Contradictions of the STATE IN the Struggle to IMPROVE ACCESS and the SOCIAL Determinants of ILLNESS

The contradictions of the state under late capitalism pose major theoretical and strategic challenges in public health and other fields whose practitioners aim to improve conditions for underserved or otherwise oppressed people. These contradictions involve the state's role of service to the capitalist class, versus the state's welfare function of service to the poor and vulnerable. In this presentation, we analyze these contradictions, with the goals of understanding of the state more clearly and applying this understanding to the development of political strategy. Empirically, we explore the ways in which corporations have become powerful actors in the political and economic landscapes, and the role the state has played in this development. Focusing on the pharmaceutical industry, we find that revolving door practices have provided a key instrument in furthering the growth of corporate power, leading us to reconsider the concepts of class struggle and the role of the state in the maintenance of the dominant class's privileges. Our findings lend support to Harvey's theory of neoliberalism as a specific project to restore power to the dominant class, and also to Marx's conception of state power subordinated to capitalist economic power. With the weakening of the capitalist economic system, pressures for state invention will increase. A meaningful conceptualization of the state must inform strategies toward a national health program and other redistributive policies that address inadequate access to services and that change the social determinants of ill health and early death.