Monday, April 21, 2014

Is the West's Neoliberal Agenda Making the Ukrainian People Sick?

I am fearful that the adoption of neoliberal reforms in Ukraine will have the unintended (or intended, depending on your viewpoint) effects that it has had in the U.S. and other nations such as the restoration of class power through the channeling of wealth and income to upper classes and/or to richer countries which has led to the deterioration of lower classes (Harvey 2007).
Harvey calls this process “creative destruction” where neoliberal reforms destroy not only prior institutional frameworks and powers, but also “divisions of labor, social relations, welfare provisions, technological mixes, ways of life, attachments to the land, habits of the heart, ways of thought, and the like” (2007:23). This will only continue to make life more difficult for the citizens of Ukraine, especially those that suffer from mental illness. Ukraine is in the middle of a complete transformation of its health and mental health system; it will be quite interesting to see what the next twenty years will bring.
A deep focus on an object in our field of vision often means that we do not see the greater threat looming in our blind spot.

Experts in public health have repeatedly and persuasively shown how racism and classism combine to shorten the life spans of people of color in the United States.

I did not generalize from those findings to consider how systems of power and economic arrangements impact the mental health of people in other countries as well until reading Shelly Yankovskyy's work on mental health care, the West's neoliberal agenda, and Ukraine.

She details how:
There is a general trend in Ukriane to dismantle and privatize historically centralized state institutions, such as healthcare. Reforms are being initiated from within and outside of Ukraine. Many initiatives to change healthcare institutions in Ukraine are funded by organizations such as USAID, World Health Organization, and U.S. federal funding aimed at “stregthening civil society.” 
Monies from these organizations are being allocated to NGOs to promote change and reform from within. Like many other newly independent nations around the world, Ukraine engaged in structural adjustment programs (SAPs) to receive funding from the International Monetary Fund (IMF) and World Bank. These programs reflected neoliberal policies which promoted a particular set of requirements that countries had to meet in order to sustain funding such as reducing funding for health care, education and other social services.

The idea is that cutting social service expenditures, decreasing industry protection, freeing interest rates, privatizing state-owned enterprises, and setting realistic currency exchange rates… will reduce state intervention while increasing competition and investment” (Shefner 2008:24), which is suppose to result in economic growth.  
Neoliberalism explicitly promotes what is called “developed capitalism” along with its assumed sociopolitical concomitants such as civil liberties and democratic institutions (Liu 2003:2). Policies reflecting the neoliberal agenda in Ukraine often promote “civil society and development” (Phillips (2005a:502) and “strategies to instill initiative, independence, and Western-style individualism” (Phillips 2005b:254), in addition to privatization. In other words, Western capitalist ideology is slowly trying to take root in Ukraine and displace Soviet ideology. 
Thus far, the major focus of reform for Ukrainian policymakers has been the neoliberal transition from “institutional” to “community-based treatment”, a transition from socialized to privatized or insurance-based care, and the adoption of the U.S.– modeled International Classification of Diseases [ICD-10]. In other words Ukraine is transitioning from a Soviet, hospital-based, socialized system of care to more of a U.S.-modeled, privatized, de-centralized system of health care. Reform of the mental health system in Ukraine is generally welcomed by practitioners and patients alike, however each of these specific reforms are problematic
As in the United States, the changes in Ukraine exist within a broader narrative of "progress" and "innovation". Neoliberalism sustains itself through a lie that its particular arrangement of political economy and social order has created prosperity and happiness for the masses:
Neoliberal advocates often point to increased prosperity, freedom, and consumer choice to justify their brand of market fundamentalism. Inherent in this argument is the assumption, left conspicuously untested, that consumer choice and wealth are, by necessity, conduits of happiness. Turning to the scholarly research, it is true that higher levels of income cross-nationally are associated with increased happiness. For example, researchers have found moderate to strong correlations (between .50 and .70) between per capita income and average well-being across nations. 
However, once income reaches a moderate level (roughly U.S. $10,000 per capita), the effects of additional income on happiness are marginal or nonexistent. In the U.S., mean happiness has remained flat since the end of World War II, while the percentage of Americans reporting being very happy stagnated in the 1960s...Neoliberal advocates are correct in asserting that a sense of freedom increases subjective well-being; they are wrong in assuming that neoliberal policies maximize perceived freedom.
Inequality has increased dramatically in the neoliberal era—even the most insouciant apologist admits this much. Pollyannaish pundits argue the inequality is irrelevant so long as society is getting richer in absolute terms. They also argue that inequality is the price paid for the freedom to pursue one’s talents. The scientific research, however, tells a drastically different tale...

A quick glance at the table reveals that inequality is associated with lower overall population health and mental health as well as a host of social ills. Even social mobility, the cause célèbre of neoliberal aficionados, is negatively correlated with inequality (i.e., the more equal the society, the greater the social mobility). These data further help to understand the lack of a relationship between per capita income and happiness: It is not the income that matters so much as its relative distribution.
Power has a deep relationship to public health and how "mental illness" is defined.

Political radicals have often been branded with the mark of "insanity" and mental illness by the State. African-American freedom fighters were harassed by the American Apartheid establishment with the threat that they were "schizophrenic". Feminists and other Leftists/Progressives were put in insane asylums. The Soviet Union was infamous for how it used the logic of "mental health" and "hygiene" to legitimate the imprisonment of political activists deemed a threat to the regime.

The status of who is designated as "mentally ill" exists in a social context of desirability and norms which serve existing hierarchical relationships between the in-group and those marked as "different" or "abnormal".

Like race or gender, "mental illness" is a social construct.

Of course, the crisis in Ukraine is much more complicated than the American mainstream media has depicted. In this cauldron, we have Neo-Nazis, the forces of neoliberalism, Putin's efforts to expand the near/old Russian Empire, ethnic rivalries, war profiteers, etc.

An over-simplified narrative about the crisis in the Ukraine reflects how the American people have very little understanding of global politics beyond a childishly simple "good guy/bad guy" narrative that is cultivated by the corporate media, and shined to a perfect gloss for consumption by Right-wing Authoritarians.

The American media has ignored how wealth inequality is not an accident but rather the result of intentional policy decisions by political actors who are beholden to the plutocrats and the corporateocracy. The destruction of the American middle class and the evisceration of the social safety net to siphon money up to the very rich are choices made by neoliberal policy makers.

Could it be that the same political actors who have succeed in radically remaking American society around an Austerity and neoliberal model, do not want the American people to "connect the dots" between their struggles here and those of other people abroad?

Moreover, as I have suggested on multiple occasions, the forces of neoliberalism and Austerity have enacted policies that are designed to shorten life spans, and by doing so, to kill those people identified by the plutocrats as "useless eaters" or in Mitt Romney's parlance, the "takers". This is not hyperbole; it is an accurate description of how Austerity and neoliberalism serve a larger, global, bio-political agenda.

The suffering of the American working classes, poor, and middle class is not an accident: it is a function of political policy. What will it take for the American people to acknowledge such a plain fact?


joe manning said...

Neoliberalism's austerity is all about scraping the social safety net domestically and abroad. Its an "every man for himself" policy that ossifies class distinctions while changing the working class into an unemployed mass. The media presents austerity as something that's going to help but obviously it hinders. Elites don't want folks to organize for any reason and the general immiseration is another way to atomize society.

chauncey devega said...

We cook ourselves in the hot boiling water of "individualism".

jemand2 said...

I've heard this dynamic called the "wealth pump." The method by which countries are labeled peripheral and looted, certain segments of society in the rich core similarly disempowered and looted, all to retain the wealth of a shrinking few.

The blogs I usually see it mentioned in often connects it to an observation of the tighter supply of oil, and the greater expense to extract fossil fuel resources.

joe manning said...

Criminal capitalism.

joe manning said...

Rugged individualism is internalized as small business ideology but I think its more mythical than real. It seems that the main direction is toward Tammany style fascist groupings, given the ease with which they coalesce. Its the "I'm in the "toughest gang in town" mentality.

DanF said...

Putin to the East, Austerity to the West. Rock meet hard place...

chauncey devega said...

T-shirt quotable.

chauncey devega said...

Maybe I am a perv, but that could easily be whispered in a lover's ear.