public health and real subsumption?
Once again I'm typing to find the rest of a thought that I can only see the top of - typing is digging carrots out of the dirt, basically.
I'm currently reading/skimming through George Rosen's A History of Public Health book. A lot of it's focused on stuff that I'm not really the audience for really but there are occasional bits that I'm struck by bigly. For instance, it has a bit where it says something to the effect that public health proper/public health in the contemporary sense really originates with the industrial revolution, as a way to respond to that. It seems to me that this means public health is a response to a round of real subsumption, just in the logic of Marx's categories.
If you're not familiar with the terms, Marx at some point distinguishes between what he calls formal subsumption and real subsumption. The former is when there's a pre-existing practice that gets pulled into/comes to fall under capitalist social relations and continues to be practiced largely as it was. The latter is when capitalist social relations actively remake an area of social life in keeping with capital's imperatives. These two categories are sometimes used as names for epochs, the first being a time when labor processes and lifeways in capitalism were more proximate to those in precapitalist societies, and the second being later times when society has more been remade by capital. I think that usage is mistaken and really 'formal subsumption' is better understood as just a heuristic device on Marx's part rather than a name for anything in the actual world. (I think this in part because I think if you take an social practice and situate it within a different overarching/organizing social logic that practice will be changed immediately in key ways from the perspective of the people involved, so anything that is assumed to be 'formal subsumption' in the world is actually real subsumption poorly understood.) I like the discussion of real subsumption in Søren Mau's wonderful book Mute Compulsion, which I reviewed here: https://legalform.blog/2023/01/30/review-essay-economic-power-liberalism-and-crisis-nate-holdren/.
In one sense, any location in capitalist society (take 'location' as you like - geographic or institutional) is really subsumed by capital and subject to change over time under the pressures of capital's imperatives. (Social murder is in a sense a name for the real subsumption of people's lives, changing people's health for the worse.) At that level of generality I think the term doesn't do much beyond note that capital is a bit like a rushing river remaking the terrain it flows through. I think the term is best used as a name for rounds of especially intense remaking such that some object of analysis is undergoing massive capital-driven changes in its large scale/longer term trajectory and/or the qualitative tissue of practice and experience it involves. Real subsumption is a 'focus on the forest, not the trees' concept, generally speaking, though the line between those two foci is blurry really. (I want to note as well that real subsumption isn’t one and done - phenomena can be remade by capital more than once, that’s not at all uncommon, I think.)
It may well be that 'public health emerges as response to real subsumption' is just playing around within the logic of Marx's terms or walking around taping post-its with Marx words on phenomena, I'm unsure, but I want to think more about it and see if it sheds any light. Spitballing some more: generally speaking in capitalism we tend to find domains of life taken as relatively fixed and as relatively apolitical. Real subsumption, on the other hand, is a term for intra-systemic dynamism, for change in the world due to capital. When phenomena undergo real subsumption it unfixes aspects of whatever is being really subsumed, and raises the chance of it being politicized in a way that challenges the larger social order and/or capitalist social relations. I think part of public health (and this isn't entirely unique to public health) as a form of capitalist-state-affiliated knowledge and ideology and politics involves helping carry out localized unfixings and politicizations of social relations - there can be change in this small domain, kinda thing - while also involving resources to keep everything localized - the changes will be ONLY in this small domain, kinda thing. So public health is both response to and means of enacting real subsumption and also means of managing responses to real subsumption so they don't get too expansive/ambitious in their aspirations - helping channel responses into system-compatibility. (I want to stress both that all of this is a matter of conflict and that not all conflicts are anti-systemic.)