So I said I'd write something about the NHS 299 march at the Tory conference on Sunday to go on Sheffield Medsin's blog; this is the result.
Sheffield Medsin and Sheffield Save Our NHS joined over
50,000 people in Manchester on Sunday – including a zombie
flashmob, a brass band, and a seven-year old girl with disproportionately
large lungs who delivered the most rousing rendition of ‘When they say cut back…’
I’ve ever shouted reply to – to defend a universal health care system owned by
the public and run for its health, and to stand in solidarity with health
workers across the country facing job losses, and deteriorating working
conditions. Those behind the compound perimeter of police and private G4S
mercenaries could be left in little doubt that, as the thousands of voices
raised in song outside reminded them, they were the 1%; and the 99% outside
weren’t going to be ignored.
Not that they weren’t going to try their best to maintain
such wilful ignorance. The lack of mainstream media coverage of recent changes
to the NHS has been so predictable as to become a running joke amongst those aware
of the impacts of cuts and privatisation on the nation’s health, so it’s hardly
a surprise that Sunday’s demonstration was widely ignored in many venues – all the
more so, since the tory-police-G4S triumvirate conspired to do their level best
to prevent coverage. Where there was coverage, some worried that the
diversity of people and issues on display served to ‘muddy the message’ of
a march ostensibly publicised as campaigning to ‘save the NHS’. The idea, so
the argument runs, is that campaigning against fracking, punitive
welfare policies, or generally voicing
opposition to austerity turns an actionable list of discrete demands into
an inchoate expression of general discontent to which it is difficult to
formulate a concrete response; these ‘non-NHS’-related demands then distract
from the main opposition to the alterations to the organisational structure of
the health system.
Such an argument, however, rests on at least two, interrelated, premises, neither of which are well supported.* Firstly, it asserts a definition of relevance to political questions about health systems that is procedural or institutional in nature – roughly, the relevant issues to political questions regarding public health are just those that are explicitly and primarily concerned with people’s health, and/or conventionally handled by health care institutions. On this definition of relevance, energy or housing policy could not be relevant to Sunday’s protest, because their explicit primary concern is not ‘health’.
Contrast this view with what could be called a consequentialist definition of relevance, according to which a subject is relevant to questions about health systems just if it has significant impacts on individual and/or public health. From this view, public health concerns straightforwardly extend to opposing an energy policy that embraces subsidised fossil fuel exploitation in favour of renewable energy development, or defending strong welfare support and rejecting austerian economics. For those who care about health, some of the most important issues are those not directly related to health care systems.
When confronted with such evidence, the appeal of the
institutional/procedural definition of relevance seems minimal. For those who
accept the WHO’s famously
holistic line on the definition of ‘health’,** there can be no debate about
which notion of relevance is applicable – for even if they do not directly
concern themselves with disease or infirmity, ‘wellbeing’ is certainly a
central consideration of policy related to social support, energy supply, or
just about any other policy question. Even if one adopts a more restrictive definition
of health, however, there is good reason to adopt the consequentialist view of
relevance. Put simply, this is because health care is an instrumental, not a final
good. We value being free of illness, injury or infirmity for its own sake; the
particular mechanisms by which that is achieved are valued only insofar as they
achieve their goals. The procedural/institutional definition of relevance
mistakes the instrumental good of health care for the final good of health.
All of which is not to say, of course, that those institutional
questions directly concerning health care are not relevant; the transformation
of one
of the most efficient and equitable health care systems in the world into
one modelled on the wasteful,
inefficient and profoundly inequitable US health system served as the
trigger that brought many of us to Manchester on Sunday. But it would be a
mistake to confuse that trigger with the ultimate values that provide it with
its normative force.
Recognising the greater weight of the consequentialist
definition brings us neatly to the second flaw in the ‘muddying the message’
objection – the assumption that protest is functionally equivalent to petition.
The objection requires that the purpose of such a rally is to present to the
target (i.e. the Conservatives) a
single defined policy proposal, and show a significant weight of support behind
it. But why think that would be the case? An alternative would be to interpret
it as showcasing an alternative vision of society, involving revision of
approaches to all manner of questions that are relevant (on the broader,
consequentialist definition) to social justice in health – presenting a
coherent model of social and political structures independent of the
foundations of the present one. For if we take seriously the implications of the
consequentialist definition of what is relevant to public health, then the
evidence sketched above highlights that just such a thoroughgoing revision of
dominant assumptions about the structures of a just society are required.***
A protest themed around protection of the NHS, but that also
argues against austerity, militarism, welfare state retrenchment and fossil
fuel exploitation is not just a disorganised expression of dissent; rather, it
presents the outlines of a coherent sketch of an alternative society. A
publicly-owned, democratically-run and universal NHS is perhaps the greatest
existent concrete anchor connecting us with that alternative; that’s why we,
and over 50,000 others, marched to defend it.
* I’m
assuming here that the criticism is offered as legitimate questioning, rather
than the usually liberal-centrist concern trolling that accompanies most forms
of progressive protest in the English-speaking industrialised nations (see e.g. just about every soi-disant ‘liberal’ columnist’s
coverage of the Occupy movement).
** There are
some good reasons (e.g. in Ruth Faden and Madison Powers’ Social Justice) for rejecting ‘healthism’ – i.e. acknowledging
dimensions of wellbeing other than health; but that’s an issue for another time…
*** The petition
model of protest also assumes that we can rationally hope to negotiate in good
faith with the current administration; there’s
little enough reason, however, for anyone to put such trust in them.
No comments:
Post a Comment