Anne Engelhardt (SAV in Germany), Sonja Grusch (ISA Austria)
he health and social care crisis is a part of the overall reproductive crisis in capitalism that threatens workers’ lives. It affects predominantly women workers who are low-paid or even unpaid and endure hard working conditions due to the structural understaffing, largely due to capitalist austerity measures and privatization, of the sectors they are working in.
It indirectly highlights the priorities in a capitalist world — profit over people — as well as directly highlighting its contradictions. Capitalism and its crises increase the demand for health and social care work, as people experience more ill-health due to worsening working conditions, war, poverty, and the climate crisis. Sexism, and racism, LGBTQ-phobia and general work-induced stress produce mental health problems and violence. At the same time, resources for this sector are limited by increasing workloads and austerity measures.
“Healthcare and healthcare workers are at the vortex of all the crises in our society—social, economic, political and environmental. A real solution at the tip of the iceberg must address those massive inequalities at the foundation. That’s why I’m a socialist, fighting for the transformation of society.” Marty, Nurse from Philadelphia/USA
For a free and quality public social and health care system for all!
Paid for by the profits of big business
“Even on (rare) days when we have our full complement of nurses in the Emergency Department at my hospital, it’s not enough. Yesterday, there were six ICU patients waiting for beds (and nurses) in the unit at the start of the shift. Then there were two traumas before 8 am. The day before, four gunshot wounds all arrived at the same time—shortly after another pediatric trauma. We have no time to take care of all the other patients—never mind just take a minute to collect our thoughts and process our own emotions. How has the management addressed the crisis? By eliminating the sheet for nurses who couldn’t take their lunch break to sign up to get paid for this unpaid half hour!” Marty, Nurse from Philadelphia/USA
The health and social care crisis did not start with Covid-19. While most people consider health to be a human right, this is clearly not the case in a profit-driven system. Workers in health and social care units have to mend both the physical and mental wounds caused by life under capitalism. They provide care for the elderly and children, help working class people to recover from pandemics, injuries, trauma etc. that the capitalist system inflicts on us.
Yet like everything else in capitalism, our health is a commodity. In some phases of capitalist development it is seen as a “worthwhile” investment, but not in others. For example, during the capitalist boom period following the end of the Second World War, there was a lack of a sufficient workforce. In many countries, under pressure of a relatively strong and radical labour movement, and fearing the existence of the Stalinist countries with their planned economies, which despite their lack of democracy and bureaucratic mismanagement were growing at a faster rate, the capitalists had to concede to the demands of the working class to establish public healthcare systems and the welfare state. However, the following period of neoliberalism opened the health sector where it was formerly public to private capital and speculation and put profits over needs. Rather than providing a public service, healthcare became a business driven using lean-production methods.
Globally, today, healthcare is one of the biggest and most profitable sectors. Around 10% of global GDP is linked to health, and associated industries are amongst the quickest growing and most profitable businesses. It is estimated that revenue from healthcare will reach $60.72 billion in 2023 with an annual growth rate of 10.95%. In the US alone, around 800,000 private health companies exist, the world’s biggest being the McKesson Corporation which generated $273.9 billion in revenue in 2022.
The economic crisis of 2007/2008 accelerated the situation. Hospitals and other infrastructures have been privatised, closed down, or exposed to severe cuts to “save” money for bailing out the banks and the financial system. The marketization of health has led to a dramatic decrease in the labour force, as hospitals and care units are only profitable, when running with “optimised” workforces, no matter if they are ‘officially’ public or not.
Where the health sector is still mainly public the struggle is on two fronts. As national capitalist states face the need to free resources in the face of growing international competition, they increasingly squeeze health workers. Even though, in some countries, the state is playing a bigger role in the economy than at the height of neoliberalism, this does not provide any relief to the health service. Austerity continues to be widespread as the money is used for weapons and to subsidise companies, and the struggle of healthcare workers for more resources is central. At the same time the struggle against the privatisation of the health sector needs to be stepped up as a privatised health service is even more oriented towards those who can pay and literally lets those who can’t afford it die.
“At present there is a stated goal to reduce the dependence of my workplace and all other public hospitals on hired contract staff from different private recruitment agencies, to increase the number of regular staff. Essentially it is a measure to save money and cut costs, as those hired from private agencies have a much higher salary. The effect after more than two months of reducing staff numbers is longer queues for surgery, meaning that patients must wait longer, combined with more overtime for the remaining staff in order to keep up. Almost every day operating theatre nurses and nurse anesthetists need to work double shifts to avoid postponing urgent operations and cancer surgery. This situation can last for a while, but many look forward to the summer season with more than just a bit of stress and fear. Double shifts will be needed almost every day then, which means over 14 hour long workdays. The surgery department where we work is new and looks very nice, however as a cost saving measure ventilation wasn’t built to standard, which means that on hot summer days humidity reaches high levels in the operating rooms, which compromises sterility and increases the risk of bacterial contamination for patients undergoing surgery. The only way to overcome this is to increase temperatures in the operating rooms, to reduce humidity. This means that operations of several hours length will be performed in 24 degrees C wearing sterile gowns — a prospect nobody looks forward to. Although all political parties say they don’t want to cut down on emergency and cancer care, reality is much different from their sweet talk.” Johan, nurse anesthetist at Karolinska University hospital in Huddinge, Sweden.
More staff and resources! For safe staffing ratios, better conditions, higher wages and less working hours with no loss of pay
Mary, a nurse in Kentucky, USA reports how staff levels are being cut even further even though they are already too low to properly treat patients:
“Recently a health care system in my state laid off 150 employees. A nurse I used to work with was one of them. She and fellow nurses were escorted to HR, told the news, and told to leave. With nothing more than a measly severance package and a pamphlet on dealing with grief.”
In a world of economic problems, the health sector stands out with its growing revenues and profits. ISA and Rosa in Brazil explain:
“In April 2021, Forbes magazine announced the ranking of billionaires, showing the entry of nine Brazilian health entrepreneurs….This was during the same period of the worst health and hospital crisis in history...The total wealth of these billionaires, which exceeds 30 billion dollars, is scandalously higher than what was invested in public health during the same year. The participation of private enterprise in health has become increasingly predominant to the point of becoming greater than public spending today.”
The profits collected by private companies from our health comes both directly and indirectly from the working class. Tax revenues finance both private and public health systems. In the US, where right wingers still present the absence of a public health system as an element of “freedom”, two-thirds of the money in the health industry comes from taxes. In Germany and many other countries, hospitals follow the Diagnosis Related Groups (DRG) system to define the cost of every diagnosis, and every patient. This includes the bed, the cleaning and heating costs for the room, the food, water for the toilet and so on. When, for any reason, the cost increases because the patient needs more time to heal, then this restriction imposed by ‘lean management’ means that the hospital makes a loss.
This means many patients are sent home too early, often needing their return at a later stage. The lack of resources in the public health systems — where they (still) exist — also often forces people to turn for help to the private sector. When patients in the still relatively good public health system in Austria have to wait for over six months for a cancer scan, they will sooner “choose” to pay for a private scan available within a week.
That is reflected in the fact that many struggles of health workers are not purely for better pay, but are often to create the conditions to enable them to actually do their job. The lack of resources is not only a burden for the workers but a safety risk for the patients. Austrian health workers regularly have to send in “reports of endangerment” about the disastrous lack of staff and resources. In Berlin Charite, one of Europe’s biggest and most important hospitals, the health workers have organised protest after protest, strike after strike to make clear that their demand “more of us is better for all” was not what was putting patients into danger, but that that was due to the everyday shortage of resources. They fought for — and won — minimum staff-patient ratios, for themselves as well as for their patients who very much understood and supported the struggle.
An injury to one is an injury to all! For a united struggle of health and social care workers from all backgrounds and across all professions
Around the world around 60 million are employed in the health sector. 70% are female and many from a migrant background. Billions, especially women, provide everyday care of children, elderly, disabled and the ill, and do so without pay. According to Oxfam, in 2022 this unpaid work was worth $10.8 trillion a year.
The reactionary backlash that is taking place internationally is linked to the care crisis as well. When Xi Jinping, Bolsonaro, Tate, Trump or Putin attack abortion rights and the struggles of women and queer people then this is to re-emphasis “traditional” gender roles. The “traditional” family is necessary to keep wages in the care sector down and to keep “reproduction” costs low. In capitalist society, the labour force itself is a commodity that needs to be produced and reproduced. This includes giving birth to potential workers, educating, cleaning, teaching, healing, feeding, and caring for both the current and the future generation.
If all this work is done motivated by “love” or by “the promise of a future in heaven” then the share the capitalists keep is even bigger. The emotional pressure on relatives, especially women, to sacrifice their time, energy and health to take care of others is enormous.
The burnout rate of healthcare workers is especially high, reaching 69% among the youngest staff in the US. Next to sexism, racism is a major weapon of the ruling classes. Many health workers are from a migrant background. Western European employers profit from well trained staff recruited from Eastern Europe leading to shortages in Romania and other countries. Those workers often face even worse conditions as they have less legal rights, while unions often have a blind spot regarding sexism and racism. The struggle for full and equal rights for all workers needs to be a central element in the work of all unions, to take up all the different aspects of oppression and exploitation of the workforce.
A health worker from the Child and Adolescent Mental Health Service (CAMHS) in the NHS in Northern Ireland reports:
“The hardest part of my job is knowing that there are literally hundreds of children waiting for help with their mental health, on an ever growing waiting list. In my role as a professional I’m powerless, but as a socialist and trade unionist, I’m not. Some days that is the only thing that keeps me going.”
But Covid was the straw that broke the health workers’ back. For a long time, the feeling of responsibility prevented these workers from protesting, now it is this very same feeling that leads to protests on a massive scale. Health workers moved “From the frontline to the picket lines” as Rosa in Northern Ireland has put it. Studies show that 2020 saw protests of health workers in the majority of countries. This has not stopped. In January, Spain experienced a “contagious rebellion of health workers” with indefinite strikes in 5 out of 17 regions, and two-day strikes in three others. In December 2022, doctors occupied the Health Ministry. In 2022, a hospital strike in North Rhine-Westphalia, Germany, lasted 11 weeks. Strikes and protests by doctors and nurses have shaken Zimbabwe and Kenya, China, Argentina and various hospitals in the US. Ambulance drivers have been on strike in Newfoundland, health workers in Northern Ireland, and nurses in Britain. 10,000 health workers in Jharkhand, India struck earlier this year and even in Ukraine, under conditions of war, hospital staff have protested. Governments are trying to stop these struggles with strike-bans such as those in South Africa, and stricter legislation as in Britain.
These movements have begun to develop an international character. Doctors in Sudan are expressing their solidarity with the NHS strike in Britain, care workers from big care companies such as Orpea, Fresenius, or Helios are linking up in meetings and supporting each other in their struggles.
This is a revolt from the bottom. Sometimes, trade union leaderships are forced to respond to pressure from below, in other cases they try to block or weaken the protests. But an avalanche can’t be stopped once it’s started. There may be pauses, there might be some workers leaving their jobs but the anger will stays as long as the need for a well funded health sector remains.Where the official trade unions don’t organize the necessary fight back, health and social workers have started to form their own structures. In some cases these new structures are within or around the existing trade unions. They are an attempt to build democratic structures as well as to push the union leaderships to organise any necessary actions. In other cases separate new union structures are formed. While these developments differ from country to country, depending on trade union history and structures, they reflect the angry uprising of an exhausted workforce with growing self confidence that has understood that we need to democratically organize and fight!
For a society that is based on the health of the many and not the profits of the few — a socialist alternative to capitalist crisis!
“For many years there has been a crisis in healthcare in Sweden with increasingly long waiting times to get an appointment, staff shortages, increased stress, canceled operations, etc. You can wait up to two days in the emergency room before being admitted to a proper ward. Those of us working in the health sector know that the crisis is due to a lack of resources, but also to the fact that health care is not planned according to the needs of staff and patients. Companies are allowed to make huge profits despite the fact that the care sector is financed by taxes.” Katja, a nurse in Stockholm/Sweden
The truth is that the health and social care crisis not only points to the brutality of capitalism but is a problem for the capitalist system itself. It is a symptom of a capitalist system in crisis which in its search for profit is destroying everything that stands in its way. The system makes people ill but once they are ill, it does not help.
Research shows that up to half of the global population is affected by mental health challenges at some point in their lives. For 15–24 year-olds, suicide is the second leading cause of death worldwide. An ill workforce leads to additional costs for the already exhausted health system and is a burden for the world economy. The direct and indirect costs of mental health-related illnesses are estimated to be over 4% of global GDP. But capitalism can’t solve this vicious cycle. Instead, it shifts the burden from one part of the working class to another, increasingly to female, migrant, young, untrained, and under or unpaid workers. These structural problems point at the same time to their solution:
As the newly self-confident health workers move into struggle for more staff and better pay, they quickly run up against the limits of the system. Anger grows as money is spent on weapons or to support zombie companies, but none is left for the care sector. The inability of the capitalist system to care for the very people it needs to exploit is obvious. This means that a wider struggle is needed, for a democratic socialist society, where resources are used to provide for the needs of the many!
12th of May: International Day of the Nurse
There are all kinds of “international days of” — amongst others 12 May is “International Day of the Nurse”. In the US “National Nurses Day” is 6 May. Of course, this does not mean a lot. 2021 was declared by the World Health Organization (WHO) to be the “Year of Health and Care Workers”. Don’t worry if you did not know this, it just reflects that those are empty words. In many countries 12 May is used to give some verbal credit — but nurses and doctors, cleaners and helpers, social workers and other care workers cannot work and live on empty promises. While the energy and pharmaceutical companies reap record profits many nurses can’t pay their bills.
These are the reasons why care workers have been protesting in so many countries, from Kenya to the US, from India to Ukraine, from Germany to Myanmar, from Britain to Canada for more resources for the health sector, for womens’ rights, and for democratic rights.
International Socialist Alternative(ISA) together with Rosa — Socialist Feminists all over the world are part of this struggle. Our members and activists are health and social care workers, trade union organisers and shop stewards and work in solidarity committees and campaigns. If you want to join in the struggle get in contact!
We Fight For:
Free, quality, public health and social care for all;
Profit out of health and social care! No to privatisation and big business profiteering — take all healthcare, social care and pharmaceutical companies into public ownership;
Money for healthcare, not armaments! Massive investment in more staff with better pay, conditions and fewer working hours to have safe staffing ratios and decent working conditions; Health and social care workers of all professions, genders and nationalities fight together;
A socialist system that cares for the physical and mental well being of the vast majority — working-class and young people — not the profits of a tiny elite.