Abstract
The dictum “follow the money” has served well those dedicated to uncovering the hidden machinations behind various forms of political and economic malfeasance. Similarly, adopting this principle allows Brent Z. Kaup and Kelly F. Austin to explain “How Capitalism Breeds Vector-Borne Disease.” The Pathogens of Finance: How Capitalism Breeds Vector-Borne Disease is a well-researched book that presents compelling evidence that makes explicit the normally latent interplay involving the financialization of the economy, landscape changes, and the emergence of infectious diseases. The book covers a lot of ground, and the authors should be commended for carefully compiling the historical, political-economic, ecological, biological, medical, and public health evidence needed to support their involved argument, and for presenting all of this in a reasonably accessible and understandable manner. This most certainly was not an easy task; but the result is an intriguing and eye-opening read.
Generally speaking, political-ecological (or political-economic) analyses of environmental issues focus on resource extraction or production and manufacturing rather than that which occurs in the tertiary sector—for example, the unfolding of services pertaining to banking, real estate, and finance. This is perhaps understandable because the environmental impacts from the primary and secondary sectors are physical, tangible, and readily observable. What is notable about this book is that the authors trace environmental impacts to the features of the economy that are less open to public and academic scrutiny—specifically, the environmental health consequences of decisions and policy changes emanating from the process of financialization and changes in the financial sector. Financialization, as the authors understand it, involves profit accumulation that occurs not as the direct and exclusive result of the manufacture and trade of commodities per se, but profit that accrues primarily through the trade of new forms of financial securities and derivatives. The authors’ use of financialization as a lens for understanding the relationships between infectious diseases, society, and the environment is pathbreaking.
The analysis starts by briefly reviewing the specifics of the financialization processes that affected each of the regional settings of their study: the exurban residential neighborhoods of northern Virginia in the case of Lyme disease; the large-scale monocrop agricultural fields of Mato Grosso in central Brazil in relation to Zika and dengue; and the coffee farms of the Bududa District in eastern Uganda with reference to malaria. Detailed historical discussions are then provided on how the development of financial derivatives and futures markets led to widespread reconfiguration of the banking sector, housing and real estate development, public and private health insurance, and the financing of debt and structural adjustment plans. The authors then outline how such changes in the financial field resulted in significant changes in regional landscape in ways that established the ideal ecological conditions for disease vectors and pathogens to flourish.
Thus we see, for instance, that the liberalization of the financial markets in the 1970s, in conjunction with the creation of new financial instruments, enabled bankers and financiers to create and extend their investment possibilities. Previously, the banking sector was divided such that securities and investment firms were relegated to dealing only with stock market trade, commercial banks only with business accounts, and savings and loan banks with consumer savings and mortgages. This all changed with the creation of mortgage-backed securities where interest-bearing loans were packaged together so that they could be traded on Wall Street. As a result, by the 1980s investment and securities firms came to be the dominant actors in the housing sector.
With this shift, the operating logic of the banking and mortgage industries changed from promoting the public good (i.e., provision of housing for the population) to seeking rent. The effects of this transition could be discerned, for instance, through the promotion of higher interest rates on home loans; during the 1980s, interest rates topped 9 percent. Notably, this shift to mortgage-backed securities ultimately contributed to the financialization of residential landscapes where the relatively better-off were largely the ones who could pay for homes at the elevated market prices. Consequently, in the 1990s, due to the housing preferences of this relatively affluent social stratum, homes were constructed on large lots of land that were available only in areas situated just outside urban centers. This resulted in a distinctive fragmented forest ecology consisting of areas having large edge-to-interior ratios, smaller patch sizes, and some isolation or distance from other forested parts. These types of changes in the regional ecology of areas such as Northern Virginia established ideal conditions for the proliferation of blacklegged ticks and the Lyme-disease-causing pathogens they carried. The authors take a similar approach to uncovering the complex chains of causation between financialization, landscape change, and pathogens such as Zika, dengue, and malaria in their respective locales.
As discussed by the authors, not only did financialization influence the emergence of disease, but it also affected how public health officials could respond to disease. For example, in reference to Lyme disease, changes in government regulation of fringe benefits (including pension and insurance benefits programs) ultimately enabled insurance companies to offer scaled-down health care plans. This was accompanied by the entry of managed care organizations (MCAs) into the health care provisioning sector, a sector they soon came to dominate. These developments were subsequently bolstered by the adoption of evidence-based medicine guidelines for diagnosis and treatment, which essentially made it easier for health insurers to deny claims, thus maximizing the profits of insurance companies. Because Lyme disease is associated with nondescript symptoms, while telltale signs such as the “bull’s-eye” rash may not be readily apparent in all patients (or may become visible only much later), it became easier for insurers to classify patients as untreatable outliers who on that basis would be denied treatment. Falling prey to the neoliberal logic of the times, Lyme disease sufferers were left on their own to self-diagnose or find the “right doctor” who could prescribe the appropriate testing and treatment they required.
As the authors explain, the influence of the neoliberal logic of financialization was also evident, albeit in different ways, in responses to dengue, Zika, and malaria. For instance, as funding for research and development on malaria response became increasingly dependent on international venture capital, the promotion of a rather bizarre intervention based on a new “commodity"—the development and introduction of a genetically modified mosquito strain (FriendlyTM Aedes aegypti) into certain regions of Brazil to decrease the mosquito population—became more common. In Uganda, certain changes in the funding of health care were adopted to help pay the interest on foreign loans and generate shareholder value for the pharmaceutical industry. This made medical services unaffordable for much of the population, while introducing significant difficulties in accessing anti-malaria medications and ultimately turning the prevention and treatment of malaria into an individual responsibility.
What this work demonstrates—and analytically this may actually be its greatest contribution (even though the authors themselves may not be aware of this)—is how political ecology may inform the sociological imagination in, yes, imaginative ways. Revealing how seemingly individual acts such as purchasing and maintaining a home in the northeastern United States or growing soy in central Brazil or coffee in eastern Uganda and the ways we are able to respond to and deal with vector-borne infectious diseases are all affected by broader financialization-related forces pertaining to newly introduced financial instruments, housing policies, and structural adjustment plans, as well as public and private health insurance schemes, exemplifies the sociological imagination at work. I would recommend this book to not just health or environmental sociologists, but to those in economic sociology and the allied interdisciplinary fields such as urban and environmental studies, geography, public health, or business and society.