Healthcare systems across the world are facing a deep crisis in the face of austerity, rising healthcare needs and mass staff shortages. This is translating into a massive spike in excess deaths. People are perishing pointlessly under this rotten system. Only a revolutionary overthrow of capitalism can liberate public health from the yoke of capitalism.
As most of the world staggers out of the coronavirus pandemic, we are facing a global health catastrophe. In Europe, mortality is 10 percent above average, with some countries reporting increases of up to 23 percent. In Canada, a children’s hospital had to request the support of international humanitarian charity the British Red Cross to cope with the scale of illness and suffering.
While the mouthpieces of the capitalist class are quick to blame the COVID-19 pandemic, which certainly exacerbated the crisis, the reality is that this healthcare catastrophe is ultimately a product of the inefficiencies and indifference of the market.
Austerity ravaged services
How do we explain this worsening healthcare crisis when global health expenditure has increased over the last five to ten years? For one thing, the additional spending is not enough! In the richer countries, governments have consistently failed to meet spending targets, meaning healthcare systems have already been underfunded for years, even decades.
A failure to adequately pay healthcare workers has led to a mass exodus of staff from hospitals / Image: Socialist Appeal
Moreover, the source of this additional funding is not from economic growth, but deficit-financing and imperialist loans, particularly in underdeveloped countries.
This leads to both a need to pay back these loans – giving with one hand while taking away with the other – and setting healthcare systems atop a house of cards. Whether it’s through an inability to service debts or the collapse of the precarious system as a whole, or both, global healthcare is teetering on the edge of crisis.
In Europe, healthcare has failed to keep abreast with the medical needs of the population. Austerity has ravaged levels of staffing and resources which, coupled with mismanagement, has led to a perfect storm. World Health Organisation (WHO) European regional director Hans Kluger paints a dystopian vision:
“All of these threats represent a ticking time bomb… likely to lead to poor health outcomes, long waiting times, many preventable deaths and potentially even health system collapse.”
A failure to adequately pay healthcare workers has led to a mass exodus of staff from hospitals and the community, who were pushed to the brink during the COVID-19 pandemic. In France, there are now fewer doctors than a decade ago. As a result, 6 million patients do not have a regular general practitioner. In Britain, 40,000 nurses left the National Health Service in the last year.
In Germany and Finland, once leaders in healthcare, vacancies numbering in the tens and hundreds of thousands have left health and social care systems running on fumes. As one leading German newspaper put it, the country is learning “what it means when a system implodes”.
500 Cuban doctors, usually deployed to assist poor neighbouring nations in South America, have reportedly been sent to the region of Calabria in Italy, in an attempt to paper over the cracks.
Similar issues plague the US healthcare system. Hospitals are closing at alarming rates, operating theatres are shut down due to staff shortages, and patients are spending hours and days waiting in the Emergency Department.
Out of touch and out of options within the limits of capitalism, politicians are struggling to address the crisis. Attempts by the German health minister to simply redistribute nurses and doctors has been labelled “absurd” and “an act of desperation” by leading medical staff.
Faced with increasing health needs and skeletal health services, many countries are opting for austerity measures. In the shadow of a looming recession, it is predicted that 83 out of 189 economies will face a contraction in government spending on healthcare this year. Workers across the world will be made to pay with their health, or even their lives.
The poorest suffer most
The health crisis in low-to-middle income countries is impacted by imperialist exploitation. Coupled with the collaboration of national bourgeoisies and the financial domination of entities like the World Bank, many such countries have an extreme reliance on aid, though of course ultimately more is extracted from these countries in the form of debt servicing and simple robbery than they receive. Nonetheless, in South Sudan for example, over 50 percent of the healthcare budget is provided by aid. In Tanzania, 98 percent of HIV/AIDS funding is from other countries.
Faced with their own crises at home, European governments like the UK have cut international aid by billions / Image: Harriet Pavey
Faced with a capitalist crisis at home, European governments are delivering cuts to international aid. British Prime Minister Rishi Sunak, while in his previous job as Chancellor, cut UK aid by £4.5 billion. These cuts included the UK Partnerships for Health Scheme, which would have seen British healthcare workers train 78,000 staff globally, helping 430,000 patients. Similar measures have been taken by Norway, once considered the leader in global aid.
In Afghanistan, the collapse of the US-backed regime and the victory of the Taliban has led to a wave of sanctions. The Afghan healthcare system relied heavily on foreign support, meaning the withdrawal of Western staff and resources has gutted hospitals and community clinics. As a result, three-quarters of the Afghan population have been plunged into acute poverty, with child malnutrition rates doubling and 90 percent of healthcare clinics predicted to close.
Many economies are victim to debt-traps from imperialist institutions like the International Monetary Fund (IMF), which draws funding away from healthcare. In 2019, lower-middle income countries spent more of their GDP on debt repayments (9 percent) compared to healthcare expenditure (8.3 percent). These figures are far more appalling in low-income countries. Between 2016 and 2019, the average debt repayment in Sierra Leone constituted 36 percent of government revenue, with half of government debt to the IMF.
The advice from the World Bank’s Chief Economist in a 2020 Financial Times article was to “first fight the war, then figure out how to pay for it” – not unexpected advice from a body notorious for offering loans attached to brutal austerity and privatisation measures.
On top of chronic underfunding and immense debt burden, poorer economies are acute victims of the economic crises inherent in the capitalist system. In 2014 in Brazil, a contraction in the economy led to 2.9 million people losing private medical insurance. This exacerbated disparities in healthcare outcomes and coincided with a resurgence of infectious diseases like syphilis, malaria and dengue.
The COVID-19 pandemic showed how debt-burdened economies and underfunded healthcare systems were not prepared; the impending global recession is likely to further exacerbate the healthcare crisis, with healthcare cuts primarily harming the poorest and most vulnerable members of society.
The gross disparity between healthcare expenditure in wealthier and poorer nations is a problem that existed well before the COVID-19 pandemic. High-income countries, representing 15 percent of the population, spent 80 percent of the global health expenditure. The USA alone accounted for 44 percent of spending.
This inequality has led to a ‘brain drain’ phenomenon, where healthcare workers migrate to wealthier countries for better pay and conditions. In one startling example, the death of a single neurosurgeon in Uganda meant a 25 percent decrease in the number of neurosurgeons for a population of 44 million. The overall economic detriment to countries equates to billions of dollars.
Meanwhile, the entire continent of Africa, comprising 16 percent of the global population and 23 percent of the global health burden, accounted for a mere 1 percent of global healthcare spending in 2015. Of this 1 percent, 35 percent was ‘out-of-pocket’, meaning it came from the meagre wages of workers.
Solutions?
Faced with this impending global collapse, what is the solution offered by the strategists of capital?
Healthcare workers are taking matters into their own hands, with a wave of strikes internationally / Image: Barcex, Wikimedia Commons
In their 2022 Global Health Care Outlook report, consultancy firm Deloitte encouraged health leaders to “reimagine and transform the struggling and constrained public health system into ones that are human-centred, inclusive and resilient to future shocks”.
Unfortunately, this health crisis demands more than a reimagination, and certainly not any ideas from the same capitalist class that has spent the last few decades purposely underfunding the healthcare system.
In the Canadian province of Ontario, premier Doug Ford has responded to the increasing health burden with heavy privatisation, targeting 50 percent of elective surgeries. Despite protests from Ontario’s College of Physicians and Surgeons, highlighting that such a move will “further tax our health human resources and further increase wait times for more urgent hospital-based care”, these plans are set to go ahead.
Healthcare workers are already taking measures into their own hands, with a wave of strikes internationally.
In Madrid, 5,000 GPs and paediatricians have been on strike against privatisation, real pay cuts and overwork. In Britain, the Royal College of Nursing had their historic first ever vote for strike action. They have been joined on picket lines by ambulance staff and other health workers, with junior doctors also being balloted for strike action.
Members have been out on the picket lines since the early hours of this morning, fighting for #FairPayForNursing to protect a depleted profession and the patients in our care.
— The RCN (@theRCN) February 7, 2023
As @patcullen9 said "we must keep going, and continue to have our voice heard." #RCNStrike pic.twitter.com/DAY3ADazeG
The Tory government has proceeded to declare war on the same nurses it celebrated as heroes just a few years ago. The Blairite-dominated Labour Party, for its part, has launched attacks against nurses and doctors for standing up for the health service.
Shadow Health Secretary Wes Streeting has spat bile against the doctors’ union BMA, while leader Keir Starmer has bluntly stated that Labour would carry out austerity in power, and rely on private provision to “cut waiting times”. Among Starmer’s helpful suggestions to ‘ease the pressure’ on the NHS was the idea that patients could avoid a professional triage by testing at home for internal bleeding!
All this will prepare further almighty struggles in the event of a future right-wing Labour government.
In India, anganwadi (child care centre) workers have seen indefinite strike action last year against unbearable working conditions and low pay of their members. In Zimbabwe, the government has resorted to a ban on healthcare strikes in response to protracted struggle with doctors and nurses, who have been striking for inflation-busting pay rises.
These actions represent a growing class consciousness amongst healthcare workers, a recognition that the provision of healthcare is not exempt from the crisis of capitalism.
However, strike action alone cannot resolve the underfunding and chaotic planning of healthcare globally. Ultimately, you cannot plan what you do not control, you cannot control what you do not own.
All healthcare resources, from private hospitals to the pharmaceutical industry, need to be nationalised without compensation. Health services must be run under the democratic control of workers, those who have the most specialist knowledge of the population’s health needs.
Decades of under-funding can be reversed by the expropriation of the banks and monopolies, including the private sector parasites who prey on the vulnerability of sick and dying patients.
Resources can be allocated on a democratic and rational basis according to need. Unions should lead mass training and recruitment campaigns, particularly targeting sectors in the poorer countries where expert staff are desperately needed.
Patients' health and lives are being held hostage by a capitalist system wracked with crisis and contradiction. Only a global socialist revolution, placing the levers of the economy into the hands of workers, can resolve this pandemic of inefficiency and austerity.