National Pride and a National Healthcare System: The Strikes Defining the UK’s Future

In December of 2022, months of separate public service worker protests spiraled into the largest national health service strikes ever witnessed in British history.. Now, more than three months on since their start, Britain’s National Health Service workers show no signs of stopping as the stakes have only strengthened. At the core of these strikes are key demands by employees that have been routinely denied by the British government. The workers are asking for pay raises due to historic levels of inflation and greater overall funding for the NHS. 

This marks the NHS’ largest strike, and yet the government is still refusing to meet union demands. The government is refusing to meet the pay raises of NHS workers because they claim to be unable to afford it and for fear of increased pay leading to higher prices, thus worsening inflation and raising interest rates and mortgage payments. 

The UK has undergone a ‘cost of living crisis’ since late 2021 which has led to an decrease in British disposable incomes thanks to inflation. Although the government has attempted to aid in this crisis through support packages, such as capping household energy prices, many NHS workers say that this is still not sufficient support. Over 120 NHS trusts are expected to strike, including nurses in cancer wards, A&E departments and intensive care units.

The strikers are adamant that the public understand their need to protest. David Hendy, a 34 year old nurse, revealed his thoughts on the issue: “This job is slowly killing nurses. The nursing workforce in the last 10 years has been through hell and back. We've got through COVID, I've got colleagues who died from COVID. I myself have had it three times…morale is rock bottom.” Hendy is not alone in his experience, after decades of poor pay and the trauma of the COVID-19 pandemic, nurses are fed up. Despite being publicly supported for their heroism throughout the pandemic, many NHS workers feel unappreciated and ignored. Victoria Banerjee, a nurse for over two decades, stated that "The workload is phenomenal now and our patients are sicker than they’ve ever been.” 

Many nurses feel unable to keep up with the pressing demands placed upon them. There is a resource and staffing crisis within the NHS, magnified by over 25,000 nurses leaving the profession in the last year alone. The staff shortage means that many nurses are forced to double up on shifts and patients, performing unprecedented levels of care. Nurses have expressed their fear at endangering patients simply because they cannot adequately attend to each and every one. Pediatric nurse, Jessie Collins, revealed that “During one of my worst shifts I was the only nurse to 28 unwell children … it’s not safe and we cannot deliver the care that these children need at times.” Nurses on the picket lines have described their working conditions as dangerous and scary and their testaments reveal not just anger, but blatant fear for themselves and their patients. 

A Department of Health and Social Care spokesperson stated in an interview that “Ministers have had constructive talks with unions, including the RCN and Unison,” however these talks have not led to any sufficient action. The RCN (Royal College of Nursing) have rejected pay deals that do not properly address the impact of inflation. The core argument of the government is one of financial prudence. They refuse to increase salaries given the increase it will lead to in regards to the national budget and its potential to only worsen inflation. 

The National Health Service has played an influential role in the national fabric for decades, ever since its creation in 1948. It is regarded as a source of pride and unity for all citizens, which adds to the intensity of the recent strikes. 

History of the NHS

In 1948, following the devastation of World War II, a recently established Labour Party prime minister, Clement Attlee, set about establishing a radical new system for the British people. Atlee’s government implemented the economic reforms advocated by famed economist, John Keynes, that prioritized nationalizing industries, improving national infrastructure, and developing a welfare state designed to actively take care of three vulnerable groups in society: the young, the old, and the working class. Perhaps the most pivotal creation brought about by the new welfare state was the National Health Service, founded in 1948. 

The NHS did not provide new forms of medicine or care, but it radically transformed the average British individual’s relationship to healthcare. No longer did people pay for healthcare service on an individual basis, instead they paid collectively as taxpayers. The NHS redistributed and equalized the healthcare process, allowing everyone access to care for the first time in British history. British citizens no longer had to worry about affording care or going into debt due to high medical bills. Aneurin Bevan served as Minister of Health under Atlee’s government and was directly responsible for the creation of the NHS. The son of a coal miner, he spent his political career advocating for the working class. His foundational philosophy of the NHS can best be understood through his poignant statement that “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community.”

The NHS continued to grow all throughout the latter of the 20th century despite major economic crises, such as the Winter of Discontent in 1978 and the rise of mass striking and inflation. Developments in healthy living and improved national knowledge surrounding daily health habits brought about lower mortality rates and changes in fatal diseases. The NHS sought to expand their care process and better understand how more external factors, such as diet, exercise, geography, and economic class were playing a role in the health of British citizens. Changes in daily habits and medical breakthroughs transformed people's understanding of the modern medicine and the NHS was capable of. 

The Politicization of Healthcare 

By the end of the 20th century, the NHS was widely beloved and respected for its life-changing impact on the British public; but it was also becoming an increasingly controversial institution in politics, with both Labour and Conservative using the NHS as a campaign and voting strategy. The demand of the NHS seemed endless and the services continued to grow in number, but this constant growth fueled by media and political attention only created a gap in which “what was possible and what was provided seemed to be widening.”

As the NHS continued to grow, so did the political debates surrounding it. Both Labour and Conservative argued over funding and regulation. In particular, many of the debates focused on the distribution of the financial burden to taxpayers and overall distribution of the national budget. Increases in immigration and national health crises became key factors in helping to politicize this institution. 

The British government has been defined by Conservative, Tory rule and a large variety of prime ministers for the past decade. As a result, the changes made to the NHS are rooted in Conservative policies. The recent downfall of the NHS is rooted in over a decade of underfunding from a Conservative government. 

A lack of staff and available resources destroyed the NHS. Waitlists for appointments are now a factor of daily life, forcing many citizens to wait months to receive basic care. This shortage has a death toll; in November of 2022, at least “1,488 patients are estimated to have died in Scotland as a result of waiting too long in emergency departments.” British citizens are dying in emergency rooms because nurses and doctors cannot tend to them with the urgency required but they are also slowly dying at home as they wait for an appointment. Delayed appointments are affecting overall well being according to a survey in which 25% of individuals said the wait for treatment has a “serious impact on their mental health” as over 7.2 million people are currently waiting for treatment. The inability of the NHS to properly support its citizens reveals a profound failure in matters of funding and organization. 

Identity Lost

Viewing the NHS strikes solely as a salary issue does not accurately portray the true issue at large. NHS employees are striking because the system is failing and the UK government is unwilling to help. The inability of the NHS to effectively provide for its patients reveals a far darker issue that goes beyond low salaries and inflation: The United Kingdom can no longer afford to take care of itself. 

The NHS is a tremendous source of pride for individuals all across the United Kingdom. In a recent study by Engage Britain, over 77% of British citizens polled stated that the NHS makes them feel proud to be British. However 20% of those surveyed also revealed that they had been forced to turn to private sector care due to limited appointments and resources. Private healthcare companies are growing rapidly as the “market for private health care in the United Kingdom has doubled since before the pandemic.” The growing influence of private healthcare across the UK demonstrates the dire nature of the situation. 

Perhaps that is why these strikes feel more intense than any other historically, and not just due to record turnout. The strikers are asking for more than a living wage; they are asking for a sense of dignity and pride that they can collectively unite behind, and above all they are asking for a sense of hope. The NHS strikes show a healthcare system that is clearly in shambles, but they also show a nation destroyed and without a unifying identity to rally behind. Even if the strikers and the government can come to an agreement based on each of their demands, it is unlikely that the true underlying issues of the strike will be solved anytime soon.

A Look at Healthcare Infrastructure: Vaccination and Disease Prevention

Healthcare infrastructure is understood as the “nerve center of the public health system.” It encompasses the capacity of a governing system on the issues of disease prevention, health promotion, and the ability to respond to both acute and urgent emergencies. A solid infrastructure is imperative in evaluating health needs and appropriately delivering and improving the public health of a given area. Collectively, public health and various health systems work to achieve a higher standard for global health. Global health is important and impacts everyone, as global health is imperative for global security and the security of individual populations. Without a solid foundation, individual populations are susceptible to weak public health, which can have a domino effect in the greater scheme of global health and endanger the health of others. 

Healthcare is a hot-button issue, something that’s incredibly evident in the United States (U.S.) domestic politics; policymakers and concerned citizens often wrangle with conflicting ideas about what constitutes an adequate healthcare system. It is easy to scapegoat some forms of healthcare as socialism, but what is often ignored is the nuanced nature of healthcare systems. One of the primary issues posed to various healthcare systems is disease prevention and vaccination and in the time of anti-vaxxers, disease prevention is of paramount importance when considering public health risks. 

One could examine countless cases and healthcare discourses in order to explore and understand the intricate manner in which healthcare systems exist and operate, but some particularly intriguing cases include Sweden, Brazil, the U.S., and Pakistan. These countries not only reflect regional healthcare differences but also highlight different ‘successes’ and ‘failures’ of each respective health system.

Sweden

Sweden’s healthcare system follows a decentralized model, which means that Sweden is broken down into 290 municipalities and 20 city councils. These city councils or other forms of local government are responsible for overseeing healthcare administration. Each city council has the ability to set the tax rates which fund the healthcare system in tandem with patient fees and selling services. 

Fortunately, Sweden currently sustains high vaccination rates, with approximately 97 percent of its citizens receiving three doses of two major vaccinations intended to prevent diphtheria, pertussis--also known as whooping cough--and tetanus, as well as measles, mumps, and rubella. While these vaccination rates seem high, there are still issues of individual cases and sporadic outbreaks of these vaccine-preventable diseases. Aside from vaccinations, Sweden has implemented a national standard for disease prevention, with three types of prevention exercises revolving around counseling: brief advice, counseling, and advances counseling. 

Sweden is typically revered for its high health standards. Sweden’s 97 percent major vaccination rate is high, and certainly worthy of praise. However, some consider Sweden’s healthcare system weak in their prevention methods, such as counseling. Counseling is seen as a method to mitigate the primary challenge around the world: health literacy. Health literacy is considered to be an adequate understanding of healthcare instruction and one’s ability to protect their health and wellness. While disease prevention counseling is useful, it doesn’t account for patients that are less proactive in relation to health, or for those patients that live in rural areas and face accessibility issues. Sweden can make improvements to their already solid health system by promoting more effective prevention tactics, to prevent outbreaks of preventable diseases. However, the country’s main area of concern, which can be seen in other nations, is addressing the issue of accessibility. Greater accessibility would allow rural populations to receive the same resources that more central locations are afforded. Without a greater awareness for people that live far from cities, nations like Sweden cannot achieve the highest standard of health, which is something all governments should strive for. 

While other healthcare systems, like those in Brazil, do not share the same high rates of vaccination, there have been more advances toward increasing these vaccine rates, which benefits the overall population of the nation. 

Brazil

Brazil’s healthcare infrastructure accounts for the largest healthcare market in all of Latin America. However, the vast majority of healthcare administration in Brazil is owned by private providers, which leaves most of Brazil with few public options. The public option in Brazil is typically regarded as underfunded and without adequate equipment, which motivates most Brazilian people to gravitate toward the private option. In order to bridge this issue, the public option has been receiving investments from private options. This privatizes healthcare and allows providers to operate regionally. 

Brazil, similar to many other countries, also has a mandate within its legal policy that requires citizens to receive specific vaccinations. However, due to their weak public health infrastructure,  many of these vaccinations are not easily obtainable. Most individuals must, therefore, seek these vaccinations by a private option. Many regions in Brazil are susceptible to yellow fever, rabies, typhoid fever, dengue fever, malaria, and Chagas Disease. There are also ongoing incidents of measles, mumps, rubella, hepatitis A/B, tetanus, and diphtheria. Some vaccinations, if deemed necessary, are mandated by the Brazilian government and parents that do not get their children vaccinated are susceptible to legal charges. These vaccinations are strongly recommended to tourists, contingent on where they are visiting, as certain areas are more susceptible to transmissible diseases than others. Though the Brazilian government is attempting to enforce these vaccinations, approximately 1 in 5 children in Brazil die from vaccine-preventable diseases. Regarding disease prevention, there has been a push for an increase in testing for HIV/AIDS, which remains as one of the top ten causes of death in Brazil. 

Brazil’s strengths can be seen in recent action toward increased testing and prevention measures for HIV/AIDS. Additionally, another strong element of Brazilian healthcare is its government-mandated vaccinations. The Brazilian government has the ability to charge parents who do not vaccinate their children with child abuse, which reaffirms the government’s commitment to disease prevention and eradication. The primary weaknesses of this system are a lack of an adequate of a public option, which leaves many people in Brazil with an inability to access vaccinations that are typically monopolized by the private sector. This reveals the undertone of power dynamics, and how that has contributed toward inequalities in Brazilian healthcare. 

Brazil has exemplified a strong implementation of better preventative measures, but the first step toward improvements in Brazil should be increasing health equity. This can be achieved by the Brazilian government promoting and improving public options for health, which would allow more people to access healthcare, rather than by exploring expensive private options that are unlikely to reach rural areas. If healthcare in Brazil were higher on the list of the government’s priorities, Brazil would be able to avoid future public health crises and begin to alleviate the issue of healthcare acting as a means to segregation. Unfortunately, inequality and power dynamics occur in many other health systems, like the United States. 

The United States

Currently, the United States operates under a market-based insurance system. This allows for high insurance prices, which leaves many people unable to obtain insurance or face high deductibles that disincentivize people from seeking care. While public options do exist, most resources come from private options, which are either purchased through an independent insurance agency or a benefit through certain jobs. Private options allow these private providers to curate their facilities in specific fashions, such as in specific locations or with specific deductibles. 

Approximately 90 percent of children in the United States have received vaccines that are responsible for the prevention of measles, mumps, and rubella, as well as tetanus and diphtheria. The American Academy of Pediatrics has also released guidelines intended to encourage parents to vaccinate their children and prevent sixteen easily preventable diseases. While vaccination methods are effective, there is still a portion of people against vaccinations, which counts for less than 10 percent of the U.S. population. Disease prevention is typically contingent on the primary care provider, but the Center for Disease Control, which is a federal agency under the Department of Health and Human Services tasked with supporting health promotion, prevention/preparedness, and promoting public health, does make a conscious effort to release disease prevention guidelines. 

The United States has a strong ability to access vaccines and various technologies that make disease prevention and control feasible, as well as an adequate resource of vaccinations. The primary weakness exemplified in this healthcare system is the evident barriers between healthcare provision that leaves many both uninsured or underinsured. Additionally, free-market systems have the ability to allow private healthcare providers to be more selective about who they serve, and therefore perpetuate racial, gender, socioeconomic and other types of disparities that propagate discrimination in various forms. Similar to Brazil, the United States is responsible for utilizing healthcare as a means of segregation. Many populations are left marginalized by a free-market health system. The first step toward mending the health system in the United States would require limiting the drug lobby that is responsible for price gouging and pigeonholing many Americans into seeing healthcare as a privilege, rather than a right. The next step would be to break up private corporations that are responsible for hospital closures and inadequate healthcare in segregated areas. Overall, the United States has the means to achieve a high standard of healthcare, but the primary issues come from lobbyists that promote keeping prices high, and lowering the quality of care for patients. 

While the United States has generally well-developed health mechanisms, other nations like Pakistan face the issue of a shattered health workforce, which weakens the overall infrastructure and inhibits positive growth. 

Pakistan

Similar to Brazil, Pakistan has a large private health sector, with a dwindling public health sector. Public options and their regulations are handled by provincial governments, except for certain federally regulated areas. Healthcare is typically handled through disease-specific agencies, in some instances. However, healthcare in Pakistan is not easily accessible for certain regions or groups. Additionally, the healthcare system is becoming increasingly weak due to a shortage of healthcare professionals. 

Pakistan has one of the highest mortality rates among children in the world. This can be partially attributed to the vaccination system that has vaccinated between 56-88 percent of children vaccinated, depending on which vaccination. This is the same system that has been unable to eradicate certain diseases, such as polio, Most disease prevention tactics are left to a primary care provider. Therefore, there seems to be a lack of prevention measures taking place within the medical system, in both public and private options. This is likely due to health systems focusing more on increasing accessibility for healthcare in rural areas, promoting a better healthcare workforce, and increasing nutrition information. In order for Pakistan to achieve a stronger health system, Pakistan should prioritize education. By utilizing education as a means, more people will be inclined to be proactive when it comes to their health. This will create a stronger healthcare workforce, which will set the stage for a stronger health infrastructure at large. 

Pakistan’s stance on disease-specific agencies is a strength within its healthcare because it allows specialists to care for patients, based on their own specialties. Weaknesses include general disorganization and inconsistencies among the healthcare infrastructure, which has allowed easily preventable diseases to run rampant, a disparity of healthcare workers, and an extreme lack of health literacy. 

Concluding Remarks

While each case is vastly different and depends on the goals of governments, the status quo, and access to resources, the common trend of the weaknesses of each system has to do with the power dynamics in each respective nation. This goes to show that as much as various topics within the fabric of international relations and affairs that these topics are often tied to power dynamics that are responsible for the marginalization of certain groups. Therefore, at the global level, it is important to hold organizations that wield an unfair amount of power accountable for their actions. This can include, but is not limited to, private health corporations and policymakers. 

Additionally, global health can benefit from strengthening the relationship between health and education. By increasing health literacy, more people will be able to be self-sufficient regarding healthcare, as well as have a greater understanding of the variety of health practices and a stronger sense of prevention and preparedness in the face of various health threats, whether it be the common cold or HIV infections.

The Digital Frontier: Virtual Care After Natural Disasters

Virtual care is a growing facet of the medical world, with 77% of Americans indicating interest in it. If utilized in response to natural disasters, it could help keep hospitals from being overrun, treat patients who would otherwise be unable to seek care due to inclement conditions, and generally, improve both access to and quality of health care during such times.

Natural Disasters in the U.S.

Each year the United States faces natural disasters, and while many are predictable, their aftermath often presents unforeseen challenges. Hurricanes cause the most damage, but by definition natural disasters also include wildfires, drought, severe weather, flooding, tornadoes, and some winter storms. Between 2013 and 2016 natural disasters cost the United States between $18 billion and $34 billion annually. In 2017 the costs totaled a record $195.2 billion following major storms including Hurricanes Irma and Maria. Costs in 2018 topped $91 billion, making it the fourth most expensive year for natural disasters.  2018 also broke the record for most single disasters with losses exceeding $1 billion; 14 total with 1 drought event, 8 severe storm events, 2 tropical cyclone events, 1 wildfire event, and 2 winter storm events. Despite the scale of funding currently allocated to natural disaster management, there are numerous aspects of preparation and response policies which could be improved. Access to and quality of healthcare is a major issue during all types of natural disasters, as inclement weather, damaged infrastructure, and other factors prevent potential patients and medical staff from reaching care centers. Virtual care services enable patients to seek efficient, confidential medical advice from certified physicians anywhere they have wireless, internet, 4G or LTE connection capability.

Policy Solutions

In the past 16 years New Orleans, eastern Kentucky, and central/eastern Massachusetts have suffered serious and financially costly storms and natural disasters with greater frequency than almost any other area of the country. Each area endures different types of natural disasters, New Orleans with tropical storms and hurricanes, eastern Kentucky with severe weather, tornadoes, flooding, and Massachusetts with severe winter storms. Due to their varied disaster types and the frequency with which they experience such events,  FEMA and HHS should allocate $105,000 for a trial of providing discounted virtual care services to individuals affected by natural disasters in these three areas for a period of one year. The breakdown of funds designates $35,000 to each of the three areas, covering up to half of a ‘visit’ to a virtual care physician. As average price for a visit ranges from $15 to $75, depending on insurance type and status, the aforementioned funds would cover approximately 1,000-2000 visits in each area. An initial run of this size would ensure funds are not over-allocated; people are often wary of new technologies, and a larger trial run could lead to a large number of virtual slots going unused and wasting valuable dollars. Agencies should disburse the funds across 5-10 virtual care companies, to spread risk and decrease the chances that a technical issue or other systematic factor prevents individuals from utilizing the service.

In order to access the discounted rates, individuals would enter their street address and zip-code on the virtual care portal entry page, which would recognize or deny their location as being part of the impact zone at declared by FEMA. The agencies should also encourage NGOs already incorporated into the National Response Framework, such as the American Red Cross, to establish virtual care platforms. Such expansions could further promote the virtual care platform, and support improved quality of and access to care at no additional cost to the government.

As previously mentioned, virtual care can be accessed from anywhere there is a charged device with internet capability. This access can help reduce issues of hospital crowding and the use of limited resources and time on patients with non-life-threatening injuries. It can also prevent people from putting themselves in further danger by leaving a safe area and entering inclement conditions to attempt to reach a care center because they are unsure if they or a loved one need immediate medical attention. Virtual care visits typically last less than fifteen minutes, and doctors can; assess cuts, burns, and bruises for severity; help a pregnant woman discern if she is in labor and guide her through the next steps; determine if chest pain or anxiety is cause for emergency care; guide individuals through putting an injured limb in a makeshift sling or splint; provide necessary dietary alterations or pharmaceutical advice; etc. Most virtual care companies employ physicians who speak hundreds of languages, meaning that language is not a barrier to care as it may be during an in-person medical visit.

The US Army utilizes virtual health platforms throughout their Europe based operations, and for soldiers stationed in remote locations across the globe. Dr. Steve Cain, the Army’s Virtual Health Deputy for Regional Health Command Europe (RHCE) said of the program, "We have an ever-expanding group of people we need to care for. Virtual health provides us the capabilities to do so." Physicians involved in the programs reported they experienced no changes in the quality of care provided, with soldiers also indicating the service was more convenient and less expensive than alternatives. A 2017 study of virtual care visits in Canada found that 93.2% of participants rated their virtual visit as high quality and 91.2% reported it was “very” or “somewhat” helpful in caring for their health issue.

There are potential pitfalls within the trial as well. Cell towers may be damaged during the disasters, leading to difficulties accessing the virtual portals. The four major carriers - Verizon, Sprint, AT&T and T-Mobile - have taken steps to protect against this, and after Hurricane Harvey 98% of Verizon customers’ cellular service remained in tact. The technological aspect of care is likely to be challenging for elderly patients navigating it on their own, or possibly to individuals seeking care under duress. Individuals whose homes were damaged or who had to flee suddenly may not have their insurance information and may be reluctant to pay higher costs for care without their plan information. Additionally, medical records may be lost in the disasters, and if individuals are unsure of their medical history or current medications, providing safe quality care can become difficult. Individuals who are unfamiliar with virtual care may find it an untrustworthy source of medical advice, leading to low use rates and failure of the trial.  While hospitals and care centers may push back against the loss of patients, their revenue source, researchers found “…. only 12 percent of telemedicine visits replaced an in-person provider visit, while 88 percent represented new demand.” Even a slight drop in patients may allow them to better care for the considerable remaining inflow they will experience post-disaster; and possibly avoid damaging lawsuits and credit reviews which typically plague care centers post natural disasters.

Every year the frequency and often severity of disasters grow, leaving trails of devastation in their wake. Virtual care provides an immediate, accessible solution to relieving part of the disruptions of quality of and access to healthcare which arises in the wake of natural disasters. By funding a trial in three different part of the United States, researchers will be able to track who uses virtual care, and also who benefits the most from it. Virtual care is growing in government and public healthcare systems. For those facing the consequences of natural disasters, it represents the possibility of faster, safer, and more efficient healthcare.

The Role of Jamaican Nurses in Health Care Sectors

Mary Seacole was in London in 1854 when she heard about a shortage of nurses on the frontlines of the Crimean War. The Jamaican nurse offered her services but was turned away. Some contention remains about whether Seacole was rejected because she was a mixed-race woman or because she did not apply properly, but Seacole regardless navigated her own way to the battlefield. After opening a hotel and caring for soldiers near what is today Kadikoi, Ukraine, Seacole wrote a best-selling autobiography about her experiences travelling the world.

On its face, the story of a Jamaican nurse stepping forward to try and fill a need in the United Kingdom’s healthcare system seems like a relic of the colonial era. But fifty-five years after Jamaica gained its independence, Jamaican nurses are still heading to the United Kingdom. Unlike Mrs. Seacole, they are not being turned away. On the contrary, they are being given job offers that they cannot refuse.

The Caribbean Community and Common Market estimates that between 1996 and 2006, 50,000 nurses left Jamaica to work in other countries. This migration resulted in a loss for Jamaica of $2.2 million dollars in nurse training expenses. According to Janet Coore-Farr, head of the Nurses Association of Jamaica, Jamaica lost around one fifth of its specialized nurses in 2016 alone. The chairman of the University Hospital of the West Indies reports that around half of specialized nurses trained by the hospital are recruited by foreign organizations before they even graduate.

The nursing shortage has had dire consequences for the Jamaican healthcare system. Reports of short-staffed hospitals cancelling surgeries due to a lack of specialized nursing staff appear frequently in Jamaican newspapers. The impacts of the nursing shortage are not limited to any one sector of the healthcare system. According to a UN Development Programme report on Jamaica’s ability to meet the Millennium Development Goals, nursing shortages have adversely impacted Jamaica’s immunization and maternal health clinics. In 2006, the World Health Organization published a report providing evidence of a correlation between density of healthcare workers and population health outcomes.

Decades of nursing migration have caused a sizeable decline in nurses relative to Jamaica’s population. According to the World Bank, Jamaica had 1.65 nurses and midwives per 1,000 people in 2003. By 2008, that number had decreased to 1.08. For comparison, the World Bank listed the average number of nurses and midwives for OECD nations at 7.7 per 1,000 population in 2012. Meanwhile, the demand for nurses in Jamaica is expected to grow as the population ages. The World Bank estimates that the English-speaking Caribbean will need  10,700 more nurses by the year 2025. Nurses are a key component of any healthcare system, and a shortage of this magnitude could leave the nation unprepared to handle disease outbreaks and other public health emergencies. But nurses are also a key component of Jamaican society, often serving on the frontlines of public health provision and education in their communities. Without an adequate number of nurses, these communities will suffer.

Push and Pull Factors in Jamaican Nursing Migration

At its core, Jamaica’s nursing shortage is the product of decades of nursing shortages in the developed world. A rising demand for nurses, due in part to increasingly complex needs of an aging population, has been coupled with a decreasing supply of qualified nurses in many countries. A 2007 study of nurses in the American Midwest region found that 38% of surveyed nurses reported feeling problematic burnout associated with their jobs. Young nurses are even more likely to experience burnout, with almost 44% of nurses under the age of 30 reporting the same level of burnout. The stressful nature of the nursing profession has been compounded by staff shortages, driving more nurses away from nursing. Ironically, the nursing shortage also been exacerbated by a shortage of nurses qualified to teach in nursing schools. Over 75,000 qualified applicants are turned away yearly from US nursing schools because of a shortage of qualified faculty.

As nursing shortages ravaged healthcare systems in places like the United Kingdom, United States, and Canada, these countries began working to attract qualified nurses from other countries. In the case of the United Kingdom, the migration of nurses from other parts of the Commonwealth began with the formation of the National Health Service. A BBC documentary drawing attention to Britain’s black nurses reports that as staff shortages threatened the nascent NHS, thousands of nurses from Britain’s colonized countries stepped in to fill the need. According to a 2017 report by the British parliament, around 1,700 Jamaican medical staff currently work for the NHS.

In the face of these staff shortages, Jamaican nurses are attractive candidates for international recruiters. As part of the English-speaking Caribbean, Jamaican nurses are usually native English speakers. Due to their English fluency, Jamaican nurses passed the National Council Licensure Examination, a test used in the licensing of nurses, at higher rates than other international applications.

What attracts Jamaican nurses to positions abroad? The promise of higher salaries is an important factor. The average starting salary for a nurse in Jamaica is around $8,000 US dollars, and even experienced nurses may only make $20,000. Compare this to the the average starting salary of a registered nurse in the US, which in 2015 was $65,490. And while international medical centers often offer Jamaican-trained nurses lower salaries than they would to graduates of US and UK medical schools, these salaries are still significantly higher than in Jamaica. The World Bank found that only 6% of non-migrant nurses were satisfied with their salaries, compared to 85% of nurses who migrated out of Jamaica.

The Future of Jamaican Nursing

What does Jamaica’s nursing shortage tell us about the modern-day relationships between former colonizers and the formerly colonized world? It tells us that, even in a postcolonial world, relationships between colonizers and the colonized are complex and are still primarily an issue of inequity. The nursing shortage contributes to very real disparities in healthcare quality between Jamaica and many of the nations that are recruiting their nurses. Short-staffed clinics and hospitals and overworked medical staff can negatively impact the quality of life for many Jamaicans.

The migration of Jamaican nurses to other countries in search of better employment opportunities also benefits Jamaica economically, further complicating the relationship between the county and more developed nations.In order to get the most complete picture of Jamaica’s nurses working abroad, it is important to highlight the benefits that working abroad provides to the nurses and their families as well as to the nation as a whole. Surveys of migrating Jamaican nurses have found that those who migrate are considering a number of non-economic factors, including the chance to reunite with family members abroad, access better professional development opportunities, and have a better quality of life overall. Working abroad for higher salaries also allows nurses to send remittances home to their families. Remittances comprise an important part of the Jamaican economy, with an estimated $2 billion in remittances being sent back to the country each year. This money can be used to benefit Jamaican families and communities in a very real way.

How can Jamaica and the countries whose healthcare systems benefit from employing Jamaican nurses work together to reduce the nursing shortage? In response to the shortage, Jamaica has begun employing an international recruitment system of its own. The island is hoping to bring medical personnel from India and Cuba into its healthcare system in order to fill vacant positions. This outcome is ironic: as the developed world continues to lure away Jamaica’s nurses, Jamaica must try to attract its own nursing from elsewhere in the developing world. By recruiting nurses from other developing countries, Jamaica runs the risk of creating nursing shortages elsewhere in the world. Even countries that invite their nurses to find employment abroad are not immune to shortage. Under the 2001–2004 Medium Term Philippines Development Plan, the Philippines trained and actively encouraged its nurses to seek employment overseas. But within a few years of implementing this policy, the Philippines faced a nursing shortage of its own. Relying on the recruitment of nurses from even poorer countries can lead to a cycle of recruitment and shortage that strains healthcare systems across the world.

It is clear that the developed world must also take steps to reduce its dependence on nurses from Jamaica and other developing nations. Jamaican Minister of Health Dr. Christopher Tufton addressed the United Nations in January of 2017 to request the organization’s help in crafting multilateral and bilateral agreements to encourage the developed world to more responsibly manage their need for medical personnel without straining the healthcare systems of other countries. Writing for the Online Journal of Issues in Nursing, nurses Brenda Nevidjon and Jeanette Erickson offer several recommendations for reducing the nursing shortage in the developed world. These recommendations include increasing the number of nurse educators to allow for larger numbers of nursing students in medical schools and implementing a combination of long- and short-term strategies to improve the recruitment and retention of nurses.

When Mary Seacole’s offers to provide medical care for British soldiers injured on the frontlines were rejected, she probably could not have imagined the day when British hospitals would clamor over the opportunity to hire Jamaican nurses. The nursing shortage in Jamaica raises important questions about the future of the Jamaican healthcare sector and the relations between former colonizers and the formerly colonized in today’s postcolonial landscape. Jamaican nurses have been serving the healthcare systems of the United Kingdom and other developed nations for centuries. Now it is time for the developed world to support Jamaica’s healthcare system in return.