[TLDR (too long didn’t read): If you are reading this, chances are you care about HR. This Reader is about the uphill battle health activists face to counter the forces of privatization and to rescue the right to health from the doldrums. For a quick overview, just read the bolded text]. Traducir/traduire los/les Readers; usar/utiliser deepl.com.
-The toxic combination of bad policies, economics and politics is in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible. Social injustice is killing people on a great scale. (WHO, Report on the Social Determinants of Health, 2008)
The galloping commodification and privatization of health
1. The strategy employed by the private sector –and many a government– to push for the further commodification of health works at two levels: a) through the commodification of various dimensions of health and social needs, and b) through the capture of public resources by for-profit care providers, insurance companies and private investors.
2. As a result, commercial-for-profit entities move-in to areas that are now supported by the state. Private enterprises thus compete with public providers in providing services in the market for healthcare services. In the market, private providers have several advantages as they are able to curtail costs by reducing wages and by resorting to unscrupulous practices such as compromising on the quality of care. They also push unnecessary interventions and medical products and thus actively increase the cost of care borne by patients.
3. To make things worse, patients often lack the knowledge and the information to be able to make a choice between private and public interventions and are lured by the, often unethical, market tactics employed by private institutions. As a result, over time, private providers garner larger and larger proportions of the market share and in many situations end up becoming the dominant provider of services.
4. This pattern fosters the development of skewed priorities –and the poor, the aged, the most vulnerable, migrants and other are denied care as it is more expensive and not profitable to have private systems in place to reach out to them.
5. Last but not least: Commodification, and its contractual view of care, challenge the aspirations and principles of health professionals for whom caring with dignity is a prime objective. [As is no news to you, in the health sector, working conditions are deteriorating in the frantic attempt to abolish superfluous costs. The sector puts pressure on wages, working hours and social benefits. Poor and insecure working conditions have an obvious negative impact on the quality of care!].
The commercial dynamics modifies the distribution of resources in favor of the needs for profit maximization and to the detriment of the true social needs of health
6. As said, the commercial sector is reluctant to provide comprehensive services to all patients since most cannot afford the full costs of private care –not forgetting that many important diagnostic and treatment medical procedures may be skipped since they are less profitable.
7. Ah! and yes! In order to be profitable, the commercial sector needs public financing in order to broaden its scope of operations by catering to a minority of wealthy individuals that can afford the full cost of private care. Therefore, by accessing the support of public financing they actually gain market share.
8. It is thus in the interest of the commercial sector to promote a segmentation of the health system. In such an approach, centers of excellence are set apart and privatized as they are likely to provide opportunities for higher profits.
Bottom line
9. We live in an era where the developed countries that contribute tan important chunk of finances for the functioning of WHO have today a cynical disregard for the ability of WHO to shape the global governance of health.
10. In this climate, there are important benefits for public interest civil society organizations and social movements in adopting a perspective on health that is rooted in its social dimensions: a) We are all now more able to understand why ill-health so disproportionately affects some populations, b) The perspective emphasizes going for the causes-of-the-causes pushing us to concentrate on what is needed to keep people healthy, and c) It frames the problem as a social problem, again, pushing us to look at key interconnections.
11. It is thus essential and urgent to reject the commercial and mercantile logic being pushed in most regions of the world as regards the health sector. It is no mere coincidence that several struggles across the world are making this demand.
Building a global movement for health (PHM)
12. Health transcends the entire spectrum of existing social movements and is indeed feeding diverse struggles. Health is what brings together various movements with a shared claim. From whichever angle one looks at it, health injustices are making a powerful call to mobilize. This is the very force for mobilization that lies at the core of our struggles and enables and forces us into alliances. All this requires building a mass movement sufficiently powerful to threaten the interests of the global elite.
13. This will not happen overnight. We first need to spread a shared political vision around the right to health articulated in a clear, coherent and radical narrative to be widely communicated. We need to build alliances and the needed organization that will coordinate our actions.
14. Health can and must become a common thread for different struggles in many different places; it must connect causes and, through that, favor collaboration.
15. Day after day, mobilizations are gathering impetus fueled by the increasingly evident contradictions embedded in the unfair, harmful and oppressive economic system around us. The awareness that for the realization of the right to health it is necessary to multiply our actions at all levels, is growing. (Rosa Luxemburg Stiftung, 2018)
Claudio Schuftan, Ho Chi Minh City
Your comments are welcome at schuftan@gmail.com
All Readers are available at www.claudioschuftan.com
Postscript/Marginalia
-Come to think of it, not really facetiously, the current system recommends ten tips for staying healthy, namely: don’t be poor; don’t have poor parents; own a car; don’t work in a stressful, low paid manual job; don’t live in low quality housing; go on holidays; don’t become unemployed; take advantage of all the social protection benefits you are entitled to; don’t live next to a major road or near a polluting factory; and learn how to fill housing applications forms before you become homeless. (Gordon 1998)