_535924193500748062gmail-Footnote" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><a href="#m_535924193500748062__ednref1" name="m_535924193500748062__edn1" title=""><span style="font-family:Arial"><span><span style="font-size:11pt;font-family:Arial;color:black;border:medium none">[1]</span></span></span></a><span>    </span>Horton R. Medicine and Marx. <i>Lancet </i>2017;
<b>390:</b> 2026.<span></span></p>

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<div id="m_535924193500748062edn2">

<p class="m_535924193500748062gmail-Footnote" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><a href="#m_535924193500748062__ednref2" name="m_535924193500748062__edn2" title=""><span style="font-family:Arial"><span><span style="font-size:11pt;font-family:Arial;color:black;border:medium none">[2]</span></span></span></a> <span>   </span>Waitzkin H. A Marxist view of medical care. <i>Ann
Intern Med</i> 1978;<b> 89: </b>264-78.<span></span></p>

</div>

<div id="m_535924193500748062edn3">

<p class="m_535924193500748062gmail-Footnote" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><a href="#m_535924193500748062__ednref3" name="m_535924193500748062__edn3" title=""><span style="font-family:Arial"><span><span style="font-size:11pt;font-family:Arial;color:black;border:medium none">[3]</span></span></span></a><span>    </span>Horton R. Rosa Luxemburg and the struggle
for health. <i>Lancet</i> 2019; <b>393: </b>114.<span></span></p>

</div>

<div id="m_535924193500748062edn4">

<p class="m_535924193500748062gmail-Footnote" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><a href="#m_535924193500748062__ednref4" name="m_535924193500748062__edn4" title=""><span style="font-family:Arial"><span><span style="font-size:11pt;font-family:Arial;color:black;border:medium none">[4]</span></span></span></a><span>    </span>Sengupta A, Bodini C, Franco S. The struggle
for health: an emancipatory approach in the era of neoliberal globalization.
Brussels: Roxa-Luxemburg-Stiftung, 2018.<span></span></p>

</div>

<div id="m_535924193500748062edn5">

<p class="m_535924193500748062gmail-Footnote" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><a href="#m_535924193500748062__ednref5" name="m_535924193500748062__edn5" title=""><span style="font-family:Arial"><span><span style="font-size:11pt;font-family:Arial;color:black;border:medium none">[5]</span></span></span></a><span>    </span>Green A. Amit Sengupta. <i>Lancet</i> 2019; <b>393:
</b>24.<span></span></p>

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<div id="m_535924193500748062edn6">

<p class="m_535924193500748062gmail-Footnote" style="line-height:200%;margin:0in 0in 0.0001pt;font-size:11pt;font-family:"Helvetica Neue";color:black;border:medium none"><a href="#m_535924193500748062__ednref6" name="m_535924193500748062__edn6" title=""><span style="font-family:Arial"><span><span style="font-size:11pt;font-family:Arial;color:black;border:medium none">[6]</span></span></span></a><span>    </span>Waitzkin H and the Working Group on Health
Beyond Capitalism. <i>Health Care Under the Knife: Moving Beyond Capitalism for
Our Health. </i>New York: Monthly Review Press, 2018.<span></span></p>

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