The following thoughts were presented at an international health workers’ meeting in Vienna in July 2026. The following text can also be read in combination with a contribution on the current moment in the NHS and its discussion at a health workers meeting in Bristol.

• The health sector within the capitalist cycle

• Global dependence and national regulation of the health sector

• Changes in the ‘technical composition’ of health work: new workers, work organisation and technology

• Current struggles 

• The debate within the left

• What could be our tasks?

 

The capitalist cycle

There is a close relation between the ‘capitalist cycle’ and the development of the health sector. By capitalist cycle I mean a political-economic cycle from boom to crisis, which is characterised by a leading industry and technology, a specific political mediation of the class conflict and an international centre of development. Each cycle provides the material basis and a time window for the working class to develop specific forms of collectivity and a political horizon to surpass the capitalist mode of production. With each cycle the form of organisation and the vision of a social alternative changes. It makes sense to look at previous cycles in order to understand our current moment and how it determines the health sector and its contradictions.

The cycle of industrialisation 1850 to 1914

With the industrial factory system and the emergence of industrial wars (American Civil War, Crimean War etc.) we see the development of a modern hospital system. The victims of industrial accidents, urban poverty and modern shot-wounds become the human material for medical fixes and experimentation. The hospital system in turn enabled industrial wars and the slaughter in factories. The influence of the Church on the health sector had been curbed since the French Revolution, which turned surgeons from artisans into modern medical professionals with military titles. With industrial development, the centre of medical progress shifts from Paris and Amsterdam to London and later on Berlin. Doctors and surgeons became entrepreneurs, initially to teach, later on to develop medical devices and material together with industrial engineers. Medical interventions largely mirrored the mechanical-chemical stage of industrial innovation. The experimentation with anesthesia, for example, combined the ‘revolutionary’ bourgeois scientists of the Lunar Society and the profit-oriented US dental surgeons with the modern means to disseminate knowledge, such as steam ships and the telegraph system. An international system of medical academia emerged. The period from 1850 to 1950 is known as the Golden Age of Medicine, and it overlaps with the ascent of capitalist development.  

The cycle of wars and developmental regimes 1914 to 1950

We see a stark centralisation and militarisation of the health sector throughout the two World Wars and an integration of the medical caste into the state regime, e.g. during Nazi fascism. A Fordist mass-hospital developed with a more formalised division of labour. During the Second World War more than half of Germany’s doctors were sent as part of the medical corps to the front-line. The social concept of health shifted from ‘management and mending of the poor’ to the creation of a healthy ‘national body’: health became a national developmental goal, also to discipline and divide the working class. This was also expressed in the widespread influence of eugenics, which was not limited to fascist regimes. In Germany, the medical class exceeded the Nazi state’s plan of forced sterilisation. With the emergence of industrial trusts a global pharma sector developed, often closely linked to the state regimes. The Russian Revolution and the workers’ movement forced the capitalist states to invest in general welfare measures, such as mass vaccination and medical examinations, which were later on militarised.   

The global expansion and democratisation of the industrial health sector 1950 to 1980

The post-war years see the emergence of US industrial, military and financial hegemony and also a shift of the medical centre to the US university labs, medical equipment manufacturers and global health planning boards. Global institutions such as the IMF and the WHO not only spread US liberal market interests, but also global health standards. A massification of surgeries took place, led by the US, for example expressed by the significant increase in cesarean sections. While health professionals were sent as planners from the global north to the south, more and more health workers migrated in the opposite direction. We also see a further mechanisation of health work, with an increased use of scanning technology and micro-surgical equipment.The working class and feminist social movements of the 1960s and 1970s changed the composition of the sector drastically. The semi-feudal power of doctors and professors was questioned and patients questioned their passive role, e.g. in the form of the anti-psychiatric movement. While in 1950 only 10% of all medical students in the UK were women, by the 1980s women accounted for nearly half. Workers questioned the impact of industrial labour and urban living on their health. This caused the bourgeois concept of health to shift from being a national goal to being a social right. 

The decadent phase 1980 to now

In the global north, and most pronounced in the US, we see a ‘Next Shift’ from industrial labour to care work, with a feminisation of labour and a decline in average wages. The over-accumulated capital is transferred from manufacturing into health insurances, hospital chains and costly ‘lab science’, e.g. genetics and more recently medical digitalisation and AI. While general health expenditures increase, the life expectancy and/or the number of years lived in health starts to decrease in the US and other western nations from 2020 onwards. Or using a different picture: while patients spend less time in hospital after (surgical) treatments and the patient turn-over has increased, they come back into hospital more frequently. 

In the hospitals we see the emergence of a ‘managerial caste’ from the 1980s onwards and a starker separation between lab science and application within the hospital. The status of doctors decreases, while native nurses are pushed into costly university degrees. The wage difference between nurses and auxiliary staff increases at the same time. The social discourse about health changes from ‘social right’ to individual responsibility. This neoliberal turn is accompanied by the proliferation of health charities and NGOs. The ‘elite’ aspect of health, e.g. in the form of global cosmetic surgeries, becomes more prominent. Most western nations are trapped in a spiral: the industrial restructuring of the 1980s de-composed working class communities and caused a social and mental health crisis, which in turn inflated the state’s health expenditure. An increasing mass of ‘medically unfit’ people causes temporary labour shortages. Pharma companies make billions from the process of decomposition, e.g. in the form of the US opioid pandemic. The health sector is drawn into the crisis of legitimisation of capitalism, which is, for example, expressed in the widespread public sympathy for Luigi Mangione, who shot a CEO of a US health insurance company. The global Covid pandemic showed the degree of mis-coordination of a privatised and underfunded sector. 

Global dependence and national regulation of the health sector

The global pandemic also showed the consistent contradiction between the fact that the health sector is globally interdependent, but largely regulated nationally. With the current tendency towards protectionism, trade wars and militarisation, this contradiction sharpens. 

The elements of global interdependence are manifold. In particular the global north relies on a massive influx of labour from the global south. The relation becomes increasingly parasitical, in the sense that labour migration from countries like the Philippines, India, Nigeria, but also Bulgaria or Georgia, cause severe disruptions to the local health sector. In the UK, the NHS increasingly relies on the fact that the expenditure of training nurses and doctors is undertaken by other nation states. 

Other dependencies relate to the capital sector, such as global pharma companies, medical equipment and implant manufacturers, medical software and tech corporations, international hospital chains and the global intertwinement of health insurance funds. We also see an increase in global organ and tissue trade, medical tourism and reproductive surrogacy. Last, but not least, the regional medical science sector largely depends on similar global corporations, e.g. medical journals and academic institutions. To a certain degree there is an international exchange of health management and administrative processes, such as the development of diagnostic related groups (DRGs). 

A prime example for the tension between global dependence and national regulation is the pharma sector. In the current trade war, the US state tries to force other states to pay more for drugs and to invest into pharma manufacturing sites in the US. After the threat of tariffs and of an investment strike by pharma companies, the UK government agreed to divert £45 billion from essential health services in order to pay higher drug prices. Regional drug prices also increased due to the US-led war in Iran and the blockade of the Strait of Hormuz, as most raw materials for pharmaceuticals are manufactured in India and other countries of the global south. We see similar tendencies in the software industry. Many European health systems rely on large US tech and data corporations, such as Amazon, Microsoft or Palantir. These companies are increasingly used as bargaining chips, and become willing profiteers of the block confrontation.

The contradiction appears even sharper when looking at labour migration. While states like the UK are utterly dependent on migrant health and care workers, they tighten the visa and residency rights in order to channel popular discontent, enforce ‘protectionist’ control and discipline the wider workforce. While the aim is to curb the aspiration and demands of migrant workers, the outcome is contradictory: many migrant workers consider leaving the country and others disengage. 

The nation states try to use international private capital to lower the costs of the health service, e.g. in the form of public-private partnerships to build hospitals or outsourced health services. The current global moment limits this effort of ‘privatisation’ in two ways. Firstly, privatisation itself becomes an increasingly shaky option, with service providers like Carillion going bust or with medical tech-companies becoming increasingly fuelled by unstable stock-market bubbles. Secondly, with the preparation for future large-scale military confrontation the state needs tighter control over the civilian health infrastructure. The military command openly demands a strengthening of the public infrastructure for military-logistical purposes.     

The Covid pandemic made clear that health is a global relation and that national and sectorial mis-coordination is fatal. In May 2026 the international nation state system failed to agree on a ‘pathogen access and benefit sharing’ (Pabs) system in the run up to the World Health Assembly in Geneva. Such a system would be a minimum requirement to react to future pandemics.  

At the same time we can see a first glimpse of an international health movement, based on the increasing confidence of health workers’ struggles and the insight that an alternative to the capitalist health system is vital. 

Changes in the ‘technical composition’ of health work: new workers, work organisation and technology

These are very general trends. For us the main question will be how the changes in the origin and concentration of the workforce, in the division of labour and technology and the internal hierarchy shape the material basis for strikes and struggles. 

Peak concentration

Over the last decades smaller clinics have been closed and concentrated in larger hospitals. There is a limit to this concentration process if we take the catchment area and the practicability into account: ambulances and patients can only travel so far in order to get medical support. In this sense it is not surprising that the sizes of hospitals differ significantly according to population density. 

For example, in the UK there are around 1,150 hospitals (out of which 200 are private), with an average of 173 beds each. In comparison, the Top 16 metropolitan  hospitals have more than 1,000 beds each. (as a sidenote: Compared to other nations, the UK has a very low total number of hospital beds relative to its population. The average number of beds per 1,000 people in OECD EU nations is 4.6, but the UK has just 2.4. Germany, by contrast, has 7.8. This is compensated by a risky over-occupancy of hospitals – often reaching 90% plus, which causes major issues (‘corridor care’) and additional risks during ‘adverse events’, such as a pandemic.)

There are also political reasons for limiting the concentration of a workforce in a single work-place: in general it is more difficult to enforce restructuring and privatisation on large workforces. In the UK it is mainly the smaller clinics, mental health surgeries and elderly care homes that are privatised. This can create internal contradictions: due to the fact that ‘community care’ is often underfunded, patients who are medically fit, but need additional care, cannot leave the hospital – which creates health risks and additional costs for the general health system. 

The ‘peak concentration’ also affects other health institutions, such as laboratories or medical warehouses.

Peak specialisation

Hand in hand with a process of concentration we also saw a process of specialisation in hospitals. For example, certain nursing tasks, such as taking blood samples or counting medication for patients, have been delegated to a specific group of workers who only perform that task. In some cases, such as counting medication, additional automation technology has been introduced. 

The problem is that the total work load in hospitals is fluctuating more than in the average factory or warehouse. In order to ‘keep workers busy’ management likes to add extra jobs to the general job profile, e.g. health care assistants are also expected to take blood samples or perform bladder scans. This creates a double-movement: tasks are singled out for specialisation and at the same time these tasks might also be pushed down the wage scale, from higher to lower paying job categories. In some cases new, ‘intermediate’ job categories, such as ‘advanced practitioners’ are introduced and the classic structure ‘health care assistants – nurses – doctors’ is further segmented. 

Over the last two, three decades we have seen the following general tendency: a certain feminisation and proletarianisation amongst doctors and an ‘academicisation’ of nurses. This results in the general pay gap between doctors and nurses shrinking and the pay gap between nurses and health care assistants and other auxiliary workers widening.

The myth of automation and digitalisation

Similar to the industrial world, the impact of automation is often exaggerated, which also has a political element: employers like to make workers feel that they are replaceable. It is unlikely that bed care will be mechanised or robotised in the medium term, the type of work doesn’t lend itself to automation.

If we take the example of ‘surgical robots’ we can see that these are not really ‘robots’, but rather tools for surgeons. Often the size of the tool (micro-surgery) is more important than the fact that it also has a computerised element. Robotic surgery doesn’t lead to a drastic ‘de-skilling’ of the surgeons and it doesn’t drastically reduce the operation time. 

Comrades report similar contradictions about automation in pharmacies and laboratories, where the machinery tends to depend on human corrections and maintenance to a degree that the workforce cannot be reduced significantly. In the UK, the digitalisation of patient records and medical documentation has cost billions of Pounds, but the cost-saving results are not in sight.

In the UK it was not coincidental that in many hospitals nurses had to return to 12, 13-hour shifts around 15 years ago, when large investments into digitalisation and other technology were made. Management is happy to save 30 minutes handover time by shifting from three to two-shift models, even if this increases fatigue and medical errors.

While AI can replace human labour in particular fields, for example X-ray scan analysis, the impact of ‘tele-medicine’ or ‘health apps’ seems inflated by the financial ‘start-up’ bubble, rather than being a sophisticated technological plan to change human labour and care. Still, these are fields that require collective analysis from below. 

Limits to outsourcing: an inflated administration

From the 1990s onwards the drive towards outsourcing of hospital services, hospital maintenance, agency work and the creation of market-relations between different parts of the NHS picked up speed. This was facilitated by ‘cheap money’, that many of the outsourced companies depended on. 

We can see the limits of this outsourcing process: while some parts of the health work-force could be pushed into more precarious conditions and ‘having to balance the books’ put more pressure on specific departments, it inflated the administrative apparatus of the hospitals and wider health sector. More and more people were needed to coordinate between in-house and outsourced companies and to record the financial transactions between parts of the public health sector. 

Apart from ‘admin work’, the ‘allied health professions’ was another segment of the health work force that saw a bigger increase in numbers. It would be important to discuss this trend, e.g. to what degree it is due to ‘better patient care’ in the form of therapies, the wish for health workers to avoid ‘bed care’ and the tendency of management to split up the bigger nursing workforce. 

Current struggles 

Despite the national character and national regulation of the health sector we see occasional appearances of international cycles of struggles amongst health workers, e.g. the nurses strikes end of the 1980s, beginning of the 1990s. 

Throughout the 1990s the relative numbers of health workers increased. While manufacturing jobs were threatened and industrial wages were depressed with re-locations and automation, this was less possible in the health sector. Unsurprisingly we saw a quantitative increase in industrial disputes led by health workers. In comparison to other skilled workers, the wages of nurses increased.

Only with the Covid pandemic we experienced a qualitative shift towards an international dimension of struggles. Health workers around the globe were pushed over the edge by the impact of the pandemic, which exacerbated the already dismal conditions on the hospital floors. At the same time their labour was discussed and sometimes praised in public for the first time, which boosted the general confidence as a workforce. While not coordinated in a conscious fashion, we can see that strikes in the health sector developed common tendencies, e.g. the focus on staffing, and problems, e.g. how to deal with minimum service levels and professional divisions. In many countries there was not only a visible upturn in industrial actions of health workers after Covid, but also a strengthening of the links to ‘social’ campaigns around health. Within the political left, ‘health’ became a topic (‘Care Revolution’).    

The current limits of strikes

While promising, both international strikes and ‘health movements’ display common limitations. When it comes to strikes there are three main problems. 

Firstly, most strikes remain stuck within the formal boundaries set by professional hierarchies, labour laws and trade union bargaining tactics. In most cases, strikes are limited to a single ‘profession’: doctors, nurses, health care assistants, auxiliary workers etc. tend to go on strike separately. This means that strikes can be undermined by using scabs in combination with making use of the daily division of labour. For example, when phlebotomists (colleagues who take blood samples) went on strike in Gloucester in the UK, doctors, nurses and health care assistants continued to take blood samples, thereby, unwittingly or not, undermining the strike effort. The strike dragged on for a year. To be effective, the organisation of the strike has to be based on the actual daily division of labour and cooperation on the shopfloor, rather than on formal job categories. 

Secondly, and relatedly, there are few successful strategies of how to deal with scab labour. In some cases colleagues continue working because they are officially not part of the strike, because they belong to a different union or to a different professional category. In other cases, in particular in the US, management uses organised scab agencies. If the trade union announces a two day strike, management would lock out workers for a week in order to attract nationally operating ‘strike nurses’. Apart from denouncing these agencies and scab nurses on social media or issuing health and safety concerns, there haven’t been many successful attempts to stop scab labour from weakening the strikes.

Thirdly, only a few disputes managed to find an answer to the question of minimum service levels and of how not to harm patients during strikes. Related to this, we have to ask ourselves how to exert economic pressure in a public health sector, where ‘harming the bosses profits’ is not an immediately obvious option. The ‘minimum service levels’ are often used to take the control over the strike away from the workers. Management and trade union officials agree on a minimum staffing level during strike days (’derogation’), and workers are presented with the outcome. Often the procedure is unnecessarily complicated. In some cases, workers managed to keep control, e.g. keeping direct communication between wards and picket lines and deciding autonomously when to send people in to support. In some cases workers developed different forms of struggles, such as boycotting to fill in documents that are used to financially reimburse the employer. Only in a few cases workers found more offensive ways to create economic pressure, e.g. in Argentina health workers and teachers fought outside the official union structure and blocked roads to oil fields and tourism resorts, thereby also impacting local state finances.

The current limits of ‘health campaigns’

When it comes to the campaigns to defend the health sector we often see a division between largely symbolic ‘national’ campaigns, such as ‘Defend our NHS’ in the UK or the ‘Marea Blanca’ in Spain on one side and the various local struggles to defend particular health services on the other. The latter often remain locally isolated, whereas the former often remain detached from the concrete struggles of workers and patients, focusing excessively on the parliamentary and legal sphere. The public campaigns are often presented as ‘cross-class’ and ‘in the public interest’, while the health crisis has a clear class content. The working class would have to find their own analysis and voice again to denounce the class aspect of modern illness. In some cases, public campaigns reproduce professional hierarchies, e.g. in the form of separate ‘doctors’ organisations.

Another phenomena of ‘health worker activism’ outside of the immediate workplace emerged in the wake of various movements against state repression. From the times of the Arab Spring in Syria to movements against military dictatorships in Myanmar, Sudan or Palestine to actions against racist police structures, such as ICE in the USA, health workers were often at the forefront of protests and in the spotlight of repression. Sometimes the outstanding position of health workers can be explained by social status, e.g. doctors are seen as respectable and people refer to them. In many cases doctors and health workers take on immediate tasks, e.g. to care for injured protestors, thereby becoming a direct target for state retaliation. In other cases, health workers managed to use their community links and their work organisation in order to weaken state repression, e.g. in the US, hospital workers would use various tactics to delay the discharge of ICE detainees/hostages and in the meantime reach out to community activists and lawyers to support the detainee. This example shows the potential of ‘worker control’, of using means and relationships at work in our favour.

In many countries the anti-war movement against the genocide in Palestine has created new links between health workers. In the UK, the campaign against using Palantir in the NHS has brought together workers and ‘political activists’. Management reacts by banning wearing the Palestine flag at work or victimising health workers who speak out. While many actions remained marginal, e.g. in the form of small protests in front of hospitals, some elements of the campaign became more integrated into daily work, e.g. in the form of data and IT workers criticising not just the moral dimension of using Palantir, but also the negative impact of the data platform on daily work relations. While the genocide in Palestine is one of the most brutal expressions of current warfare, we have to encourage a wider questioning of the implication of the health sector in the general drive towards militarisation – the main enemy is at home.

In this complex scenario it would be false to speak of an established ‘health movement’, but it would equally be false to discard the potential of health workers’ struggles becoming the centre of a wider social force to question the capitalist health crisis. In order to facilitate this, the revolutionary left needs political independence, practical engagement and theoretical clarity. 

The debate within the left

There are various challenges for the wider left milieu when it comes to supporting an emancipatory tendency within health workers struggles and health movements.

The Covid aftermaths

The (revolutionary) left still has to resolve its internal dispute that emerged during the Covid pandemic. The issue of how to interpret and how to react to the pandemic – and to the state response to the pandemic – still creates tension within the milieu. There are deeper personal-psychological reasons for how comrades react to an existential threat like a pandemic, which should not be neglected. But there are also fundamental theoretical questions to address, such as the character of (capitalist) science and the state, and more generally, the question of materialism and universalism. More concretely, we have to develop a clearer understanding of what situations of crisis, such as a global pandemic, mean for the question of counter-power and revolutionary transition. 

Situations like the pandemic are a litmus test for the state of political maturity of the working class. It was clear that the bourgeois nation state system was not able to overcome the social fragmentation of the capitalist health sector (multinational pharma corporations, global PPE supply-chains, detached science sector, hospital vs. community care divide etc.) and to find an effective response in the ‘general interest’. It is clear that the working class, and the health workers in particular, have to be able to act in the general interest and impose this general interest against the limited interest of the nation state, the patent-interest of the medical corporations, the caste privilege of the science sector and so on. This requires being able to act and plan as a collective workforce that relates to the wider class needs. The ability to gather the required knowledge to develop an alternative social plan is not separate from the development of the social power to enforce it. Only through a longer cycle of struggle that overcomes professional and sectorial boundaries can we transform from a segmented health workforce to a collective workforce that is able to take on its social responsibility. Each struggle, campaign and theoretical effort has to be analysed in this regard: does it contribute to the development of a collective workforce and its social power or not. 

The limitations of the ‘care debate’

There are positive aspects about the efforts to connect the feminist debate around ‘social reproduction’ with the question of health and ‘care work’. It shows that social labour tends to be interdependent and that what happens in hospitals is not detached from the labour in private homes – and that the particular way in which these two forms of labour are separated creates the material basis for sex oppression. 

At the same time the limitations of the ‘care debate’ are obvious. By theorising health work primarily as ‘emotional’ and care labour, its complex nature is ignored and made invisible. Hospital and health work is of course about ‘caring’ and ‘reproduction’, but it is also complex labour that spans from global material manufacturing and supply-chains (pharma, equipment) to administrative planning commissions to laboratories, science and university departments to a network of community structures that not only provide ‘care’ but also act as extended tentacles of state power and control over working class lives. 

Only by overcoming a simplified framework of ‘care work’, we can discover the potentials of the health sector for the development of social alternatives to capitalism. Rather than ‘The People’s Republic of Walmart’, with its relatively simple supply-chain of commodities, it is structures such as the NHS with its 1.3 million workers, its dazzling flow of information and its various forms of complex labour that have to be seen as laboratories for future communist planning.

The skewed focus on ‘privatisation’

Of course it is correct to fight against attempts to make profits from health work and to make working class patients pay for health services. At the same time it is wrong to limit our critique to aspects of privatisation and to claim that otherwise ‘the NHS is ours’. This is unhelpful in two ways.

Firstly, this focus renders invisible the problematic nature of the ‘public’ health sector as a capitalist state sector, which is based on a stark and hierarchical division between intellectual and manual labour and riddled with bureaucratic self-interest.

Secondly, this focus underestimates the function of the private sector by reducing it to being a ‘parasitic’ entity. On the contrary, it is often the ‘private sector’ that combines health labour internationally or that links ‘health labour’ with technical labour. Often it is the major private surgical instrument and implant manufacturers that organise international conferences for surgeons to exchange experiences. As mentioned above, the national health service depends on a network of global pharma and software industries. We have to include workers in these sectors into our vision of a ‘collective workforce’ and the question of how to reappropriate the health sector in the medium term.

The political dependence on trade unions and other legal institutions

In Germany it is particularly apparent that the left lacks direct roots within the health workforce and is therefore dependent on the official trade union structures to act as a transmission belt or bridge. This dependence is politically fatal, as the left is not willing or able to propose alternative forms of strike organisation that would overcome internal divisions and increase its effectiveness. 

Due to its material intertwinement with the trade unions, the left remains largely silent about the shortcomings of post-strike agreements between employers and unions, while a militant minority amongst the workers criticises it openly. The flip-side of this silence is an abstract external critique of trade unions that doesn’t relate to the actual dynamics and contradictions within the striking workforce. Instead of complaining about ‘eternal betrayals’ by the trade union bureaucracy the challenge would be to develop strategies to break the trade union framework from within the actual organisation of the strike – which is not neatly detached from the trade union structure. During most of the strike the division between ‘striking workers’ and ‘activist supporters’ was not overcome. ‘Supporters’ felt obliged to provide services and didn’t interact with the strike as ‘workers’ themselves, who have their own experiences and visions of strike organisation.    

The problems of self-organised health services

Apart from the health workers disputes, the public campaigns to defend public health services and the engagement of health workers in movements against state violence we can also see the development of a discourse – and sometimes practice – of alternative, self-organised health services. Some of these initiatives relate to concrete historic and political reference points, such as the Black Panthers or the struggles in Rojava, others refer to the general idea of worker cooperatives. 

Throughout the history of working class struggle there has always been an interplay between the struggle against capitalist and state exploitation and the experimentation with alternatives. In this sense these efforts of self-organised health is a necessary ingredient for the development of a collective workforce and class movement. At the same time we have to be aware of the historical juncture and current context, where the local state often encourages the formation of health cooperatives, charities and NGOs as a form of soft privatisation and austerity. This in itself is probably no news to most of the comrades who engage in self-organised structures.

Another challenge is the material nature of health work. It is not surprising that self-organisation is largely limited to labour intensive and low-tech areas of health work, such as midwifery, mental health work or ‘basic provisions’. It is one thing to see this ‘marginalisation’ as an outcome of the balance of power between workers and capital: currently we don’t have the power to provide self-organised spaces with MRI scanners, Gnome laboratories or complex forms of chemotherapy. It is a different thing to glorify this marginalisation ideologically, through superficial criticisms of ‘technology’ or ‘school medicine’. The critique of capitalist technology has to develop hand in hand with the power to appropriate and transform it.

What could be our tasks?

There are only a few spaces for international debate amongst pro-revolutionary health workers. In that sense even a mere exchange of experiences is an important first step. Beyond the level of exchange there obvious tasks:

• Commonly prepared and discussed interviews and reports about the potentials and limitations of current strikes. What are common international features, what elements are specific to the locality?
• An inquiry about the current changes in the division of labour within hospitals and which role technology and management strategies play. A discussion how these changes impact and shape effective forms of struggle.
• A better understanding of the ‘current cycle’, e.g. what is the class nature of the current health crisis and are we actually in a decadent phase, in the sense that capitalist development doesn’t create major medical breakthroughs anymore or ceases to be able to effectively counteract the ill-making effect of capitalist exploitation.
• A debate about how health workers’ struggles, ‘movements’ for health and self-organised health spaces can interlink as a class movement.
• The challenges to re-compose a collective health workforce that is capable of imposing alternative plans and measures against the singular interests of the state, corporations and the professional caste – the question of the dictatorship of the proletariat in the 21st century.