Midwives: Reject Philanthrocapitalism and Stand for Economic Justice

September 30, 2014

To: Canadian Association of Midwives Board of Directors and Membership
Re: Support for Stephen Harper and the Conservative Party of Canada

Dear CAM Board Members,

I am writing to express my concern over the public support expressed by the Canadian Association of Midwives and CAM President Joanna Norman Nemrava for the federal Conservative position on maternal, infant, and child health and apparent lack of critical perspectives from CAM on the policies of the Conservative Party of Canada and the Department of Foreign Affairs, Trade, and Development.

On September 23, 2014, the President of CAM posted on her facebook profile: “Joanna Norman Nemrava As CAM President, I am headed to the UN General Assembly at the invite of our Prime Minister, regarding maternal newborn health issues and the PMs address to the UN Assembly….”. Following this posting, the CAM President then went on to post this September 22nd article from the Globe and Mail: Harper to focus on maternal, child health at United Nations[1]. This follows on the May 29, 2014 letter available on the CAM website addressed to Stephen Harper from Joanna Nemrava on behalf of CAM to “applaud” the continuation of funding for maternal, infant, and child health and invites “further discussions on how midwives can contribute to saving the lives of mothers and babies.”

I am gravely concerned that CAM accompanied the Prime Minister to the UN for his speech. I am also concerned that there is a lack of critical voice of the federal Conservative Party policies on development. This trip has the appearance of condoning right-wing policies of the Conservatives that are harmful to women, children and their communities. Millions of Indigenous women on Turtle Island and across the globe find themselves in the path of the aggressive and destructive mining and extractive practices of Canadian-based corporations. The health of poor women is profoundly impacted by economic austerity and Conservative neoliberal economic policies such as the failure to act on a national childcare program and instead institute an insubstantial and regressive child-care benefit voucher-system. Women are affected by escalating climate change, food insecurity, occupation, and war. Having CAM leadership accompany the Prime Minister and publicizing this on the CAM website sends a message that as a collective we are supportive of the Prime Minister’s approach to maternal and newborn health devoid of a structural analysis of how the Muskoka Initiative or other funding initiatives of the Federal government not only fail to address the conditions which underlie health inequities but might actually exacerbate these inequities in the long-term.

International aid is not a politically-neutral or benign process. Indeed, many question the decision to fold the Canadian International Development Agency into the Department of Foreign Affairs, Trade, and Development, in line with the United States. A policy statement from the Department of Foreign Affairs, Trade, and Development reads “[a]s the linkages between our foreign policy, development and trade objectives continue to grow, the opportunity to leverage each of these grows at equal pace”[2]. Not to say that CIDA was completely unproblematic, but many of the CIDA-funded projects struggled to advance women’s economic and social rights, as well as women’s reproductive rights. The loss of an arm’s length organization to oversee federal development funding has facilitated an environment which is completely intolerant of reproductive freedom and legal, safe, and accessible abortion services. Family planning for the Conservative Party of Canada excludes women’s right to safe and accessible abortion services. The World Health Organization estimates that 13% of maternal deaths stem from unsafe abortion practices[3]. Political agendas now directly influence international aid funding and eliminate funding potential for any programs which are morally and politically unpalatable to the Tories and their financial backers.

The conflation of foreign policy and trade objectives with international development in practice also means that aid is used to leverage Canada’s economic and geopolitical objectives. The priority countries for Canadian international development say more about Canada’s economic and geopolitical interests than about the needs of the world’s poor. In countries such as the Philippines, Congo, Colombia, Peru, Honduras, and Burma Canada has significant economic interests, particularly in the mining sector. Other priority areas, such as Afghanistan and Haiti have suffered from direct Canadian military intervention and development projects are explicitly used to prop up unpopular governments imposed in the process of foreign invasion. Similarly the aid directed to the Palestinian West Bank is entirely focused on strengthening police forces to safeguard Israel’s security, while Palestinians continue to suffer under illegal occupation.

Families in urban poor communities on Negros Island, Philippines, may be victims of forced migration due to mining exploration by Canadian-traded corporations. Land and livelihood are destroyed by the drive for gold mining profits.

Families in urban poor communities on Negros Island, Philippines victims of forced migration. Land and livelihood destroyed by the drive for gold mining profits.

Around the world Canada advocates for the privatization of health care and health care systems through its participation in multilateral institutions like the IMF and WTO. In Africa and Latin America, Canada is aggressively pursuing Foreign Investment Protection Acts (FIPAs) that force poor countries to pay Canadian corporations damages when their mining activities are interrupted or halted by popular resistance. These and similar economic policies create the gross structural inequities that contribute directly to fact that 29,000 children die of poverty every day[4]. Even if Canada’s intervention into maternal and newborn health were unproblematic, it can’t be simply lauded in isolation from the whole context of Canadian foreign policy, including foreign aid policy which is perpetuating and exacerbating a massive global wealth and health gap.

It is strategic for Stephen Harper to paint his leadership with a veneer of concern for human rights and social justice. I am saddened and extremely worried that it appears as if the Canadian Association of Midwives is lending credibility to this veneer at this critical junction for human rights, the well-being of women and families, and the future of the planet. Development aid, trade relations, foreign investment, and military intervention are increasingly united in an undemocratic and non-transparent behind-closed-doors environment to exclude the growing voices of dissent, including those voices from the very regions being discussed and negotiated.

Harper’s government has repeatedly ignored or overridden community concerns for public health and environmental justice for communities impacted by the tar sands or pipeline construction, even from those communities who lay claim as the original inhabitants and traditional protectors of the land as recognized by international law, and even at times by Canada’s own Supreme Court rulings[5]. Despite this growing dissent, the International Energy Agency reports that tar sands production will increase from 1.3 to >4.2 million barrels per day by 2035. The Agency reports that at this level of production they anticipate a “catastrophic increase in global temperature”[6]. There are currently over 80 projects dominated by major transitional corporations such as Shell, Imperial Oil, Chevron, and Suncor, among others[7]. This expansion of oil sands production means further encroachment onto the traditional territories of the Lubicon Cree First Nation, Mikisew Cree First Nation, Duncan Lake First Nation and the Athabasca Chipewyan First Nations (and many more through pipeline construction) despite ongoing dissent within these communities and documented public health and environmental harms which will impact generations to come.

In particular, in 2011 the unceded traditional territory Lubicon Cree experienced one of the large oil pipeline spills in the history of Alberta. Simultaneously the Federal government refuses to acknowledge the sovereign rights of the Lubicon Cree, which in and of itself is a grave human rights violation, and the failure to protect the rights of the Lubicon Cree has been condemned by UN human rights bodies[8]. In addition, Oil Sands Reality Check states “[e]ighty per cent of the traditional territory of the Mikisew Cree and Athabasca Chipewyan First Nations has been rendered inaccessible for most of the year by tar sands development, and the Beaver Lake Cree have documented 20,000 treaty rights violations.[9]

Environmentalists say it will likely take years to clean up over 28,000 barrels of oil that spilled into a wetland near Peace River, Alberta. Photo: Rogu Collecti/Greenpeace

Environmentalists say it will likely take years to clean up over 28,000 barrels of oil that spilled into a wetland near Peace River, Alberta. Photo: Rogu Collecti/Greenpeace.

Further, there is a vast and growing body of literature interrogating the relationship between wealth and health inequities[10], in particular infant mortality and stillbirth rates which continue to show a relationship with income gradients even in countries undergoing rapid development[11]. Those communities with the greatest wealth inequities are most often those same communities who experience the highest maternal and infant mortality and stillbirth rates. Economic exploitation and widening wealth disparities may lead to increases in infant deaths at a greater rate than increasing development aid can reduce them. Structural conditions of our societies lie at the root of the issues that the Muskoka Initiative claims to want to tackle with development aid while sidestepping any hard discussion or examination of Canada’s role in the exacerbation of these structural inequities.

Harper’s maternal and newborn health strategy is window dressing on an overall economic and foreign policy that is aggressively pushing Canada economic interests, particularly in mining and extractive industries in ways that cause serious environmental and social damage to poor people and communities around the world. Unconditional applause for the funding of the Muskoka Initiative is something I urge CAM members to question. If development aid is directly partnered with international trade and investment, our support for international aid should be accompanied by a hard look at the international and national economic policies and actions of the federal Conservatives.

Increasing the numbers and locations of practicing midwives can only go so far to rectify maternal, infant, and child health inequities. In February of this year The Lancet – University of Oslo Commission on Global Governance for Health stated that “the deep causes of health inequity cannot be diagnosed or remedied with technical solutions, or by the health sector alone, because the causes of health inequity are tied to fairness in the distribution of power and resources”. Importantly the Commission goes on to explain that “construing socially and politically created health inequities as problems of technocratic or medical management depoliticizes social and political ills, and can pave way for magic-bullet solutions that often deal with symptoms rather than causes”.[12] This is important insight into how fundamentally inequitable global decision making processes which ultimately favour the wealthy and the powerful impact global health.

I believe as a professional organization we are currently engaging in this process without sufficient collective discussion or analysis; a process not only of global significance, but one which could determine the future for generations and perhaps even the survival of the planet. I urge CAM to re-consider any suggestion of an organizational relationship with the Conservative Party and to distance ourselves from regressive, exploitative, and fundamentally unjust political and economic positions. It is time to start talking more deeply about democratic processes and economic and social justice. I, for one, would be encouraged to see CAM participating in such a dialogue either through supporting progressive research or striking a social justice committee.

Thank you for your time and for considering my input into this matter.


Martha Roberts, RM
Strathcona Midwifery Collective
MSc Candidate, Faculty of Health Sciences, Simon Fraser University

[1] http://www.theglobeandmail.com/news/politics/harper-to-continue-focus-on-maternal-child-health-at-united-nations/article20719673/
[2] http://actionplan.gc.ca/en/initiative/department-foreign-affairs-trade-and-development
[3] http://www.who.int/reproductivehealth/topics/unsafe_abortion/magnitude/en/
[4] http://www.unicef.org/mdg/childmortality.html
[5] http://www.fns.bc.ca/pdf/William_en_%28SCC-2014%29.pdf It is of interest to note that James Anaya, Special Rapporteur on the rights of Indigenous Peoples, focussed on the Canadian Government’s lack of democratic engagement with Indigenous peoples in Canada in his Report to the 27th Session of the Human Rights Council in July, 2014: http://unsr.jamesanaya.org/docs/countries/2014-report-canada-a-hrc-27-52-add-2-en.pdf
[6] International Energy Agency. (2010). World Energy Outlook 2010. Paris, France: International Energy Agency.
[7] Ibid.
[8] Readings: http://www.lubiconlakenation.ca/index.php/resources/information-for-the-public/other-readings
[9] http://oilsandsrealitycheck.org/factcategory/human-rights/
[10] CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization. Accessed October 23, 2011, from: http://www.searo.who.int/LinkFiles/SDH_SDH_FinalReport.pdf
[11] http://www.who.int/bulletin/volumes/92/6/13-127977/en/
[12] Ottersen, O.P., Dasgupta, J., Bluin, C., Buss, P., Chongsuvivatwong, V., Frenk, J., Fukuda-Parr, S., Gawanas, B.P., Giacaman, R., Gyapong, J., Learning, J., Marmot, M., McNeill, D., Mongella, G.I., Moyo, N., Mogedal, S., Ntsaluba, A., Ooms, G., Bjertness, E., Lie, A.L., Moon, S., Roalkvam, S., Sandberg, K.I. & Sheel, I.B. (2014). The Lancet – University of Oslo Commission on Global Governance for Health: The political origins of health inequity: prospects for change. The Lancet, 383, pp. 630-667.


The Importance of Theory: Class and the Structural Determinants of Health

I have thought a great deal about how people refer to class and how this stunts or facilitates their grasp of the structural determinants of health.

Theories of class have profound implications for our ability as the progressive health sector to analyze and respond to social inequities in health. Yet, overwhelmingly those in public health adopt measures to address health inequities without taking the time to understand how underlying theories of class can ultimately render their actions ineffective in achieving meaningful and lasting change. Good intentions become simply a matter of appearances; the essence of economic exploitation is concealed.

The growing literature on the social determinants of health is an important contribution to an understanding of the relationship between class and health. A social determinants of health approach applies a broad theory of class as a market location, the status attached to employment, the ability to earn a livable income, access to adequate resources for living a healthy life, and residing in an environment conducive to health. Solutions promoted by the pundits of the social determinants approach include reducing health inequities through improving income distribution via social policy and progressive taxation. While this is a definitive leap forward from a biological deterministic or a behavioural approach to health inequities, Marxist thinkers have criticized the social determinants approach as rooted in a theorizing of class that is individualistic and incomplete.

Marxists counter-pose a theory of class as a social relation of production and connect inequities in health to structural inequalities rooted in capitalism. Marxists argue that a social determinants of health approach fails to address the mechanisms that perpetuate social and economic inequities between the rich and the poor by ignoring the exploitation of the working class by the bourgeoisie. Understanding the determinants of health from a Marxist class-based perspective illustrates the necessity of social and economic transformation to achieve a truly responsive health care system and to achieve health for all and dictates that class interests be exposed in this transformative process as we seek to redistribute productive ownership from the ruling to the working class. Through this framework it is argued that many health professionals and academics have a vested class interest in maintaining the medical-industrial complex and the professional and academic institutions which comprise the capitalist superstructure, and therefore, it is logical that in academia and in the institutions of medicine and public health that a social determinants of health approach would dominate.

Class and the Social Determinants of Health

Proponents of the social determinants of health rely on proxy definitions for social class in their quest to demonstrate the connection between class and health and analyze the relationship between wealth inequities and health inequities. Those who adopt this approach to understanding illness / health inequities amongst historically, socially, and economically marginalized populations have defined class loosely based on employment status, type of employment, educational attainment, and access to material resources, including comparative ‘wealth quintiles’. Although a variety of mechanisms are used to explain connections between poverty, gender, and health, the primary mechanisms include a focus on how differing access to the material resources necessary for living a healthy life generate widely disparate ‘choices’ available to low-income versus upper income individuals, resulting in health inequities.

Class as Income, Access to Material Resources, and Healthy Choices

Income inequality and relative social deprivation are arguably the most popular proxy measures for class in health literature pertaining to the social determinants of health. The relationship between poverty, lack of access to material resources necessary for living, and gross health inequalities has been the focus of major work in public health since 1978 and the International Conference on Primary Health Care in Alma Ata, Kazakhstan.


This conference produced the famous Declaration of Alma Ata, and was closely followed by the Ottawa Charter for Health Promotion in 1986. Interest in the social context of health and disease, and ultimately in the social determinants of health continued to grow, and in 2005 the World Health Organization launched its Commission on the Social Determinants of Health under the direction of Sir Michael Marmot. The final report of this commission declared that it was critical for governments to take immediate action to reduce ‘avoidable’ inequalities in wealth and health.

The social determinants of health approach made tremendous strides in moving public health and health promotion beyond a biomedical and behavioural approach to health, which squarely placed the blame for health inequalities on genetic traits, individual characteristics, and the idea of choice. The position advocated by this approach is that poorer health outcomes among impoverished and low-income individuals, and more broadly in low-income communities, such as higher rates of both chronic and infectious diseases, higher rates of mental health issues, and greater wear and tear on the human body through social and economic stress, can be traced to the economic deprivation and limitations of those with lower-income. This approach seeks to demonstrate and quantify the connection between poverty and ill health using a variety of measures, but the most predominant are absolute measures of income, relative income as measured by income quintiles, and individual and community access to fundamental resources necessary for health, such as clean water, housing, and adequate nutritional intake.

The shortcomings of the social determinants approach lie in its inability to explain the mechanisms by which wealth is distributed in society or to develop a critical response to the discussion of who has access to what resources. Responses from this approach are limited to state and private sector redistributive measures to reduce poverty and improve the general living conditions of the poor devoid of a critical analysis of the roots of unjust wealth distribution. Further, it has been argued that this approach protects those in power by masking the material interests of those invested in the economic structures of society. In a context disproportionally weighted to the rich, relying on healthy public policy and progressive taxation is bound to fail because it does not fit the material interests of the bourgeoisie; when gains are made, they are nearly impossible to defend in times of supposed ‘austerity’.

It has been 36 years since the Soviet Union hosted over 1,500 delegates from 134 different countries to declare the importance of social equity to health, and yet rather than a reduction in poverty, what we are witnessing today is unprecedented wealth inequities both between the rich and the poor and between rich and poor nations. And despite class contradictions, critics ponder why it is that redistributive policies that were first advocated 3 generations ago are still not enacted.

The Social Gradient, Social Location, and the Social Environment

A second approach to the connection between class and health has been the social gradient theory which employs a comparative analysis between social classes as defined by income quintiles to examine the relationship between relative social status, income, and health outcomes in any given society. Sir Michael Marmot is one of the biggest names in the social gradient theory.

Drawing on a wealth of epidemiological data, such as the foundational Whitehall Study of British civil servants which demonstrated a correlation between occupational hierarchy and health outcomes, Marmot and other proponents of the social gradient theory point to connections between relative (as opposed to absolute) income and health. This theory postulates that as wealth inequalities within a nation are reduced, so are the relative health outcomes attributable to said inequalities. Therefore, countries which adopt measures to redistribute wealth and ensure equal access to ‘life enhancing’ resources to the disadvantaged, demonstrate improved health outcomes for all members of the society. As Marmot himself declares, “the unnecessary disease and suffering of disadvantaged people, whether in poor countries or rich, is a result of the way we organize our affairs in society” (Marmot, 2006, p. 2081). While this work on the social gradient has advanced the understanding of the relational nature of class and introduced a greater analysis of the role of political economy in health, the theory of class still rests on a measure of relative income in a given society.

Critics of the social gradient approach argue that the mechanisms for wealth redistribution identified by Marmot and colleagues, including redistributing control over resources through ‘empowerment’, ‘inclusion’, ‘social engagement’, and the generation of ‘social capital,’ mystify the concrete material process by which class is determined and wealth is produced and expropriated under capitalism. The social gradient approach to health inequalities obfuscates the process of wealth appropriation by the ruling classes.

Not surprisingly, many of the positive examples that Marmot, Wilkinson, and others draw on to illustrate that societies with greater wealth equity also demonstrate broad improvements in health outcomes are the very societies which have strong socialist forces or are governed by Communist parties. What this shows is that those societies that adopt broad sweeping structural transformation to halt the appropriation of wealth from the working classes fair far better in terms of health outcomes.

Social Status and Social Comparison

Finally, progressive health theorist and social epidemiologists have also questioned the relationship between social status, social comparison, and health. In particular, Richard Wilkinson postulates that social comparison, humiliation, and shame are important mechanisms by which those who have lower social status as determined by income, education, and the nature of employment (i.e. ‘bad jobs’ or low status employment) have poorer health outcomes than their rich counterparts. This fall-back on psychology to fill the void left by the social determinants of health approach is interesting, and while there may be a grain of truth in this assertion, certainly self-esteem and social comparison exist as a complement and not a stand-alone approach.

Class and the Structural Determinants of Health

The Marxist approach to theorizing the relationship between health inequities and the economic and social structure of society is broadly coined as the structural determinants of health. Building on the social determinants of health, Marxists take the theory one step further and look beyond existing wealth and health inequalities to the very structures which give rise to the inequalities in the first place.

Broadly speaking, Marxists define class, not by income or access to material resources, but rather as a relation between classes predicated upon the exploitation of one class by another. A structural determinants of health approach identifies exploitation of the working class under capitalism as the mechanism by which health inequalities between the bourgeoisie and the working class are created.

Social Relations, Exploitation, and Parasitism

For Marxists, it is not enough to identify that “social injustice is killing people on a grand scale” (WHO, 2008); in order to eradicate this injustice, the exploitative nature of class relations under capitalism must be exposed and eradicated.

For over a century, Marxists have pointed to class relations as the mechanism by which health inequities are produced and maintained under capitalism. In 1884 Engles’ The Condition of the Working Class in England traced the suffering and ill health of the British working class to the bourgeoisie who lived on the surplus wealth produced by their workers. Class is thus understood as a social relation mediated by the exploitation of the working class via the expropriation of surplus value by the bourgeoisie; “exploitation thus occurs when the class process involves appropriation of the surplus labor of laborers by non-laborers [broadly, the bourgeoisie]” (Muntaner & Lynch, 1999). As Navarro poignantly declared in his 2009 article ‘What we mean by the social determinants of health’, “class dominance and class alliances existing in the world today are at the root of the problem of poverty” (Navarro, 2009, p. 9), and that “it is not inequalities that kill, but those who benefit from the inequalities that kill (ibid, p. 15).

Borrowing an analogy from the natural sciences, class relations between the bourgeoisie and the working class mimic a disease process whereby the bourgeoisie acts as a parasite on the working class, weakening workers as a class under capitalism. Through the parasitic process, the parasite (the bourgeoisie) draws necessary resources for living from the productive and reproductive capacities of its host (the working class). Parasitism is a process whereby the host bears the bodily risks, the basic energy expenditure, and the long-term drain on physical resources to provide for itself as well as for the ever-growing needs of the parasite. Parasitism is a process, but also an outcome, as the host is irreparably harmed through the parasitic process.

The concept of parasitism is not new to Marxist theory, but one which has not been broadly applied to understanding or theorizing health inequities. Vicente Navarro argues this oversight is intentional, as academics, scientists, and health professionals have a material interest in maintaining the capitalist superstructure upon which modern science and medicine rest.

Ultimately, it is societies which have taken direct action to halt this parasitic process and struggled against capitalist and neo-liberal frameworks for health action that have made the greatest strides in building responsive health systems and achieving greater equality in wealth and health.

Useful reading and works cited:

Armelagos, G.J., Brown, P.J, and Turner, B. (2005). Evolutionary, historical and political economic perspectives on health and disease. Social Science & Medicine, 61(4), pp. 755–765.

Birn, A. (2009). Making it Politic(cal): Closing the Gap in a Generation: Health inequity through action on the social determinants of health. Social Medicine, 4(3), 166-182.

Brown, P.J. (1987). Microparasites and Macroparasites. Cultural Anthropology, 2(1), pp. 155-171.

Council for Health and Development (CHD). (2003). Diagnosing Poverty: Building Community [DVD]. Brussels: International Action for Liberation.

Council for Health and Development (CHD). (1998). 25 Years of Commitment and Service to the People: Community Based Health Programs 1973-1998. Manila, Philippines: author.

Council for Health and Development. (2003). Health of the people: Health of the nation. Manila, Philippines: author.

CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization. Available from: http://www.searo.who.int/LinkFiles/SDH_SDH_FinalReport.pdf

De Belder, B. & Vanobberghen, R. (1999). Kasama: the Philippine struggle for health and liberation through the eyes of two Belgian doctors. Brussels: Geneeskunde voor het Volk.

De Vos, P., De Ceukelaire, W., Malaise, G., Perez, D., Lefevre, P., and Van der Stuyft, P. (2009). Health Through People`s Empowerment: A rights-based approach to participation.  Health and Human Rights, 11(1), 23-35.

Feo, O. (2008). Neoliberal Policies and their Impact on Public Health Education: Observations from the Venezuelan Experience. Social Medicine, 3(4), pp. 223-231.

Muntaner, C., and Lynch, J. (1999). Income Inequality, Social Cohesion, and Class Relations: A critique of Wilkinson’s neo-Durkheimian research program. International Journal of Health Services, 29(1), pp. 59-80.

Muntaner, C., Guerra Salazar, R.M., Benach, J., and Armada, F. (2006). Venezuela’s Barrio Adentro: An alternative to neoliberalism in health care. International Journal of Health Services, 36(4), 803-811.

Muntaner, C., Lynch, J. and Oates, G.L. (1999b). The Social Class Determinants of Income Inequality and Social Cohesion. International Journal of Health Services, 29(4), pp. 699-732.

Navarro, V. (1976). Medicine Under Capitalism. New York: Prodist.

Navarro,V. (1983). Radicalism, Marxism, and Medicine. International Journal of Health Services, 13(2), 179-202.

Navarro, V. (2009). What we mean by the social determinants of health. Global Health Promotion, 16(1), 6-16.

Navarro, V. and L. Shi. (2001). “The political context of social inequalities in health”. Social Science and Medicine, 52, 481-491.

Raphael, D. (2002). Poverty, Income Inequality, and Health in Canada. Toronto: The CSJ Foundation for Research and Education.

Rioux, M.H. (2010). The Right to Health: Human Rights Approached to Health. In, Staying Alive: Critical Perspectives on Health, Illness and Health Care, 2nd Edition. (Eds. T. Bryant, D. Raphael, M. H. Rioux). Toronto: Canadian Scholars’ Press Inc.

Shelby, T. (2002). Parasites, Pimps, and Capitalists: A naturalistic conception of exploitation. Social Theory and Practice, 28(3), pp. 381-418.

Wilkinson, R.G. (1999). Income Inequality, Social Cohesion, and Health: Clarifying the theory – a reply to Muntaner and Lynch. International Journal of Health Services, 29(3), 525-543.

A poem for Kerry

But let justice run down as waters, and righteousness as a mighty stream.
Amos 5:24

I think of you.
Your grace and your fire. Your clear sight.

The day you were heavy in your pregnancy with Claire
and we sat together as you
taught me your guidelines for antibiotic use.
All those times I thought of you
as I referred to your notes.
Saving little lives
with essential medicines.

How when I was desperate for postpartum hemorrhage medications
in the mountains of Negros
you sent me a bottle of misoprostol.
Across an ocean you reached out
to rural women
struggling to survive.

That day you dropped by clinic with Sarah
and we chatted (and laughed) over lunch
about motherhood
and struggling to make a difference
in this world.
Your openness and honesty a salve
to an alienated heart.

And as I was speaking about Liberation Medicine
at the Organizing Centre I looked up
and saw you had tears in your eyes.
At that moment I loved you so much,
and I knew you understood
the pain of privilege not deserved;
the sickness of silence
amidst such thunderous need;
the sadness of waste
when so many are hungry.
That healing takes so much more than health care.

The night you gave me a lift home from the dinner
Kiran hosted in memory of Sue.
Sarah was sleeping in her car seat, lulled by the rhythm of the windshield wipers.
You told me how proud you were of my work for social justice.
And you understood how hard it is to carry on
once the pain of the world has been laid bare before you.
And our last embrace.

I make this commitment in your memory. To you.
I will never exchange
the struggle for justice
for the comfort of ignorance.

Vancouver to Gaza Public Report Event


The 2012 Vancouver2Gaza delegation travelled to Gaza in the early summer. The delegates met with groups involved in health work, refugee rights and BDS as well as women’s, students and youth organizations to work to build links between progressive movements here and the Palestinian revolutionary left.

This community reportback was held in Vancouver on July 22 and in addition delegates have been producing blogs, videos, and a written report documenting their experience.

Delegates include: Khaled Barakat (delegation coordinator), Brian Campbell, Cy Canuel, Kathy Copps, Charlotte Kates, Aiyanas Ormond, Martha Roberts and Jase Tanner. The delegates work with numerous organizations including the Boycott Israeli Apartheid Campaign, Alliance for People’s Health, Seriously Free Speech Committee, Samidoun Palestinian Prisoner Solidarity Network, International League of People’s Struggles, among others. For more biographical information about delegates, please visit http://www.vancouver2gaza.org

The Right of Return: Still the Key

The Right of Return has long been a key struggle for the Palestinian people. Many refugees still have the keys to the homes from which they were driven in 1948, 1967 and at every other step of the building of the racist colonial Israeli state.

On our visits to the Shati (Beach), Jabalia and Nuseirat refugee camps in Gaza we met with numerous families who have lived in the cramped and impoverished refugee camps since fleeing the Zionist terror in 1948.  Large families of 3 and 4 generations of refugees live sometimes 10 to 20 family members in a three room flat, and unemployment (officially 40% in Gaza), and the poverty that goes with it, is concentrated here.


One comrade we met in Shati Camp lost a young daughter to an Israeli missile strike which also destroyed his house.  Her picture hung on the wall of his small living room and he was visibly emotional as he told us that her name was Hadiqah, which means garden in Arabic, but also refers to a historical neighbourhood in Jerusalem which has been ‘ethnically cleansed’ of Palestinians. He also lost a son who joined the resistance and was killed by the Israeli Occupation Force.  Every family in the refugee camps has lost at least one family member to the occupation.


These refugees suffer the daily violence of the Nakba (the disaster of 1948) and of Israeli occupation and war against the Palestinian people.  Overcrowding, joblessness, reliance on the oppressive and paternalistic ‘aid’ of UNWRA, and the stuckness of knowing that you have a right to return to your land, where life can resume, but being perpetually and violently blocked from realizing that right.  A similar, and in some cases more oppressive situation persists in refugee camps in the West Bank, Jordan, Syria and Lebanon.

There can be no justice without these refugees being allowed to return to their homes and lands.  Only the right of return fulfills this basic aspiration of the 5 million Palestinian refugees in the areas inside and immediately adjacent Palestine.

The Right of Return is also a key political demand.  It is a demand that challenges the false idea that a just and lasting peace can be achieved with the creation of a tiny dependent Palestinian state in the West Bank and Gaza.  Moreover it is a demand that resonates with and unifies Palestinians living under occupation in the West Bank; under siege in Gaza; in refugee camps in Jordan, Syria and Lebanon; around the world in the Shatat (Palestinian diaspora); and within the Israeli Apartheid State created on the Palestinian lands occupied in 1948.

Overcrowded, partially destroyed by air strikes, refugee camps are visible symbols of racist colonial policies.


Press Release



Besieged Gaza, Occupied Palestine

We condemn in the strongest possible terms the latest Israeli war
crimes committed against our people in the Gaza Strip. We call on the
international community and the Arab and Islamic worlds, to take up
their responsibility to protect the Palestinian people from this
heinous aggression and immediately terminate the continuing Israeli
policy of collective punishment.

Over the last 6 days, Gaza City has been bombed by Apache
helicopters,F16 and drones. More than 16 civilians, including
children, have been killed and more than 70 injured in Beit Hanoun,
Jabalya, Khan Younus, and Gaza.

Gaza has been enduring Israeli policies of extermination and
vandalism since June, 2006. The Palestinian people have already been
under siege for more than 6 years. The continuing international
conspiracy of silence towards the genocidal war taking place against
the 1.5 million civilians in Gaza indicates complicity in these war

We call upon the international community to demand that the rogue
Apartheid State of Israel end its siege. We also would like to remind
the members of the UN that the International Humanitarian Law and
International Human Rights Law such as The Fourth Geneva Convention
stipulate the protection of civilian lives and property, unless
Palestinian women and children are not considered civilians.

Palestinian General Federation of Trade Unions (PGFTU)

General Union for Health Services Workers

General Union for Public Services Workers

General Union for Petrochemical and Gas Workers

General Union for Agricultural Workers

Union of Womens Work Committees

Union of SynergiesWomen Unit

Union of Palestinian Women Committees

Womens Studies Society

Working Womans Society

Palestinian Students Campaign for the Academic and Cultural
Boycott of Israel (PSCABI)

University Teachers Association

The One Democratic State Group (ODSG)

Palestinian Women: An Inspiration to Anti-Imperialists

Today we met with former political prisoners with the Palestinian Developmental Women’s’ Studies Association and with leaders from the Union of Palestinian Women’s Committees.

It was exciting and inspiring to meet face to face with these brave and tireless women who continue to dedicate themselves to the struggle against Israeli occupation despite enormous odds and grave challenges.  We analyze that women are at the crux of imperialism, super exploited as both a source of free reproductive labour in the home and in the community, and as cheap labour within the working class.  As Comrade Parvati from the Communist Party of Nepal (Maoist) so brilliantly explained, women face a three-prong struggle: the struggle for national and social liberation, the inner-party struggle to advance women’s leadership at great odds given the enormity of the chauvinism and male violence women face in society, and the inner struggle against the internalized sexism against which women themselves must struggle.  The stories of both hardship and resistance the delegation heard today highlighted that Palestinian women bravely face this three-prong struggle.

The heart-wrenching stories of women arrested for defending their land, their homes, and their husbands and sons from Israeli aggression are ones I will never forget.  Of women forcefully dragged from their homes and sentenced to serve time in Israeli prisons for resisting displacement and Israeli encroachment into historic Palestinian homeland .  Women separated from their infants, tortured, sexually harassed, fearing for the lives of their children, and enduring long separations from their families.  Women shared how their sons were killed while being tortured or detained.  The women insisted that our delegation decry the lies propagated by the imperialist aggressors and tell the world that Palestinian women love their children!  What choice to they have but to resist when the very existence of the Palestinian people is threatened by Israeli apartheid.  “Why is our resistance illegal?”They ask.  “Who is violating international law?”

Following the incredible stories of the women freedom fighters we met with the leadership of the Union of Palestinian Women’s Committees.  The UPWC struggles for women’s political and economic rights and for increasing women’s political participation in electoral politics in society at large and within the progressive movement.  The UWPC is economically independent, raising funds through food production and traditional Palestinian textile arts; at lunch we had the absolute pleasure of sampling their incredible food and perusing their stunningly beautiful crafts.  Through these efforts the Committees have been able to provide cultural, political, economic, and social programming to the most marginalized women in Gaza.

Israeli occupation is the greatest source of violence against women.

The UPWC works in the community, engaging women in political education in their  homes, recruiting women to participate in political formations led by women, and assisting women to develop economic independence, in particular for those who have absent husbands.  During our discussions UWPC leaders explained that, while they struggle against male violence and women’s oppression in Palestinian society, the greatest source of violence against Palestinian women is Israeli occupation.  Women’s rights to dress freely and participate more fully in society must accompanied by liberation from the extreme violence and deprivation of the Israeli military occupation of Palestinian land and the accompanying economic domination.

Palestinian women resist occupation on all three fronts that Comrade Parvati describes.  Palestinian women face great personal barriers to participating in the national liberation struggle; through the efforts of the UPWC women overcome major social and psychological barriers erected by male supremacy and chauvinistic social norms to their political struggle and participation.  The struggle to liberate their minds and concurrently incite change at the community level goes hand in hand with the national struggle for liberation.  The efforts of the UPWC contributes to the development of leadership within the progressive sectors, raising women’s perspectives and demands at the movement level.  Lastly, Palestinian women participate in the Palestinian liberation movement as armed combatants; in 2009, 10% of armed Palestinian combatants were women.

I have always been inspired by the struggles and leadership of Palestinian women, and today I witnessed first-hand the reasons why Palestinian women should be and are at the forefront of anti-imperialist women’s struggles for liberation across the world!

Martha, from Gaza, June 19, 2012

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