This paper distinguishes a materialist from a medical approach to health (including as medical the clinical, epidemiological, sociological, environmental, and radical approaches). Three themes are developed. The first concerns a broad definition of medicine. Derived from the actual strategies that capital and labor adopt to health, this definition encompasses all attempts to manage the social factors responsible for ill-health as “conditions” while maintaining (or concealing) the contradictory basis for these conditions in capitalist social relations. The second theme concerns the roots of medicine. Radicals treat scientific medicine as a tool introduced by capitalists and a professional elite to maximize profits, increase productivity, and control women and other oppressed minorities. The materialist view, by contrast, emphasizes the role of worker initiatives in transforming the relations responsible for epidemic disease in the 19th century and the extent to which this transformation led directly to the utility of medical care after 1900. The fact that modern medicine can acknowledge its dependence neither on these initiatives nor on the progress of suffering created through the accumulation process is far more important than the market position of doctors in determining medicine's limits and the ideology of professional doctors. The third theme concerns the utility of a materialist epidemiology for reinterpreting many of the same issues examined by radicals, including medicalization, victim blaming, professional ideology, elitism, the exclusion of certain oppressed groups from “the sick role,” and medicine's failure to combat the diseases of stress. The basic contention is that a revolutionary health strategy is impossible as long as medical care remains the centerpiece of our analysis.
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