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• Reframing the power relation: from feudalism to capitalism
  Leonard Grant
  Published on: 19 October 2022

• Published on: 19 October 2022

  Reframing the power relation: from feudalism to capitalism

  • Leonard Grant, PhD Student and Academic Course Manager (MHPE) CenMEDIC and The University of Winchester

  I would like to thank the authors for their analysis of the structural imbalances of power that exist in global health. I particularly agree with their argument that diversity, equity and inclusion initiatives work only to strengthen existing structures rather than to dismantle them.

  However, I would like to problematise the framing of the power relation in this article and suggest an alternative.

  To describe the contemporary problems with the “structural imbalance of power” in global health as feudal perhaps implies that they are somehow historic or located in the past, when they are operating and located within modern political economy. Feudalism, as a system of production, is predominantly associated with medieval Europe. Therefore there is a danger, in this piece, that the solution gestured towards is one of modernisation, to develop the relations from these feudal ones. However, from feudalism developed capitalism, both in Europe (Marx et al., 1981; Robinson, 2000) and also, as Alavi (1980) argues, in the colonial Indian context the authors explore in detail in their article.

  Colonisation is inseparable from the rise of capitalism as a means of production (Vergès, 2021), of which developing healthcare infrastructure to support the colonisers was an integral part, as the authors identify. Colonial expansions were not primarily a thirst for adventure but a thirst for profits, for resources, for land and for new people to exploit (Blaut, 1989; Bryan...

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  I would like to thank the authors for their analysis of the structural imbalances of power that exist in global health. I particularly agree with their argument that diversity, equity and inclusion initiatives work only to strengthen existing structures rather than to dismantle them.

  However, I would like to problematise the framing of the power relation in this article and suggest an alternative.

  To describe the contemporary problems with the “structural imbalance of power” in global health as feudal perhaps implies that they are somehow historic or located in the past, when they are operating and located within modern political economy. Feudalism, as a system of production, is predominantly associated with medieval Europe. Therefore there is a danger, in this piece, that the solution gestured towards is one of modernisation, to develop the relations from these feudal ones. However, from feudalism developed capitalism, both in Europe (Marx et al., 1981; Robinson, 2000) and also, as Alavi (1980) argues, in the colonial Indian context the authors explore in detail in their article.

  Colonisation is inseparable from the rise of capitalism as a means of production (Vergès, 2021), of which developing healthcare infrastructure to support the colonisers was an integral part, as the authors identify. Colonial expansions were not primarily a thirst for adventure but a thirst for profits, for resources, for land and for new people to exploit (Blaut, 1989; Bryan et al., 2018). As Walter Rodney demonstrates (Rodney and Recorded Books, 2012), the profits from British colonial endeavours were directed back to Britain, developing British society and infrastructure at the cost of underdeveloping colonial countries. The global North, built as it is on theft of the world’s wealth, is a creation of the global South (Fanon, 1963; Vergès, 2021). Therefore, to be anti-colonial one must be anti-capitalist.

  The alternative I would suggest in this article is to name these relations as capitalism, not feudalism. To understand the persistence of colonial and neo-colonial relationships in global health, it’s necessary to understand how these relationships are related to our current system of production, oppression and exploitation: capitalism. For example, the well-documented phenomenon of “brain drain” where doctors are being lost to their global South contexts can be understood, in part, as an expression of the contradictions of capitalism. The structures that enable imperialist exploitation of the global South for the benefit of the global North, including through the global health ecosystem are capitalist, not feudal.

  Imperialism, to which the authors allude, is not called the highest stage of capitalism for nothing (Lenin, 1916). The financial leverage that imperial countries hold over colonial and neo-colonial countries cannot be broken only by considering the positionality of individual actors but rather by dismantling and reforming the existing relations of production, returning genuine autonomy to the global South. I hope that through this, global health is truly transformed.

  Bibliography
  Alavi, H. (1980) India: Transition from feudalism to colonial capitalism. Journal of Contemporary Asia 10, (4) 359–399. https://doi.org/10.1080/00472338085390251
  Blaut, J. M. (1989) Colonialism and the Rise of Capitalism. Science & Society 53, (3) 260–296
  Bryan, B., Dadzie, S., Scafe, S., and Okolosie, L. (2018) The heart of the race: Black women’s lives in Britain. London ; New York: Verso
  Fanon, F. (1963) The wretched of the earth. New York: Grove
  Lenin, V. (1916) Imperialism, the Highest Stage of Capitalism. https://www.marxists.org/archive/lenin/works/1916/imp-hsc/
  Marx, K., Fowkes, B., and Fernbach, D. (1981) Capital: a critique of political economy. London ; New York, N.Y: Penguin Books in association with New Left Review
  Robinson, C. J. (2000) Black marxism: The making of the Black radical tradition. Chapel Hill, N.C: University of North Carolina Press
  Rodney, W., and Recorded Books, I. (2012) How Europe Underdeveloped Africa. Baltimore, MD: Black Classic Press
  Vergès, F. (2021) A decolonial feminism. Trans. by Bohrer, A. J. London: Pluto Press

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  Conflict of Interest:
  None declared.

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