Domhnall MacAuley: Northern Ireland happiness

Domhnall MacauleyPeople in our wee country are the happiest. Unexpected, perhaps,  given the long history of violence and social unrest. But, people can be happy in the most difficult circumstances and happiness isn’t always related to the social or material environment. Almost impossible to define, we often only recognise true happiness when its gone. So, it’s great to see Northern Ireland in a positive light—we should celebrate this special feeling that we all knew and felt. Although, in truth, we didn’t know exactly what it was.
Looking across my desk in general practice, happiness is often hidden. But, there are immensely positive aspects of Northern Irish society. There is great family cohesion, community support, and a strong local network. With illness or bereavement people rally around. Visiting old or ill patients, I am struck by the kindness of their neighbours, dropping in to help, doing the shopping, or quietly providing meals.  People know those living on their street and in the neighbourhood and may collect their prescriptions from the surgery and the chemist, telephone if worried, or take them to hospital appointments. Random acts of kindness come naturally. Unlike what we hear of many other major cities, there appear to be few completely isolated individuals—if something happens there is usually someone who knows them, calls an ambulance, or chases up a relative. The troubles forged cohesion in local communities who looked inward for support.  People stuck together, stayed in the local area, and seldom moved away. Emigration was to move from West Belfast to North Belfast. While unrest may have stifled industry and investment, it might also have slowed some of the downsides of progress. Traditional community values are disappearing but perhaps more slowly.

Does health bring happiness? There may be a link but Northern Ireland has huge numbers of the working age population with a limiting long term illness and those receiving disability living allowance.  So, this collective happiness is not a reflection of an exceptionally healthy community. On the contrary, chronic ill health is a problem. Perhaps more would be done if we weren’t so happy and content. Could a side effect of happiness inhibit progress- could contentment stifle change?  Would it be better if we were a little more disagreeable?  Where is the public pressure for better hospital hygiene after the pseudomonas baby deaths, where is the medical reaction to the RAE results and low ranking of the medical school, where is the resistance to the fragmentation of our health service? People in other countries shout louder.  Perhaps we need a little unhappiness.

Domnnall Macaulay is primary care editor, BMJ