Organising for a justice based health system
On Sunday 26th September, Just Treatment ran a workshop on ‘Organising for a justice-based health system’ as part of The World Transformed 2021. The workshop brought together a fantastic panel of speakers with a room of around 50 participants to discuss how health and the NHS intersects with other struggles for justice, and how we can act on these links to expand the health movement going forward. This is a brief report of some of the key themes and ideas explored in the session.
We were delighted to be joined by:
Rob Abrams - Climate & Health Lead at Medact, a non-profit organisation supporting health workers to campaign for health equality and justice.
Cat Hobbs - founder & director of We Own It.
Guppi Bola - strategist, researcher and organiser focused on building an economic democracy that centres reparative justice, and co-founder of Decolonising Economics.
Kavian Kulasabanathan - junior doctor and active member of both Race & Health and the People's Health Movement UK.
Juman Kubba - Just Treatment patient leader.
The collective discussion focused on 2 key questions:
How does the NHS interact with wider issues and organising for justice?
How do we expand the health justice movement and its coalitions with other causes?
An underlying theme of all the discussions was the idea that we cannot simply defend the NHS, but must fight to make it a much better public health service. On the first question, the following key themes were raised:
Social causes of ill health. We talked a lot about how our current health system fails to address the root causes of why we get sick. Participants highlighted poverty, poor housing and environmental degradation as core issues which have major impacts on people’s health. We also discussed that this is a cyclical process - i.e that poor material conditions make people unwell, and then people who are unwell face greater challenges with work, housing etc.
Precarious work. Participants highlighted the NHS as a “home” for poor pay and working conditions, citing shortages of staff, the removal of the nursing bursary and NHS staff relying on foodbanks as key examples. We talked about the fact that the NHS is sustained by the low-paid work of largely migrant communities, and that certain kinds of labour are “invisibilised”.
Racism & marginalisation. Speakers and participants raised important points about how structural racism is inextricably linked to the NHS - both in terms of its history of reliance on migrant labour, and also how certain policies are implemented today. We talked about problems of accessing care e.g for those who don’t speak English and those who don’t hold British passports, as well as racial biases that manifest in our health services, such as the idea that “black women can withstand more pain” than their white counterparts. We also talked about how many other marginalised communities are let down by our current health system - including the disempowerment of disabled people, the major lack of support for trans people and the way that women’s health is often deprioritised or not taken seriously.
Criminalisation & policing. We spoke about how numerous aspects of the way our health system currently runs require medical professionals to police which of their patients can access care, for example through passport checks and charges on migrants. We also discussed that marginalised groups such as sex workers, drug users and homeless people face huge barriers in accessing care because they are criminalised, and that our current system pursues damaging carceral responses to vulnerable people with mental health conditions.
On the second question, the key ideas and actions suggested were:
Politicising healthcare and the identity of “patients”. We talked about how the government has deliberately sought to depoliticise the NHS as an issue, and that patients are often positioned as “service users” rather than as a collective group with power and agency. We must actively push back against this by encouraging NHS users to see themselves as part of the fight for a better healthcare system.
Building stronger trade unions and public support for them. We talked about the need to ensure all NHS workers are unionised, and that as a movement we platform and support the struggles of more “invisible” NHS workers, through concrete acts of solidarity such as strike funds. We also talked about the power of NHS worker unions extending their support to social justice campaigns, and also raising political demands that go beyond just pay and conditions (these demands should be led by local community needs).
Making connections with other movement groups and campaigns. We talked about the need for coalition-building and active partnership between health campaigners and tenants’ unions, decriminalisation campaigns, anti-racist and migrants’ rights groups and climate justice activists, particularly at a local level.
Developing stronger narratives around climate and health. We talked about the need to make interventions into dominant narratives around the climate crisis to insert health at the centre of it, and to give support to localised campaigns around climate change that have clear links to health e.g community anti-pollution campaigns.
Running community-led support and training. We talked about how many groups of NHS users face major barriers to accessing the care they need and that community-led support can help to overcome some of these obstacles, e.g training in how to navigate NHS structures, support with translators and so on. We also talked about the value of creating spaces at a local level where patients can come together and collectively share experiences and challenges they are facing in the healthcare system.
Reaching people through mutual aid networks. We talked about how the explosion of mutual aid groups during the pandemic has shown that there is a hunger for health justice in this country. These groups present a key opportunity to further politicise people by highlighting the gaps in healthcare provision left by the current system. It’s important that we don’t let these new networks die out!
Utilising health education as a key tool for justice. We talked about how pushing for changes to medical education could be a really powerful tool for transforming perspectives on health and embedding more holistic approaches, e.g integrating social determinants of health into the medical curriculum.
Prioritising collective care in organising spaces. We talked about the fact that, if we want to integrate health into other justice-based campaigns and causes, it’s vital to centre a culture of collective care directly within all our organising spaces so that we can position health as a collective issue rather than an individual one.
As well as all of this, we of course spoke about the urgent work of opposing the government’s dangerous NHS Corporate Takeover Bill - which would take our NHS further down the route of a health system run in the interests of private profits rather than patient health. This vision for our NHS is the opposite of the NHS New Deal, which calls for a fully funded, truly public NHS which respects health workers, gives patients the power to shape its future, and ensures everyone the quality care we all deserve. We are proud that the NHS New Deal directly addresses many of the points raised in the workshop discussions.
A big thanks to everyone who came along to the workshop and contributed to the discussions - it’s only through coming together as NHS patients and staff, and sharing ideas and strategies like this, that we can build a nationwide movement for health justice.