An Examination of the “Industrial Pathology” of the Capitalist Public Health Crisis

The COVID-19 pandemic has continued to spread globally, not only directly causing hundreds of millions of infections but also triggering enormous economic and social crises, leading to a global economic recession. Since the establishment of the public health system in 19th-century Britain, capitalist societies have developed relatively comprehensive and systematic mechanisms for responding to plagues. Yet why, when confronted with the impact of the COVID-19 pandemic, have they still fallen into a predicament of being unable to advance or retreat? Tracing its origins reveals its foundation; looking back at the process of establishing the capitalist public health system helps us to more deeply understand the historical genes and internal ailments of the current crisis. In *Capital*, Marx, through his examination of the *Public Health Reports* from the period of the British Industrial Revolution, keenly discerned the internal pathological mechanism of the capitalist public health crisis. When plagues broke out in Britain, the infection and mortality rates differed among various population groups; the main cause of plague prevalence was social, closely linked to the capitalist mode of production. “Because it attacks the individual at the very roots of his life with its own specific division of labour, the manufacturing period also first provided the materials and stimulus for industrial pathology.” [1]1 Karl Marx, *Capital*, Volume 1, Chapter 15, Section 5, quoting from the *Public Health Reports*.

新冠肺炎疫情在全球范围持续蔓延，不仅直接导致数亿人的感染，而且引发巨大的经济危机和社会危机，导致全球经济衰退。自19世纪英国创立公共卫生体系以来，资本主义社会已形成相对全面、系统的瘟疫应对机制，但面对新冠肺炎疫情的冲击，为何仍会陷入进退失据的困境？溯其源者得其本，回望资本主义公共卫生体系的建立过程，有助于我们更加深刻地理解当前危机的历史基因和内在病症。在《资本论》中，马克思通过对英国工业革命时期《公共卫生报告》的考察，敏锐地洞察到资本主义公共卫生危机的内在病理机制。英国暴发瘟疫时不同人群患病率和死亡率不同，瘟疫流行的主要原因是社会性的，与资本主义生产方式紧密关联。“因为它以自己特有的分工才从生命的根源上侵袭着个人，所以工场手工业时期也首先给工业病理学提供了材料和刺激力。”

Although “industrial pathology” was not Marx’s original creation—from the early 18th century, medical experts or professional associations had keenly observed a correlation between industrial production and workers’ illnesses—Marx carried out a historical materialist transformation of traditional “industrial pathology,” especially the important achievements of the *Public Health Reports*. He moved from surface appearances to the root contradictions between productive forces and relations of production, establishing a close causal and logical connection between the capitalist mode of production, plague prevalence, and the harm to workers’ life and health, fully demonstrating capitalism’s exploitation and oppression of workers, thereby making “industrial pathology” truly a powerful weapon for criticizing capitalism. Although domestic and international academic circles mostly analyze the relationship between the capitalist mode of production and life from Foucault’s discursive system of “biopolitics,” and rarely adopt the concept and theory of “industrial pathology” mentioned by Marx in *Capital*, in fact, within the argumentative logic of *Capital*, “industrial pathology” has an irreplaceable and important value. Lu Xiaoguang, who earlier expounded the aesthetic value of “industrial pathology,” believes that without the detailed descriptions and investigative reports of “industrial pathology,” Marx “would find it difficult to truly understand the concrete picture of the contradiction between wealth growth and ‘deformed human beings.’” Through the linkage and argumentation of “industrial pathology,” Marx shifted the critique of political economy from a traditionally overly abstract study to a realistic, concrete historical materialist standpoint. This not only profoundly exposed the alienation and persecution of human beings by the capitalist mode of production but also further discerned the institutional roots of the capitalist public health crisis.

“工业病理学”，虽非马克思原创，从18世纪初开始，医学专家或行业协会就曾敏锐发现工业化生产与工人患病之间存在相关关系，但马克思对传统“工业病理学”尤其是《公共卫生报告》的重要成果进行了历史唯物主义的改造，从表象深入到生产力和生产关系的矛盾根源，在资本主义生产方式与瘟疫流行、工人生命健康受到戕害之间建立起紧密的因果关系和逻辑关联，充分论证了资本主义对工人的剥削压迫，使得“工业病理学”真正成为批判资本主义的有力武器。尽管国内外学界多从福柯的话语体系“生命政治学”分析资本主义生产方式与生命的关系，较少采用马克思在《资本论》中提到的“工业病理学”的概念和理论，但事实上在《资本论》的论证逻辑中，“工业病理学”有着不可替代的重要价值。较早阐述“工业病理学”美学价值的陆晓光认为：不借助“工业病理学”的翔实描述和调研报告，马克思就“难以真切了解财富增长与‘畸形的人’之间矛盾的具体景象”。通过“工业病理学”的衔接和论证，马克思将政治经济学的批判，从传统的过于抽象的研究转向现实的、具体的历史唯物主义立场，不仅深刻揭露资本主义生产方式对人的异化和迫害，还进一步洞察资本主义公共卫生危机的制度根源。

The core discovery of Marx’s “industrial pathology” is that the industrial production of the capitalist system ultimately develops into a force of “alienation” or “reification”; human creations hinder the possibility of people achieving happiness—the industrialization process not only failed to realize humanitarian ideals but instead made workers’ living conditions increasingly worse. The public health crisis manifests the internal pathology of capitalist society in a typically morbid way, serving as a concrete embodiment of alienated labor and structural contradictions in capitalist society. Starting from the more critical perspective of “industrial pathology,” a profound analysis of the capitalist public health crisis, uncovering its pathological mechanisms such as value misalignment, internal contradictions, and functional failure, helps us to deeply understand today’s COVID-19 crisis in Western capitalist countries and to more clearly define the guiding ideology and action program needed for the healthy development of public health undertakings.

马克思的“工业病理学”的核心发现是，资本主义体系的工业化生产最终发展成“异化”或“物化”的力量，人类的创造物阻碍了自己实现幸福的可能——工业化进程非但没有实现人道主义理想，反而使工人的生活境况越来越糟。公共卫生危机以一种典型病态的方式展现了资本主义社会的内在病理，是资本主义社会的异化劳动和结构性矛盾的具体体现。从更具批判性的“工业病理学”出发，深刻剖析资本主义公共卫生危机，发掘其价值错位、内在矛盾和功能失灵等病理机制，有助于我们深刻理解今天西方资本主义国家的新冠肺炎疫情危机，更加明确公共卫生事业健康发展所需要的指导思想和行动纲领。

I. Value Misalignment: The Alienation and Disorder of Capital Priority

一、价值错位：资本优先的异化和紊乱

Dr. Simon, the editor-in-chief of the *Public Health Reports*, had long served as the Medical Officer of the Privy Council in Britain. Under his leadership, British doctors conducted extensive investigations into the plague pandemics of the time, discovering a certain connection between the prevalence of plagues and the poor living, labor, and sanitary conditions of workers, and proposing legislative suggestions such as improving workers’ living environments and safeguarding their rights to labor health. However, they attributed the root causes of the public health crisis to the incompetence of managers, legal vacuums, insufficient professional strength, etc., failing to find the deeper etiology and inevitably falling into a cycle of failed responses to public health crises. The bourgeoisie “discussed and enacted laws to eradicate the various recurring epidemics,” but “the capitalist social system still produces the ills that must be treated.” [2]2 Karl Marx, *Capital*, Volume 1, Chapter 15, Section 5. During the period of Marx’s writing of *Capital*, plagues such as diphtheria, typhoid, smallpox, and cholera periodically spread, causing enormous harm to the British people. In response to these phenomena, Dr. Simon could only remain at the level of describing phenomena and expressing moral indignation within traditional “industrial pathology.” Marx, however, was able to penetrate appearances to reach the essence. Through his transformed “industrial pathology,” he pointed out that the crux of the capitalist public health crisis lies not in issues of public resources, medical technology, etc., but in the alienated and misaligned value orientation within the capitalist mode of production. Capitalist production inverts the value of capital and people, allowing the value of capital to override the value of people, thereby fundamentally neglecting people’s life and health.

《公共卫生报告》主编西蒙医生曾长期担任英国枢密院卫生官。在他的领导下，英国医生群体对当时的瘟疫大流行进行广泛调查，发现瘟疫大流行与工人居住、劳动和生活状况的恶劣之间具有一定的联系，提出改善工人居住环境、保障工人劳动健康权利等立法建议。但是，他们把公共卫生危机根源归因于管理者的无能、法律的真空、专业力量的不足等，没有找到深层次的病因，不可避免地陷入应对公共卫生危机的循环失败之中。资产阶级“讨论和颁布法律，以求根绝一再发生的各种流行病”，但是“资本主义的社会制度还是产生出必须加以治疗的弊病”。在《资本论》的写作期间，白喉、伤寒、天花以及霍乱等瘟疫周期性流行，给英国民众造成了巨大的伤害。针对这些现象，西蒙医生只能停留在传统“工业病理学”的现象描述和道德感慨层面，马克思却能透过现象抵达本质，通过改造后的“工业病理学”指出，资本主义公共卫生危机的症结不在于公共资源、医疗技术等问题，其根源是资本主义生产方式中异化和错位的价值导向。资本主义生产颠倒了资本和人的价值，让资本的价值凌驾于人的价值之上，因而从根本上忽视了人的生命健康。

First, under capitalist production, the value of capital is higher than the value of life. Marx pointed out that the “aim of the capitalist mode of production is to preserve existing capital value and to maximize the valorization of capital value (i.e., to make this value increase more and more rapidly). Its specific character is to use existing capital value as a means for the greatest possible valorization of this value.” [3]3 Karl Marx, *Capital*, Volume 3, Chapter 15. The actions of capital itself, as well as the capitalists as personified capital and the proletarians as the sole source of surplus value, must all submit to this purpose, following the logic of maximizing and absolutizing capital value. In the face of capital, human needs such as maintaining life, health, safety, happiness, and a good life, once they conflict with the value principle of capital maximization, become tools and means that can be sacrificed. Both capitalists and proletarians are reduced to instrumental values and reified existences serving capital’s self-valorization. Of course, capital clearly favors the capitalists; those first sacrificed in a pandemic are the proletarians dominated by capital. Therefore, Marx exposed this incisively: “Experience shows to the intelligent observer that, although from a historical standpoint capitalist production is hardly more than yesterday’s birth, it has already struck deep and terrible blows at the very roots of the people’s life.” [4]4 Karl Marx, *Capital*, Volume 1, Chapter 10, Section 5.

第一，在资本主义生产下，资本价值高于生命价值。马克思指出，资本主义生产方式的“目的是保存现有资本价值和最大限度地增殖资本价值（也就是使这个价值越来越迅速地增加)。它的独特性质是把现有的资本价值用做最大可能地增殖这个价值的手段”。资本自身的行动，以及作为人格化资本的资产者和作为剩余价值唯一来源的无产者，都必须服从这个目的，遵循资本价值最大化和绝对化的逻辑。在资本面前，保持生命健康安全、幸福美好生活等人性需求，一旦与资本最大化的价值原则相抵触，就会成为可被牺牲的工具和手段。无论是资产者还是无产者，都沦为服务于资本自我增殖的工具价值和物化存在。当然，资本显然更偏爱资产者，疫情中首先牺牲的是那些被资本支配的无产者。因此，马克思一针见血地揭露：“经验向有头脑的观察者表明：虽然从历史的观点看，资本主义生产几乎是昨天才诞生的，但是它已经多么迅速多么深刻地摧残了人民的生命根源。”

Second, the logic of capital is inherently destined to neglect people’s life and health needs. For the sake of capital’s interests, the bourgeoisie, which proclaims humanitarianism, turns to the opposite of humanitarianism, remaining indifferent and unwilling to act in the face of the risk of a pandemic. Although Dr. Simon’s *Public Health Reports* presented a large amount of “industrial pathology” data, only Marx, using the scalpel of historical materialism, could penetrate from phenomena to the root, revealing the value misalignment hidden behind “industrial pathology”: “Capital is reckless of the health or length of life of the labourer, unless under compulsion from society. To the out-cry as to the physical and mental degradation, the premature death, the torture of over-work, it answers: Ought these to trouble us since they increase our pleasure (profit)?” [5]5 Karl Marx, *Capital*, Volume 1, Chapter 10, Section 5. In response to this phenomenon, Engels once warned that the bourgeoisie “delights in forcing the working class to suffer the torments of epidemics,” but plagues and diseases are no respecters of persons, and this evil consequence “will always fall back on the capitalists themselves.” [6]6 Friedrich Engels, *The Condition of the Working Class in England*. Clearly, Engels also deeply understood that the actions taken by capitalist governments and capitalists in the face of a public health crisis are inevitably temporary, passive, and reactive, “only compelled by extreme necessity to propose social reform bills, and as for existing laws, they simply do not enforce them whenever possible.” [7]7 Friedrich Engels, *The Condition of the Working Class in England*. By placing capital valorization first, without prioritizing people’s life and health, capitalism is doomed not to implement the value principle of “human beings as ends,” and is also doomed to fall into a cycle of failed responses to public health crises.

第二，资本的逻辑注定忽视人的生命健康需求。为了资本的利益，宣称人道主义的资产阶级，走向了人道主义的反面，在疫情大流行的风险面前无动于衷、不愿作为。尽管西蒙医生的《公共卫生报告》呈现了大量“工业病理学”的数据，但只有马克思利用历史唯物主义的手术刀，才能从现象深入到根源，揭示隐藏在“工业病理学”背后的价值错位：“资本是根本不关心工人的健康和寿命的，除非社会迫使它去关心。人们为体力和智力的衰退、夭折、过度劳动的折磨而愤愤不平，资本却回答说：既然这种痛苦会增加我们的快乐（利润），我们又何必为此苦恼呢？”恩格斯针对这一现象曾警告说，资产阶级“以逼迫工人阶级遭到流行病的痛苦为乐事”，但是瘟疫和疾病面前人人平等，这种恶果“总会落到资本家自己头上来”。显然，恩格斯也深深地明白，资本主义政府和资本家面对公共卫生危机时所采取的行动，必然是暂时、消极、被动的，“只是迫于极端必要才提出社会改革法案，至于已经存在的法律只要有可能就根本不去执行”。把资本增殖放在第一位，而没有把人的生命健康摆在优先位置，资本主义注定不会落实“人是目的”的价值原则，也注定会陷入应对公共卫生危机的失败循环。

Third, although times have changed, the pathological mechanism of capital supremacy remains. More than 100 years have passed since Marx and Engels’ critique of the “industrial pathology” of the London plague epidemic, but the COVID-19 pandemic crisis has made us understand that the intrinsic pathological mechanism of capitalist society remains. When the COVID-19 pandemic spread globally, the sluggish measures taken by some capitalist countries, represented by the United States, to prevent the spread of the epidemic were astonishing. This led the United States, which faced this public health crisis with a huge advantage, to repeatedly miss opportunities, ultimately turning a crisis into a tragedy. The hesitation and incompetence of capitalist countries in responding to public health crises stem from the value misalignment and inversion in their social mechanisms, namely, prioritizing capital interests over human life and health. In the early stages of the pandemic, the U.S. government’s Coronavirus Task Force explicitly recommended strict control measures in a memorandum, but these were rejected by the decision-making layer due to concerns about impacting capital markets. This value misalignment of capital supremacy “led the government neither to effectively warn the public nor to prepare for the potential consumption of medical resources brought by the pandemic, pushing the American people to the brink of infection and death.”

第三，时过境迁，但资本至上的病理机制依旧。马克思恩格斯对英国伦敦瘟疫大流行的“工业病理学”批判已过100多年，但是新冠肺炎疫情危机让我们明白，资本主义社会的内在病理机制依旧。当新冠肺炎疫情在全球蔓延，以美国为代表的部分资本主义国家在防止疫情扩散方面所采取的迟缓措施令人惊愕，导致了以巨大优势面对这场公共卫生危机的美国，屡屡错失良机，最终将一场危机演变成一场悲剧。资本主义国家应对公共卫生危机的迟疑和低能，根源就在于其社会机制中的价值错位和颠倒，即将资本利益优先于人的生命健康。疫情初期，美国政府新冠病毒应对工作组曾在备忘录中明确建议采取严格的管控措施，却被决策层以波及资本市场的担忧拒绝。资本至上的价值错位“导致政府既未对民众进行有效示警，也没有为疫情大流行所带来的潜在医疗资源消耗做准备，把美国民众推向感染和死亡的边缘”。

II. Internal Contradictions: Structural Deficiencies of the Capitalist Mode of Production

二、内在矛盾：资本主义生产方式的结构缺陷

Capitalist public health crises are often intrinsically linked to economic crises. In the mid-to-late 19th century when Marx wrote *Capital*, the occurrence of capitalist economic crises was often accompanied by the spread of public health crises. This symbiosis reveals that capitalist public health crises are deeply embedded in its mode of production and are an intrinsic product of capitalism. Marx’s “industrial pathology” exposes that the secret of how capitalist production leads to public health crises lies within capital itself, in the contradictory movement between constant capital and variable capital: to maximize capital valorization, capitalist production inevitably economizes on constant capital such as means of production and labor conditions, and also inevitably produces and maintains a relative surplus industrial reserve army to control variable capital. When impacted by a public health event, capitalist production, through the above internal contradictory mechanism, allows and exacerbates the spread of the public health crisis.

资本主义公共卫生危机往往与经济危机具有内在关联。在马克思写作《资本论》的19世纪中后期，资本主义经济危机的发生，往往伴随着公共卫生危机的蔓延。这种共生性揭示了资本主义公共卫生危机深深内嵌于其生产方式中，是资本主义的内在产物。马克思的“工业病理学”揭露了资本主义生产导致公共卫生危机的秘密就藏在资本内部不变资本与可变资本的矛盾运动之中：为实现资本增殖最大化，资本主义生产不可避免地要节约生产资料、劳动条件等不变资本，也不可避免地要生产和储备一支相对过剩的产业后备军，以控制可变资本。当遭遇公共卫生事件冲击时，资本主义生产就通过上述内在矛盾机制放任和助长公共卫生危机蔓延。

First, the contradiction between economizing on constant capital and improving labor conditions artificially creates and intensifies the crisis. Marx pointed out that, driven by the pursuit of maximizing surplus value, capitalist production is extremely frugal with constant capital such as means of production, but “very wasteful” with “human material,” preferring to waste the life and health of workers, who constitute “variable capital,” rather than spending more to improve their working environment. “Industrial pathology” materials such as the *Public Health Reports* show that “the more people in a place who live by indoor common labor, the higher the mortality rate from lung disease in that area, other conditions being equal,” and “various types of female seamstresses—dressmakers, garment workers, ordinary seamstresses—suffer from three disasters: overwork, insufficient air, and inadequate or poor nutrition,” and “lung diseases caused purely by bad air exist through these sacrifices.” Based on these, Marx further analyzed that the prevalence of plagues like tuberculosis among the working class was caused by factory owners economizing on constant capital such as buildings and ventilation equipment. “The concentration of large numbers of workers in the same workshop is, on the one hand, a source of increased profit for the capitalist, and, on the other hand, unless working hours are shortened and special preventive measures are taken as compensation, it is also a cause of waste of life and health.” Thus, it is evident that capitalists show no mercy to the workers who create surplus value for them, and capitalist governments are unwilling to spend more costs to improve public health conditions. This is determined by the internal contradictions of capitalist production. Capitalist production inevitably treats the compression of workers’ labor and living conditions—that is, the waste of workers’ life and health—as an important means of extreme economization on constant capital and maximizing capital valorization.

第一，节约不变资本与改善劳动条件之间的矛盾，人为制造和激化了危机。马克思指出，出于对剩余价值最大化的追求，资本主义生产对生产资料等不变资本极尽节约，“对人身材料却非常浪费”，宁愿浪费作为“可变资本”的工人生命健康，也不愿意多花钱改善他们的劳动环境。《公共卫生报告》等“工业病理学”资料显示，“一个地方靠室内共同劳动为生的人越多，在其他条件相同的情况下，那个地区由肺病引起的死亡率就越高”，“各种女缝纫工——女时装工、女服装工、普通女裁缝，都有三种灾难，这就是劳动过度，空气不足，营养不够或消化不良”，“纯粹由于空气不良而造成的肺病，就是靠这些牺牲者而存在的”。马克思依据它们进一步分析，肺结核等瘟疫在工人群体中间流行，其背后的原因是工厂主对建筑物和通风设备等不变资本的节约。“大量的工人在同一个工场里集中，一方面是资本家利润增长的源泉，另一方面，如果没有劳动时间的缩短和特别的预防措施作为补偿，也是造成生命和健康浪费的原因。”由此可见，资本家毫不怜悯为他们创造剩余价值的工人，资本主义政府不愿意花费更多成本来改善公共卫生条件，这是由资本主义生产内在矛盾所决定的。资本主义生产必然将工人劳动和生存条件的压缩，即工人生命健康的浪费，当作不变资本的极尽节约、实现资本增殖最大化的重要途径。

Second, the “industrial reserve army” deliberately created by controlling variable capital becomes a catalyst for the spread of the crisis. Marx believed that, to control variable capital expenditure, capitalist accumulation inevitably reproduces a large-scale relative surplus population or industrial reserve army, which becomes a driver of epidemic spread. First, capitalist production must maintain a relative surplus industrial reserve army that is always available for exploitation, existing in a state of unstable employment. “This reserve army is crippled in one part of the year by being forced to engage in inhuman labor, and in another part of the year it is impoverished and degraded due to lack of work.” The poor living conditions of the industrial reserve army often become the source of infectious diseases. Second, capitalist production promotes population mobility. When these mobile workers, whom Marx called the “light infantry of capital,” move between different factories, communities, and cities to survive, they invisibly become “a mobile column of infectious diseases, bringing smallpox, typhus, cholera, scarlet fever, and other diseases to the areas where they camp… These temporary settlements have no sanitary facilities.” Finally, those completely unemployed individuals eliminated by capitalist production, including domestic workers, able-bodied paupers, orphans, children of the poor, and those unable to work, become victims during plague outbreaks. The history of Western capitalist societies since industrialization has repeatedly proven that workers, especially unemployed workers, are the most vulnerable groups to plague pandemics. In their destitution, they unconsciously become vectors for the spread of plague, and through the “boomerang effect” of risk transmission, ultimately trigger a public health crisis for the entire society.

第二，控制可变资本刻意制造的“产业后备军”，成为危机蔓延的催化剂。马克思认为，为控制可变资本支出，资本主义积累会不可避免再生产出大规模的相对过剩人口或产业后备军，成为瘟疫流行的助推器。首先，资本主义生产要保持一支相对过剩却又随时可供支配的产业后备军，处于就业不稳定的状态，“这支后备军在一年的一部分时间里由于被迫从事非人的劳动而遭到摧残，在另一部分时间里则由于没有工作而穷困堕落”。产业后备军恶劣的居住环境往往成为传染病的发源地。其次，资本主义生产促进人口流动，当这些流动工人，即马克思所言的“资本轻步兵”在不同的工厂、社区、城市流动以求生存时，无形中就成为“一支流动的传染病纵队，它把天花、伤寒、霍乱、猩红热等疾病带到它扎营的附近地区……这种临时性的村落没有任何卫生设备”。最后，那些被资本主义生产淘汰的完全的失业者，包括家庭劳动者、具有劳动能力的赤贫者、孤儿、贫民子女以及丧失劳动能力的人，则成为瘟疫暴发中的牺牲品。工业化以来西方资本主义社会的历史一再证明，工人特别是失业工人是瘟疫大流行首当其冲的易感人群，他们在穷困潦倒中不自觉地成为瘟疫传播的媒介，通过风险传播的“飞去来器”效应，最终引发整个社会的公共卫生危机。

Third, the internal contradictions of capital operation persist, and population consumption has become a means of capital valorization. Because the internal contradictions of capital operation have not been eliminated, in the COVID-19 pandemic crisis in Western capitalist countries, the biggest victims remain the “relative surplus industrial reserve army” mentioned by Marx in his “industrial pathology.” According to data from U.S. public health departments and media reports, groups such as the elderly and the unemployed became “sacrifices” of the government’s ineffective pandemic response. A *New York Times* report on May 11, 2020, showed that at least 28,100 residents and staff of U.S. long-term care facilities for the elderly had died from COVID-19 infection, accounting for about one-third of U.S. COVID-19 deaths. Additionally, mortality rates among ethnic minorities such as African Americans and Latinos were generally higher than the overall population mortality rate. These data and facts cruelly confirm Marx’s assertion: promoting the rapid consumption, rapid turnover, and mobility of the laboring population is also an important means for capitalism to maximize surplus value. The plague pandemic has become a “natural” way for the capitalist mode of production to clear the surplus population.

第三，资本运行内在矛盾依旧，人口消耗竟成资本增殖的手段。由于资本运行的内在矛盾仍未消除，在西方资本主义国家的新冠肺炎疫情危机中，最大的受害者仍是马克思在“工业病理学”中提到的“相对过剩的产业后备军”。根据美国公共卫生部门和媒体报道的数据，老年人、失业者等群体成为政府抗疫不力的“牺牲品”。《纽约时报》2020年5月11日报道显示，美国老年人长期照护机构已有至少2.81万名入住者和工作人员死于新冠病毒感染，约占美国新冠死亡病例的1/3。此外，非裔、拉美裔等少数族裔死亡率，也普遍高于总人口的死亡率。这些数据和事实残酷印证了马克思的断言：推动劳动人口的迅速消耗、快速迭代和流动，也是资本主义实现剩余价值最大化的重要手段。瘟疫大流行竟成为资本主义生产方式清理过剩人口的“自然”方式。

III. Functional Failure: Severe Internal Attrition of the Medical and Health System

三、功能失灵：医疗卫生系统的严重内耗

Medical experts and professional associations under the capitalist system only use “industrial pathology” to reveal pathogenic mechanisms, but Marx’s “industrial pathology,” transformed through historical materialism, can reveal the limitations of doctors and the medical and health system itself under the capitalist mode of production through insight into relations of production. Marx pointed out that the value of doctors in the capitalist system is instrumental; their purpose is not human life and health, but the reproduction of producers of surplus value. When a public health crisis strikes, the medical and health system finds it difficult to leverage its professional advantages and scientific spirit to fight the epidemic; instead, it becomes a bargaining chip in political games between different interest groups, ultimately leading to a predicament of functional failure. The failure of the United States and other Western countries to respond to the public health crisis this time confirms this conclusion of Marx’s “industrial pathology.” In the 2019 Global Health Security Index, the United States ranked first in the world with a score of 83.5. As early as September 2018, the United States formulated and issued the *National Biodefense Strategy* to prepare for public health crisis responses. However, due to the inherent limitations of the capitalist medical and health system, these advantages and strategies did not play a corresponding role in the face of the COVID-19 pandemic.

资本主义体系下的医学专家和行业协会只会利用“工业病理学”揭示致病机理，马克思利用历史唯物主义改造后的“工业病理学”却能通过对生产关系的洞察揭示资本主义生产方式下医生及医疗卫生系统自身的局限性。马克思指出，资本主义体系中的医生，其存在价值是工具性的，目的不是人的生命和健康，而是剩余价值生产者的再生产。当公共卫生危机来袭，医疗卫生系统难以发挥专业优势以科学精神抗疫，反而会成为不同利益集团之间政治博弈的筹码，最终导致功能失灵的困局。此次美国等西方国家的公共卫生危机应对失败，就印证了马克思的“工业病理学”的这个结论。2019年全球卫生安全指数系统中，美国以83.5分高居世界第一。早在2018年9月，美国就制定出台了《国家生物防御战略》，为公共卫生危机的应对作准备。然而，由于资本主义医疗卫生系统的内在局限性，这些优势和战略在新冠肺炎大流行面前并没有发挥相应的作用。

First, doctors within the capitalist system are a dependent group subordinate to the bourgeoisie. In *Capital*, Marx soberly points out that within the capitalist system, doctors are neither the bourgeoisie nor the exploited working class, but rather a dependent group subordinate to the bourgeoisie. Doctors do not directly create surplus value; they are employed by capitalists, and their duty and mission are to help capitalists realize the extraction of surplus value, forming a component part of the operation of the capitalist system. Consequently, under the capitalist system, doctors and the medical and health system are perpetually haunted by the nightmare of privatization and commercialization. Hospitals and doctors are reduced to a link in the commercial system, market orientation becomes the standard for doctors’ actions, and social welfare is cast aside. In 1852, Marx wrote in a letter to Engels: although “my wife is ill, little Jenny is ill, Lenchen is suffering from something like typhus,” yet “a doctor, I could not call in the past, and I cannot call in now, because I have no money to buy medicine.” [9]9 Marx’s letter to Engels, September 8, 1852. “Lenchen” refers to Helene Demuth, the family housekeeper. When Marx was in financial straits, no matter how urgently he needed basic medical services, he could only endure pain and fend for himself; doctors dominated by capital became indifferent ornaments, because they would only treat patients for money. In a pandemic, the excessive capitalization of basic medical services results in the expansion and catastrophization of the crisis.

第一，资本主义体系中的医生是从属于资产阶级的附庸群体。在《资本论》中，马克思冷静地指出，在资本主义体系之中，医生既不是资产阶级，也不是被剥削的工人阶级，而是从属于资产阶级的附庸群体。医生不直接创造剩余价值，他们被资本家所雇佣，职责使命是帮助资本家实现剩余价值的获取，是资本主义体系运行的组成部分。因此，在资本主义体系下医生及医疗卫生系统始终面临私有化、商业化的梦魇。医院和医生沦为商业体系的一个环节，市场导向成为医生开展行动的标准，社会福祉则被抛在一边。1852年，马克思在致恩格斯的信中写道：尽管“我的妻子病了，小燕妮病了，琳蘅像是患了伤寒”，但是“医生，我过去不能请，现在也不能请，因为我没有买药的钱”。在马克思经济窘困时，无论多么需要基本的医疗服务，都只能忍受痛苦、自生自灭，受资本支配的医生成为无动于衷的摆设，因为他们只有拿钱才会看病。在瘟疫大流行中，将基本医疗服务过度资本化的代价就是危机的扩大化和灾难化。

Second, the essence of capitalist medical and health activities is the “repair of labor capacity.” Marx believed that within the capitalist system, the value of a doctor’s existence lies in “as long as he can protect health, maintain the source of all value, i.e., labor capacity itself.” The doctor’s essence is instrumental: by preserving the source of value—the health of labor power—they enable it to continuously produce commodities and surplus value, ultimately maximizing capital accumulation. The doctor’s labor, i.e., the essence of medical and health activities, is the “repair of labor capacity,” sharing the same nature as workers’ labor for self-improvement and better living, such as housecleaning or physical exercise—both are labor that produces, trains, and maintains labor capacity, and do not directly create surplus value. Therefore, in its essence, capitalist medical and health activities do not serve people but are subordinate to and compliant with capital accumulation and surplus-value production. This leads to government public health governance having to constantly yield to the controlling will and internal games of capitalists, carrying serious risks of internal friction and governance failure. When medical and health activities align with capital accumulation, they receive attention and support; when they conflict with capital accumulation, they encounter all kinds of obstruction. During the mid-to-late 19th century when Marx was writing *Capital*, interest groups in the British Parliament repeatedly attempted to alter epidemic prevention measures and cut public health budgets. In particular, Conservatives representing water supply companies and polluting industries repeatedly proposed abolishing the General Board of Health and health officers to protect the capital interests of their own sectors, frustrating Dr. John Simon’s public health reforms, affecting the effectiveness of epidemic prevention, and leading to the spread of plagues. [10]10 Sir John Simon (1816–1904) was the first Chief Medical Officer of the British government and a key figure in 19th-century public health reform. The General Board of Health was a central public health authority established in 1848 and abolished in 1858 under pressure from commercial interests.

第二，资本主义医疗卫生活动的本质是“劳动能力的修理”。马克思认为，在资本主义体系里，医生的存在价值是“只要他能保护健康，保持一切价值的源泉即劳动能力本身”。医生的本质是工具性的，通过保持价值源泉——劳动力的健康，使其能够源源不断产出商品和剩余价值，最终实现资本增殖的最大化。医生的劳动即医疗卫生活动的本质是“劳动能力的修理”，与工人为提升自我、改善生活而进行的诸如打扫家务、锻炼身体等劳动具有相同性质，都是生产、训练和维持劳动能力的劳动，并不直接创造剩余价值。因此，从其本质上而言，资本主义医疗卫生活动并不服务于人，而是从属和服从于资本增殖和剩余价值生产。这就导致政府公共卫生治理始终要屈从于资本家的支配意志和内在博弈，存在着严重内耗和治理失灵的风险。当医疗卫生活动与资本增殖相一致，就会受到重视、得到扶助；而当其与资本增殖相左时，就会受到百般阻挠。马克思创作《资本论》的19世纪中后期，英国议会中的利益集团曾多次试图更改疫情防控举措、削减公共卫生预算，特别是代表供水公司、污染行业的保守党人多次提议废除卫生总署及卫生官，以维护自己所在行业的资本利益，令西蒙医生的公共卫生改革受挫，影响到瘟疫防控成效，导致了瘟疫蔓延。

Third, capitalist medical expenditure is a “non-productive cost” that must be compressed and controlled. Since the essence of medical and health activities is the “repair of labor capacity,” therefore “in any case, the services of doctors belong to the non-productive costs of production. They can be counted as repair costs of labor capacity.” Marx believed that capitalist medical and health expenditure is not oriented toward people’s life and health but toward capital accumulation. “This non-productive cost must be reduced as far as possible to the necessary minimum, and made as cheap as possible.” This means that when medical expenditure conflicts with capital accumulation, it becomes an object that must be reduced. If, for some reason—for example, a public health crisis causing a decline in bourgeois income and a fall in capital profits—“capitalists and workers still want to consume the same amount of value in the form of material products, they will buy fewer services from doctors, teachers, etc.” Following this logic further, we find: when capitalists need doctors to maintain workers’ labor capacity, doctors can occupy an important place in the capitalist system; when crisis comes, profits fall, and workers most need medical care, doctors become dispensable objects of reduction. This is the fundamental reason why, at the onset of the COVID-19 pandemic, overall societal demand for medical care was rising, yet some Western capitalist countries were trying every means to reduce medical supply, with medical budgets falling instead of rising, and heads of disease control departments being replaced. The internal contradictions of the capitalist system severely weaken its capacity to respond to public health crises, leading to functional internal friction and governance failure in the medical and health system during epidemic prevention and control.

第三，资本主义医疗支出是必须压缩和控制的“非生产费用”。由于医疗卫生活动的本质是“劳动能力的修理”，因此“在任何情况下，医生的服务都属于生产上的非生产费用。可以把它算入劳动能力的修理费”。马克思认为，资本主义医疗卫生支出并不是以人的生命健康为导向，而是以资本增殖为导向。“必须尽可能地把这种非生产费用缩减到最必要的最低限度，尽可能地使它便宜。”这就意味着，当医疗支出与资本增殖发生矛盾时，医疗支出就成为必须缩减的对象。假如由于某些原因，例如公共卫生危机发生导致资产阶级收入减少、资本利润下降，“资本家和工人还想以物质产品的形式消费原先那样大的价值量，他们就要少购买医生、教师等等的服务”。沿着这一逻辑作进一步推演，我们会发现：当资本家需要医生保持工人的劳动能力时，他们便能在资本主义体系之中占有重要的一席之地；当危机来临、利润下降、工人最需要医疗卫生的时候，他们却成了可有可无的缩减对象。这就是为什么新冠肺炎疫情暴发之初，社会整体对医疗卫生的需求在上升，而部分西方资本主义国家却在想方设法地缩减医疗卫生供给，医疗卫生预算不升反降，疾控部门负责人被撤换的根本原因。资本主义体系的内在矛盾严重削弱了其应对公共卫生危机的能力，导致了医疗卫生系统在瘟疫防控时的功能内耗和治理失灵。

IV. Applying the Remedy: Epidemic Response Strategies Based on “Industrial Pathology”

四、对症下药：基于“工业病理学”的疫情应对方略

In *Capital*, Marx used “industrial pathology” to profoundly analyze the internal pathology of capitalist public health crises, and in further discussions in *Capital* and related texts such as the *Critique of the Gotha Programme*, he proposed remedies for “periodically recurring epidemics.” Comparing these remedies with the great anti-epidemic spirit formed by the Chinese people in fighting COVID-19—putting life first, national unity, sacrificing life and defying death, respecting science, and sharing a common destiny—the two are similar in approach and share the same lineage, providing useful reference for the world to overcome COVID-19 or other pandemics.

马克思在《资本论》中运用“工业病理学”深刻剖析资本主义公共卫生危机的内在病理，并在《资本论》的进一步论述和《哥达纲领批判》等相关文献中就“周期复发的流行病”的解决提出了对症药方。将这些药方与中国人民抗击新冠肺炎疫情形成的生命至上、举国同心、舍生忘死、尊重科学、命运与共的伟大抗疫精神相比，两者异曲同工、一脉相承，为全世界走出新冠肺炎疫情或者其他瘟疫大流行提供了有益借鉴。

First, institutional change is the fundamental way to resolve capitalist public health crises. Facing common enemies of humanity such as plagues, relying solely on social reforms by technocrats and doctors cannot alleviate the public health crises endogenous to the capitalist mode of production. As long as the ownership of the means of production remains unchanged, and the social structure formed by productive forces and relations of production undergoes no fundamental transformation, the role and function of the public health system are destined to be merely tools and appendages for capitalists to extract surplus value from workers. Dr. John Simon had already exposed in his *Public Health Reports* the tragic plight of ordinary people facing epidemics under the capitalist system, but aside from empty moral regret and indignation, he could achieve almost nothing. The root of this inability to act lies not in the doctors themselves, but in the capitalist mode of production and the alienated labor it causes. Facing a public health crisis, the capitalist system can never truly put the people’s life and health safety first (for the people) to replace capital’s insatiable greed for surplus value, nor can it rely on social institutions to mobilize and integrate more resources to escape difficulties (relying on the people). Based on the results of Marx’s “industrial pathology” analysis, it is not difficult to conclude: to achieve something in the face of an epidemic and avoid the tragic scene of herd immunity, attention must be paid to the issue of social system change, breaking through the limitations of capitalism’s “profit-seeking only.” Only when the ownership of the means of production undergoes change, and the contradiction between productive forces and relations of production is resolved by structural changes in ownership, can the value of doctors and medicine in healing patients’ bodies and minds and diagnosing and treating social ills be highlighted.

第一，制度变革是破解资本主义公共卫生危机的根本途径。面对瘟疫等人类共同的敌人，仅仅依靠技术官僚、医生群体的社会改良，难以纾解资本主义生产方式内生的公共卫生危机。只要生产资料所有制不改变，生产力与生产关系所构成的社会结构不发生根本性变化，公共卫生体系的角色和功能注定只是资本家榨取工人剩余价值的工具和附庸。西蒙医生在《公共卫生报告》中早就揭露了资本主义制度下普通民众遭遇疫情时的悲惨境遇，但除了空有道德遗憾和悲愤外，几乎没有什么实际作为。这种难有作为的根源并不在于医生群体本身，而在于资本主义生产方式，以及资本主义所导致的异化劳动。面对公共卫生危机，资本主义制度始终无法把人民的生命健康安全真正地放在第一位（为了人民），以取代资本对剩余价值无止境的贪婪追求，更难以依托社会机构动员和整合更多资源走出困境（依靠人民）。根据马克思的“工业病理学”的剖析结果不难得出：面对疫情时要想有所作为，避免群体免疫的悲惨场景，就必须关注社会制度的变革问题，突破资本主义“唯利是图”的局限性。只有当生产资料所有制发生变革，生产力和生产关系之间的矛盾被所有制的结构性变化消解时，医生、医学在医治病人身心、诊治社会疾苦上的价值才能够凸显出来。

Second, doctors going deep among the masses of the people is an important pathway for alleviating the public health crisis. In the final part of *Capital*, according to the “identity of revenues and their sources,” Marx divides doctors into two classes: “Doctors … also form two classes, because they belong to two different social groups, each of whose members derive their revenue from the same source.” [11]11 The reference is to Marx’s discussion of the division of doctors into two classes based on their source of revenue in the final, unfinished part of *Capital*, Volume III, Part VII, “Revenues and Their Sources.” One class is the appendage of the capitalists, relying on selling their souls and labor to become accomplices of the bourgeoisie in exploiting the proletariat; the other class consists of those doctors who devote themselves to serving the cause of the poor in “dispensaries for the poor.” The dispensaries for the poor were medical institutions gradually established under the British poor-relief system in the late 18th and early 19th centuries to provide free medical services and medicines to poor residents within parishes, and they represented the progressive force within the medical profession. Marx’s classification of the class attributes of doctors fully demonstrates that only by truly serving the masses of the people can doctors extricate themselves from the “unproductive labor” of serving the exploitation of surplus value and avoid becoming appendages of the capitalists. In *Capital*, Marx expresses a people-oriented expectation for the professional value of doctors, arguing that the medical profession should go among the masses of the people in factories and farms to observe popular conditions, heal the wounded and rescue the dying, embed their own value in the masses of the people, put the people’s interests first, and take the people’s life and health as the starting point of action. Marx highly praises the method of going deep among the workers to conduct investigations, as adopted in compiling the *Public Health Reports*. In the preface to the first volume of *Capital*, Marx notes with admiration: “If we could find such competent, impartial, and resolute men as the English factory inspectors, the English medical writers on *Public Health*, the English commissioners of inquiry into the exploitation of women and children, into housing and nourishment, etc., the situation in our country would astonish us.” According to the logic of Marx’s “industrial pathology,” when doctors break free from their subordinate position of serving surplus-value production, when they integrate their own value into the protection of the people’s life and health, and when the responsibility of serving the people becomes a universal role consensus and professional ethics among the medical profession, then doctors and the medical and health system can truly rely on the masses of the people, integrate more social resources to prevent or alleviate the public health crisis, and help the masses of the people escape from difficulties.

第二，医生深入人民群众是缓和公共卫生危机的重要途径。在《资本论》最后一部分，根据“收入和收入源泉的同一性”，马克思把医生看成两个阶级，“医生……也形成两个阶级，因为他们属于两个不同的社会集团，其中每个集团的成员的收入都来自同一源泉”。一个阶级是资本家的附庸，依靠出卖自己的灵魂和劳动，沦为资产阶级剥削无产者的帮凶，另一个阶级，则是那些投身于服务贫民事业的“贫民诊所”的医生。贫民诊所是18世纪末19世纪初在英国济贫体制下逐渐建立起来的为教区内贫困居民提供免费医疗服务、药品的医疗机构，是医生群体中的进步力量。马克思对医生阶级属性的分类，充分表明了医生只有真正服务于人民群众，才能够把自己从服务于剩余价值剥削的“非生产劳动”中解脱出来，不至于沦为资本家的附庸。在《资本论》中，马克思对医生的职业价值提出了人民性的期许，认为医生群体应该到工厂、农场的人民群众中间体察民情、救死扶伤，将自身价值寓于人民群众之中，将人民利益放在首位，将人民的生命健康作为行动的出发点。马克思高度赞许编写《公共卫生报告》采取的深入工人群众调查的方法，在《资本论》第一卷序言中，马克思不无羡慕地指出：“如果为此能够找到像英国工厂视察员、编写《公共卫生》报告的英国医生、调查女工童工受剥削的情况以及居住和营养条件等等的英国调查委员那样内行、公正、坚决的人们，那么，我国的情况就会使我们大吃一惊。”按照马克思“工业病理学”的逻辑，当医生从服务剩余价值生产的附庸地位跳脱出来，当他们将自身价值融合到人民群众生命健康的保护之中，当服务人民的担当成为医生群体普遍的角色共识和职业伦理，医生及医疗卫生系统才能真正依靠人民群众，整合更多社会资源阻止或缓和公共卫生危机，帮助人民群众走出困境。

Third, respecting the scientific nature of medical and health care is an important condition for resolving the capitalist public health crisis. The “industrial pathology” transformed by Marx is not only a powerful weapon for criticizing the capitalist mode of production but also an important aid for Marx in creating a new world. When drafting the *Critique of the Gotha Programme* in 1875, Marx specifically supplemented the Gotha Programme’s clause on “state supervision of factory industry, workshop industry, and domestic industry” by adding: “The inspectors must be doctors.” [12]12 The *Critique of the Gotha Programme* (1875) is Marx’s critique of the draft program of the unified German Social Democratic Workers’ Party. The clause cited is from the original Gotha Programme. Marx regarded doctors as important allies of the working class, assigning them to discover, supervise, and stop various unfair phenomena in factories, and to use the theoretical knowledge of “industrial pathology” to protect workers’ health and prevent public health crises. This reflects Marx’s trust in and respect for the professional competence and scientific nature of doctors. Under the capitalist system, this professionalism and scientificity of doctors may be a dispensable appendage, but under the socialist system with public ownership of the means of production, when the contradiction between productive forces and relations of production is dissolved by the structural change in ownership, the social value of doctors in saving lives and healing the sick through their practice of serving the people becomes all the more evident. In the face of an epidemic, doctors must be freed from the instrumental rationality of “preserving the source of value,” extricated from endless entanglements with interest groups and politicized debates, their professional competence must be respected, their professional expertise brought into play, and the strategy for epidemic governance must be restored from a “moral issue” or “value issue” to a “scientific issue.”

第三，尊重医疗卫生的科学性是化解资本主义公共卫生危机的重要条件。经马克思改造后的“工业病理学”，不仅是批判资本主义生产方式的有力武器，而且也成为马克思创造新世界的重要帮手。在1875年撰写《哥达纲领批判》时，马克思针对哥达纲领提出的“对工厂工业、作坊工业和家庭工业实行国家监督”条款，特别补充说：“视察员必须是医生。”马克思把医生当作工人阶级的重要同盟，安排他们发现、监督和制止工厂里的各种不公平现象，利用“工业病理学”理论知识保护工人健康、防范公共卫生危机，这反映出马克思对医生专业能力和医学科学性的信任和尊重。在资本主义体系下，医生的这种专业性、科学性可能是可有可无的附庸性质，但到了生产资料公有的社会主义制度下，当生产力和生产关系之间的矛盾被所有制的结构性变化消解时，医生在服务于人民的实践中所能发挥的治病救人的社会价值，才会更加明显。面对疫情，要让医生从“保持价值源泉”的工具理性中解脱出来，摆脱无止境的利益集团纠缠和泛政治化讨论，尊重其专业能力，发挥其专业特长，将疫情治理策略从“道德问题”“价值问题”还原为“科学问题”。

At present, the COVID-19 pandemic continues to rage globally. Due to the value misalignment, inherent contradictions, and functional failures of capitalism in responding to the public health crisis, we must still be prepared at all times to struggle against the periodic recurrence of epidemics. However, through the “industrial pathology” developed by Marx in *Capital* on the basis of historical materialism, we have also found favorable factors for overcoming the plague: namely, adhering to the priority of people-centered value, upholding responsibility for the people’s life and health, transforming relations of production and the mode of production, and fully respecting and bringing into play the scientific and professional spirit of the medical and health system. By making good use of these powerful weapons and advancing together with all of humanity, we will surely be able to control and overcome the epidemic.

当前，新冠肺炎疫情仍在全球范围内肆虐，由于资本主义应对公共卫生危机的价值错位、内在矛盾和功能失灵，我们仍要时刻准备与流行病的周期性复发作斗争，但是通过马克思在《资本论》中基于历史唯物主义发展的“工业病理学”，我们也找到了战胜瘟疫的有利因素，即坚持以人为本的价值优先，坚持对人的生命健康负责，变革生产关系及生产方式，充分尊重和发挥医疗卫生系统的科学专业精神。用好这些有力的武器，全人类携手共进，我们就一定能控制、战胜流行病。

(Author’s bio: Li Ling, Researcher at the Center for Ethics and Moral Construction, Renmin University of China; Executive Editor-in-Chief of China Ethics Online)

（作者简介：李凌，中国人民大学伦理学与道德建设研究中心研究员、中国伦理在线执行主编）

Online editor: Tongxin

网络编辑：同心