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Good public services build a healthy society, not insurance covers

The social logic of public health services needs to be reclaimed if a real difference in health outcomes are desired.

By Sarojini Nadimpally & Deepa Venkatachalam

Published: Mon 30 Sep 2019, 9:00 PM

Last updated: Mon 30 Sep 2019, 11:20 PM

From the Rohingya exodus to Bangladesh to the deaths of children due to acute encephalitis syndrome (AES) and the current health situation in Kashmir. From the relentless conflict, cholera and food crisis in Yemen and the war, forced migration and hunger in Africa to the economic crisis in Venezuela - all these and many other contexts in the world today reflect the centrality of health. These examples draw attention to the health situation as a consequence of the inequitable distribution of social, economic and political power, the contours of which are increasingly shaped by neoliberal policies.
Most of the world today is in a constant struggle to gain access to the determinants of health, including gender and social justice, food security and sovereignty, safe drinking water and sanitation, housing, education, reduction of poverty, gainful employment and equitable and inclusive development, better working and living conditions, and an end to various forms of violence, conflict, war, militarisation and discrimination, etc.
Moreover, healthcare continues to be accessible only at extremely high economic costs and social hardship to a vast number of people, a majority of whom live in lower- and middle-income countries, and comprise primarily of girls, women, children and others marginalised due to race, caste, ethnicity, disability, sexuality, etc. Access to the determinants of health and quality and accountable healthcare is thus a global emergency.
Many of these concerns were acknowledged and sought to be addressed by the Alma Ata Declaration on Health for All more than 40 years ago.  However, there has been an evident shift in the health discourse from universal care to universal coverage over the past decade or more. Universal healthcare is built on the concept of health as a human right; the right to health and healthcare as universal, inalienable, indivisible and interdependent. The focus on "coverage" and not "care" is a serious concern.
As Dr Amit Sengupta, well-known activist and a coordinator of the People's Health Movement (PHM) argued: "UHC is essentially designed to universalise 'coverage' rather than 'care' which is built on, and lends itself to, standard neoliberal policies, steering policymakers away from universal health options based on public systems," and "in glossing over the importance of public provisioning of services, many proponents of UHC are actually interested in the creation of health markets that can be exploited by capital."
UHC, especially in a number of lower- and middle-income countries is often translated into state-funded health insurance schemes, which has furthered the privatisation of the public health services. The coverage model does not envisage provisioning of comprehensive healthcare nor its quality; its focus is on a pre-defined package of services that excludes a bulk required to address the health needs of the people.
Further, evidence of these insurance schemes indicates that they have neither provided protection from high out-of-pocket healthcare expenses, nor have they facilitated equitable access to quality healthcare. On the contrary, evidence reiterates that strengthened public-sector financing and provisioning, and 'care' not 'coverage' along with access to the determinants of health, are necessary to transform people's health and lives.
The social logic of public health services needs to be reclaimed if a real difference in health outcomes are desired. Moving toward 'health for all' or 'building a healthier world' require transformations not only in the area of healthcare but also in a wide range of determinants of health. This is an impossible task unless the role of transnational in?uences and forces, including that of the private sector, multi and bilateral trade agreements that impact health outcomes - especially of the most marginalised - are challenged.
The reality of a healthier world is extremely distant until peace, equality, justice, democracy, human rights are restored and protected and unless countries agree to public health systems that are accountable to all people and communities they serve.
Until then, the struggle must continue.

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