Friedrich Engels was only twenty-four years old when he wrote “The Condition of the Working Class in England”. Even though he was a high school drop-out, Engels developed the concept of social determinants of health and diseases 150 years before the World Health Organization (WHO) defined it. The dialectical materialist approach he employed in his analyses proved a useful way of interpreting the “causes of the causes” of diseases. Rudolf Virchow, the prominent German physician, translated Engels’ ideas into medical language and promoted socialist medicine in Europe. His famous report on Upper Silesia typhus epidemic became the masterpiece of socialist medicine.
INTRODUCTION
Friedrich Engels, the founder of socialist medicine, was born on 28 November 1820 in Barmen, Germany. Dropping out of school at the age of 16 - 17, Engels began to write articles describing the working and living conditions of German workers and capitalist exploitation in the column “Letters from Wuppertal” in “Der Telegraph für Deutschland” (a newspaper).
Engels settled in Manchester, England, to work in his family's business. He was only 21 – 22 years old. He observed the working and living conditions of workers in the cradle of capitalism and published his observations as a book under the title “The Condition of the Working Class in England” in March 1845.
The Condition of the Working Class in England is the product of 22 months of observations, testimonies, research and readings of Engels during the period November 1842 – August 1844. Engels started to write his book in September 1844 and completed it in 6 months. The book, which was published in German, was translated into English in 1887 (Engels, 1997).
1. LIBERAL APPROACH TO HEALTH / DISEASE
Having no formal education in the field of medicine/health, Engels developed a "socialist" approach to medicine and health by analyzing the health problems of workers with a dialectical and historical materialist method.
According to the miasma theory that dominated nineteenth-century medicine, disease was caused, roughly, by bad air emitted by decaying organic material. However, this theory, which has dominated medicine for centuries, began to be shaken at the beginning of the nineteenth century.
Louis Villermé, a liberal-minded physician and thinker in France, scientifically demonstrated that mortality in Paris was explained not by miasma factors such as distance to the Seine River, altitude, etc., but by the socio-economic status of individuals. These findings were in line with the statement of Peter Frank, the founder of public health science, that "poverty is the mother of disease."
In the first half of the 1800s, many publications were made by liberal-minded writers in many European countries, especially England and France, seeking and revealing the relationships between diseases and poverty and the working and living conditions of workers. Socio-economic factors and the environment began to come to the fore.
The 1840 Allison and 1842 Chadwick reports, published at the time of Engels' arrival in England, attribute the causes of widespread diseases among working people mainly to poverty and "environmental" factors.
Liberal thought sees the solution of health problems in helping the poor (philanthropy) and improving the working and living conditions of the workers. Utopian socialists, with similar thoughts, propose to improve the situation of workers through cooperatives (Akalın, 2013).
2. ENGELS' APPROACH TO HEALTH / DISEASE
Engels' approach to the health problems of British working people was more "deep" than the approach of liberals and utopian socialists. Engels argued that the causes of diseases and premature deaths common among workers should not be sought in poverty or poor working and living conditions, but in the organization of production and the social environment that caused them (the causes of causes).
According to Engels, the solution to health problems was not philanthropy and improving the working and living conditions of the workers, but the abolition of private property and the establishment of an egalitarian order (Akalın, 2013).
2.1. Determinants of Health/Disease
Today, the health model of the World Health Organization (WHO) is a model that partly fits within the framework drawn by Engels in his book The Condition of the Working Class in England. Working and living conditions of people have a special place in the model that defines health as the product of general social, economic, cultural and environmental conditions and biology.
However, today, some intellectuals, who accept the role of social factors in the etiology ofdiseases, like nineteenth century liberals and utopian socialists, deal with these factors by "purging" them from their relations with the socio-economic order. For example, while accepting that the income level of individuals is the most important determinant of their health and that income inequality lies at the root of health inequalities, they never address the conditions that "produce" income inequality.
Today, the capital continues to organize medicine and health in line with its own interests, although it accepts that the society cannot be made healthier by healing individual patients, and that prevention is more effective than treatment (Akalın, 2015).
2.2. Engels' influence on the Medical Authorities of the time
The health problems discussed by Engels in his book titled The Condition of the Working Class in England include environmental toxins, lead poisoning, infections such as tuberculosis and typhus, nutrition and food supply, alcoholism, unbalanced distribution of medical personnel, class-based inequality in death rates, work accidents and occupational diseases.
Unlike his contemporaries, however, Engels believed that the cause of the misery of the working class should not be sought in petty grievances, but in the capitalist system itself. According to Engels, it is not enough to describe the conditions of the workers, the mechanism that produces these conditions should be criticized and a way out of these conditions should be proposed.
Engels' thoughts found their first echo in German-speaking geographies. German physicians, who read Engels' book, began to "translate" Engels' thoughts into medicine. The most prominent among German physicians was Rudolf Virchow, whose name was considered to be one of the founders of socialist medicine.
Adopting the dialectical and historical materialist method used by Engels in approaching problems, Virchow argued that the living conditions, poor housing and nutrition conditions of workers made them "prone" to diseases; in other words, they created a "sufficient" condition for the occurrence and development of diseases.
Virchow put forward these thoughts in his report on the typhus epidemic that broke out in the Upper Silesian coal mines in 1847/48. Virchow, who was assigned by the German government to prepare a report on the measures to be taken to prevent such epidemics, determined that the cause of the epidemic was "social" rather than medical (biological) as a result of his investigations in February and March 1848.
He listed the measures to be taken to prevent such epidemics from occurring again as follows: Unlimited democracy, leaving the decision-making authority to the local, education for all, removal of the church from state affairs, tax and agricultural reform, industrial development... (Akalın, 2013).
2.3. Socialist Medicine / Health Approach
As the 1848 riots spread across Europe, German physicians Virchow, Neumann, and Leubuscher published a journal titled “The Medical Reform” from July 1848 to June 1849. The socialist understanding of health and disease was given wide coverage in the journal. The relationship between the social structure and the distribution of diseases was widely discussed. It was emphasized that employment, wages, housing and nutrition conditions should be improved for health.
Some of the ideas in the 48 issues of the magazine can be listed as follows:
Everyone has the right to work.
Protecting everyone's health is the duty of society.
The government should take a close interest in the health of the people.
The fight against diseases cannot be achieved only with medical services, social measures are also required.
The interaction between health and socioeconomic conditions is an important research topic.
With these considerations, the three basic principles of socialist medicine can be summarized as follows:
1. Health is a social problem.
2. Social and economic conditions influence health, disease and medical practice.
3. In order to improve health and fight against diseases, social measures should be taken as well as medical measures (Akalın, 2013).
CONCLUSION
The socialist understanding of medicine/health, formulated by Engels and translated into medicine by Virchow, became flesh and bone for the first time in history with the 1917 October Revolution. One of the best students of Marx and Engels, Lenin, with a very good understanding of the social determinants of health and disease, managed to organize asocialist health system (Semashko model) in Russia, together with his close friend Nikolay Semashko, the first Minister of Health of the Soviet Union ( Akalin, 2010).
Lenin once stated that “tens of thousands of men and women who spent their whole lives incapitalist societies to enrich others, died prematurely due to diseases caused by starvation and constant malnutrition, disgusting working and miserable living conditions, and overwork”. When Lenin seized the power, he first removed the “sick climate” in Russia.
Many countries that entered the path of socialism in the twentieth century, adopting the socialist medicine / health approach, organized their health systems in line with the needs ofthe workers (people). Today, socialist medicine is still alive in Cuba and contributes to the health and well-being of Cubans.
Akif AKALIN
* https://bilimveaydinlanma.org/engels-ve-toplumcu-tip/
REFERENCES
Akalin, A. (2010). Socialist Medicine: The Soviet Experience. Istanbul: Yazılama.
Akalin, A. (2013). Introduction to Socialist Medicine: Lecture Notes on Socialist Medicine.Istanbul: Yazılama.
Akalin, A. (2015). Socialist Approach to Health and Disease. Istanbul: Yazılama.
Engels, F. (1997). The Condition of the Working Class in England. (Y. Fincancı, Trans.) Ankara:Sol.
Lenin, V.I. (1901). Another Massacre. Accessed on: 29.08.2019 https://www.marxists.org/archive/lenin/works/1901/may/07.htm
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