The aftermath of WWII saw a number of struggles for health to become recognised as a common good. Many people fought for health practices to be supported via the public sector, and for care to be made available universally and for free at the point of use (that is, paid for through general taxation, rather than via a single payer model).
Some of these struggles were more successful, other were less so, but whenever change came about it was not a top-down decision, but a result of complex mobilizations that often created transversal connections between those affected, organizers and professionals.
In our current research, which we present here in form of a growing zine and library, we focused on one of such struggles for health that took place in Italy in the 1960s and 1970s. We believe that reactivating some of the stories, techniques and imaginaries that came out of it can be a useful exercise in our present days, in the aftermath of the Covid-19 syndemic, an event with a death poll that could have been, in large part, preventable.
We focus on Italy not only because it is our context of origin, but also because during the decades 1960s and 1970s, it was an extremely lively political laboratory that became significant beyond its own context, including by inspiring a number of working class’ mobilization for healthcare in South America, for instance.
Italy in these decades was subjected to a fast industrialization that deeply altered the life and work patterns of many. Assembly line work, organised according to the principles of scientific management, was brutal, dangerous, poisonous and mentally alienating. It should come as no surprise therefore that the struggles for health were largely working class struggles, addressing simultaneously question related to conditions of labour at the workplace, environmental degradation, gender roles in the home and the desirability of technological innovation.
The title we chose for this zine is our English translation of the one of a newspaper article - RITMI DA PAZZIA - which denounced how in the factory workers are subjected to a constant accelleration in the name of profit. These rhythms are maddening in the sense that were making people furious and push them to organize for change, while at the same time they also provoked many to experience negative mental health conditions. As we shall see, burnouts, depression and psychosis were widespread experiences linked with chain work.
David Harvey remarked that under capitalism, to be healthy is defined simply by the ability to perform labour (DavidHarvey,“The Body as Accumulation Strategy,” *Spaces of Hope*, Berkeley:2000,
pp. 97–116) - this is why people need a doctor’s note to certify that they are sick so they can skip work. However, many do not agree with this narrow definition.
The struggles for health in Italy begun as the political questioning of its opposite – which these movements identified not as sickness nor as fitness, or the capacity to optimally perform work. Rather, political movements begun to focus on the key term nocività – translatable as noxiousness in English.
Noxiousness instead is the property of damaging a living process and to provoke pathologies, both to a singular organism and to an entire ecosystem. A noxious process or substance can have temporary or permanent damaging effects on health; it can move fast or become chronic; it can cause death or “merely” negatively impact the capacity of living beings to reproduce and thrive.
So by focusing on noxiousness - which is produced and not a condition of the individual body, as sickness is - these movements open up the problem of health in a strategic way. They linked the wellbeing of workers, who were exposed to toxicity at work, with that of their living conditions in their neighbourhoods which were destitute and polluted, and with the conditions of domestic labour, and with the impact of capitalist production over the broader environment.
The Covid-19 pandemic brought back at the centre of attention the relationship between medical-scientific knowledge and political strategies in the field of healthcare, the very same relationship that has been the core issue in the historical struggles around healthcare that we have been encountering in the archives centred on 1960s and 1970s' experiences in Italy.
During the pandemic, the dynamics of decision-making regarding the management of the health crisis were characterised by many difficulties that brought to the surface some key aspects of the relationship between the governed and the governors, the so called 'experts' and those who are not; in other words, the crucial and essential nodes of democratic order.
On this terrain, all the critical signs characterising the current processes of depoliticisation that the neoliberalist governance has generated during last decades have become apparent.
Let's be clear: the contribution of experts is relevant in order to make decisions in the most informed way possible, all the more so in situations of health emergencies; however, the massive recourse to them runs the risk of taking the place of the responsibility of politics and institutions, the risk of presenting solutions as unquestionable, just because they are 'technically' founded, without a common discussion on what is needed and which are priorities.
During the pandemic, this exclusion defined at least two different models of care, of taking care of the emergency. On the one side, the care proposed by governments, that has been often rhetorical and sectorial. Let's think for instance on all dispensable bodies who were put in charge of the growing necessities of care, without receiving back any increase in wage, or at least an increase of the safety conditions in which they worked. On the other side, we have the model of care promoted by solidarity and mutual aid collectives, neighbourhoods and groups, whose aim was to redistribute the resources needed to face the emergency as much as possible, while at the same time denouncing the extremely dire conditions in which public services versed, due to decades of strategic disinvestment.
How is then possible to reconcile the needs of politics and democracy with the expertise of the experts? From our point of view, the answer cannot be found in the abstract, but must sought out by delving into the merits of different political priorities, the quality of different democratic processes and the knowledges that different expert can bring to the table.
The Italian history of healthcare struggles during the 1960s and 1970s offers a lesson that is still of great interest, highlighting how the issues involved in decisions concerning public health – the health of everybody - are mainly political in nature, thus, they always involve decisions that require not only technical judgements.
A significant turning point for a new health paradigm, capable of keeping together scientific knowledge and political planning, occurred in Italy in the 1960s and the 1970s, when the figure of the expert became an expression of the Gramscian synthesis 'specialist + politician'. The movement for healthcare service reform was an expression of this renewed paradigm.
Indeed, during those decades an unusual assemblage came together, in which specialists and non-specialists, intellectuals and workers could meet, study together, denounce and constructe a different way of conceiving production, of conceiving technology and science.
Health was considered as a sphere of life as well as the activity of taking care of people. In this context, care took on a meaning that was opposite to the therapeutic medicalisation of society, to became the terrain of new mobilisations, in which a number of social and political actors got involved, including students, feminists, intellectuals, professionals and politicians. This connection generated new collective fields of research, new knowledges, and original forms of struggle and institutional experimentation. And the resulting cross-sectorial and transdisciplinary synergy in turn re-defined the terms of encounter between science and politics.
Medicine and science had to be rethought both in their connection with society, the environment, and the productive sector; as well as in relation to their overall aims and founding values – disentangling themselves from a logic of profit to pursue the possibility of health and pleasure for all.
In this context of struggles, the topic of power relations was understood in the perspective of a modification of relations between classes, of a growth in the rights and faculties of every human being, and of new relations between the experts and the general population. The function of the expert was understood as the most relevant for the fate of the workers' and democratic movements. Based on new demands from society – both in terms of the rejection of the practice of 'delegation' around health matters and of the overcoming of the separation between specialists and workers – a possible alternative function of the expert was envisaged.
Of particular importance was what happened in the field of work medicine and healthcare provisions within the factories. Thanks to new methods of co-inquiry, trade union practices found a new lively terrain of politicization, aimed at building new relationships between workers (committed to reducing harmfulness within the factory) and technicians, doctors and chemists.
Workers' subjectivity and experience became an instrument for building collective knowledge and, at the same time, the crucial node through which technicians started thinking about possible transformations into the reality of work and society at large. Consequently, a new language was constructed, a language that was able to connect the protagonism of the workers with that of the medical / scientific community.
In order to intervene in the problems connected to the production cycle, new techniques were needed, new political and value-based instruments that would allow for transformations in the workplace as well as in healthcare provisions, inside and outside the productive cycle.
Health struggles in the workplace, therefore, extended their claims to the conditions impacting the environment at large, by linking the psycho-physical wellbeing of workers with that of the rest of the population and other living beings.
