A Nation of Sick Proletarians Reloaded

For bourgeois politics, the health figures are just too bad to be true.

As the Covid-19 pandemic was ravaging through the planet, I was thrown into a state of hypochrondia. Severe pains in the neck, back and jaw, accompanied by a hoarse voicebox all threw me into a pit of distress as I waited desperately throughout the NHS backlog to find out what was wrong with me. Paranoid that I had long COVID, my body was hit with a double whammy of tension muscle dysphonia and temporomandibular disorder. Eventually, after the best part of a year, I was given some drugs, referred to a voice therapist and sent on my way. The voice therapist told me I was better off seeing a counsellor or psychologist. The bottom line, she gently informed me, was not so much any physical condition as it was my mental health causing me to strain my voice and clench my teeth in my sleep. The resolution to a whole year's worth of physical anguish and medical mystery felt quite underwhelming in the end.

Minor though this little anecdote may be, there are many more instances like it, and they have become a site of political contestation. Since the COVID-19 pandemic, 3.7 million workers have declared they have work-limiting health conditions. People aged 16-34 years old are now as likely to report one as someone aged 45-54 ten years ago. And of the over 900,000 16-24 year olds neither in employment, education or training, 240,700 of those are out of work due to sickness. Much of these rises are indicative of growing mental ill-health. These health realities and their impact on people’s ability to work have been diagnosed as the root cause of the nation’s sluggish employment rate. Concurrently, the British state’s ability to collect census data on the population has broken down over the past four years. Between 2019 and 2023, the overall response rate to the Office for National Statistics’ Labour Force Survey collapsed from 39 per cent to 13 per cent of invited households. The increasingly limited reach of census data has added fuel to the flames of a wave of scepticism about the economic inactivity problem plaguing Britain’s labour market.

Central to this growing doubt, a recent report from the Resolution Foundation, ‘Get Britain’s Stats Working’, uses HMRC tax records to challenge the notion that there has been a rise in economic inactivity since 2019. Using this administrative data, the authors paint a picture of relatively straightforward congruence in the economic inactivity rate in the period immediately before the pandemic until now. This report, factoring in adjustments such as the growth of migration, argues that the employment rate has been persistently stationed around the 76% mark. Suggesting that the rise in health-related benefits reflects “changes to incentives and stringency in different parts of the benefit system”, the Financial Times’ chief data reporter John Burn-Murdoch embraces the findings in the Resolution Foundation report. Rejecting the idea that there has been a deterioration of the population’s health, Burn-Murdoch argues that Britain’s uneven fluctuations in economic inactivity are a product of a welfare state undergoing regular change.

It is undoubtedly the case that the expansion of welfare spending is the single biggest measure of widespread economic inactivity we currently have access to. According to the Institute for Fiscal Studies’ ‘Health-related benefit claims post-pandemic: UK trends and global context’ report, there has been a large increase in spending on working-age health-related benefits, from £36 billion in 2019–20 to £48 billion in 2023–24. Claimants of disability and incapacity benefits are younger and more likely to be female, with most out of work for two years prior to having their claim accepted. New awards to under-40s have grown by 150% and the proportion of claims on the basis of mental health has increased nine points in four years to 37% (12,100 a month). The share of the working-age population reporting a disability, having increased by 2% between 2014 and 2019, rose to 23% in 2023 with health-related benefit claims increasing even more.

The implication in John Burn-Murdoch’s contribution, that the system is currently prone to being gamed greater than previously, does not stand up to scrutiny. As Dan O’Hara has unsparingly evidenced on X, just a quick glance at the GP Patient Survey shows a 4% increase over the past year in people with a physical or mental health condition lasting 12 months or longer. The same survey also reports that those too sick to work have jumped up each year since 2021, by 4.5%, 4.5% and 6.2% each year. This data corroborates a developing story of rising mental health conditions such as anxiety and depression, musculoskeletal diseases like arthritis and back pain, and even learning disabilities.

We live in a country with 38% of Universal Credit (UC) claimants in low-paying work frequently resulting in, as documented by Aditya Chakrabortty, “chronic pain and ravaged mental health”. According to the DWP’s own report, one in five claimants are in debts up to £10,000, with 81% of those indebted running out of money before their next payment ‘always’ or ‘most of the time’. Two-thirds of UC claimants have gone without food. Work in this country doesn’t pay, it demeans and depresses us. The social safety net, designed by Thatcher and reinforced by Blair, subsidises low-waged and insecure employment. The NHS waiting list currently stands at 7.57 million, one of the worst in Europe. The confluence of workplace stress and hypertension, ailing public services, spatialised inequality and a welfare system less generous relative to earnings than in most comparable countries are all ingredients for a health disaster.

Additionally, whilst Britain joins much of the planet’s population in the tendency towards demographic ageing, it also bucks the trend: the country of the National Health Service can now boast a stalled life expectancy, with people over the age of 50 now expected to live 2.3 years less than in the past. Reported upon by the International Longevity Centre, this reality goes hand-in-hand with a 21-year gap between male health life expectancy and life expectancy in the unhealthiest local authorities. In Blackpool, one of the most deprived areas in the country, healthy life expectancy is as low as 54 for women.

The claim, reproduced by former Spectator editor Fraser Nelson on Channel 4’s Dispatches, that it is easy to obtain benefits but far harder to escape them does not stand up to scrutiny. Philippa Day, found dead with a letter ruling out a home assessment visit after her benefits had been slashed from £228 to £60, shows us a labyrinthine system which punishes the poor. Anyone who has applied for health-related welfare knows full well how intrusive, strict and dehumanising the process can be.

Speaking to an incapacity benefits claimant on Dispatches, Nelson could not hold back his glee. The interviewee, reflecting on the mental health crisis that led him to the welfare state, talked of his inability to re-enter the labour market because of a hole in the system. Nelson had discovered the problem with today’s labour market: the country’s poor are trapped in a Kafkaesque system of dependency they desperately want out of, cornered by a creaking state’s failure to tilt towards workfare. Not at all interested in the stark reality that work simply does not pay anymore, Nelson gallantly asked the interviewee if he could simply go it alone and take the risk without benefits for six months whilst he completes the training.

This interviewee is one of the millions of targets of the Department for Work and Pensions (DWP) white paper, ‘Get Britain Working’. Faced with growing inactivity on the labour market, Kendall’s department is tasked with reducing the £266.1 billion annual welfare budget, achieving an 80% employment target and, in the words of health advisor Alan Miburn, ensuring employers “wean themselves off the easy solution of importing more workers from overseas.” Unwilling to challenge the Treasury, drastically increase investment or substantively raise taxes on society’s wealthiest, this government is determined to boost economic growth by reasserting the moral and disciplinary value of work.

Britain’s rise as a nation of sick proletarians is mirrored by its decline as a capitalist power. These anxieties, concerned far more with their impact on employers’ profits and national productivity than the health of the population, were acutely expressed by the New Statesman’s Andrew Marr. The famous broadcaster claimed that we now have a “generation who haven’t got the disciplines of work, haven’t got the socialising that work gives you, haven’t got all those things that work brings us, and if you don’t get those in the first ten years, you probably will never have it...” Explicit about the need to socialise workless cohorts of the population into forms of labour exploitation (and the dangers if the populous are not), Marr is one note amongst a growing chorus of voices interested in disentangling the nation’s health crisis from its labour market dysfunction.

The value of hard work, as late historian Tom Nairn has made us aware, is fundamental to how Labour defines its image and its mission in government. In this spirit, DWP chief Liz Kendall has announced a meagre £240 million investment involving the rebranding of Job Centres as the National Jobs and Careers Service; a new “Youth Guarantee” project providing every 18 to 21-year-old with access to education, training or apprenticeships; an independent review of the role employers play in promoting health and an exclusive workplace; a further review of benefits reform; and a cash injection into parts of Yorkshire and the North East to stop people falling out of work because of ill health. The threat of workplace MOTs, job coaches on mental health wards and obesity drugs to combat the “burden” of “widening waistbands” all underlie this. Labour leader Keir Starmer’s declaration of a war on “benefits Britain” and those who try to “game the system”, littered on the front page of the Daily Mail, signals how far Labour are willing to go to get British workers back working hard. The DWP’s approach is reminiscent of the British state’s ‘Hostile Environment’ for migrants, involving stitching practices of compulsion into the fabric of welfare and health systems, forcing the sick and disabled onto the labour market. This is in no small part driven by Labour’s hostility to tighter labour markets, increased worker bargaining power and higher welfare bills.

On the other end of this spectrum, we see Reform UK’s Nigel Farage reproducing the sovereigntist frame of Brexit and applying it to the body with conspiracist diatribes against the World Health Organization and the impositions of vaccine mandates, lockdowns and top-down global pandemic treaties. Across the Atlantic, Robert F. Kennedy, Jr.’s eclectic mission to revitalise the health of the American population, overcome chronic disease, combat ultra-processed food, challenge Big Pharma and regenerate agriculture is accompanied by his conspiracist opposition to fluoride in water and vaccines. Whether Farage can rearticulate the politics of Make America Healthy Again in a bid to deepen the privatization of the still popular NHS - an ambition he has been persistently vocal on - remains to be seen.

Figures such as Fraser Nelson are invited to scrutinize the poor and sick on mainstream television despite his eugenicist pontifications over squeezing the disabled and workless from our genetic codes, and Clinical Psychologist Lucy Johnstone is drawn upon to challenge the apparent ease with which neurodivergent conditions are repelling people from work and reinforcing mental ill-health. Both sets of politics pose substantive threats to the health and freedom of the population, but the weaponisation of Johnstone’s oeuvre may pose tougher questions to those of us who reject the compulsion to work regardless of our suspicion of the effort to box psychosocial conditions into the rigid, Big Pharma-friendly definitions of the DSM-5.

The bottom line is that renewed capitalist biopolitics represent efforts to frame national capitalist decline through the prism of the body, weakening bodily sovereignty in an effort to permit the revitalisation of capitalist productivity, putting surplus ‘waste’ to work against its best wishes. Far-right biopolitics intervenes in biophysical defence of the idealised ‘little man’ against corporate capitalism's declinist destination, playing on the anxieties of petit-bourgeois and surplus populations worried that they are disposable to the system-at-large.

Communists need a biopolitics of our own, insisting on good health and social freedom as the centrepiece of our vision of futurity. Rather than threaten the sick, disabled and workless with bad jobs, a shrinking social safety net and magnified stress, perhaps it is time that we build a society predicated upon long, healthy lives, guaranteeing reduced working time and access to secure, nondisciplinary welfare and health systems run by and for the people. But to hear more from me on this, check out the next issue of Salvage journal.