12 mars, 2024

Critical analysis of the neo classical theory in sexual and reproductive health, is Capitalism good for your health?

In this paper, we will try to go through the main concepts linked to the neo classical theory. The essay will be in 4 parts:

First, we will discuss the concept of demand of health and health seeking behavior using the example of illegal abortion. 

Second, we will try to define 3 of the main key market structures using several examples.

Since pareto efficiency isn’t possible in the market of health, market failure takes place through several mechanisms, we will try to study in the third part, one of the market failures through the example of the TCP .

In the fourth part, we will discuss the impact of capitalism on health.

Neo classical theory in health: the case of Abortion in Eastern Mediterranean Region:

Statistically, one in three women will need to have an abortion during her life [1]. Abortion remains highly restricted in EMR , except in Tunisia.  Restrictions are based on conservative and religious arguments. Yet, abortions are still widely performed. According to the WHO, in 2003, 2,800,000 unsafe abortions took place in the EMR [2] leading to 12% of all maternal deaths in the region [3].

There seem to be no official data about demand in this context, but depending on the SES, there are options like abortion in unsafe environments or medically assisted abortion performed in private clinics [4] while women with higher SES can afford safe abortion abroad. Women lake agency and are mainly directed in their choices by their income.

The regulatory rigidities make demand and supply of abortion services part of the black market: there are no controls of the quality of the service nor of the price : women have to pay huge amounts of money to access abortion creating a very unequal access to abortion services and to endorse a coast premium due to the risks involved either due to health impact or to possible legal impact. These restrictive laws also discourage women from having complement of abortion service, since they don’t seek post-abortion care [4]

 “Better health outcomes for women are a political issue and involve a collective struggle against entrenched male power” [5]. There is a need to legalize abortion and to regulate the market of abortion service provision. 

Examples of Key market structures: 

Perfect Competition:

Perfect competition is a gold standard that is unattainable since it’s based on assumptions that are quite difficult to assemble in health market. There is usually a limited number of sellers in the market due to patents or licenses, the latter restrict the freedom of entry into the market. Sometimes products can have similar effects, but they aren’t perfectly homogeneous. Finally, buyers (patients) unless being themselves health professionals do not have perfect knowledge about products provided.

On the other hand, depending on the situation, underground market could be more prone to have perfect competition in health market. In contexts where abortion is illegal, providers can theoretically enter or exit the black market if they bare the risks and can provide either medical or surgical abortions. Buyers aren’t agent but they can make a choice depending on their income. Knowledge about the services is disseminated unofficially through trust networks [6]. It is a largely unregulated market rising concerns about the quality and safety of the abortion services.


Oligopoly is a type of imperfect competition that involves few firms, with restricted entry for new firms. Oligopolistic firms have control over price.

Oocytes freezing is turning into an increasingly important demand due to demographic and societal changes. Yet, this demand isn’t satisfied due to restrictive laws.

These restrictions made firms set up in countries where the law allows oocyte freezing.

If we take the example of IVI clinic[7]which operates in London, Dubai, Portugal and Spain and which offers its services around the world, we can talk about a collusive oligopoly where a low number of firms  operate in many countries with  a restricted entry into the market because of they developed a specialized production and marketing skills. Those firms around the world are sharing information about production methods with each other.

This Oligopoly might disappear if regulations change and they are starting to, since in France, the change in the bioethics law that occurred in august 2021, gives the right to French women to freeze their oocytes without medical reason [8].


Abortion services in an illegal context can also be a monopoly since risks taking in the black market, can be a barrier to entry.

Monopoly market is a single seller market with diverse barriers to enter the market for other producers. Monopoly is the art of eliminating competition. Monopolistic firms aren’t price takers but rather price makers.

Monopoly creates a dependency situation that can become critic.

The most recent example took place during the COVID-19 pandemic, there was a huge rise in the demand of many medical tools.  Monopolistic firms controlling the market through patents and through signing bilateral commercial licensing and purchase agreements couldn't ensure the sufficient supply which undermined access for many developing countries.

This led to a proposal by South Africa and India to temporarily waive monopolies on COVID-19 medical tools during the pandemic [9].

The discussions didn’t have the hoped outcome since EU leaders maintained their support to the existing TRIPS [10]; while the US allegedly supported a vaccines waiver which discussions upon are still stuck while some countries are facing a 5thCOVID wave [11].

Rich countries are backing pharmaceutical corporations and opposing such initiatives in very critical situation. There is a need to decolonize the market.

Market failure, the example of the Tunisian Central Pharmacy:

Market Power is one of the most important market failures that happens when there is a monopoly.

The drug market in Tunisia is composed by 48% of imported goods and 52% of goods provided locally. The TCP [11]is a public institution that is the exclusive supplier of public and Para public health establishments, for imported drugs (76%) [12] but also for drugs produced locally (24%) [12]. It also ensures the monopoly of the importation and supply of medicines and all other medical products in the country [12].

It aims to maintain the regularity of the supply and the quality of the goods as well as their distribution which allows it to rule out any competition [13].

Barriers to entry are legal and offer exceptional custom conditions allowing the clearance of products transiting to the TCP [14].

The TCP is experiencing the same debt as the Tunisian health sector leading to shortages in drugs [15] and the deterioration of its relationships with its suppliers [12].

In this context and despite the continuous increase in its business volume, the TCP has seen all of its margins decline over the last few years in particular due to exchange losses [12]. This had an impact on the availability of drugs in general, including vital drugs and oral contraceptive at some point.

The state intervention shouldn’t jeopardize the sustainability of the healthcare provision. Though being a very good prototype that ensures safety in medical supply, the TCP is lacking a proper budget that would give it the means of its aspirations.

Is Capitalism bad for your health?

Capitalism is the economic system that derive from the market theory. It is based on 6 main pillars which are private property, self-interest, competition, market mechanisms defining prices of goods, agent rational consumers and a limited government intervention [16].

For many reasons, markets fail to establish perfect competition and the actual market fundamentalism divorces economics from social capital [17].

Under capitalism, humanity moved from a market economy to a market society which changed and corroded society mechanisms [17], undermining the satisfaction of the human psychological needs [18].

Indeed, capitalist political and social structures impose a production mode that alienate workers and consumers [18]. Producers objectify workers and clients [19] which disable the “healthy and happy development” of the individuals in capitalist societies [20].

For workers, due to routinization, job stratification and loss of meaning, work becomes detrimental to mental health, leading to burnout [19].

Studies show that workers in capitalistic societies are experiencing normalized work-related degradation of mental health [18].

The WHO reports that “stress at work is associated with a 50% excess risk of coronary heart disease, and there is consistent evidence that high job demand, low control, and effort-reward imbalance are risk factors for mental and physical health problems”.

For consumers, the spread of subjective neutral values based on market price flatted values and lead to underinvestment in what matters for the wellbeing. Competition and individualism combined deteriorated the social capital and lead to consumerism as an attempt to express social position.

Consumers experience loneliness, alcohol and drug abuse, physical and mental health issues, because capitalism divorces humans from their own nature [18].

In addition, oppression and discrimination aiming to ensure optimal markets, lead to racism, sexism, violence against women [21]and economic inequality [18].

Capitalism is based on principals that aren’t adapted to the irrational and impatient humans. As Thaler & Sunstein, point out in their book Nudge, capitalism would be perfect for “mythical Econs”. Meanwhile, it is impacting negatively the health and the environment through overproduction and overconsumption.

New philosophical approaches to economy are getting developed and might be an alternative for capitalism. The economist Gunter Pauli proposes an economic model namely the Blue economy which promotes a more rational use of resources and production systems.



 [1] Mazuy,M., Toulemon, L. and Baril, E., 2015. Un recours moindre à l’IVG, mais plus souvent répété. Population &Sociétés, N 518 (1), p.1.

[2] Eastern Mediterranean Region: EMR include: Afghanistan, Bahrain, Djibouti, Egypt, Islamic Republic of Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, South Sudan, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates & Yemen.

[3] Unsafe abortion Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003 [Internet]. Apps.who.int. 2003 [cited 26 November 2021]. Available from: http://apps.who.int/iris/bitstream/handle/10665/43798/9789241596121_eng.pdf?sequence=1

[4] Saja M. Women’s Right to Abortion in Lebanon A Position Paper by Nasawiya [Internet]. Theaproject.org. 2021 [cited 26 November 2021]. Available from: https://theaproject.org/sites/default/files/Newest-Abortion-Position-Paper.pdf

[5] Kevin Deane & Joyce Wamoyi (2015) Revisiting the economics of transactional sex: evidence from Tanzania, Review of African Political Economy, 42:145, 437-454, DOI: 10.1080/03056244.2015.1064816

 [6] Rubai K. View of Trust without Confidence: Moving Medicine with Dirty Hands | Cultural Anthropology [Internet]. Journal.culanth.org. 2021 [cited 28 November 2021]. Available from: https://journal.culanth.org/index.php/ca/article/view/4711/530

[7] http://hello.apricity.life/ivf/ [Internet]. Hello.apricity.life. 2021 [cited 28 November 2021]. Available from: https://hello.apricity.life/ivf/?utm_site_source_name=website&utm_source=google&utm_medium=paid%20social&utm_campaign=WINNERS-GENERAL-MAX-CONV&utm_term=EM&utm_content=ivf%20london%20clinic&utm_creative=526890964761&gclid=Cj0KCQiA7oyNBhDiARIsADtGRZbXMavfKgtim_WAft0MwPt6HppSGoyJThW3dxmjHCFYVGjVJV_XNF8aAvePEALw_wcB

[8] Congélation des ovocytes en France : 5 questions sur les nouvelles règles [Internet]. LCI. 2021 [cited 28 November 2021]. Available from: https://www.lci.fr/societe/video-toutes-les-francaises-peuvent-desormais-faire-congeler-leurs-ovocytes-voici-les-regles-2198079.html

 [9] MSF to wealthy countries: Don’t block and ruin the potential of a landmark waiver on monopolies during the pandemic [Internet]. Médecins Sans Frontières Access Campaign. 2021 [cited 28 November 2021]. Available from: https://msfaccess.org/msf-wealthy-countries-dont-block-and-ruin-potential-landmark-waiver-monopolies-during-pandemic

[10] World Trade Organization TRIPS waiver to tackle coronavirus - Think Tank [Internet]. Europarl.europa.eu. 2021 [cited 28 November 2021]. Available from: https://www.europarl.europa.eu/thinktank/en/document.html?reference=EPRS_ATA%282021%29690649

[11] Beattie A. Talks to waive patents on Covid vaccines are ‘stuck’, WTO head warns [Internet]. Ft.com. 2021 [cited 28 November 2021]. Available from: https://www.ft.com/content/b9a66140-f031-4ed6-9048-f6029832c511

[11] Development Aid [Internet]. DevelopmentAid. 2021 [cited 6 December 2021]. Available from: https://www.developmentaid.org/#!/organizations/view/237179/central-pharmacy-of-tunisia-pharmacie-centrale-de-tunisie

[12] La pharmacie centrale de Tunisie Mission [Internet]. Phct.com.tn. 2021 [cited 6 December 2021]. Available from: http://www.phct.com.tn/index.php/apropos/mission

[13] La Pharmacie Centrale de Tunisie notée ''CCC'' avec perspective stable par PBR Rating [Internet]. ilboursa.com. 2019 [cited 6 December 2021]. Available from: https://www.ilboursa.com/marches/la-pharmacie-centrale-de-tunisie-notee--ccc--avec-perspective-stable-par-pbr-rating_19018

[14]Souissi Jaziri, Camelia, & Moulahi, L. (2013). Role of the tunisian central pharmacy in the import of radio-pharmaceutical products. International Conference on Radioisotopes Production and Utilisation : Radioisotopes and health, Book of abstracts, Tunisia (TN), 16-17 May, 2013, (p. v). Tunisia: National Center for Nuclear Sciences and Technologies.

[15] Tunisia allocates $190m to reduce Central Pharmacy deficit [Internet]. Middle East Monitor. 2018 [cited 6 December 2021]. Available from: https://www.middleeastmonitor.com/20180629-tunisia-allocates-190-million-to-reduce-central-pharmacy-deficit/

 [16] Sarwat J, Mahmud A. What Is Capitalism? Free markets may not be perfect but they are probably the best way to organize an economy [Internet]. FINANCE & DEVELOPMENT. 2021 [cited 8 December 2021]. Available from: https://www.imf.org/external/pubs/ft/fandd/basics/2_capitalism.htm

[17] The Reith Lectures - Mark Carney - How We Get What We Value - From Moral to Market Sentiments - BBC Sounds [Internet]. bbc. 2021 [cited 8 December 2021]. Available from: https://www.bbc.co.uk/sounds/play/m000py8t

[18] Matthews D. Monthly Review | Capitalism and Mental Health [Internet]. Monthly Review. 2019 [cited 8 December 2021]. Available from: https://monthlyreview.org/2019/01/01/capitalism-and-mental-health/

[19] Karger H. Burnout as Alienation [Internet]. 2021 [cited 8 December 2021]. Available from: http://www.jstor.com/stable/30011472 (Links to an external site.)

[20] Paul Baran and Paul Sweezy, Monopoly Capital (New York: Monthly Review Press, 1966), 285.

[21]Federici S. Crise du capitalisme et violences sexistes. Entretien avec Silvia Federici – CONTRETEMPS [Internet]. Contretemps.eu. 2021 [cited 8 December 2021]. Available from: https://www.contretemps.eu/crise-capitalisme-et-chasse-aux-sorcieres-entretien-avec-silvia-federici/


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