The capitalist world-system and international health.

A number of world health problems which have been discretely considered in the past are viewed in this paper as interwoven with each other and with the functioning of the capitalist political-economic world-system. Thus, climactic explanations ("tropical medicine"), and even poverty when conceived in cultural terms or as a structural problem resident entirely within a single nation, are seen as inadequate for understanding any or all of the problems discussed briefly here: poor general health levels in peripheral and semi-peripheral nations, especially rising infant mortality rates in countries such as Brazil; comerciogenic malnutrition; dumping and exploitative sale of drugs, pesticides and other products banned or restricted in core nations; genocidal and other threatening approaches to population control; export of hazardous and polluting industry to peripheral and semi-peripheral nations; similar export of human experimentation; the sale of irrelevant, high medical technology to countries lacking basic public health measures, the "brain drain", and medical imperialism. Also discounted are moralistic inveighing, complaints about inadequate information and its transfer, discussions of bureaucratic bumbling or inter-agency politics and professional rivalries, various forms of victim-blaming, and other explanations and corrective approaches which ignore class structure and the control, distribution, and expropriation of resources in nations and the world-system. The framework suggests the importance of a worldwide cultural hegemony, including a medical cultural hegemony, established by and in the service of the ruling classes. Socialist-oriented nations which are quasi-independent of the capitalist world-system are seen as suffering less from its effects. This suggests that we should conceive of world socialist health and world capitalist health, rather than any kind of unified phenomenon called "international health".