[TLDR (too long didn’t read): If you are reading this, chances are you care about HR. This Reader is about health systems moving into the private sphere against all logic and against social justice. For a quick overview, just read the bolded text]. Traducir/traduire los/les Readers; usar/utiliser deepl.com
If we lived in a democracy, we would have a fully public medical system, because the majority wants it (Susan Rosenthal)
–The fact that we do not have such a system proves that we do not live in a democracy.
1. Businesses and governments view public-sector spending as a drain on the economy. While public facilities can deliver social services more effectively, this costs money! The same services delivered for profit in the private sector make money –and that is seen as a benefit for the economy.(?) The way things are, every medical service that can be removed from a hospital has been or will be removed soon. The only services left in the public sector will be those too unprofitable to privatize. Hospitals themselves are being privatized through Public Private Partnerships (PPPs). PPP hospitals are built with public funds and managed by a private corporation. (…?) When nurses demand staff-to-patient ratios, and when anyone demands higher wages, it is seen as if they are challenging the primacy of profit, the foundation of capitalism.*
*: To maximize profits, private clinics will do simple surgeries such as cataracts, and hip and knee replacements, leaving more difficult, complex surgeries in the public system. When clinic surgeries become complicated, patients will be off-loaded to the public system, along with the cost of treating their complications (assuming patients survive the transfer). The push for maximum profit also inevitably leads to fraudulent billing.
2. Who can we count on to protect our health services, then? Corporations in the field are surely not required to protect the public interest. Politicians will not protect the public when doing so means angering the business class and losing corporate donations. The only people we can really count on are those who work in public health services, because their job conditions directly affect the quality of services.
3. Who would you rather manage a hospital? Executives and bureaucrats obsessed with the bottom line? Or medical and support staff who actually do the work? We need to stop wasting time on what does not work, and face the problem squarely. (S. Rosenthal)
In health, we have continued to be tied to concepts of the Global North that do not respond to the peculiarities of the South (Oscar Feo)
4. It is not enough to win elections and come into government to sever these ties (we have already tried this and not always with success. First, we must ask ourselves: do we come to government to manage what we have, or to build and manage something new? This, since we repeat a discourse that does not belong to us. As a result, we end up promoting targeted, non-universal, disease-centered social policies, often based on conditional transfers, typical of neoliberal policies.**
**: There is a perennial problem with targets, and that is that we think they are always still reachable –until they are not.
5. We must, therefore, rethink and reformulate health systems and this requires deconstructing and dismantling this categorical framework that expresses coloniality and dependence on the North. This, in order to build a system of categories that allows us to rethink health and health systems from the perspective of the South.
6. In the territories where lifestyles and health are socially constructed, we do not need vertical and centralized programs, but need communities and health workers to trigger and bring about processes and links based on comprehensive primary health care and buen vivir. For all this, we must put at the center of social policies actions that address the social determination of health.*** (O. Feo)
***: Health does not begin in clinics or hospitals any more than justice begins in law courts or peace starts on the battlefield. Rather, health starts with the conditions in which we are born and raised, and in schools, streets, workplaces, homes, markets, water sources, kitchens, and in the very air we breathe. (Tedros A. Ghebreyesus)
7. Worrying
- Diseases are not a calamity, but an extremely profitable business for investors who profit from these things. The pretext used is of biblical simplicity: public facilities are insufficient and inefficient, so this creates space for private activity. …Aha! but public facilities are more and more insufficient, because neoliberal governments reduce investments and staffing, close public hospital and clinics, on-and-on… (Louis Casado)
- We do not have medical schools merely to explain diseases; we have medical schools to cure diseases. We do not have schools of public health merely to explain epidemics; we have schools of public health to prevent and control epidemics. These disciplines should be moral (and political) disciplines, in the sense that they should aim to improve the world, not merely to explain or predict it. Getting there is within reach in a very practical and affordable sense. But… (Jeffrey Sachs)
- Ensuring patient rights is an extension of applying human rights principles to health care. Patient rights discourses are not based upon human rights notions. In the context of neoliberalism, they are predominantly embedded within the logic of quality of care, economic, and consumerist perspectives. Relatively powerful actors such as care-providers and health facility administrators use a panoply of discursive strategies such as emphasizing alternate discourses and controlling discursive resources to suppress the promotion of patient rights among care-seeking individuals in health facilities. With neoliberal health policies promoting austerity measures on public health care system and weak implementation of health care regulations, the patient rights discourse remains subdued. health facility administrators and care-providers wielded power to oppress care-seeking individuals. (Meena Puttaraj et al)
8. Not less worrying
- WHO at 75 is a technocratic institution dependent on the politics of its member states, with too little socio-political autonomy to advance truly global public goods for health. Health systems and social determinants look rather downgraded and it is UHC (and not PHC and a NIEO) that gets mainstreamed. (Remco van der Pas)
- It is important to note that WHO, however ideal we might envision it as an institution for realizing the right to health, is not a panacea and, in times of crisis, these institutions will fail. No institutional model is perfect, but WHO can be significantly improved. To do so this will require considerable political and financial support from member states. It requires the Organization to audit and radically revise its mandate, scope, financing and relationship-towards and with member states. The starting point for WHO reform must be to assess what states want and seek from it and to work to create that vision of the Organization, rather than continue with the mismatch between expectations, achievements and failures that only creates broader challenges later in the perceived success of a flawed WHO. (Clare Wenham, Sara Davies)
Claudio Schuftan, Ho Chi Minh City
Your comments are welcome at schuftan@gmail.com
All Readers are available at www.claudioschuftan.com
Postscript/Marginality
–COVID may have felt like a catastrophe for rich countries, but do not poor countries have far more pressing problems? (Alison Katz) Food for thought.