Author of Finding Lights in a Dark Age, Saying NO to a Farm-Free Future and A Small Farm Future
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Posted on November 7, 2022 | 24 Comments
We debated the pitfalls of diving too deep into the likely politics, including the social policy, of small farm societies of the future under my last post. Maybe this post runs that risk. Or maybe it doesn’t dive deep enough. Anyway, here I’m going to broach under five headings a few aspects of social policy that I think small farm societies of the future will wrestle with – I hope without easy solutionism or false optimism. Then in my next post I’ll publish the draft chapter about social policy issues I cut from my book. And that will conclude this little cycle-within-a-cycle about human welfare in a small farm future
It’s been put to me that arguments for a small farm future are disablist, because the physical demands of agricultural work are unsuitable for people with many kinds of disability. If I thought any other kind of future was feasible for most of humanity, perhaps this critique would trouble me more. As it is, I’d say the challenge is how to make a small farm future fit as well as possible with the needs of disabled people.
Lacking expertise in this myself, I think it’d be great if disability experts and activists applied themselves to this question. My opener for the debate would be to say that local, primarily horticulture-based food and fibre production is eminently suited to people with many kinds of disability, and societies more geared around it than our present one could actively mitigate or remove conditions that are quite disabling in our present urbanized and commodified world. Of course, it’s true that some disabilities preclude any significant physical farm work – but they don’t necessarily preclude the work of community connectivity, the other key component of community self-reliance. So again it’s possible that a small farm future offers richer opportunities than a commodity-capitalist future for disabled people as social connectors and for their own social connection.
There would remain people for whom neither option is possible and who would require a lot of care. This is a concern because it’s possible there will be less economic surplus or ‘slack’ available in a small farm future to enable such people to receive the care they need. But this is debatable – as discussed in previous posts, an end to serving the god of capital accumulation releases a lot of human time, which is what the severely disabled most need. Caring responsibilities would no doubt tend to fall disproportionately upon the families of those in need, and – within those families – upon women. The challenge, then, will be to spread the load more fairly. The challenge in contemporary welfare systems is exactly the same. In this sense, the daily care aspects of severe disability may not be much different in a small farm future.
For all the talk of overpopulation that dominates the conversation (talk that, incidentally, rarely acknowledges the impact of life expectancies rather than birth rates on human numbers), from a social policy perspective the bigger issue is that many countries face greatly increasing proportions of old people as the population boom of the mid-20th century followed by the more recent fertility crash works its demographic logic out across the life course.
Being old is not, of course, intrinsically a problem. But age is associated with increasing care needs of the kind I was just discussing and this may prove challenging. The good news in the medium term is that, among all the profound problems we’re bequeathing to later generations, a large population of dependent elderly people is not going to be one of them in most places. But it’s going to be a problem in the shorter term. Here in Britain, Liz Truss’s administration wasn’t in power long, but long enough to foreshadow several troubling future problems. One of them manifested in the tension between Home Secretary Braverman’s burning desire to reduce immigration and Prime Minister’s Truss’s burning desire to boost economic growth, prompting her to reach for the easiest policy lever on the latter front – increasing in-migration by young adult workers. Inasmuch as this aspect of Trussonomics might still win the day despite the eclipse of its eponymous originator, rich countries with ageing populations may turn out to be disadvantaged relative to poorer ones with younger populations. This will be part of the painful rebalancing toward the cycling of local resources (including labour) involved in the path to a small farm future.
Looking at a slightly younger part of the age distribution, an awful lot of care work and other activities that build and sustain local communities rests on the shoulders of what might be termed the ‘young elderly’ – that is, people aged, say, 58-75 (an inevitably arbitrary range I’ve carefully chosen so as to exclude me from it). Thank heavens for the young elderly! One of the reasons they can fulfil this role is because they’ve had the time over their life course to buy themselves out of serving capital accumulation. In small farm futures where that possibility is inherently restricted, perhaps the lower bound of the young elderly range could stretch down to such young ages that it includes even the likes of me. More community building. More wellbeing.
The education of young people in a small farm future raises many questions that I propose to leave for another time. Other than suggesting that it will need to be, well, pretty different from most present school and college curricula, here I’ll just make a couple of general points.
I think it’s a good idea for young people to have rich interactions with other people across the stages of the life-course rather than to spend a lot of time in large groups rigidly segregated by age. Hilary Cottam, whose book Radical Help I mentioned recently, likewise says that in her research with young people she found that they sought connections with the wider world and with people of other ages, yet “public services emphasise youth-only activities and spaces and so they break the natural links through which young people learn and flourish” (p.93).
It’s probably easier for young people to experience non-youth only activities and natural links in rural and agrarian settings, so that’s one possible benefit of a small farm future.
Another kind of youth programme – one that was quite widespread in Western European countries in the late 20th century, though now in decline – was compulsory community service, involving spending a year or two working in residential care facilities, farms and other occupations contributing to wider common good. Ecological thinkers like John Barry have called for its restoration and rollout. This strikes me as a good idea that could bring considerable benefit to young people themselves and to wider society. I don’t think it should necessarily be restricted only to young people, but it should definitely include them. It’s one way of complementing and perhaps of usefully limiting the power of the family. I will say a little more about it in my next post.
This is probably the real raw nerve welfare question posed against arguments for a small farm future. It manifests especially at the heroic and high-tech end of the medical spectrum, as in Philip’s question under a recent post – “How would a low cost social-economic environment deliver, say proton beam therapy for cancer treatment – £250m for the two that are operate in the UK?”
I’ll provide an honest answer to that question in a moment (spoiler: “it probably wouldn’t”), but first I want to say a little about the health benefits of a small farm future and, more importantly, why Philip’s question, while reasonable, probably isn’t the best one to ask.
So first, assuming a good basic level of hygiene and public health, a distributist society of job-rich employment in low-energy local food and fibre production could have these health advantages over the present situation:
So there are grounds for thinking that population health status could be considerably better in a small farm future. Nevertheless, a small farm future is no defence against individual bad health, and in view of its low-capital, deindustrialized character, it’s possible that the health care available in this situation will be inferior.
I’ll raise four questions for discussion on that point. First, could it be possible that health care in a small farm future wouldn’t necessarily be inferior, because we have the wrong image of what health care involves? Just as high-tech, low labour input, capital-intensive industrial farming isn’t superior to job-rich, skills-intensive agroecology, so the professions of medicine and nursing are fundamentally labour and skills intensive practices – might these survive in new guises or even prosper in a small farm future?
That question prompts the second one. It’s often assumed that effective contemporary health care emerged in lockstep with modern capitalist surplus generation. But can we separate the ‘modern’ from the ‘capitalist’? Though it’s not a panacea, the effectiveness of modern medicine stems in large part from its (‘reductionist’) cause-and-effect biological modelling – not an achievement of capitalism as such, but of modernity. So maybe a more important health care question about a low-capital small farm future is whether such a society can sustain this intellectual model and the kind of prioritization of resources it involves, than whether it can muster the liquid capital.
Prioritization of resources leads to the third question. I’ve often heard people say “I’d be dead if it wasn’t for modern medicine” as a kind of unanswerable final gambit for any alternative way of organizing human affairs. It may be true in any given case. Hell, it may even be true for me. But people enjoyed a reasonable lifespan in many nonindustrial societies, with three caveats – mortality was high for infants, women in childbirth and people in dense cities. A small farm future easily takes care of the latter, especially with a good grasp of basic water hygiene. The first two can largely be addressed via good anti-microbial hygiene, core medical skills and infectious disease prevention, possibly including vaccination. These are not high tech or capital intensive in the grand scheme of things, and in terms of avoidable years of life lost would be far and away the most important priorities for medical intervention in a small farm future.
In fact, a good deal of the burden of ill health today relates to chronic and community-related conditions that expert medical services are powerless to simply cure. Conditions such as diabetes, various forms of heart disease, hypertension and obesity are complemented by more mysterious presentations such as TATT (‘tired all the time’) and MUS (‘medically unexplained symptoms’) which account for about 30% of doctor visits in the UK. To quote Hilary Cottam again, TATT and MUS “are the codes of the twenty-first-century doctor trying to cope with the complex troubles of modern life: part physical, part mental, part spiritual, and deeply embedded in the wider cultural and economic pressures within which we live” (Radical Help, p.138).
Cottam reports research across the life course that shows medical interventions may improve a patient’s health status in the short run, but generally have little long-term impact in these chronic modern conditions. Perhaps, as the shamans of old-time cultures knew, what matters most is the patient’s proper integration into the wider community. Which I take to be an encouraging pointer to the possible good health available in a small farm future.
Still, ultimately I have to face Philip’s question. There are some medical interventions requiring super-expensive or high-tech therapies that probably won’t be available in a small farm future. There’s no way of saying it gently, and I don’t take it lightly. All the same, I do feel the need to put some qualifiers around it. Once again, I’d emphasize that we’re heading into a low capital and low energy future whether we like it or not. In this sense, the health outcomes that a wealthy citizen of North America or Western Europe expects today probably isn’t a relevant comparator. Besides, the decline of high-tech health care in the wealthy countries would barely dent global population health stats, and would probably be more than offset by the gains from agrarian localism worldwide.
I recall a figure from thirty years ago back in the days when I worked in the health policy sector that claimed something like a third of all health care expenditure was devoted to people in the last six months of their lives. I’ve been unable to locate a contemporary reference on that point, but if it’s true I suspect rethinking our priorities around life and death as part of the general rethink now needed about the place of humanity in the wider biosphere might sweeten the pill of a less salvation-oriented and more person/community-centred end-of-life care. As Giorgos Kallis puts it in his interesting book, Limits, “Western societies consider high life expectancy to be the ultimate indicator of social well-being … We are supposed to take care of ourselves in order to live as many years as possible. But why? We do not really know why. Living, for us, is the meaning of life, and we aim to extend it indefinitely” (p.91).
Should I be faced with a terminal diagnosis, maybe I’ll angrily disavow Giorgos’s words. Life wills itself. But human life also wills wisdom, and wisdom entails knowledge of limits that cannot be crossed.
This touches on wider issues discussed in the previous couple of posts and that I’ll come back to when I get onto Part IV of my book in this blog cycle. So I’m going to keep it brief and simply offer this provocation for discussion. In many so-called ‘indigenous’ or ‘tribal’ societies, there is neither unemployment nor poverty as such, though the people may be judged materially poor by the standards of modern, high-energy, capitalist societies. Might the passing of such societies into a lower energy, postcapitalist small farm future create opportunities for people to likewise become indigenous to place and largely overcome the problems of poverty and unemployment? And if so, could it be compatible with other aspects of welfare I’ve discussed, like science-based health care?
Well, I believe that we’re heading into insecure times, and perhaps one other thing to be learned from several indigenous societies is that allaying insecurity is often neither possible nor, when overzealously pursued, desirable. But seeking to minimize certain insecurities is an understandable and indeed inevitable human trait. How we do so, and how we judge our efforts and those of others are the stuff of politics. And I’ll be exploring some aspects of that in future posts.
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An obvious point that was made to me was that the ‘average’ cancer victim loses two years of life.
Clearly there are a significant number that will die of cancer for want of a better term in what should have bene the prime of life but most will not.
All the modern medicine in the world is useless if modernity destroys our world. The loss of high-tech diagnostics, pharmaceuticals and all the rest would be a small price to pay for a livable earth.
This raises the question of whether modern medicine is possible in any sustainable and earth-friendly low-energy society (so we can have the best of both worlds)? I think the short answer is no. We can’t have high tech medicine in a low tech world even if all the technical information needed for modern medicine were at our fingertips.
But since clean water for drinking, the most effective public health measure and the enabler of vastly increased lifespans, does not require any aspect of modernity, we can still salvage some of the recent increases in life expectancy for a future low-energy world.
It should also be remembered that for any species that reproduces sexually and has a stable population, the maximum number of a female’s offspring that can survive to reproduce is two. All of human history indicates that meeting this requirment is not that difficult to do, regardless of the sophistication of medical technology available. A small farm future doesn’t need modern medicine to enable a stable population (which also happens to be the only sustainable alternative).
Not mentioned above is what to do with the mentally ill , I believe that the retarded will be easily fitted in to the small farm situation , low tech make them a much needed extra pair of hands but what do you do with the paranoid schizophrenic , or a dangerous lunatic , some way would have to come about to keep society safe .
The elderly are a mine of information / experience they have seen a lot over their lifetime some usefull some not , it’s there , oral history for the asking .
People who are mentally ill and dangerous have existed throughout history, though they are actually very rare — most people who are mentally unwell pose no danger to others. And our current setup seems very bad indeed in how we support people with mental illness and keep them, and those around them, safe.
The Industrial Revolution and modernity’s deleterious effects on the human psyche are well documented.
Jeremy Naydler touches on the origins of this in an illuminating fashion (In the Shadow of the Machine, p191), noting that in 1700 the British Isles had one lunatic asylum, Bethlem, which held around 100 patients.
“By the end of the same century,” writes Naydler, “in 1800, it is estimated that numbers of confined lunatics had risen to as many as 10,000. By the end of the nineteenth century, as if it were Psyche’s tribute to the Goddess Reason, the number had escalated to 100,000.” Naydler goes on to note that the first documented case of schizophrenia can be traced to this period, when a man called James Tilly Matthews suffered a paranoid fantasy, significantly involving an ‘influencing machine’ he termed the Air Loom, operated by criminals he called the Air Loom Gang, who he claimed tortured him with their machine.
Back to the Future, I think there’s every reason to believe a Small Farm one would serve to alleviate many of the mental health problems we seem to be wading further into today. Consider the rise in popularity of so-called ‘Care Farms’, also many biodynamic farms which are in part staffed by people with special needs, the vaunted benefits of garden work in prisons and schools, etc. Rebalancing the nature-deficit disorder with more grounded lifeways should keep much mental illth in abeyance. It would appear one crucial switch is to utilise tools, machines and systems that serve people, rather than the other way around.
On a more personal note, a member of my family is an addict, and he has noticed that he is most at peace and least likely to use alcohol and street drugs when he is regularly spending time with other people outdoors. I wish we lived on the same continent, I could use his help at the allotment and it would probably do him a lot of good.
I think there are also a few easy wins that would remain available in a lower-energy, moderate-tech society. One is the ability to harvest hormones from animals for use in humans. Thyroid hormone and insulin are the obvious two, which began use in the 20th century and have massively improved quality of life and health outcomes for people with type 1 diabetes (who used to just… waste away to nothing and die) and various forms of hypothyroidism (though some — not all — of these were previously successfully treated with iodine, readily available in seaweed unless we mess the sea up too much for even that to grow, in which case we’re probably toast anyway). And I’ve mentioned anaesthesia (arguably as important for surgery — including C-sections — as germ theory is) already on a previous post.
Yes, there are treatments that will become unavailable. I know at least two people who have had treatment for cancers in the last decade which would literally have killed them 30 years ago. But everyone does die sometime, and we aren’t in any way living in a society where nobody dies young, even in the comparatively rich West.
I would like to add addiction to the list of maladies that might be better addressed by a small farm future than by the current status quo.
I think, though, that there is a real risk of any future (small farm or otherwise) being pretty dystopian and extremely unkind to disabled people. I base this on how we have handled the (ongoing) covid-19 pandemic. The problem is not a lack of technology — there are countries using lower-tech, non-pharmaceutical interventions to keep transmission much lower than in the UK or US — but a willingness by those who hold power to prioritize the needs of capital over the needs of humans, even to the point of using substantial mainstream media misinformation to do so. We’ve been instructed to make personal decisions about precautions based on the risks and infection rate data, but they have repeatedly outright lied about the risks, and gradually taken away timely infection/transmission data. I am livid. The deaths from our refusal of simple preventive measures, at least in the West, far outstrip deaths from lack of access to high-tech treatments.
A trend that I find very worrying is one of societal changes that are urgently needed being blocked on the grounds of ableism. The one I see most often is whataboutery regarding schemes to encourage cycling and reduce driving in urban and suburban areas: there is always someone who will pipe up and say we can’t put in that cycle path or remove that bit of parking or whatever, because “disabled people need to drive”. Well, I’m disabled and I can’t drive; my bicycle is a mobility aid (especially when some conditions flare up), which I cannot use safely in nearly as many places as drivers can use their cars. I don’t want to get into the weeds on this here, except to say that truly inclusive infrastructure is harder to design and implement but far from impossible, and that disabled people who do use cars as mobility aids are being used as rhetorical fodder by those who simply find it inconvenient and a bit slower (but not painful or damaging to health) to drive less. The joke is on them — we are all going to have to learn to live with drastically reduced mobility sooner or later, and reducing or eliminating car use will also reduce rates of disability from asthma and serious injury. (And a no-car or low-car future is necessarily a small farm one, too.)
So we need a re-evaluation, and some restructuring, of how we provide care — whether labour-intensive or high-tech; I think it’s important to listen to disabled voices in this, but I am increasingly of the opinion that a lot of what is needed can’t or won’t be implemented from the top down due to conflicts of interest and perverse incentives (it sure serves vaccine manufacturers if we all have to get a flu and Covid booster every year, instead of keeping the air in public indoor spaces clean and wearing reusable masks on public transport; I am very pro-vaccine, but not to the point of abandoning all other interventions. Similarly I’ve had my tetanus jabs but I do still wear gloves and boots if I’m turning compost or digging a new bed or handling machinery…) Unfortunately we are, as a society, also not all that accustomed to organising care and mutual aid these days, though pockets of it do exist. I am not sure if I have already flagged up the work in this area of the Four Thieves Vinegar Collective and their, um, interventions to make medications more available outside of the dominant insurance-based gatekeeping paradigm (in the US context); I would like to see more of that sort of thing, but I think it will take considerably more collapse of existing structures of governance and profit for such efforts to catch on.
Not sure where I’m going with this comment (I shouldn’t comment before breakfast really) except to say that as usual, yes, things are probably going to suck in some ways, but things suck in a lot of ways now too. (Ask anyone on disability benefits, or anyone with a poorly-understood chronic condition.) When I first read your book I was concerned, even alarmed, about the lack of discussion of medical and social care. Having spent a couple of years hanging around on this blog, I’m a lot more relaxed about not having exact answers there, because it turns out “hey it sucks now too” is sadly something of a pattern. How we care for one another will need to be worked out, like all other aspects of a small farm future, with trial and error and attention to local context and conditions. Reluctance to detail exactly how that can happen is not to handwave away the steep challenges, but to embrace the complexity and uncertainty involved in any such endeavour.
I do think it is still important to recognise the myriad ways our current strategy fails sick and disabled people and causes illness and disability, so we can try to avoid those failure modes. And I think it is also very important to keep asking “how do sick and disabled people fit into this future?” because of the tendency of some people (fascists, it’s always fascists) to scapegoat us as burdens or filth or whatever and describe semi-utopian fantasies where caring for us is unnecessary because we don’t exist, then try to get there by “cleansing” humanity, usually by killing people from multiple out-groups. Ugh. So this post, which both acknowledges present difficulties in allocation of care and asks important questions about how we allocate resources for care in the context of a small farm future, is very welcome. Thank you for holding the conversation.
Just has a side , there is a shortage in novacane round here .
Chris, when I have time I will return to compliment you on your patience. But until then…
My mother referenced the health care costs in the last six months of life from Betty Friedan’s book Fountain of Age.
And here is a study: The Lifetime Distribution of Health Care Costs
Some research shows that healthcare expenditures spike during the final year of life, and time-to-death is the real driver of healthcare expenditures (instead of age per se). Trouble is, “at an individual level time-to-death is unknown”, and patients without a terminal prognosis might still die within a year.
“Our findings support other literature that it is not age per se, but time-to-death (TTD), particularly the final year of life, that is a strong driver of HCEs [health care expenditures]… At an individual level TTD is unknown…”
Health care expenditures, age, proximity to death and morbidity: implications for an ageing population
https://eprints.whiterose.ac.uk/135894/1/CHERP107_health_care_expenditures_ageing_morbidity.pdf
Regarding healthcare costs during the last *two* months of life, the article below (updated 2010) says the US government spent more on this than they spent annually on the Department of Homeland Security, or the Department of Education.
“Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives. That’s more than the budget for the Department of Homeland Security, or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked.”
“…when it comes to expensive, hi-tech treatments with some potential to extend life, there are few restrictions. By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.”
https://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/
Yup , medicine will spend any amount of money to keep someone alive , a relative ( 85) has just had a pacemaker fitted to keep his ailing heart working , it will extend his life some , but quality of life ? he has Alzheimer’s , can’t speak or feed himself and is in a secure nursing home . No health provider dared to say no just in case they get sued .
There is much substantive and consistent research pointing to the social determinants of ill-health. This includes well documented evidence of the inverse relationship between nearly all significant health morbidities and mortalities and social class. (Its a myth, for example, that company executives are more prone to heart attacks, more likely if you are poor). Perhaps a SFF would focus more on public health approaches and prevention rather than intervening when illness strikes. This is an area in which health systems continue to struggle with, partly (mainly) because it involves for governing classes and vested interests politically and ideological unpalatable policies. Whilst some public health interventions, such as vaccination programmes, are founded on relatively costly research, many interventions are decidedly low-tech. This is true for the general care of the elderly, although it is labour intensive as Chris points out.
There is also accumulating evidence of the benefits to mental health of spending time outdoors and in gardening in particular. For the briefest of summaries:-
https://notesfromasuffolksmallhoding.blogspot.com/2019/01/feeling-bit-down-try-ecotherapy.html
One thing to think about, though, is a potentially unprecedented situation (I stand to be corrected) of an area of advanced knowledge and technology, previously in common use, being disregarded by necessity or maybe through priority decision making. This would not just apply to high cost medical technologies of course. I wonder how this would play out in practice and in mindset. There might also present openings for the ‘entitled’ or the unscrupulous.
As we’re still just about in leaf-peeping season, and to accompany your most apt ecotherapy post Philip, here’s a short film that gives a little more information on the benefits ‘forest bathing’ for human health.
http://www.woodlanders.com/blog/2017/12/12/episode-21-shinrin-yoku-forest-therapy
One thing among many that stood out from the film was how the participants were encouraged to touch the moss. This brought to mind a fascinating essay at Aeon.co entitled A Touch of Moss, by Nikita Arora, which meandered in unexpected directions and hence was a thought-provoking and rewarding read.
And here’s another short film, for anyone who would like to hear more about Shinrin-Yoku (forest bathing):
https://faircompanies.com/videos/science-of-forest-bathing-less-sickness-more-well-being/
From the website…
A belief that nature is good for you may sound like common sense, but in Japan, researchers have taken the idea to the laboratory and produced evidence that a walk in the woods could help prevent cancer, fight obesity and reduce stress and depression.
The Japanese have coined the term “shinrin-yoku”, or forest bathing, to codify the practice of exposing yourself to nature (particularly trees). The government has invested millions in both research and “forest therapy trails” – there are now 60 of them in Japan- where the forests have sufficient density and trails are of sufficient length to provide the benefits of foresting bathing.
The concept is to take a “bath” in the forest by letting nature enter all five senses. Qing Li, associate professor at Tokyo’s Nippon Medical School and president of the Japanese Society of Forest Medicine, argues that the sense of smell is most important.
“The effect of forest bathing is the total effect, but the biggest effect is from the olfactory, smell, we call them phytoncides. Also, people call them essential oil, aroma.” Li’s research has shown that trees’ aromas, known as phytoncides, boost our body’s NK (natural killer) cells which help fight tumors and virus-infected cells. Phytoncides are the medical equivalent of essential oils; the most effective aroma is Japanese Cypress.
Great post Chris, thank you. Our relationship to death seems to underpin our cultural expression and structural politics, but maybe they are more co creative. The myth of scarcity is surely correlated to our fear of death.
I can imagine posters like those 1930s railway images advertising holidays to the sea or the country buy promoting a small farm future with ruddy cheeked, hard working folk of all ages and abilities. Or maybe now it should be a well made short film. Either way be good to show more people the obvious (to us) benefits of SSF.
Thanks for another set of good comments – and time also for another one of my periodic apologies that I can’t always find the time to respond to people’s comments as fully as they deserve. Anyway, a few quick thoughts:
Health care futures: regrettably, I have to agree with Joe that access to high-tech healthcare is probably going to contract in the future, and by ‘future’ I mean every likely future scenario, small farm or otherwise. The sugar coating on this bitter pill is along the lines of Philip’s point (and some of mine above) that high-tech healthcare comes pretty low on the list of factors contributing to good health. And of course, if it goes a lot of people globally won’t miss it because they never had access to it in the first place.
Mental illness & disability: I daresay Simon is right that mental health got worse with the onset of modernity and industrialization. Figures like the number of asylum inmates are hard to interpret though, because as much as ‘actual’ prevalence of ill health they also represent changing ideas about it and the rise of a therapeutic mindset (Foucault’s ‘Discipline and Punish’ is a classic analysis of this) – a mindset that IMO is something of a mixed blessing.
I basically agree with Diogenes on the place of what he calls ‘the retarded’ in a small farm future, or ‘people with learning difficulties’ in the current jargon. The question is, difficulties in learning what? There are many things such people can easily learn to do that contribute to the provisioning of the household. I suspect also that a society of such households could accommodate itself more flexibly to various kinds of mental illness (aka creativity, eccentricity, spirituality, emotional honesty etc.), though not all of them.
To reduce or not to reduce: interesting points from Simon about nature cure. I baulk at research to identify the causative agents in the phytoncides of Japanese Cypress. Cue monoculture cypress plantations and industrial production of phytoncide tinctures for urban apartment dwellers to sniff as they eat their fermented studge. Instead of that kind of reductionism, I’d prefer it if people could just go for a walk in the freaking woods. On the other hand, I appreciate the kind of reductionism that figures out cholera is a water-borne bacterial infection and not an imbalance of bodily humours. The challenge is knowing when to be reductionist and when not to be – not a challenge that I believe our contemporary culture rises to very impressively.
The end of life: thanks John, Ruben & Steve for unearthing data about health care and end of life. It’s a tricky one. On the one hand, it seems entirely reasonable that people should be able to call upon care resources when they get seriously ill. On the other, I can’t help feeling that the data may still hint at a cultural problem in our inability to reckon equably with death’s inevitable limit.
Ableism & disablism: thanks Kathryn for laying out the various problematic narratives around these in navigating the high-energy present and the low-energy future. Nothing really to add – except to question whether care for known, local disabled individuals might be more forthcoming than care for ‘the disabled’ in nation-statist political situations like the post-Covid debates. I agree of course on the dangers of ‘othering’ language and policies.
Finally, thanks for your comment Joel and also for the one under my previous post that I didn’t find the time to answer: https://chrissmaje.com/?p=2029#comment-254025. In writing this blog, I often encounter some difficult lines to tread – between extolling the virtues of small farm societies and acknowledging the difficulties in moving towards them from the present situation, between acknowledging commons and common humanity as politically fundamental while acknowledging that actual large-scale collective organization is difficult and not always optimal. I also agree on the difficulties of ‘marketing’ future realities that you discuss in your earlier comment. The practice I seem to have adopted as a keyboard-tapping smallholder is to ‘market’ a small farm future in words, while keeping my agricultural practices as unexposed as they can possibly be from ‘the market’, where the poor outcomes you describe are rife.
whether care for known, local disabled individuals might be more forthcoming than care for ‘the disabled’ in nation-statist political situations
A friend of mine has a husband with rapidly-progressing severe memory loss and delusions, initially thought to be vascular dementia but as it turns out caused by an inoperable brain tumour. He is physically still quite fit. He’s in his 90s so has “had a good innings”. My friend, his wife, can no longer provide all of the care he needs, and she is absolutely exhausted from trying. It has been… interesting, to say the least, to watch how their surrounding community, extended family (which is both small and widely distributed), and state have become involved in his care. It is, of course, impossible to untangle what is happening from what people expect should happen — the state does not actually provide support until certain conditions are met on paper, while the reality is more complex; the community largely has an expectation that the state will provide, and the degree to which community members provide some help out of their personal resources depends both on their ideology (“I pay my taxes, that should be enough!”) and on their perception of the situation on the ground. Would the community step up if they knew the nation-state would not? Well, maybe, but that isn’t the experiment we are running.
It’s the same problem I have with a strong emphasis on families looking after their own: my experience has been that families really don’t always do this adequately, but part of the reason for that is the external pressures placed on family units under a particular model of capitalist production. I have no idea whether my own childhood might have been better under a distributist system; I am certain it would have been different.
I am warming to an anarchist response to all of this, which I don’t yet have anywhere near enough grounding in to articulate well. It seems to me that the combination of individual agency and acting together for mutual or common benefit is important. At this point, I don’t think that is necessarily opposed to some form of distributism.
(Meanwhile, here in the UK withdrawal of nation-state support for “the disabled”, people who are unemployed, children if their parents don’t meet certain conditions, refugees, etc etc is clearly part of a national program of neoliberal economic policy justified by othering rhetoric. I despair sometimes at how well “divide and conquer” works.)
The main thing I took away from Discipline and Punish was the image of Bentham’s Panopticon, largely because I’m curious about the effects of the built environment on people, but also because village life, compared to the relative anonymity and anomie of big city life, occasionally feels akin to life within a panopticon, albeit a kind of psychic version.
Physically though, the central tower here is the Catholic church and neighbouring Protestant one, both spotlit at night and strikingly beautiful in yellow and ochre hues. They also peal the times of day, at 5am, 8am, 12 noon, 3.30pm, 8pm, for various services, and on the news of a death, so they don’t just stand there, but communicate and call in the flock, usually for three minutes at a time. In this way alone they start to feel a little like useful neighbours, if only for gauging when to get up, when to down tools, or when to go and ask who’s died. It’s certainly intimate, and for now that feels ok, wholesome even.
Simon – yep, the Panopticon is a good metaphor in that book, if you can get to it past the horror of the first couple of pages. Your discussion of church towers brings to mind my mother’s story of growing up in a Yorkshire mining village, where the pit whistle would blow at three regular times each day to mark the new shift. If it blew any other time, it was a signal to the rescuers that there’d been an accident. I can’t imagine the impact that must have had when my mother and the other kids sitting in the classroom of the local school heard that off-schedule whistle, and wondered if one of their dads was dead. Her own grandfather died in a methane blast that killed almost everyone on his shift – i.e. nearly a third of the working men in the village. Who’d want to live in a sleepy agrarian village when you can have industrial progress, eh?
Kathryn – yes, all good observations. I guess I’d distinguish between a politics of known local people and the notion that care in that situation could only be a private family or neighbourly affair. For example, I’m thinking of situations where people vote when given the option for higher taxes/more generous services locally than they’re prepared to do nationally.
As a boy in Notts I remember one occasion of a pit accident and the way the hours of uncertainty totally changed the atmosphere one otherwise carefree summer’s day. I’ll have to revisit that whole Foucault text at some point… I’ve probably blocked out those first few pages! On another sombre note, they have been running the air raid siren through its paces here a few times in recent weeks, as elsewhere in Hungary – just routine annual maintenance.
It would be interesting (and possibly useful) to figure out some sort of average size of community people are willing to contribute ‘more’ to financially… I know I have heard much grumbling within the C of E about how funding for parish ministry works, and there are probably lots of statistics on it somewhere.
The impression I get overall is that most people want to vote for lower taxes for themselves *and* more services for their local area, which is understandable, but not how conservation of matter works. I think subsidiarity probably helps a fair amount with this; the question then becomes one of the minimum viable scale at which things like social care, public health and medical treatment can be provided in a small farm future. I think we don’t even have that figured out for our fossil-fueled present.
You’ve got the health issues pretty much right. As a family physician here’s my perspective on it:
The healthiest people I see in my GP surgery (or more correctly, don’t see because they hardly ever attend) are those who don’t smoke, have normal body weight and reasonably well balanced mental health.
In contrast, the poster child for unhealthy people is North America (USA and Canada, where I had the misfortune to work for a few years) which have a massive prevalence of obesity combined with an obsession with high-tech medicine.
Immunisations are one of high-tech society’s great benefits, but unfortunately I fear they may go away in our low tech future. The first vaccination was invented by Edward Jenner who discovered that inoculating people with cowpox could protect against smallpox. That was a low-tech vaccine but unfortunately it was a one-off – there isn’t an equivalent cow-measles, cow-polio or cow-whooping cough vaccine which can be produced in a low-tech way.
Likewise, replacement substances like insulin or thyroid hormone which patients have to take every day. There isn’t a low tech way of producing these either.
Maternal mortality will probably rise a bit, but we can keep that to a minimum by preserving current knowledge of obstetrics and hygiene. Childhood mortality will probably rise a lot, and we will probably have to compensate for that in the old fashioned way by having more children.
You’ve probably heard of peak oil, but try this one: peak amputations. We will first reach a peak in obesity, then about 20-30 years later a peak in diabetes, then another 20-30 years after that a peak in diabetic complications like blindness or gangrene of the legs requiring amputation. Not a pleasant prospect, which is one reason why I’m working on developing / rediscovering plant based anaesthetics for use in basic surgery.