The health of the nation – Part 2

This is the second part of a discussion article offering a detailed look at the effects of partition, at the continued role of British imperialism in Ireland and the effect it has had and continues to have on our people. The focus on public health in the Six Counties argues for an all-Ireland approach to the provision of health services and the necessity for a universal, free public health system, from Derry to Kerry. Responses to these articles, with a maximum of about 300 words, are welcome.

In part 1 of this article in June’s Socialist Voice it was noted that funding for the National Health Service was similar in all NHS regions. Despite this, the NHS in the North is the worst-performing, with the worst medical outcomes by a huge amount compared with all other regions. Research by the Northern Ireland Public Service Alliance found that health service performances are 40 per cent related to the socio-economic factors and 10 per cent to the physical environment, with only 20 per cent due to clinical care.

Many on the left and within trade unions (not all) are failing to join up the dots of this research. Instead of tackling the cause of the abysmal performance of the NHS in the North, i.e. the failed socio-economic development as a result of British rule, they go after the symptom and strive to unite workers behind a campaign to save the NHS.

In order to save the NHS, socio-economic development in the North has to be transformed, otherwise it will fail. Despite the damning evidence, many on the left seek to patch up the health system, as if it is the cause of all the problems rather than a symptom of systemic failure. This only confuses the class in a never-ending struggle to obtain compromises for workers from the capitalist class, thus prolonging capitalist domination.

Under capitalism, how does the socio-economic development in the North compare with Britain and with the South of Ireland since partition, from a workers’ viewpoint?

At the time of partition the GDP per capita in the Six Counties was twice that of the 26 Counties. In 1920 about 80 per cent of the industrial output of Ireland came from three counties, centred on Belfast, with the remaining 20 per cent spread over the other twenty-nine counties. By 1911 Belfast was the biggest city in Ireland, with a population of nearly 400,000, and it was growing fast.

Today the 26-County state exports goods and services valued at €280 billion. The equivalent figure for the Six Counties is a mere €11 billion. In other words, the Six Counties now export only 3½ per cent of the value of goods and services that leave the Southern state.

The population of the Six Counties has increased by half since 1921. In 1961 it was 1.42 million, with 2.8 million in the Twenty-Six Counties. Since then the population of the Six Counties has increased by less than half a million, while the population of the 26 Counties has increased by more than 2 million. Belfast had a greater population than Dublin a century ago; now Dublin has a population of 1.4 million, while the entire Six Counties has less than 1.9 million.

The GDP per capita in the south of Ireland is the fourth-highest in the world, at $83,400. The United Kingdom now ranks 21st in the world and comes in at $46,827 per capita. The GDP per capita in the North is $29,310. There are twenty-six areas in the United Kingdom with GDP of less than $18,500. 8½ per cent of these areas are in England, 20 per cent in Scotland, 45 per cent in Wales, and 60 per cent of them in the North.

GDP is an unreliable measure of an economy, but it is an indication. The average industrial wage in the South is €47,500. The average pay in the North is €25,260; it is €33,850 in Britain. Average disposable income in the South comes in at €25,310. In Scotland it is €20,427, in Wales it is €18,226; bottom of the pile is the North, at €17,748.

The health service in the North is the worst-functioning region of the NHS. We see that the average worker in the North has a lower disposable income and lower average income. The socio-economic status of the North is the worst-performing part of the British administration.

Ordinary working people in Ireland, north and south, have been failed by capitalism. Despite the superior wealth creation in the South, inequality is rampant, and its public services are in crisis. Since partition the once-thriving Northern economy has collapsed. When it did thrive, one section of the community prospered, to the detriment of the other, to control the colony. Since the Belfast Agreement (1998) the two sections suffer a more equal deprivation.

An independent socialist Ireland can unite all our people—an Ireland of equals, where nobody is left behind, a country ruled in the interests of every citizen and not just a tiny elite, whether in London, Dublin, or Belfast. Rule by Britain, Fine Gael or Fianna Fáil will never and can never lead to a society reaching its full potential. A workers’ republic is in the interest of all the working class, Catholic, Protestant, Dissenters. We must end the artificial imperialist division of people and country.

An all-Ireland public health service, free at the point of entry, from the cradle to the grave, would be a foundation stone of a new, independent socialist Ireland. The founding principles of the NHS would be a good starting-point to build on. We should not stop with health: we need to develop all-Ireland publicly owned transport, education, communications, environment and economy for the common good in preparation for a new Ireland with a shared future for everyone, as the reality of reunification is inevitable. Failing to prepare is preparing to fail.

There was a successful counter-revolution in the South when British rule ended in the twenties. We must learn from our history and be ready and prepared for the reunification of Ireland. This time workers must be in control.

Workers have no allies in the ruling class, be they in London or Dublin. As James Connolly said, “the capitalist class is a beast of prey, and cannot be moralized, converted, or conciliated but must be extirpated.” It is time to break the connection with capitalism and for all workers to unite under the red banner of socialism and to build a new, independent Ireland for all our people—uniting the country, uniting our people in a shared future together in peace, independent and socialist.