Blog: Reflections on the Occupy Movement

When the “Occupy Wall Street” protests first erupted in the autumn of 2011, few could have foreseen how rapidly the movement would at first swell, and then spread, over the face of the nation.  Similarly, of course, few predicted that the abuse of a street vendor in Tunisia would spark a wave of uprisings throughout the Arab world.  But such is the unpredictability of the politics of protest, particularly when the seeds of discontent are already deeply sown.

As we proceed through another new year, and indeed an election year, the meaning and the trajectory of the “Occupy Movement” remains as uncertain, and as controversial, as ever.  As concerned citizens and medical professionals, many of us lean one way or the other in our opinions of the movement.  It would, however, also be worthwhile to inquire as to whether there is anything in the movement’s principles which intersects with the concerns of American medicine in a more general and theoretical sense.  It is my argument here that this is indeed the case, and separate from our opinions on the movement’s  methods or specific arguments, we should be cognizant of its implications for our profession, and more importantly to understand why it is supported  by some of our colleagues, and by so many of our patients.

To begin, we should start with what is perhaps the primary concern of the Occupy Movement, the increasing influence of corporate money on the functioning of American democracy.  “No true democracy is attainable,” states the Declaration of the Occupation of New York City, “when the process is determined by economic power.”  Some of the rage is, of course, directed at the manner in which massive public moneys were indiscriminately utilized in the bailout of major banks and insurance companies in the fallout of the economic crash of 2008.  However, the concerns of the occupiers are far broader.  The Supreme Court’s decision in Citizens United v. FEC, which allows for the unlimited expenditure of corporate money in political campaigns, in this well-supported reading is merely another step in the dangerous path towards a money-dominated democracy.[1]

It would be fair to conclude that this is one area in which a primary plank of the occupy movement overlaps with a major concern of our profession, insofar as it leads us to ask: whose interests’ are primary in the formulation of healthcare policy?  Nearly all, of course, would respond that healthcare reform legislation must, in the final analysis, be undertaken out of concern with the welfare of patients.  However, it is only with great naïveté that we can overlook the role of corporate interests in the healthcare policy-making process, and the manner in which such intervention can have consequences contrary to the interests of our patients.  The results are often tangible and obvious, for instance with the decision to prevent Medicare from directly negotiating with pharmaceutical companies in the purchase of prescription drugs, or with the unnecessarily generous patent allowances given to the makers of biologic agents.  There is also no mistaking the role that such influences have in structuring the overall contours of the health care debate.  The rapid demise of the “public option,” for instance, or for that matter the exclusion of any discussion of a single-payer plan in the early days of the healthcare reform debate, are in part the result of such influences, particularly in light of the popularity of these ideas among the general populace.[2]

Second, however, we should also consider the broader concerns of the Occupy Movement, namely the consequences of rising inequality on our society.  In this instance the overlap of the concerns of the movement with those of our profession are only more evident.  From at least the early nineteenth century, studies have explored the association between economic class and disease.   Since then, of course, the medical literature on health disparities, whether those of race, socioeconomic class, or gender, has simply exploded in quality and quantity.[3]  We now even have data from randomized studies demonstrating the effect of the socioeconomic environment on specific diseases.[4]  At the same time, however, we live in an epoch which has witnessed a historic surge in economic inequality.   There is simply no way to square these facts without concluding that, at the very least, social and economic inequality is a concern shared by our profession with the Occupy Movement.

Further examples abound.  Instances of corporate malfeasance resulting in public health catastrophes are well-documented.  The potential public health effects of climate-change are doubted by few.  The impact of a lack health insurance on health outcomes, and indeed on mortality, is yet another well-studied phenomenon.[5]  In short, the medical community has demonstrated, with a great degree of rigor, the various determinants of health that extend beyond the strictly biologic.  Yet, it might fairly be asked, what is the use of such data if not carried into the realm of action, of policy and of politics?

The “Occupy Movement,” although without a clearly enumerated series of grievances or demands, has at its core some of the following concerns: the weakening of the democratic process in the face of increasingly influential corporate interests; environmental degradation; rising inequality, whether social, economic, or political; the use of torture; and the provocation of unnecessary wars.  A strong case can be made for the deleterious effects on health of each of these core concerns.  It is therefore only reasonable to point out, again, the convergence of concerns between the movement and medical professionals.

We may not all want, or be willing, to join the protestors in the respective Liberty Plaza’s of our cities or towns, but at the very least it would only be fair to admit the basis of evidence upon which their concerns lie.  “An action,” wrote Ralph Waldo Emerson, “is the perfection and publication of thought.”  Is it time, we might add, that we thought to follow through with the implications of our publications, to action?

[1] Dworkin R. The decision that threatens democracy. The New York Review of Books. May 13, 2010.

[2] Blendon RJ and Benson JM.  Understanding how Americans view health care reform.  N Engl J Med 2009;361(9):e13.

[3] On the issue of racial disparities, see: Smedly BD, Stith AY, Nelson AR, eds.  Unequal treatment: confronting racial and ethnic disparities in health care.  Washington, DC: National Academies Press, 2003.

[4] Ludwig J, Sanbonmatsu L, Gennetian L, et al.  Neighborhoods, obesity, and diabetes – a randomized social experiment.  N Engl J Med 2011;365:1509-19.

[5] Wilper AP, Woolhandler S, Lasser KE, McCormick D, Bor DH, Himmelstein DU.  Health insurance and mortality in US adults.  Am J Public Health 2009 Dec;99(12):2289-95.