Public Health | Cuba shows the way

We have two health services in Ireland, and both are on the verge of collapse.

Since Covid exposed their existing inadequacies, very little capacity has been added to either service in preparation for the next wave. We should have been building and training staff for several new hospitals. In fact bed numbers have been slashed in the last twenty years.

In 2000, when the population in the South was under 4 million, we had 23,000 hospital beds; today, with a population of 5 million, we have only 14,500.

Instead of improving and expanding the system they cut services, postponing elective procedures, appointments, operations and consultations to deal with the pandemic, both here and in the North. Despite this drastic action, both health services are still in daily danger of being overwhelmed. Only the heroic efforts of our exhausted health workers have kept these two sinking ships afloat.

This cannot continue indefinitely. Meanwhile the waiting-lists grow as procedures are postponed.

The cost of the new children’s hospital spirals on the money carousel, for developer, banker, politician, and profiteer. It is boom time for private hospitals, which are expanding, now flush with public money thanks to the extortionate sums paid to them by the state for their temporary use by the public service during peaks of covid.

These hospitals should be seen for what they are: they are but leeches on society, making millions for their wealthy owners on the back of an underfunded public health service. At the start of the pandemic, when the extortionate rates demanded by these private hospitals became known, it should have been exposed. They should have been nationalised for the treacherous extortion they foisted on the people of Ireland at the height of the pandemic.

Wishful thinking! Here in “the best small country in the world to do business in,” we reward greed. Millions continue to be handed over daily to the wealthiest elite in fees in the middle of the deadliest pandemic in over a hundred years. There should be no place for these bloodsucking parasites to hide.

The crisis continues with the establishment narrative that Sláintecare, along with the NHS in the North, is the silver bullet, the future for health services in their vision of a reunified Ireland. This is the establishment’s solution.

Great as the NHS was at one time, it is now on its knees, with longer waiting-times, fewer hospital beds and a worse doctor-to-patient ratio in the North than the HSE provides in the South.

The fact of the matter is that we have two two-tier health systems, both north and south. The use of private medicine in the North has exploded as a result of the length of time people have to wait in the NHS. GPs, dentists, dispensing pharmacists and opticians are, and always have been, profit-making businesses, supplying services under contract, often at the same time using the facilities of the NHS for their private patients. This practice is now in overdrive as they pick the bones of the once-mighty NHS.

We need to decolonise our minds and go much further than the NHS: set our goals much higher, and mirror the Cuban model.

We need a fully funded, publicly owned all-Ireland health service, free at the point of entry, from the cradle to the grave, from crèche to care home, incorporating research and development, based on the Cuban system, where public health is the first and only priority—not a second-rate two-tier system forced as a compromise from capitalism.

Forced compromises are always temporary. Only five years from the founding of the NHS the British Labour Party attempted to impose charges for its services; and it has been under attack ever since. South of the border, Noël Browne was defeated by church and state in his attempt to bring in a similar, though much more limited, health system, which led directly to the two-tier health service in the South.

Capitalism is ideologically opposed to a public health service. It was always a forced compromise after the war and to compete with the services provided in socialist countries.

So what of the Cuban model? Cuba continues to increase the ratio of doctors to population, which now stands at 8.4 doctors for every 1,000 citizens. Ireland’s HSE has 3.3, the NHS has 2.9.

Cuba has 5.3 hospital beds per 1,000. The HSE has 3, and the NHS has 2.5.

If an impoverished Third World country like Cuba, suffering the effects of an economic blockade for sixty years, can provide a First World health service for its people, surely this should be the foundation stone on which to build the unity of our people.

And Cuba doesn’t stop at having more hospital beds, or a better doctor-to-patient ratio: it applies to every aspect of the health system, as health is given priority by the state. The high doctor-to-patient ratio is a result of in-house training provided by the Cuban health system, which also provides training for thousands of doctors from all over the world.

The HSE and the NHS scour the world for qualified doctors, who were trained at enormous expense in Third World countries, so depriving those countries of doctors as well as saving the HSE and the NHS the expense of training them.

As a result of this practice there are more doctors from Malawi in Manchester than there are in Malawi. There is just one doctor for every 40,000 people in Malawi, and life expectancy is a mere 64, with infant mortality among the highest in the world.

Cuba is not only one of the few lower-income countries to have vaccinated a majority of its population (ranked ninth in the world, with 78 per cent of its people fully vaccinated) but the only one to have done so with a vaccine it developed on its own.

Cuba has developed a suite of five vaccines, two of which—Abdala and Soberana 2—received official regulatory approval in July and August. They are developing a vaccine that can be given nasally; another is a universal booster for people originally vaccinated with other vaccines. And some of their vaccines can be stored at room temperature, which will get over the problem for many poor countries that do not have electricity supplies available everywhere, so enabling vaccination in the remotest parts of the world.

This is what can be achieved when health is the priority, not profit.

If covid has taught us anything it is the importance of public health. We must aim for the highest standard for our people.