July 2011        

Growing inequality as public health suffers

The recent TASC report on health confirms what most people already know: that inequality in the health services continues to grow. This is despite the promise of Mary Harney to create a “world-class” health service through the “trickle-down” economics so beloved by Fianna Fáil, the PDs, the Labour Party, and Fine Gael.
     Among the findings of the TASC report are:
• Inequality is endemic in Ireland: in 2009 the income of the top tenth of the population was eleven times that of the bottom tenth.
• Ireland experiences serious socio-economic mortality differentials: men living in the poorest areas live on average 4.5 years less than those in the most affluent areas, while the differential for women is 2.7 years.
• Unskilled men will, on average, die six years earlier than their professional counterparts.
• Health improves and life expectancy increases in line with social class, income, and education.
• Previously unpublished research by the Institute of Public Health shows that, if socio-economic mortality differentials were eliminated, the Irish people would, over an extended period, gain more than 13½ million extra years of life.
     And since the beginning of the year we have had lower front-line staffing levels and more cuts in public hospital beds, ward closures, A&E, disability and invalidity services, carers’ services, patient transport, and other services.
     A report published by the OECD, Health at a Glance (2007), shows that in 2005 Ireland had only 2.8 acute hospital beds per 1,000 population, compared with an OECD average of 3.9. On 12 December 2009 the Irish Times gave a more recent report: “The report from the OECD states that Ireland has 2.7 acute beds per 1,000 of the population compared to the OECD average of 3.8 per 1,000 of the population.”
     The answer of the Government was to play down the need for acute beds in public hospitals. The HSE in its Acute Hospital Bed Capacity Review: A Preferred Health System in Ireland to 2020, commissioned from PA Consultants, stressed that with more beds at the local level and with better primary care etc. there would be less need for acute beds, with fewer delays and a better service
     The problem is that the primary care centres and local beds do not exist. But they might exist some day. Live horse and get grass.
     Meanwhile the austerity measures, on top of the failed neo-liberal policies, continue to hit the non-rich worst. The rich can afford private insurance, private clinics and hospitals, and better access to consultants. Their private insurance is heavily subsidised by the general public, and their private medical costs can be reclaimed against their taxes. After all, the rich write the rules. The poor can put up with this inequality or shut up. “That’s the way it is,” we are told.
     So this inequality in health just doesn’t fall from a tree. There is little mention of how the forces of neo-liberalism ran down an already unequal health service to create a market for private investors to establish co-located hospitals with cheap sites and massive tax breaks. No mention of private dialysis and cancer centres run by transnational companies in which many consultants and other doctors-turned-businessmen have invested heavily.
     In most analyses of health, other than that of the Communist Party, there is no mention of how class relations affect the health of our population and how class relations are reproduced in the public and private health-care institutions of Ireland.
     For—contrary to what some might tell us—Ireland is not a classless society!

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