28.03.2025

Ensure a healthy living standard for all

Cancer of capitalism

James Linney looks at the shocking effects of social inequality on health and life expectancy … and Labour’s austerity cuts can only make things worse

On February 21 the Cancer Research UK charity published a report called ‘Cancer in the UK 2025: socioeconomic deprivation’.¹ There was an accompanying spattering of stories in the media, but it did not make many waves and you would be forgiven if it passed you by.

It is, however, worthy of further consideration: its findings, as we will see, present clear empirical evidence of the horrific reality of how inequality - an inherent trait of capitalism - is increasing and is devastating the health of the most vulnerable in society.

The report presents data gathered on how deprivation in the UK (comparing the most deprived parts to the least) influences cancer rates, treatment and outcomes. Deprivation is here classified using several different domains, such as income, employment opportunities, health, education, barriers to housing, crime and access to public services. It probably will not come as a huge surprise to readers that the study found that, the greater the deprivation a person is exposed to, the greater the burden of any cancer that they suffer; the results reveal that being born in a relatively deprived area means you are significantly more likely to develop cancer, that you will face more barriers accessing health treatment for it, that you are more likely be diagnosed at a later stage and that, even after being diagnosed, your cancer treatment is more likely to be delayed. Yet, even to those of us expecting these findings, the size of the inequality gap and amount of suffering it represents is still shocking.

Horror number

So, for example, we read that “for all cancers combined in the UK, mortality rates are almost 60% higher in people living in the most deprived areas, compared to the least (337 per 100,000 vs 217 per 100,000) ... in the UK, around 28,400 cancer deaths each year are associated with deprivation.” It is hard to overstate the horror of these numbers, so it bears repeating: nearly 30,000 people die of cancer every year for entirely avoidable reasons.

This data tells us about trends on a population scale: each individual within this population will have their own risk factors and genetic predisposition to cancer, meaning that the exact risks of developing any one particular cancer is multifactorial and complex. But, even when we analyse each of the risk factors, they are largely influenced by deprivation. So, for example, with lung cancer, which is still the most common cause of cancer death for men and women in the UK, smoking is the major risk factor and smoking rates are at least three times higher in the most deprived areas, compared to the least - this has consistently been the case for many decades.

Of course, we should not think that being born into poverty is entirely deterministic of a person’s lifetime cancer risk. Individuals in deprived areas can, for instance, choose not to smoke or successfully quit, as many do, but the point is that, the more deprivation they are exposed to, the more barriers they face.

If each day is a struggle to keep warm, pay the rent or mortgage, feed your family, find or keep employment or pay basic bills, then taking time for being able to access support or treatment to stop smoking becomes an unaffordable luxury rather than a ‘choice’. This is why public health campaigns simply focusing on education are largely of low impact - people are not ignorant of the harms of smoking, but their lived environment makes choosing not to smoke or to give up much more difficult. Having to focus all their energy on the struggles of day-to-day survival deprives them of the privilege of being able to focus on their long-term health. Not surprisingly then, the study also shows us how people in the most deprived areas will be less likely to participate in cancer screening services (57% most deprived vs 76% least), that obesity rates are much higher (36% vs 19%) and that people are more likely to present later with cancer symptoms - meaning a delayed diagnosis and a more advanced, less treatable disease.

Tip of iceberg

Given that deprivation has such a huge impact on cancer risks and burden, why then is so little attention paid to it by modern medicine or public health campaigns? Scientists, doctors and public health policy-makers do not exist in a vacuum: they may like to think they answer only to empirical evidence, but they exist and practise within a society dominated by capitalist hegemony. One result is that public health and medicine tend to focus predominantly on individual behaviour and how that increases cancer risk, whilst largely ignoring the overreaching role society plays - in other words, looking at the effect, not the cause.

These policies fail to recognise that not only does capitalism breed inequality, but in feeding its need to constantly create new markets it pushes the sale of the very commodities that are directly cancer-causing, whether it be cigarettes, alcohol or obesogenic poor-quality food, onto the most vulnerable in society. At the same time, of course, the working class on the whole are forced into wage labour in order to survive - meaning for the majority of their waking lives they are forced to do repetitive, often sedentary work, which is harmful for both body and mind.

So far we have seen how the Cancer Research study demonstrates clearly how deprivation and inequality in the UK are responsible for putting people at enormously increased risk of cancer, resulting in death and suffering hard to articulate. But this is only the tip of the iceberg: this link can be extrapolated and applied to all major chronic health conditions: ie, those responsible for the vast majority of mortality and morbidity - such as heart disease, chronic respiratory disease, type 2 diabetes, obesity, etc.

There is plenty of data to support this conclusion - it was, for example, evidenced in a 2020 publication by the Health Foundation and authored by Michael Marmot, professor of epidemiology at UCL.² He conducted a review of how health inequalities in the UK are manifested. The findings are harrowing. Here are some of the conclusions:

Since 2010 life expectancy in England has stalled; this has not happened since at least 1900 … Life expectancy follows the social gradient - the more deprived the area, the shorter the life expectancy. This gradient has become steeper; inequalities in life expectancy have increased. Among women in the most deprived 10% of areas, life expectancy fell between 2010-12 and 2016-18.

Not only are people in deprived areas more likely to die younger, but in their shorter lives they will have fewer healthy years: “The gradient in healthy life expectancy is steeper than that of life expectancy. It means that people in more deprived areas spend more of their shorter lives in ill health than those in less deprived areas.”

We learn from these findings that health is directly linked to inequalities in the conditions in which people are born, grow, live, work and age.

Michael Marmot and the Institute of Health Inequality published a further study in 2024 called ‘Health inequalities: lives cut short’,³ which concludes with more appalling figures: “The decade from 2011 saw over a million people dying earlier than they otherwise would have done, had they experienced the death rates seen in the least deprived areas.”

In his review Marmot recommends several policy objectives that he believes are needed to reduce health inequalities:

to give every child the best start;
to enable people to maximise their capabilities and have control over their lives;
create fair employment and good work for all;
ensure a healthy standard of living for all; and
create and develop healthy and sustainable places and communities.

These are very supportable demands and could be worthy additions to a leftwing organisation’s programme of minimum demands. But they are not achievable without the working class being organised into a mass Marxist party - to think that a bourgeois state is just going to sign up to these objectives is completely deluded.

Health inequality is defined by the National Institute for Health and Care Excellence as “differences in health across the population, and between different groups in society, that are systematic, unfair and avoidable”. It continues: “They are caused by the conditions in which we are born, live, work and grow. These conditions influence how we think, feel and act and can affect both our physical and mental health and wellbeing.”⁴

Benefit Marxism

Marxism gives us the benefit of viewing health inequality as resulting from economic and class inequality - both are, although not specific to, a defining component of the capitalist mode of production. We cannot overcome inequality by simply changing government policy. The health inequalities illuminated in the studies above are mere examples of daily suffering and death which the working class is made to bear, so that the capitalist class can survive, albeit in a declining form.

Our job is to highlight this link between unfair, unavoidable suffering and inequality and the system, not just policy. As communists we recognise that the working class’s immediate priority is fighting for better healthcare, better-quality affordable food, housing, working conditions, etc. Politically policies obviously can act as a brake on or accelerate inequality and deprivation. So, for example, this week the announcement of Labour’s vicious cuts to disability benefits will inevitably force thousands of the most vulnerable people further into poverty and inevitably worse health.

But we must also be clear: it is not ending austerity (either the Tory version or Keir Starmer’s), or better pay, more funding for the NHS, better public health campaigns, etc, that are going to overcome inequality and stop the avoidable suffering - it can only be stopped with the ending of the system itself.

The studies discussed above give clear evidence of the health effects of late-stage capitalism in the UK - tens of thousands of people dying every year just in the UK, with millions more being forced into a state of poor health. Globally the suffering is multiplied many times over: millions of people each year are being sacrificed for the sake of a system that cannot exist without creating ‘haves’ and ‘have-nots’, and benefits only a tiny minority.

These studies also undermine one of the great myths of capitalism: that it equates to linear progress. Despite a relentless and continuous march of technology and advances in modern (soon to be AI-enhanced) medicine, there exists an ever-growing health inequality gap - one that will always exist unless the working class is able to cure itself of the cancer of capitalism.