We use cookies for site personalization and analytics. You can opt out of third party cookies. More info in our privacy policy.   Got it

16 million and counting: the collateral damage of capital


During the 1950s and 1960s progressive and radical movements were gaining traction around the world. In the Global North, labour unions were winning their fight for fairer wages and public services. In the Global South, newly independent governments were throwing off colonial arrangements and using tariffs, land reform and industrial policy to build national economic sovereignty.

These movements were fighting for a fairer and more just economy, and it was working. But it posed a threat to capital, particularly in the ‘core’ states of the Global North, as it constrained their access to the cheap labour and captive markets they had enjoyed under colonialism.

Capitalists responded by doing everything in their power to crush the progressive drive for change and reverse reforms – a backlash that we know today as neoliberalism. In the Global North, neoliberal policy was implemented by corporate-aligned governments, most notoriously those of Margaret Thatcher and Ronald Reagan. In the Global South, it was often done through coups and other violent imperialist interventions by the US and its allies, including in countries such as Indonesia (1965), Chile (1973), Burkina Faso (1987) and Iraq (2003).

Countries that were not subject to invasions and coups had neoliberalism imposed on them by the IMF and World Bank in the form of ‘Structural Adjustment Programmes’ (SAPs), which required governments to privatize national resources and public assets, slash protections on labour and the environment, curtail public services and – crucially – abolish programmes that sought to ensure universal access to food or other essential goods. Between 1981 and 2004, 123 countries – comprising 82 per cent of the global population – were forced to implement SAPs. Economic policy for the majority of humanity came to be determined by bankers and technocrats in Washington DC.

In Latin America and much of sub-Saharan Africa, the quantity of food that could be purchased with an unskilled labourer’s wage declined markedly, reaching levels lower than in the 17th and 18th centuries

These policies redistributed incomes to the rich and provided windfall profits to corporations in the Global North. But they had a disastrous impact on working people and small farmers around the world, particularly in terms of access to food. In India, the proportion of the population without access to sufficient calories increased from 75 per cent to 91 per cent in rural areas, and from 57 per cent to 73 per cent in urban areas, during the two decades following neoliberal reforms in 1992. In Latin America and much of sub-Saharan Africa, the quantity of food that could be purchased with an unskilled labourer’s wage declined markedly, reaching levels lower than in the 17th and 18th centuries. Something similar happened in China and the former socialist countries of Eastern Europe, where the share of people unable to afford a basic subsistence basket increased dramatically during the reforms of the 1990s. In region after region, neoliberalization produced food insecurity and caused immeasurable human suffering.

Figure 1

The Cuban alternative

But not every country succumbed to neoliberal shock therapy. In Cuba, following the socialist revolution in 1959, the government established a public food provisioning programme designed to ensure universal access to basic nutritional requirements. Cuba is the only Latin American country that did not implement SAPs, and has maintained this programme to the present day. Under this system, every citizen is entitled to a modest quantity of nutritious food at subsidized prices. As of 2015, Cubans pay only around $2 per month for these items, which is around 12 per cent of their market value. The Cuban government invests over $1 billion into this system every year. People are of course free to obtain additional foodstuffs from local markets, community gardens and commons; but the food programme secures a baseline below which no one will fall.

Cuba’s food provisioning system has been remarkably successful at fighting hunger and premature mortality. Figure 1 compares Cuba’s death rate from nutritional deficiencies to three Latin American states with similar incomes: Mexico, Peru, and Brazil. This data was obtained from the Global Burden of Disease Study (2019), carried out by Institute for Health Metrics and Evaluation at the University of Washington. It refers to all deaths associated with inadequate food, including deficiencies in calories, protein, iodine, vitamin A, iron and other nutrients. The data is age-standardized – a technique used when populations have different age profiles – to allow for comparisons between countries and across time.

Even though Cuba has a lower per capita income than all these states, it has performed much better at ensuring access to essential goods required for survival. In fact, Cuba’s death rate from malnutrition is lower than even high-income economies like Chile, the US and France (Figure 1). The US’s per capita income is almost nine times higher than Cuba’s, yet its citizens are more likely to die from lack of calories and protein. Remarkably, Cuba has been able to accomplish this while subject to a brutal economic blockade imposed by the US.

Figure 2
Deaths from malnutrition in excess of Cuban levels from 1990-2019.
Countries in yellow have a death rate due to malnutrition that is equal to or lower than Cuba's.

A long history of violence

Countless studies have demonstrated the human toll of neoliberal policy, but one way to illustrate the extraordinary scale of it is to compare the death rate from malnutrition in Cuba to countries that have either dismantled or prevented progressive food policies.

The map shows the number of deaths from malnutrition in excess of Cuban levels, in all countries from 1990 to 2019.1 Countries shaded in light yellow had a mortality rate from malnutrition equal to or lower than Cuba’s.

In total, 15.63 million excess deaths have occurred due to malnutrition that could have been prevented with Cuba-style policies. This includes 35,000 in the US; 409,000 in Mexico; 729,000 in China; 1.2 million in Indonesia; and a staggering 3.65 million in India. The only large populous region left unscathed was Eastern Europe and Russia, perhaps reflecting its history of socialist policy. In the rest of the world, almost 16 million people have died needlessly.

These deaths are not incidental to the capitalist world-system; they are intrinsic to it. From the perspective of capital, the global poor’s claims to food represent a claim on resources (land, labour, energy) that could be appropriated instead to service elite consumption and the growth of the commodity sector. Capital therefore seeks to constrain the consumption of these communities in order to make resources available for accumulation. It is only by squeezing the incomes of the poor, often to the point of causing millions of needless deaths, that capital can ensure the steady flow of resources required for profit maximization and perpetual corporate growth.

During the rise of capitalism in the 16th century, some 50 million Indigenous people in Central and South America fell victim to colonial genocide, dispossession, and starvation, as their land was expropriated to service the European market. In the 17th and 18th centuries, European trading companies trafficked enslaved people from West Africa, causing millions to die from disease, hunger, and overwork. In the 19th century, British appropriation of agricultural yields in India and China led to serial famines that caused tens of millions to die. The 16 million deaths that have occurred due to preventable malnutrition since 1990 are merely the latest manifestation of this long history of violence.

Economics for the people

It is clear that neoliberal policy has failed to achieve food security and human development for the Majority World. Cuba has demonstrated that a more effective approach is to organize production directly around meeting human needs, through public provisioning and social guarantees.

But it’s not just Cuba. Public provisioning systems have proved to be a powerful tool for poverty alleviation in many contexts. One 1986 study of health and education indicators found that at any given level of economic development, socialist countries performed better than capitalist states at securing strong welfare outcomes for their populations. These findings received further support from a 1993 study in the International Journal of Health Services, which found that high levels of democracy and strong leftwing policies were associated with improved health indicators. The public health researcher Vicente Navarro reached similar conclusions in his region-by-region survey of health outcomes in capitalist and socialist states. In Latin America, Cuba performed better than most other states; in Asia, China and the Soviet Union had stronger welfare outcomes than capitalist economies like India or Turkey; and in the high-income countries of Europe and North America, the social democracies with generous welfare states, including Sweden, Norway and Denmark, outperformed neoliberal states like the US. As the Nobel-winning economist Amartya Sen remarked in 1981, ‘One thought that is bound to occur is that communism is good for poverty removal.’

Of course, some socialist governments in the 20th century pursued policies that exacerbated hunger and mortality. These tragedies occurred not because of socialist principles as such, but because of the authoritarian nature of government power. From 1958 to 1961, China experienced a famine that killed tens of millions of people, because Mao’s government brutally requisitioned grain from the peasantry to finance industrialization and crushed any dissent. The Chinese famine underscores the importance of popular participation in economic policy-making. Socialist provisioning systems should always be democratically managed by transparent and accountable public institutions, worker co-operatives and grassroots organizations.

Nevertheless, outside of the famine years, socialist China experienced rapid gains against mortality. As Jean Drèze and Amartya Sen remarked in 1989, ‘despite the gigantic size of excess mortality in the Chinese famine, the extra mortality in India from regular deprivation in normal times vastly overshadows the former… Every eight years or so, more people die in India because of its higher regular death rate [relative to socialist China] than died in China during the gigantic famine of 1958-61.’ Dreze and Sen attribute China’s lead over India to state investments in the public distribution of food and healthcare – in other words, to socialist provisioning systems that de-commodified essential goods.

The mass poverty and hunger that characterizes our world today is not due to absolute scarcity. The world economy has extraordinary productive capacity, sufficient to end poverty several times over. The problem is that this capacity is overwhelmingly used to service the interests of capital accumulation, rather than to meet human needs. With democratic socialist policy, we can do the opposite: we can build an economy focused on people instead of profit, where the goal of production is to ensure that everyone has the goods and services necessary to live decent, dignified lives.

Dylan Sullivan is an adjunct fellow in the School of Social Sciences at Macquarie University, where he teaches Anthropology and Sociology. His research focuses on global inequality, colonialism, environmental justice, and the economics of socialist planning.

Jason Hickel is professor at the Institute for Environmental Science and Technology (ICTA) at the Autonomous University of Barcelona. His most recent books are the Divide: a Brief Guide to Global Inequality and its Solutions, and Less is More: How Degrowth Will Save the World.

 1 We calculated excess deaths in each country and year with the following formula: Excess deaths in country A = (per capita deaths in country A – per capita deaths in Cuba) x population in country A.

Subscribe   Ethical Shop