Today, health is people’s main concern.
I would like to share with you some thoughts on the description of four challenges which, I believe, beveridge health systems must face (that is, national health systems based on equality and egalitarian principles):
1º The challenge of pragmatism
In politics, ideology, by force of circumstance, gradually gives way to pragmatism.
The meaning of the word pragmatism – “the doctrine according to which practical matters are the criteria of knowledge, as opposed to intellectualism” – speaks for itself.
In fact, politics is more and more concerned with issues affecting people’s everyday lives, such as health, education and social security, among others.
As an example of this, Mr. Obama’s health reforms played a central role in the latest presidential elections in the US.
Pragmatism prevents health policies from being irreversibly affected by ideological and ephemeral aspects, by the “isms” that have brought about so much tragedy in the entire world and drives health away from the most adequate solutions.
It is when the debate becomes a partisan dispute, depending on budgetary and electoral cycles, that solutions are compromised or postponed.
2º The challenge of transversibility
According to WHO, “health promotion activities are carried out on a daily basis and comprise initiatives involving social, personal and physical resources, in addition to disease-oriented interventions”.
The global improvement of health conditions must rest on basic factors, such as reasonable income levels, good living conditions and adequate nutrition, apart from the access to information, the acquisition of social skills, the presence of a market offering healthy products, services and equipments, and economic, social and environmental conditions for the advancement of health.
Today, we can observe that the most common non-communicable diseases, such as cardiovascular conditions, cancer and chronic respiratory disease, share several risk factors like tobacco use, alcohol abuse, sedentary habits and inadequate diets. These risk factors are determined by economic, social, gender, political, behavioural and environmental factors and call for multi-sectarian answers that national health services must be able to coordinate. Many oral diseases share these same risk and determining factors. They are also a huge public health problem due to their prevalence and incidence in every region of the world and, as in all diseases, they affect less privileged and socially marginalised populations.
These chronic diseases, together with technology, lack of information and an aging population, lead to a growing tension within the health systems of the world’s most developed countries. And these tensions, leading to a restriction of the services provided by public health systems, do not depend on their efficacy or efficiency…
It is therefore necessary to look at health in a transverse way and from different viewpoints which take into account other sectors like education, social action, civil education and economy as a whole. As an example, we can mention that about 10% of the Europeans work in the health sector, which accounts for a substantial part of the economic activity in Europe.
3º The challenge of accountability
I am persuaded that the challenges facing the Welfare State, such as health, education and social security, are not only a matter of finance but also a matter of civil and educational awareness.
It is necessary to develop a pedagogical activity among the population, in order to make people aware of their rights and duties.
I think that at least part of the debate and of the solution, has to focus on the issue of accountability. Not only to define everyone’s rights, but also to develop a reciprocity mechanism regarding the duties of those involved in defining a policy for our health systems, as well as the duties of the entire society, of users, of decision makers and of all health professionals.
Citizens must be aware that we all have duties in what concerns health.
Those duties are upholding and promoting health, which involve the principles of self-accountability, the adoption of healthy lifestyles, the observance of basic notions of education and health promotion, and shared accountability for its financing.
4º The challenge of sustainability
Providing everyone with the right to health protection demands a change of several paradigms, such as making people deeply aware that health care is not free. Today, this is a perverse notion in terms of sociological behaviour. However, health services are indirectly funded by all, or at least most of us, through our taxes.
It is pointless to try to avoid reality and think that is possible to freely provide everybody with all they need…
Health systems need to be more flexible in order to better and faster adapt to the ever changing socioeconomic realities.
We must remove the ideological issues from our debate about health systems. We must make it nonpartisan, take it to the level of citizenship and have a pragmatic, transverse, individually responsible and financially sustainable approach.
In all the world, health also needs comprehensive social and political contracts.
For the sake of our health!