[TLDR (too long didn’t read): If you are reading this, chances are you care about HR. This Reader is about what is needed for the effective enjoyment of the right to health. For a quick overview, just read the bolded text]. Note: You can easily translate the Readers to many languages. Use the app deepl.com and it is done instantaneously. It takes seconds to download the app into your computer or phone and translations are of high quality.
1. The formal enshrinement of right to health (RTH) norms matters less than the political culture* and the infrastructure that is put in place to, in practice, ensure the effective enjoyment of the RTH and other rights. Proclamations to increase ‘international assistance and cooperation’ without changing the rules of the game are radically insufficient to make a dent in the political economy of global health. What this means is that these proclamations maintain the status-quo in power relations. This overlooks the fact that health is a common good –and this is non-negotiable; effectively, health is a shared responsibility!
*: i.e., by mixing the human rights-based approach with political work at grassroots.
2. The false mantra of the ‘inevitability’ of the current global economic regime and its deleterious effects on health breeds a sense of defeatism and poses one of the greatest barriers to social change. Since decision-making power in health is concentrated among a handful of Global North countries, what is needed is a shift in governance of development mechanisms away from the status-quo and towards a plural model that takes seriously decentralizing democratic decision-making mechanism, i.e., including a meaningful institutionalized role for public interest civil society in health matters. (A. Yamin and J. Courtain)
3. It is important to continue to deconstruct myths about this ‘inevitability’ and provide evidence so as to let everybody know what we are talking about. [To make matters worse, there is a lack of filters and quality controls of what is transmitted on health matters through the internet and social networks. We must keep in mind that purported truth is not to only to be based on the judgment of biased internet actors, but the true picture has to be ultimately based on our relationship with the society to which we owe ourselves. (Oscar Arteaga)].
4. We thus need to ask the right questions to uncover the real barriers to access to healthcare –and we need to ask those questions to people who experience the barriers! That way we can connect the realities of everyday lives of people to policy formulation and have a better shot at reaching the overarching global RTH goals aimed at reducing preventable ill-health, preventable malnutrition and preventable deaths,** as well as reducing poverty and inequality. (Include Knowledge Platform)
**: Mind you, in graduate health curricula, there is something called a ‘determinant curriculum’ that leads to a rather obvious utilitarian graduate profile. We train professionals to treat the disease, not to prevent it: the risk of harm and the human rights (HR) consequences for people are totally not anticipated. Such a curriculum is contradictory to the premises of the RTH. (Marcos Vergara)
Talking about access
5. Access is more than physical access to services. Take, for example, access to medicines: Courts have indeed adjudicated some of the pharmaceutical patent cases to Big Pharma. This is generating justifiable tensions between RTH activists and proponents of patent entitlements. So, by incorporating the RTH into the adjudication of patent disputes, courts in developing countries can and must play a crucial role in improving access to medicines at affordable prices.
6. Social segregation characterizes current access to healthcare, both in its financing and in the actual provision of services. Therefore, it is imperative we make important decisions as regards value predicaments between individualism and the more ‘collective sense’ of healthcare financing and provision.
7. Given the regressive nature of the value added tax (VAT), for example, the greatest effort in financing public policies falls on the poorest sectors. This tax structure is also an indicator of social inequalities and thus diminishes social cohesion –a key determinant of health. In the end, since the level of health is indeed related to the level of social cohesion, the effort to improve the level of health of the population is negatively impacted by the VAT.
8. Structural changes in health are long-term and, therefore, imply that we act with a long-term political vision. This means that health policy projects must be evaluated from a different, new, HR framework perspective that aims at significantly increasing the chances of a more equitable allocation of funds and services. (O. Arteaga)
The current misleading un-economic growth of healthcare (Daly, H. E., Hensher, M.)
–Health in a capitalist society is a product of the pathologization of physiological processes from birth to old age; this pathologization stance calls for a) individual action, b) submission to the medical-industrial complex, and c) claim holders surrendering to the damaging influence of an agribusiness/Big Food-dominated food system. (Erika Arteaga, et al)
9. You see? Un-economic growth occurs when increases in production come at the expense of resources and people’s well-being that ought to be worth more than the items made. In healthcare, this becomes visible and evident as the social and the environmental costs of the ever-expanding health/food systems actually outweighing its (human) benefits. Global evidence indicates that the un-economic growth of this expansion is characterized fourfold:
- By the scale of avoidable iatrogenic harm caused by modern health care that is considerable, thereby risking patient safety. (Estimates across high income countries range from 3 % to 16 % of all hospital admissions incur an adverse iatrogenic event).
- By the growing evidence of overconsumption in healthcare. (Studies indicate that some 10–30 % of all healthcare activity in middle- and high-income countries may represent overuse, which is a combination of overtreatment, overdiagnosis, low-value care and ‘pharmaceuticalization’).
- By the environmental impacts of health systems’ un-economic growth that are also considerable. (Globally, up to 4–6 % of greenhouse emissions can be attributed to healthcare systems and its production and consumption of medical products). In addition, residues of pharmaceuticals (e.g., antibiotics), other toxic waste products and plastics are released into the environment. and
- By fragmented health programs for populations rendered poor –referred to in Latin America as salud de pobres para pobres (‘poor health services for the poor’). These programs are actually thrown at people as charity’.*** (Erika Arteaga, et al)
***: Makes one think: Are many infectious diseases eradication and control programs (e.g., polio, measles, ebola) been dressed in the language of solidarity when their function in effect has been to ensure the safety of the rich world? (PHM)
10. Altogether, such an un-economic growth of healthcare is bound to create a feedback loop whereby preventable health harms can lead to an ‘erroneous demand’ for healthcare whereby unnecessary and low-quality care lead to further health risks for patients. (Daly and Hensher)
Claudio Schuftan, Ho Chi Minh City
Your comments are welcome at schuftan@gmail.com
All Readers are available at www.claudioschuftan.com