Many of us who grew up in relatively privileged homes in rural Ireland in the 1950s and 1960s were aware of a socio-economic group that has now almost disappeared, agricultural workers. One such person worked for my father and was very much part of my childhood. Others I got to know when I was growing up. Several of my classmates in national school went on to become agricultural workers before emigrating to England (of my class of 11 in the national school I and, I think, only one other did not emigrate writes Vincent Browne
The lives of these agricultural workers seemed bleak. They sat at different tables from the family, they ate inferior food, some of them lived in outhouses on farms, they were hired at annual fairs at annual fees of less than £100. They were hardly better off than slaves. Servant girls may have been treated even worse - they, sometimes, were no better than sex slaves to the farmer employer. I have often thought that yet another secret story of terrible abuse has still to be told about them.
But my memory of the male agricultural labourers is of them being happy-go-lucky. There seemed a lot of camaraderie among them, a lot of laughter. Some of them were good at hurling and handball, and many of them were highly spoken of in terms of their output and dedication.
That lazy assumption about agricultural labourers was shockingly disturbed recently on reading the Irish Psychiatric Hospitals and Units Census 2001, by Antoinette Daly and Dermot Walsh. On page 27 of the report, in a table showing rates of hospitalisation in psychiatric hospitals by socio-economic groups, the rate for agricultural workers appears in 1963 - just at the time I would have known agricultural workers best - as 3,465. That figure is a multiple of the rate for every other socio-economic group. No other group comes remotely close to it. The rate for the unskilled manual socio-economic group (predictably) comes next, but way below at 944. The rate for employers and managers is 123.
The figure is for the census on a particular night in psychiatric hospitals and, of course, vastly understates the number of agricultural workers that would have been hospitalised that year.
I suppose it is not surprising that there should have been such a high incidence of psychiatric illness among this group of fellow-citizens who were so thoroughly exploited by us, the bourgeoisie and the farmers of rural Ireland. But certainly I had no inkling of the pain, the misery, the desolation that these figures represent for that group.
EVEN today the incidence of hospitalisation for this group is very high at 252.8 per 100,000 population (and note that the number in psychiatric hospitals generally has declined by three-quarters since 1963 - 18,801 in 1963 and just 4,321 in 2001). Nowadays pride of place is taken by the unskilled manual socio-economic group at 314.3. The hospitalisation rate for this lowest socio-economic group is more than 10 times that of employers and managers and more than 50 times that of salaried employees/own-account workers.
The deep inequalities in Irish society generally are mirrored vividly in the statistics on psychiatric illness. It is the poor that, in the main, descend into despair and loneliness. Another report published by the Department of Community Health and General Practice at Trinity College last year, Inequalities in Health in Ireland - Hard Facts, confirms the higher incidence of psychiatric illness among the lower socio-economic groups and it is true for all psychiatric illnesses, including schizophrenia, depressive disorders and alcoholic disorders.
That report shows that for all illnesses it is the poor that are the most afflicted and it suggests that the problem with the state of our people's health is not so much inequalities in the distribution of healthcare but generally in society. It shows that the mortality rate for all males in the 15-64 category is vastly higher for unskilled manual labourers and even more so for certain heart diseases.
IN this column last July I wrote about the report Inequalities in Mortality 1989-1998: A Report in All-Ireland Mortality Data, published by the Institute of Public Health in Ireland.
It showed that in the whole of the island of Ireland in the period 1989 to 1998 the mortality rate for the lowest occupational class for all heart diseases was more than twice as high as for the highest occupational class. The mortality rate for strokes was 2½ times as high for the lowest occupational class, compared with the highest occupational class. For cancers the mortality rate for the lowest occupational class was between twice and five times greater (depending on the type of cancer) than for the highest. And so on and so on in all categories of diseases.
What these reports show is how deep-rooted are inequalities in Irish society, inequalities that reflect themselves not just in unequal wealth and income but in health and mortality, and it is true also in education.
And these inequalities feature hardly at all in our political discourse and certainly not in the dominant political agenda where the vested interests of the well off prevail: focus on crime that afflicts the well off and on reducing taxation. Even the focus on the hospital waiting lists misses the point. The problem in health is the inequalities in the state of health of our people, and that is primarily because of the inequalities in society generally. And, as a society, we could hardly care less.