An open letter to social media philanthropists

To all the friends who are seeking my support for Dry July, ice challenges, Movember etc., I salute you. Far too few people are prepared to give to others. But I won’t be donating to the organisations you’re raising money for. Before you respond with “Well, fuck you too”, which is what I’d do in the same situation, and before I discuss why, here is a list of what I’d like you to ask me to support instead, in order of what I see as their capacity for creating meaningful change:

1) A group that you belong to and contribute your time to that is trying to change why injustices (including health injustices) occur;

2) A fund to support you if you need help or specific people you support with your time who need help;

3) An organisation or group that works to provide critical information on the actions of governmental and corporate organisations that direct the politics of social issues (not “raising awareness”).

Last night I was at my first local community meeting in years — we’ve been to a lot of protests, not the same — to save nurse practitioner services in our area and I was reminded that the various health social movements we are encouraged to support on social media are either indifferent to or actively opposed to the three activities above. I’ll try and outline these from more concrete issues to the philosophical underpinnings.

1) The programmes that are supported, in the case of almost all major cancer organisations, are part of the “health industrial complex” that Clarke call biomedicalisation: the shift of care resources to capital-intensive, technoscientific, cure-products. The people working for the companies and universities involved in the research funded through the various anti-cancer councils and groups make a lot of money for their good works. But go to a campaign website and try and find out how this affects those who most need health intervention, preferably from those who express that need (we’re in a “participatory society”, right?). Good luck. Like the development industry it underwrites high salaries with the pain of others who have limited involvement in their institution’s governance. All the “evaluation” studies compound the problem. No matter how “accountable, transparent, and efficient” these organisations are, their net effect is the concentration of wealth, which is the major determinant of health.

2) The non-scientific care organisations supported by these campaigns are often hospital facilities that are the remnants of the public health system. The privatisation of the health system is in the interests of the wealthy, and we cannot expect doctors to be advocates for public health: the medical profession opposed publicly financed, single-payer universal health care coverage almost everywhere in the former British empire in the 20th century – that’s why groups like the Doctors Reform Society were established by renegade professionals to fight their conservative colleagues for public health. It’s not that cash-strapped formerly state-run institutions shouldn’t be supported but, as with the education system, there is certainly no guarantee that these are being governed in the public interest. Whether or not they have an explicit political agenda, health-cooperatives that are governed in the interests of their members are making a return and perhaps this model suits the “participatory times” we are in. The union hospital that cared for my great-grandfather (a migrant miner) at his death is more the kind of care organisation for the ill that seems valuable to support.

3) The campaigns de-politicise health. The relationship to the organisations themselves is purely through financial means that remove us from the human relationships that constitute them, even while the issues that motivate us to contribute (life and death of family and friends) are starkly human. Actual healthcare, as anyone who has engaged the systems knows, is a deeply political field structured by values about the worthiness of some forms of life over others in a resource-constrained world. The financialisation of our donor relationship to health has two negative effects on public life and democratic ideals:

a) The organisations working on health have incentives to avoid publicly speaking out on health system issues that would jeopardise support from the wealthy. This creates a domesticated discourse of health that cannot speak freely about what is actually causing health issues. Thus the dominance of randomised control trials of individualist interventions (pharmaceutical / behavioural), while social health is directed to “health promotion”, which as I have learned from Ruth, is a discourse of “responsibilisation” and the Protestant ideology that you will get what you individually work for.

b) Though our philanthropic acts we shield ourselves from involvement in the messy politics of care. We financialise our personal gesture of renunciation, pain or (in the case of Dry July) even our own health to turn it into money, the unproblematic good. The money, given over, cannot by definition be bad, as we all need it: in market discourse, at worst, it is wasted. But we are not on the hook for how the money – our labour – is spent except that we succeed or fail at our own goal. (The ice challenge, a derivative of the salt-and-ice challenge, seems to its credit to be less corporate-sponsored/formatted, but it still won’t surprise me if an ad agency has been behind its charitification somewhere)

While it may appear esoteric, it’s the guarantee of having done good is at the heart of my resistance to viral health social movements. Health is defined in our world as the absence of illness, to be guarded against and warded off. Illness comes from outside, in Calvinist terms as a punishment from God, that we can resist through control of ourselves and obedience to the Good against the sin of the body and the other. The dependence illness brings attacks precisely this resistance, testing the limits of our own capacity and resources as a caring self, calling into question our ability to “do right”. In the presence of a body that is no longer in control, faced with the inevitability of our own decomposition, caring for a specific other confronts us with how thin our aspirations and actions for social health are compared to the thick institutional politics of intimate care. It is often less “doing good” than than being undone by the absence of good.

All carers I have known have been the most articulate observers of the limits of doing good, and on how much easier lives would be if those at the care interface had even a minor share of the resources that go into the philanthropic health industrial complex. As I spend more time with the literature on nursing, I become clearer how completely distinct that historical ethic is from the world of technoscientific biomedicine (though this too is changing with nursing professionalisation). Activists have taught me that escaping the genre of individual acts and gestures (no matter how socially valorised or viral or financially successful they are) is critical in escaping the industrial modes of relation that hide our dependence on others for well-being. Sylvia Federici advocates the need for not a socialised form of production, but a collective form of reproduction, that organises the social through our dependence on each other from birth through death. I don’t know how we learn to direct our personal impulse of “doing good for the world” toward that inevitably political work of collectively working for all lives to be healthy, but I do know that charity-sponsored donation campaigns have no interest in helping us get us there.