Health Communism
Health Communism
Beatrice Adler-Bolton and Artie Vierkant
Verso Books
2022
9781839765162
The NHS is there for most of us, most of the time. Or at least it has been. And despite its many shortcomings most of us are happy that it exists. But after decades of austerity, privatisation and now the pressure of the neverending pandemic the NHS is fast breaking down. Staff are quitting in droves due to being overworked and underpaid. In retaliation, we are seeing the largest NHS workers’ strikes in its history. The outcome might well dictate to what extent the NHS, as we know it, survives. The wider left, for the most part, is disengaged.
Both the Tories and Labour are using this crisis as an opportunity to advance further privatisation. Just as many of us cannot find an NHS dentist anymore, many are struggling to find the medical care they require on the NHS. Although, many have long been abandoned by the NHS, such as trans people, racialised immigrants, those who are chronically sick or mentally ill, and neurodivergent people. Those with the means to do so are already opting out, as British healthcare further devolves into a two-tier system, with its concomitant deleterious effects on the public healthcare system. As we watch loved ones die, as we agonise over the waiting times for ambulances, as we are all denied the care we all deserve, we have to go beyond saving the NHS, beyond reforming it, beyond even just revolutionising the NHS. Instead, we must entirely reimagine and rebuild what is meant by health and care.
Beatrice Adler-Bolton and Artie Vierkant argue that capital ‘resides in health, as its host’.[1] Health Communism develops a comprehensive critique of the political economy of health. It does this whilst seamlessly moving through race, class, gender and disability. Health is not commonly imagined as ground for revolutionary struggle. Its radical organising potential is overlooked and instead health is reduced to a technocratic category, whereby ‘health’ is assumed to mean something coherent and obvious. Imagined actions, for a socialist project, are to undo the privatisation of the NHS, invest in healthcare and extend democratic reforms. However, Adler-Bolton and Vierkant contend that we can further, that there is ‘revolutionary potential’ in severing capital from health. As the Sozialistisches Patientenkollektiv (SPK) invoke we can ‘turn illness into a weapon’ and strike at a neglected weakness and sever capital from its host.
Adler-Bolton and Vierkant state that the aim of health communism is ‘all care for all people’[2] and the ‘total reformation of the political economy of health, and in so doing, the total reformation of the political economy’.[3] Health Communism approaches health from the ‘understanding that illness, disability, and debility are driven by the social determinants of health, with capital as the central social determinant’.[4] They don’t conceive of health as an individual pursuit – something an individual impossibly attains – but as a revolutionary collective struggle towards the abolition of the oppressive capitalist state that makes us sick and keeps us alive so long as we are of economic value to capital. They state: ‘health is wielded by capital to cleave apart populations, separating the deserving from the undeserving, the redeemable from the irredeemable, those who would consider themselves “workers” from the vast “surplus” classes’.[5] This book is a call for building revolutionary solidarity across the worker-surplus binary. Health Communism is a foundational text for building such a revolutionary movement. In this review essay I highlight examples from current struggles to give ideas showing where such a revolutionary movement might evolve from.
The ‘Surplus’, The ‘Debt/Eugenic Burden’ and ‘Extractive Abandonment’
To build health communism they state, ‘our political projects must centre the populations capital has marked as “surplus”’,[6] pushing back on the left’s tendency to valorise workers over everyone else. Adler-Bolton and Vierkant define the surplus as: ‘a collective of those who fall outside of the normative principles for which state policies are designed, as well as those who are excluded from the attendant entitlements of capital’.[7] They remark that it is a ‘fluid and uncertifiable population’ and importantly there is nothing inherent in being categorised as surplus: ‘vulnerability is instead constructed by the operations of the capitalist state.’ As such it goes far beyond what Marx and Engels identify as the surplus population. Their expansive definition of ‘surplus’ forces us to consider all those who suffer from the state’s processes of organised abandonment. This analytical distinction of the surplus provides the opportunity to build collective struggle across movements. It’s a fluid and complex relational categorisation.
Building on the concept of the surplus, Adler-Bolton and Vierkant introduce the ‘eugenic and debt burden’.[8] The eugenic burden might be framed as a genetic, demographic or social threat. People who exist outside of supposedly healthy, normative subjectivity. The debt burden is posed in terms of the ‘public purse’ where austerity is naturalised and justified through narratives of ‘personal responsibility’ and ‘affordability’. ‘Citizens’ are ideologically trained by the state to ‘surveil and judge others’ worthiness for aid’.[9] This might be translated into popular discourse as to who is really trans, really disabled or really a refugee. Who is deserving of care and who isn’t? Who is ‘faking’ it? Through the ‘debt/eugenic burden’ those who are deemed deviant are cast as irredeemable and considered a drag on humanity. This sometimes shows as arguments about ‘defrauding the ‘taxpaying citizen’ and the state’;[10] the ‘structural flaws of the political economy’ pushed onto the so-called ‘behavioural flaws of the individual’. In this, the deviant surplus is demonised as a malignant risk to the nation’s health.
It leads to cost-benefit calculations performed by health economists and bureaucrats leading to health rationing – parroted by the media, politicians, and in public discourse as ‘common sense’. The consequences are always less care for less people, with more people deemed surplus. Crises are opportunistically used to justify further abandoning the most oppressed. For example, trans people sequestered on endless waiting lists as services remain drastically underfunded, is justified in the name of NHS austerity budgets. In response, gender service clinics have been developed by trans people, such as the Indigo Gender Service in Manchester, which is a non-profit collaboration with the NHS. Mutual-aid groups have been formed like Trans Aid Cymru, who often have to provide the healthcare knowledge that is lacking from the NHS. The burden of advocacy is discussed by Amy Cohn’s ‘Wages for Advocacy’, which highlights the unpaid labour of trans advocates. Jules Gill-Peterson discusses the history of DIY transitions in the US in her piece ‘Doctors Who?’ It shows there is potential in self-organised care and yet there is still a need for specialised services: it’s unlikely someone can perform a hysterectomy at home. There is a need to overcome the current reality that access to medications and equipment is usually controlled and rationed by the state, with access to private care being rationed along class lines.
The pandemic has put neglect of the sick and immunocompromised front and centre leading to decisions that meant 58% of deaths in the first year of the pandemic were disabled people. These deaths, however, were often excused away as ‘natural’. They were seen as born to die early and too expensive to protect, thanks to the logic of the ‘debt/eugenic burden’. As Beauty Dhlamini emphasises, ‘Risk discourse around Covid-19 further normalises ableism’. During the first wave, nearly a third of people – largely, disabled people – admitted to hospital for Covid had, ‘Do Not Attempt Cardiopulmonary Resuscitation’ orders applied to them. The majority of whom, in defiance, ended up surviving their Covid infection.
Health Communism’s forthright argument is that the surplus and workers can unite, break the binary, and in the process undermine capital’s ability to reproduce itself. One opportunity for building such solidarity might come in the form of tenant housing unions. The tyranny of private property and landlords affects workers and surplus alike. Good quality housing is a basic prerequisite for health. Tragically, children are being killed by living in poor conditions inflicted upon them by landlords. Solidarities built in these struggles can be carried over into other struggles.
Building on this is their concept of ‘extractive abandonment’. This is a synthesis of Marta Russell’s ‘money model of disability’ and Ruth Wilson Gilmore’s ‘organised abandonment’. Adler-Bolton and Vierkant define extractive abandonment as: ‘the process by which [surplus populations] are made profitable to capital’.[11] Or as they put it otherwise: ‘In a political economy built on systems of extractive abandonment, the state exists to facilitate a capacity for profit, balanced always against the amount of extractable capital or health of the individual subject’.[12]
The state, through various mechanisms, enforces a process of ‘bio-certification’. The book discusses how eligibility for disability welfare payments are often more about ‘decertifying a body for work’ rather than certifying a body for social supports, which are guarded preciously by the state.[13] A violent system that chronically sick people have been subjected to from the Poor Laws to today’s Universal Credit. Being certified as surplus, and subjected to extractive abandonment, you are a contested site of profit in the form of incarceration, the wellness industry, and the pharmaceutical industry. You are both abandoned by the state and simultaneously captured by private business (which the state facilitates). In this instance, state abandonment facilitates private profits. Loved ones are sent to large private care homes where a profit is made through driving down standards of care as well as worker pay. As the authors remark, the surplus are a site of capital accumulation.[14]
Carceral Care
There are multiple ways the state rations care and humanity. One way this is enforced is through the carceral-sanist state and the threat of institutionalisation. Adler-Bolton and Vierkant state that: ‘carceral sanism is a preference for deprivation in the face of need, for confinement over care, a violent and dispassionate way to enforce social and biological norms.’ Incarceration might take the form of refugee detention camps, prisons, psychiatric hospitals – the state has many carceral forms to apply to those it deems unworthy of humanity and care. A recent example being the awful death of a young autistic woman who was deprived of care and humanity at a psychiatric hospital. Nearly 60% of people in inpatient mental health hospitals are autistic with an average length of stay of more than 5 years.
The Mental Patients’ Union provides an historical example of resistance to carceral-sanism from the 1970s – they sought to overturn the power of psychiatrists. Without any funding, for three years, they provided services including providing a safe space to reside in times of emergency. At one point they ran three houses alongside support by telephone and letter as well as formulating one of the first directories of side effects of psychiatric medication (which were often denied by the psychiatric profession). In doing so they provided an alternative to the option of carceral-sanism which seeks to incarcerate us when we suffer mental health crises, subjecting us to the power of the state through the healthcare profession. Today, there is Stop SIM, who are campaigning to ensure that the police are kept out of community mental health teams in England. Mental illness is not a crime and should not be used as a way to withhold medical care from people in need.
Another example of resistance is the campaigning to close Manston detention camp where people seeking asylum were detained in the most horrendous conditions and subjected to violence. In response to pressure people were moved on, however there are reports of it still being used and the camp hasn’t yet been closed. In December 2022, an Iraqi man died of diphtheria whilst being detained. The struggle to close detention centres and stop deportations is paramount to health justice.
The NHS itself is also a site of border surveillance. For example, in England, care can be withheld from people who have had their asylum claim refused, if it is deemed ‘non-urgent’. Even if the care is urgent, then they may be charged at a later date, and sometimes it might be as much as £100,000 – and inability to pay can result in asylum applications being rejected. Here the doctor is brought into the state’s border surveillance apparatus and the policy is killing people who are too terrified to seek treatment.
Whose NHS?
What role does the NHS specifically play in capital accumulation and the social reproduction of capital in the Global North? For starters, in 2020/21, the English NHS spent £16.7 billion on medicines alone. The NHS is a nexus of profit generation for pharmaceutical and other biomedical companies. On top of this, monopoly capital takes further advantage through price gouging. Medicines are usually researched on their ability to generate profit, meaning some conditions are entirely abandoned. The NHS is not inherently anti-capitalist and treatment is not administered universally. The aim is often to get workers back to work. If that’s unlikely, then you’re unlikely to receive the care you require. This is particularly so if you are in a minority patient category. For example, conditions like Myalgic Encephalitis/Chronic Fatigue Syndrome have been notoriously under-researched and under-treated, with patients left to suffer for decades. NHS workers with Long Covid have experienced this: many, now coming up to three years with the illness, have been abandoned by their employer. As a result, these abandoned populations often have to seek private, often speculative treatments.
Whilst the requirement to modernise and expand health services, in the mid-20th century, arose partly out of social struggle, it also arose from the demands of capital for improved productivity through a healthier workforce.[15] David Stark Murray, ex-president of the Fabian-influenced Socialist Medical Association (SMA), accused Aneurin Bevan of failing to ‘grasp the opportunity to make a complete break with the past.’[16] Bevan relented on more radical demands even though he had been imagined as ‘strong enough to carry through’ radical reform. Vicente Navarro, in Class Struggle, The State and Medicine, concludes that Labour and Bevan strengthened existing class divisions, rather than challenging them. He argues that Labour had no intention of troubling bourgeois control of the health sector. Centrally appointed administrators, not democratically elected workers and patients, were put in control of the health service, leaving it susceptible to the counter-reforms that shortly followed.
The story goes that the British Medical Association and the Royal Colleges held back Bevan’s reforms. That Bevan got the best deal he could. But a persuasive counter-argument is made by Navarro and others that Bevan was taken in by and overly influenced by these powerful interest groups. Even The Economist remarked, in 1945, on how Labour might have gone ‘several steps further’ based upon its parliamentary majority.[17] In 1946, The Lancet noted how the NHS was ‘much less socialistic than was predicted a year ago.’ GP and historian, David Widgery, writing in the 1970s, comments that the formation of the NHS was ‘altogether more modest’ and was an extension of the pre-war liberal trajectory of health care reforms.[18] Medical historian, Brian Abel-Smith, described how ‘The most aristocratic and reactionary bodies had found it easiest to come to terms with “socialism”.’[19] And how the BMA was anticipating to be ‘hung, drawn and quartered,’ and yet on point after point Bevan accepted their demands - another example of how the Labour Party feigns acting as the vanguard, and laps up the applause, while in reality bargaining on behalf of the bourgeoisie in the name of managerialism. But as Navarro points out, this is Labour’s ‘trademark’. What we learn from Navarro, Murray, Widgery and others, is that the Labour Party, at worst checked, and at best failed to realise, the more radical ambitions of the day.
The NHS is often wielded uncritically on the left, reproducing a fetishised, nostalgic notion of its existence. Further, the NHS is intertwined with the left’s nostalgic fetishisation of the Labour tradition and post-war social democracy; Bevan standing over us as a great statue of socialism’s past, as someone we hope to emulate again one day. All of this is understood from an ahistorical, immaterial perspective that erases the way the NHS was birthed through the bloody exploits of the empire. Welfare and warfare coming together. El-Enany highlights how welfare ‘embodied the assertion of white entitlement to the spoils of colonial conquest.’[20] Alfie Hancox provides a devastatingly lucid account of this in his essay, Lieutenants of imperialism: social democracy’s imperialist soul. Reforming the NHS within the confines of methodological nationalism would leave ongoing imperialist exploitation intact. Just as Bevan ignored this when he proclaimed that Attlees’s Britain had ‘assumed the moral leadership of the world’, despite how his government spent several years violently repressing communist and anti-colonial uprisings in some of the bloodiest years of British imperialism. We must, as Shafi and Nagdee demand, ‘refuse the British left’s historical dereliction of duty: its compromise with imperialism and its rejection of radical internationalism.’[21]
Anti-Imperialist Health Communism
What we see with Keir Starmer is no aberration, but a continuation of Labour’s imperialist history. Currently, we see many NHS campaigners and healthcare workers calling for a general election, as a means of saving the NHS. However, Starmer’s Labour, on top of failing to support striking NHS workers, has already signalled they will continue to push a two-tier healthcare system by continuing privatisation, austerity and commitment to providing real terms pay cuts to healthcare workers. Along with a renewed attack on the surplus, by promising to force people into work, rather than providing care. At best, Labour might slow down the decay of the NHS. To build health communism, one that socialises and surpasses the NHS, we must bring together the surplus movements in solidarity with one another.
Adler-Bolton and Vierkant point out, ‘Our responsibilities to collectivity and care do not end at the edge of a map’.[22] The book gives various examples from the supremacy of pharmaceutical companies who rely upon the violent coercion of imperialist power to enforce trade laws, to Israeli settler colonial violence and the withholding of healthcare from Palestinians. The climate crisis, itself, is a health crisis. The simplification of ecosystems is leading to an increasing rate of zoonotic pandemics: destruction driven by the Global North and inflicted worst on the Global South. Covid-19 vaccine apartheid demonstrates this where the majority of people in the world have had a vaccine, except for those on the continent of Africa. This is despite the fact that the AstraZeneca vaccine, for instance, was tested out on Kenyans, yet most Kenyans have not received one dose of the vaccine. This is neocolonial extractive abandonment continuing colonialism.
The struggle for health communism must apprehend the global nature of capital and look to build solidarity with subordinated populations elsewhere. 1948, the year the National Health Service Act came into being, is the same year the HMS Windrush arrived in London. Workers, particularly women, from former British colonies, would form a crucial part of the NHS’ labour force, which remains the case today. What they faced in Britain was racialised exploitation that utilised their labour towards the social reproduction of British workers whilst experiencing widespread and systemic racism. And yet, Richmond and Charnley recall how ‘Black women introduced strike action into the NHS.’[23]
A recent investigation by Nursing Narratives, has detailed that today Black and Brown healthcare workers are still experiencing ‘bullying, exclusion, unfair job allocation, high workload, excessive scrutiny and a lack of support and mentoring at all levels of working life.’ Today, 29% of GPs in the UK have qualified outside of the country. This is a drain on other countries that relies on the push/pull effects of imperialist international relations and acts as a subsidy to Britain as it outsources the need to train medical workers to the Global South.[24] For example, during the height of the Ebola outbreak, 20% of all Sierra Leonean doctors and 10% of nurses were in the UK. Not only a contributing factor to the Ebola crisis in Sierra Leone due to a lack of medical workers, it represented a subsidy to the UK in the region of £14.5-22.4 million. Meanwhile the IMF was enforcing austerity in Sierra Leone, causing them to cut healthcare spending. National redistribution of the spoils of imperialism endure today.
The Rise of the Sick Proletariat
The capitalist political economy will always demand an economic valuation of life. Reformist arguments often accept the terms of the debt/eugenic burden, rather than rejecting them outright. This liberal reflex to fight within the system for greater inclusion, rather than overturning the system itself, is a lesson provided in the form of ACT UP (AIDS Coalition to Unleash Power), which the book covers. ACT UP began as a militant political group taking action to fight the HIV/AIDS epidemic in the late 1980s in New York City. They used direct action to show how many people were being abandoned to die with the condition. They targeted pharmaceutical companies with actions like invading offices and chaining themselves to delivery trucks. They aimed to stoke public outrage at the scale of the social murder by pouring buckets of fake blood in public places, tossing ashes from dead bodies onto the lawn of the White House, holding ‘Die-Ins’ at the Food and Drug Administration and National Institute of Health, and were the first group to infiltrate the New York Stock Exchange. Health Communism recounts their radical organising. However, over time, one of the group’s caucuses, the Treatment and Data Committee, saw the radicalism as a distraction, as the sub-group increasingly gained professional recognition. The reformist desires of the cis, wealthier, white guys, came to dominate. Long story short, the focus became finding a cure for AIDS whilst jettisoning social issues and questions of access to medicine, housing and so on. As Adler-Bolton and Vierkant conclude: ‘The movement for health justice was lost in the fight for the cure’.[25]
The call to revolutionise the political economy of health, is a call to revolutionise the left. To move from imperialist social democracy to a decolonial communism. Breaking with the hegemony of the Labour Party allows the opportunity to rethink the NHS, to rethink health, just as engaging critically with the NHS, from the perspective of health communism, provides an opportunity to weaken the hegemony of Labour and its workerist, racist politics. The myth of the Labour Party is at least in-part entangled with the history of the NHS. The invocation to save the NHS is not dissimilar to the rallying cry to save the Labour Party – but whilst the latter should be left to rot, the former shouldn’t be abandoned as a ground of struggle. Indeed, health communism is an expansive project that can coalesce multifarious struggles to come together and build a new society out of the ruins of this one. Whilst defensive measures to resist state violence are needed, health communism can link struggles together and provide a positive vision that we can fight for.
Adler-Bolton and Vierkant give an in-depth account of the Sozialistisches Patientenkollektiv (SPK) which they state is the ‘closest direct ideological precursor to … health communism’.[26] The SPK were a radical patient-doctor collective that existed in the 1970s in Heidelberg, West Germany and arose within the wider context of the anti-psychiatry movement. Symbolically, Heidelberg University is important as it was a centre of Nazi psychiatry. West Germany was also a key battleground in the West’s cold war struggle with communism. The SPK arose from within the walls of psychiatric institutions, as an example of the Mad organising for their liberation. They grounded their movement in a Marxian critique of the political economy of capitalism and developed a radical praxis that included working groups that covered a range of practical help including group therapy, treatment, skill sharing, political education and mutual aid. They innovated forms of community care and ‘provided a safe haven’ for those who faced incarceration. The group was vilified for being countercultural: they were pathologised for being gay, smoking weed and wearing leather jackets. The West German state came down hard on them, charging them as terrorists, running smear campaigns and eventually sent ‘300 militarized officers…with machine guns, dogs and a helicopter’, to evict the group, arrest members and eventually torture them prior to trial.[27] The state did everything within its power to crackdown on a revolutionary ‘sick proletariat’. The threat they posed was recognised by capital.
Following the lead of the SPK, Health Communism asserts that ‘sick, mad and incarcerated people’ would need to be ‘in control at all levels’ in order to build health communism.[28] Rather than health being controlled by the class of technocrats, healthcare would become a ‘collective communal process’ that would abolish class distinctions.[29] A shift toward uniting the ‘doctor and patient in a true dialectical relationship of collaboration is to declare revolt against the capitalist political economy of health.’ The system would be reoriented ‘from the perspective of patients rather than through the materially distanced observation of patients’.[30] Historian Jack Saunders used the phrase, ‘dictatorship of the doctors’, to describe the power of doctors in the 1970s NHS workplace hierarchy, but we can extend that to their power over patients as well. Repeatedly through their history consultants have organised to protect their class privilege of utilising NHS infrastructure and staff to earn private profits. In the 1970s this sparked retaliatory action by a group of nurses and ancillary workers who highlighted how it increased their workload and yet they received none of the compensation. Solidarity here between subordinated health workers and patients could target the class hierarchy of the NHS. After all, health workers are also patients themselves. A socialised system of healthcare – and pharmaceuticals and research science – would see control in the hands of its workers and patients. The current NHS workers’ strikes are a platform from which to build.
Adler-Bolton and Vierkant don’t just provide incisive new theoretical interventions but they provide critical analysis of previous attempts to build revolutionary health movements that can inform our future iterations. We are presently staring down the end of the NHS as we know it. A&E departments are collapsing, waiting lists grow ever longer and privatisation continues. The book is a wake-up call and a call to action driven by clear analysis and radical demands. It demands us to raise the bar – to go beyond just ‘saving the NHS’ – to centre surplus populations in our struggle for global health justice, and build worker-surplus solidarity so that we may all benefit. Health communism provides an opportunity to build larger coalitions that leverage power to strike at neglected weaknesses of capital. It calls for revolutionary struggles, against the tide of reformism. We are not all sick, but ‘none of us is well’ under capitalism.[31] Health Communism demands no less than liberation for all, care for all.
References
[1] Beatrice Adler-Bolton and Artie Vierkant, Health Communism (London: Verso, 2022), 184. Emphasis original.
[2] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, xiii.
[3] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, xiv.
[4] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, xvi.
[5] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, xii.
[6] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, xvi.
[7] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 4.
[8] Beatrice Adler-Bolton and Artie Vierkant, Health Communism. 22.
[9] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 44.
[10] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 43.
[11] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, xiv.
[12] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 20.
[13] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 9.
[14] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 12.
[15] Vicente Navarro, Class Struggle, The State and Medicine: An Historical and Contemporary Analysis of the Medical Sector in Great Britain (Oxford: Martin Robinson, 1981), 10.
[16] David Stark Murray, Why a National Health Service?: the part played by the Socialist Medical Association (London: Pemberton Books, 1971), 78.
[17] Navarro, Class Struggle, 38.
[18] David Widgery, Health in Danger: The crisis in the National Health Service (London: The Macmillan Press, 1979), 32.
[19] David Widgery, Health in Danger, 29.
[20] Michael Richmond and Alex Charnley, Fractured: Race, Class, Gender and the Hatred of Identity Politics (London: Pluto, 2022), 110.
[21] Azfar Shafi and Ilyas Nagdee, Race To The Bottom: Reclaiming Antiracism, (London: Pluto, 2022), 172.
[22] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 127.
[23] Richmond and Charnley, Fractured, 75.
[24] Des Fitzgerald et al, ‘Brexit as heredity reduce: Imperialism, biomedicine and the NHS in Britain, Sociological Review, no. 68 (2020): 6, 1170.
[25] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 105.
[26] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 128.
[27] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 166.
[28] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 152.
[29] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 152.
[30] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 151. Emphasis original.
[31] Beatrice Adler-Bolton and Artie Vierkant, Health Communism, 183.