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.

The Miracle of Chile: A Story of Social Inequality and Civil Unrest

Chile’s carefully crafted image as the star of stability and economic growth in Latin America shattered in dramatic fashion in early October when the government announced a four-cent price increase for Santiago’s metro during rush hour. This seemingly innocuous rise in subway fares have embroiled Chile in protests for the last month. Protestors, who have come out in the millions in Santiago and all over the country, are not simply angry at the cost of transportation. While Chile is known for its neoliberal economic development, the country has one of the highest rates of income inequality within the OECD. The middle and working class struggle with high costs of living that cannot be sustained by stagnant wages. A privatized pension system has left the elderly in impoverished conditions. In simplistic terms, the Chilean demonstrators seek to create a more equal society. One of their most notable demands has been to create a new constitution that not only reflects these aspirations, but also Chile’s desire to emerge from the shadow of General Pinochet, a catalyst for this insurrection against the status quo. 

In the early 1970s, Chile captured the world’s attention. While the Latin American country had long been seen as a comparatively orderly and democratic country in a turbulent region, it was suddenly gripped in turmoil as General Augusto Pinochet Ugarte, a career military officer and Commander in Chief of the Chilean army, overthrew President Salvador Allende in a US-backed coup. Allende was the first freely elected Marxist in the West- a novelty in itself, especially during the time of the Cold War. General Pinochet ruled Chile for the next 15 years in a military junta, a government led by a committee of military leaders. He was removed from power in a national referendum in 1990 and Chilean democracy was essentially reinstated. Nonetheless, Pinochet’s legacy has remained entrenched within the country as the subsequent governmental structures perpetuated the military junta’s economic model and its constitution. 

General Pinochet was supposed to rule for one year before he was to step down and allow other military leaders to take over the position. Despite this agreement, Pinochet continued to rule as President of the Republic, a nominal title, where he implemented seemingly radical economic reforms. The 1980s was a new age of neoliberalism, an ideology that famously emphasizes the role of the private sector in the free-market, and gained traction in the developing world in response to the “Third World Debt Crisis.” The Washington Consensus asserted that market-driven policies were the best way to correct these struggling economies. The Bretton-Woods Institutions, such as the International Monetary Fund and the World Bank, created Structural Adjustment Programs (SAPs) in order to better facilitate this turn to neoliberalism. This program was a series of reforms that countries had to commit to in order to secure any type of loan from these institutions. These reforms included: little to no government regulation, reduced government spending (otherwise known as austerity measures), privatization, and free trade. This was a radical departure from the economic policies of President Allende, who emphasized a state-led economy and protectionist policies, yet these new policies were just the beginning of a new era of capitalism. 

The SAPs were implemented in a variety of countries in order to encourage self-sufficiency and promote investment; it was believed by many that these reforms would break the cycle of dependence on loans. However, criticism is sharp and many point to the lack of success the SAPs have had in fulfilling their own ambitions. The largest criticism is the effect austerity measures have had on already poor nations, who often adhere to them by reducing funding for social welfare programs. By reducing or eliminating funding for social welfare programs, vulnerable groups, such as women and children, are faced with an added burden that can seriously impede upon their ability to survive. There is enough evidence that demonstrates that between implementation in the 1980s and the 2000s, SAPs reduced the standard of living for many. Another criticism was that these programs were essentially neocolonialism. These reforms forced countries to open up to exploitative investment by multinational corporations, thus perpetuating uneven power dynamics within economic systems that were present during colonial rule. Scholars such as Frederick Cooper and Randall Packard were able to articulate key aspects of this claim by arguing that development was not only a way for former colonial powers to maintain some form of legitimacy, it was also used by leaders in the Global South for the same purpose. This restructuring of Chile’s economy in the form of SAPs was a strategy that Pinochet employed to legitimate a regime whose conception was an illegal coup. Furthermore, these reforms were a way in which Pinochet could bring his version of Chile to fruition. 

The SAPs were successful for Chile in more ways than one. They helped usher in an era of economic growth for the country, though there are debates about who benefited from them most. It also helped to legitimize Pinochet’s legacy, as the new leader’s victory was underscored by this nation-wide expansion. Internationally, most people recognize that General Pinochet was a brutal dictator, yet there is slightly more nuance within Chile. The 60,000 Chileans that showed up for his funeral procession all seemingly believed that Pinochet “saved” the country from Marxism. Even when pundits discuss the period’s economic growth and the advent of neoliberalism, they downplay the fact that this development came at a great price, which continues to manifest itself. The findings of two National Commissions detailed the brutality and violence of the Pinochet regime which involved arbitray arrests, torture, incarceration, disappearances and political executions. Approximately 3,000 people died. No one from the left was safe from Pinochet and the hated head of secret police, Manuel Contreras. These commissions also illuminated the fact that the General mismanaged funds for his own personal benefit. Despite the systemic and rampant abuse of human rights, Pinochet’s embezzlement and corruption was the proverbial ‘straw that broke the camel’s back’. 

Pinochet’s regime also conceptualized an entirely new constitution that came into force in 1980. It was never replaced, even upon Chile’s democratization in the 1990s. The dictatorship-era document is a combination of traditional Catholic values, liberal principles, and some elements that could be considered social-democratic. The constitution also heavily reflects the neoliberal policies of the time; it is often interpreted to hand over the responsibility of health and education over to the market, instead of the government. Furthermore, the document is hyper-executive and while the legislative has the power to enact policy, they can be limited in their scope. Although it has been altered since Pinochet’s fall, including amendments that broadened political participation to left-wing groups and limited the political role of the military, it’s presence leaves a shadow. 

The preservation of Pinochet’s constitution and the neoliberal policies of the 1980s has led to the current protests that are reverberating throughout the country. The protestors are a diverse group of people, but they have all articulated a similar feeling of an opportunity being taken from them. Chile’s post-tax income inequality is now the highest among countries in the OECD. The cost of living has increased, while wages remain low and social welfare allowances are insufficient. The pension system became privatized following the ratification of the constitution in 1980. The funds are managed by for-profit groups who guarantee a pension of $137 per month. This has created a serious burden for senior citizens who have to somehow be able to afford medications which are notoriously high; a result has been that people over the age of 80 have the highest rate of suicide in Chile. Another major problem which has been a central focus of the protests is a lack of access to water: although it has been formally declared a public good, the rights to use it are privatized and administered through a market system. This ‘water code’ is enshrined within the constitution. Watersheds are unevenly distributed throughout the country and with climate change affecting Chile, where the majority of the population is concentrated within an arid region, the issues of water rights and distribution have become a focal point. 

There are many dimensions to the Chilean protests, as demonstrators are seeking to create a more equitable society. The current president, Sebastian Pinera, a center-right billionaire politician, has promised reformative measures and has fired cabinet members, but it has yet to be enough. Chileans are pushing for an entirely new constitution that could better reflect the interests of the general public and finally break free of the dictatorship. 78 percent of Chileans support the idea of a new constitution, one where the people have a hand in its conception, and party leaders have recently agreed to hold a national referendum in April 2020. The protests have stretched well into November, and the sounds of the cacerolazo protesters continue to ring out. While the world has seemingly been rocked by protests, from Latin America to Hong Kong, it is important to remember that although systemic change may appear to be unfathomably difficult to achieve, it is still within reach.

Putin vs. the People: The Next Generation of Russian Activism

Since June of 2019, thousands of young Russians have been detained for participating in unsanctioned protests in Moscow. These protests aren’t like the Women’s March or the school strikes in the United States; they are generally unauthorized, meaning every individual who attends the demonstration can lawfully be arrested by the authorities. The stakes are higher, and desperation emanates from the massive, chanting crowds. The very air crackles with anticipation as thousands of Russian citizens all collectively think the same life-changing thoughts: the authorities are no longer our friends, and revolution is near. 

Although these protests seem to have sprung out of nowhere, the tensions in Russia have been mounting for a long time due to the changing political climate. One of President Vladimir Putin’s most outspoken political opponents, Alexei Navalny, has been railing against corruption and political repression since 2008. He often spends short amounts of time in prison for arranging and attending unsanctioned protests. He has attempted to run for elected positions numerous times, including the Presidency, but has been prohibited from candidacy on several occasions due to convictions related to his activism. He has also, like many of President Vladimir Putin’s other political rivals, fallen mysteriously ill while in custody. As a political activist he is known for criticizing the authorities on various social media platforms, like Twitter and YouTube, and has been named one of the “most influential people on the internet” by Time magazine for his massive following, which has allowed him to connect with and mobilize young activists throughout Russia.

These young activists are the basis for the anti-government protests happening in Russia. They hail from the generation that was born during or after the collapse of the Soviet Union. Some of them are students as young as sixteen years old, while the majority are college students and young professionals who, wanting to have a say in the future of their country, walked into a voting booth and were faced with the realization that their votes and their voices are being ignored by the authorities. 

According to a federal law passed in 1999, “On the Election of Deputies of the State Duma of the Federal Assembly of the Russian Federation,” candidates do not have to be affiliated with a recognized political party, such as United Russia (Putin’s party) or the Communist Party (the second largest party in the Federal Assembly, Russia’s legislative body), in order to run for elected positions. However, many candidates who have attempted to run for positions both at the local and presidential level as independents or affiliates of one of United Russia’s opposing parties have had their registration rejected. In order to be registered for the election, candidates must petition for signatures from their constituencies. Once they have received the correct number of signatures, they must register their petition with the authorities, who verify the signatures and declare the candidate’s legitimacy. Despite collecting the minimum number of signatures, most of the candidates running in opposition to United Russia have had their registration denied on the alleged grounds that the signatures had been “faked.” 

These incidents of alleged corruption are also occurring during a time of political change. The approval ratings of the current ruling party, United Russia, have dropped to a historic low: just 32 percent of Russians stated that they approved of the party in 2018. Many pro-government candidates chose not to run under the United Russia banner, afraid that affiliating with the party would negatively affect their chances of winning the election. Additionally, a Russian media startup “Proekt” reported that opposition and independent candidates were slated to win nine of the 45 Moscow districts in the local elections on September 9, according to polls. United Russia has been accused of outright corruption by many critics, including Navalny, and their image as the ruling party continues to worsen as wages stagnate, the middle class shrinks, the retirement age increases, and more Russians fall below the poverty line.

Although the younger generation of Russians have been outspoken in their desire for change, the corruption of the ruling party doesn’t just hurt the youth: older Russians feel the political and economic strain as well. According to an international Pew Research study, older generations are more likely to vote in elections than younger generations. They are, however, less likely to protest and become politically active than their younger counterparts. The study also links social media usage and political activism, stating that social media users are more likely to speak out on a broad range of political issues than people who do not use social media. The new generation of Russian activists support these findings, as growing up with the internet and cell phones has made it easier for them to utilize social media.

Many of the young Russians protesting and making their voices heard do not remember the fall of the Soviet Union, and they resent the fear and hesitation that older Russians feel when it comes to political change. It isn’t uncommon for older Russians, when asked about changing the leadership of the current administration, to reply, “If not Putin, then who?” They remember the time that immediately followed the dissolution of the Soviet Union (often referred to colloquially as “The Crazy Nineties”) in which the crime and unemployment rates skyrocketed as corruption and gangs gained control of the new country’s fledgling economy. They were surprised on New Year’s Eve in 1999 by former Russian President Boris Yeltsin announcing that he was leaving and was to be replaced with a young man that hardly anybody knew: Vladimir Putin. They recall how, after Putin took office, the economy started flourishing again and the crime rates started falling as more and more people found decent-paying jobs. Most importantly, older Russians remember the tendency for political activism and opposition to be crushed under the heel of the authorities, both before and after the fall of the Soviet Union.

Perhaps that’s why, despite being their age, the young Russian activists aren’t afraid to get their hands dirty in the fight for democratic freedoms. In a late-July protest in 2019, hundreds of protesters were arrested for participating in an unsanctioned demonstration. Dozens of others were brutalized by the police force, who had stood idly by until the climax of the protest. Live videos of the protest were streamed on Twitter, and video footage of the brutality and arrests have been seen by millions of people internationally. Two parents were threatened to have their children taken away by the authorities after being photographed and recognized at a protest, with “child endangerment” being cited as the primary cause of concern. Yet the younger generation continues to protest and put their lives and safety on the line. By ignoring the will of the authorities and showing up en masse to demonstrate their rights, young Russians are testing the boundaries of the permissible use of violence and stating their dedication to individual rights and democracy.

The very presence of state violence is nonetheless disconcerting, especially because the amount of protests and backlash from authorities is disproportionate to the importance of the most recent elections. Local councils have little power, and the elections for these positions are less important than elections for the Federal Assembly or the presidency. As such, the authorities should not be as concerned about the candidates and the protests as their actions have indicated. The authorities’ uneasiness may manifest from their slipping grasp on power as evidence of their corruption leaves United Russia’s approval ratings lower than ever. Consequently, this struggle to retain power over Russian citizens will, over time, result in a change in the way authorities respond to protests and demonstrations: either the demonstrations will have the intended effect and liberal reform will be put in place or conservative reforms will result in more and more people being arrested for speaking their minds. Should the latter outcome transpire, then United Russia will have an even more difficult time convincing Russian citizens--and the rest of the world--of their legitimacy.

Moreover, Vladimir Putin’s own approval rating is at risk if he allows any kind of conservative reforms to repress the rights of Russian citizens. Once at an all-time-high of 89 percent in the summer of 2015, his approval rating has since taken the plunge down to 68 percent. This number is still quite high, but the rather large dip in approval indicates the Russian public’s frustration with the government’s decisions. If he is able to quell the angry public, distance himself from United Russia and retain his approval rating, then Vladimir Putin could be in power for a long time. However, to do so, he’d have to ensure that the authorities’ response to protests and demonstrations remains proportionate, if unfair and illiberal. 

Should Vladimir Putin lose his control of Russia’s political sphere, then he wouldn’t be the first Eastern European leader to be deposed in this millenium. After all, Russia isn’t the only post-Soviet state experiencing massive protests and political upsets. Anti-government protests and activism have been sweeping through much of Eastern Europe and Central Asia, including Ukraine, Kazakhstan, Georgia, and Moldova. Just like the protests in Russia, most of the activists are students and young adults who came of age after the fall of the Soviet Union. Furthermore, the activism in these countries has been majoritively successful. After the violent regime change in 2014, young Ukrainians created powerful political networks, and now Ukraine has the youngest government in Europe. Activists in Kazakhstan, previously having their right to assembly deeply oppressed by authorities, now openly and loudly gather for unsanctioned anti-government demonstrations. Little by little, the young, post-Soviet generation of political activists are changing the political landscape in their own countries.

It’s difficult to say where the new surge of political activism in Russia will lead, as there are many groups that all want different things. Some simply want to wrestle power away from corruption and place it back into safe hands; others want the entire political system dismantled and rebuilt from the ground up. As more young people begin to realize that they can turn their discontentment into action, the latter option seems less and less far-fetched. Although nobody can say for certain what the future holds for Vladimir Putin and his ruling party, it’s possible that, once the political atmosphere in Russia has reached its highest intensity, something very small could lead to the upheaval of Russia’s longest-standing president. The old, Soviet generations will no longer be leading the Russian Federation--the young, tired, angry, educated, politically active young people will.