Republican News · Thursday 25 April 2002

Investing for Health: A Republican Socialist Vision

In a landmark achievement, Bairbre de Brún has managed to persuade the northern Executive to endorse the Investing for Health strategy, launched on 27 March. Investing for Health involves a radical change in the way we view health - a change towards what can only be described as a socialist vision.

Until now when we thought about health, we tended to think of its opposite - sickness, and how we could treat that sickness. Hence our concentration on hospitals and doctors, on operations and medicines. The problem with such an approach is that by the time we get to the stage of being sick, the damage is already being done. Instead of concentrating on what should be done when we get sick, Investing for Health asks how we can stay well. In other words, it moves the focus from sickness and the treatment of sickness to health and its maintenance.

Having adopted a preventative rather than curative approach to health, Investing for Health goes on to ask what factors are involved in determining whether or not we enjoy good health. It finds that health is largely determined by our social, economic, physical and cultural environment.

In other words, rather than being the result of chance or bad luck, our health is largely the result of our position within society, and the economic, cultural and physical resources that such a position affords us. So social inequality leads to inequalities in health. The report makes this point forcefully by presenting shocking data about the extent of inequalities in health between rich and poor.

It cites figures showing that a man in the most deprived fifth of the population in the Six Counties will have a life expectancy six years less than a man in the most affluent fifth. For a woman, the figure is four years. In relation to specific diseases, if you are in the least well off occupational class, you are more than twice as likely to die from heart disease, from a stroke, or from cancer than someone in the most well off occupational class.

Investing for Health sets out what should be done about this. The first is 'To improve the health of our people by increasing the length of their lives and increasing the number of years they spend free from disease, illness and disability'. The second is 'to reduce inequalities in health between geographic areas, socio-economic and minority groups'. Here lies the socialism. If inequalities in health are caused by socio-economic inequalities, and if the Executive has committed itself to the reduction of inequalities in health, then the only road to go is towards the creation of a more equal society in terms of economic, physical and cultural resources. Nor is it a matter of vague aspirations. The document lays out clear targets by which progress towards these goals can be measured and be achieved by 2010.

To improve everyone's health, the target is to increase life expectancy by at least three years for men and two years for women. To reduce inequalities in health, the target is to halve the gap in life expectancy between those living in the fifth most deprived electoral wards and the average life expectancy in the Six Counties. This gap currently stands at over three years for men and two and a half years for women. By the end of the decade, the target is that that the life expectancy of poor men will be increased by four and a half years, and poor women by three and a quarter.

These statistics may seem dry, but it is difficult to overestimate their significance. What they promise is a class redistribution of that most precious of commodities - life.

Of all inequalities in our society, those in health are probably the most reprehensible. After all, without life and the physical and mental capacity to enjoy it, we are nothing. Health is the basic building block upon which all other freedoms can be enjoyed. By succeeding in persuading the rest of the Executive to sign up to these targets, Bairbre de Brún has shown what can be done by Sinn Féin to improve the lives of those currently disadvantaged in our society. It shows that, while there is a long way to go, the struggle can deliver change for the better, and deliver it now.

In addition to the two main goals, seven major objectives are identified:

1. To reduce poverty in families with children.
2. To enable young people to develop skills and attitudes that will give them the capacity to reach their full potential and make healthy choices.
3. To promote mental health and emotional wellbeing.
4. To offer everyone the opportunity to live and work in a healthy environment and to live in a decent and affordable home.
5. To improve our neighbourhoods and wider environment.
6. To reduce accidental injuries and deaths in the home, workplace and on the road.
7. To enable people to make healthier choices.

All of these objectives, rather than just being high sounding wish lists, are measured against definite targets. For example, in relation to accidents, one of the targets is to reduce the death rate by one fifth by 2010. To promote a healthy environment, one of the targets is to lift at least 20,000 families out of fuel poverty by the end of 2004.

One of the crucial aspects of Investing for Health is that, while it is an initiative championed by the Minister for Health, the responsibility for carrying out the strategy is not confined to the Department of Health. This is why it was important for the whole Executive to sign up - the initiative will only succeed if all Departments are involved. Thus, for example, the Department of Education will be centrally involved in the target of reducing by a third the proportion of poor children coming out of school with no GCSEs by the middle of the decade, and the Department of the Environment will be responsible for developing strategies to reduce the number of deaths due to road accidents.

Nor should Investing for Health be seen as exclusive to the statutory sector. The document put the onus on everyone: "The successful implementation of the Investing for Health Strategy is dependent on the commitment, actions and co-ordination of individuals, families, community groups and organisations as well as a whole range of others, including District Councils, the business community and the voluntary sector."

This means that all republicans have a role to play in improving the health of our communities. The fight for health involves the fight for better housing, better public transportation systems, better waste disposal systems, better information about state benefits, better support to kick addictive drugs, including tobacco, better use of public spaces, better school meal diets, the list could go on for ever.

Whether you are an activist, a councillor, a member of a community group or a Local Health and Social Care Group, there are things that you can do or agitate to get done that will make a difference to your health and that of your community.

What needs to be done in the near future is that republican activists must come together and develop a programme for ourselves. Make no mistake about it, if we think that we can leave it those in government to implement this strategy on their own, it will fail. We all must engage in the struggle for the health of our communities.

Investing for Health is a fine example of the new politics that we are becoming involved in. After many years of demanding justice and equality from the outside, we are now in a position where we have the ability to start taking concrete steps towards their attainment. Using the power that entry into the Assembly has given us, in unison with the power and energy of activists, we are now in the position to demonstrate that the republican project can deliver real improvements to the lives of ordinary people.

As it stands, however, the Investing for Health strategy is incapable of eradicating inequalities of health. There are powerful limitations as to just how far improvements in the health of the population currently can go. Those limitations lie in the undemocratic nature of the Six-County statelet. While much can be done to alleviate inequalities of health by modifying the effects of socio-economic inequalities, in the end there will be a need to address those inequalities in a more direct fashion. If we are serious, we have to engage in wealth redistribution. In order to do that, we will require political and fiscal independence.

There are a number of reasons why Investing for Health is so important for republicans. First, it has the potential to provide medium term gains in that it enables us to use the interim political arrangements to improve the life and health of the population. Second, it places the health debate on republican socialist grounds. Third, it provides stark justification for the need for an independent socialist republic with the capacity to use its powers of redistribution to ensure all of us have the same chances for good health and longevity.

For all these reasons, Investing for Health has the potential to be far and away the most significant product of the Sinn Féin stewardship of the Ministry of Health, Social Services and Public Safety. It is the responsibility of all republicans to ensure that potential is fully realised.