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Diarmaid Ferriter: Population trend confirms need for radical healthcare reform

Aftermath of coronavirus pandemic and rising numbers should create required urgency

Much has been made of our population reaching more than five million for the first time since 1851. It is a figure nowhere near the pre-famine number which was in excess of eight million; neither is it close to where Sinn Féin propaganda more than a century ago promised it would be under native rule.

Sinn Féin pamphlets during the first World War sought to promote party founder Arthur Griffith’s ideas on economic nationalism by claiming the country’s natural resources were “inexhaustible” and that with adoption of the party’s protectionist policies “emigration would automatically cease” and that “Ireland out of her own riches could support 20 million of a population”.

By 1961, however, the State’s population had declined to its lowest ever at just 2.8 million and during the previous five years, net emigration was more than 215,000: “these facts will furnish canon balls for the Opposition during the general election campaign”, suggested The Irish Times in April 1961. But the balls failed to hit the target and Fianna Fáil continued in power, albeit as a minority government.

The drain upon this country's lifeblood is a tragedy that surpasses even the disaster of partition

The Irish Times response also focused on the need for industrial development and EEC membership. But it was preoccupied mainly with the devastating loss of people, its editorial noting: “the drain upon this country’s lifeblood is a tragedy that surpasses even the disaster of partition”.

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By that stage the electorate was well used to fatalism about Irish demography. The phrase “The Vanishing Irish” gained considerable currency during the 1950s and was the title given to a bestselling book that decade edited by Notre Dame professor Rev John A O’Brien. O’Brien was hardly a master of understatement, declaring at the beginning of the book: “While Ireland has not formally disowned wedlock, her children enter in to it so seldom and so late that the Irish nation is slowly but surely vanishing from the face of the earth.”

Irish bachelors came in for quite a kicking in the book and one of their critics was quoted as suggesting they were “a toothless, gummy, shifty lot, as crude as you’ll find them anywhere with more feeling for an old pipe than for a woman who might help each one to a better life”. Little wonder, then, that in the five years before the 1961 census the net emigration of women rose by 18.2 per cent in contrast to 2.5 per cent for men. According to one of the contributors to the book, Kerry author Bryan MacMahon, O’Brien had asked that the writers should “give it straight from the shoulder”.

MacMahon duly complied, recounting stories of church denunciation of “company keeping” and the tyranny of clerical control of dances and social life. It was a particularly brave thing for him to do given his position as a national schoolteacher whose management was clerical. The articles from the book were subsequently serialised in a Sunday newspaper and MacMahon recalled: “I became the subject of much misunderstanding. How dare a national teacher, whose employer was the Parish Priest, utter such sentiments? I woke up one morning to find that I had been mentioned from at least three pulpits in the locality”.

We are a world removed from such suffocation now, but notwithstanding the return to a mid 19th century rate of population, the latest figures are also notable for two trends: a consistent fall in the birth rate and the increase in the number of over-65s, with 742,300 in that category, accounting for 14.8 per cent of the total population.

Those statistics are a reminder that the overall population figure now, though represented as a historic recovery, raises new challenges of profound relevance to how we are governed and how we manage health provision. That challenge comes at a moment when the end of the Covid-19 public health crisis is being spoken of. Quite rightly, we have heard much praise for our healthcare workers and those involved in a successful vaccination rollout. We also, during the worst of the crisis, saw what was possible with political will in relation to health. At the end of March 2020 Minister for Health Simon Harris said “there can be no public versus private here”, alongside the Taoiseach Leo Varadkar’s commitment that “public and private patients will be treated equally”.

Our system is not set up to serve the health and social needs of our population

Those same two individuals, in introducing an implementation plan for Sláintecare in 2018, the product of the deliberations of the all-party Oireachtas Future of Healthcare Committee, stated: “Our system is not set up to serve the health and social needs of our population; it is configured for the past, not for the future”. There has been, since then, a further implementation plan which notes that in 10 years time there will be more people aged over 65 than under 14.

Arresting population figures and projections, along with the experiences of the coronavirus pandemic, good and bad, should generate a cross-party urgency about following through on promises of radical healthcare reform.