Healthcare for all

Siddhartha Mehta

For decades, we have been sold a myth of private health. It is a myth that our health is largely a product of individual choices and personal responsibilities. It is a myth that our healthcare is a service that private corporations can provide, and for which we must pay to survive.

But the COVID-19 pandemic has blown up this myth.

Our personal health cannot be separated from the health of our neighbors or our planet. Nor can it be separated from the structural factors and policy decisions that have determined our health outcomes long before we are born.

The right to health, in the context of these interconnections, is a universal right. Your life is worth no more and no less than that of your next-door neighbor because the fates of the two are so intimately entwined.

Today, the universal right to health is not held back by scarcity of resources or a lack of technology. On the contrary, the wealth of this world – invested well – could end the pandemic before the year’s end.

Instead, we are held back by another myth: that there exists a trade-off between public health and the health of the economy. The assumption of this trade-off dictates that all public policy is subordinate to the great god of economic growth – even if it costs us our lives. The concept of private health grows out of this second myth, which makes a commodity of our bodies, and a market for essential healthcare services.

Indeed, public health systems around the world are structured carefully to serve a profit motive. Unsurprisingly, their outcomes are inequitable and insufficient, leaving poor and marginalized communities with no recourse to private health provision.

Drawing on the evidence of health impacts of the coronavirus pandemic and the impact of policy responses, theracial, gender and class dimension in the impact of the virus is undeniable. The raw reality of systemic fragility of both public health and economic systems in the North in dealing with the social crisis has also been brought to the fore. Those countries that have been successful – such as Vietnam, Cuba and New Zealand – viewed public health as economic wealth.

Once again, we return to the basic premise. Health, in all its dimensions, is a public good.

How can we deliver a world that reflects this simple premise?

The first step is decolonization. Countries in the Global South cannot deliver on the promise of public health when they are curtailed by neocolonial conditionalities that come along with philanthropic funding and multilateral lending. This top-down approach strips countries of their sovereignty over how to fund health services, privatizes health infrastructure and cripples social policy provisions.

Most of these countries assured universal health services as a matter of course in the 1960s and 1970s. Then came structural adjustment. The imposition of the Washington Consensus in the course of the 1980s and 1990s led to a radical reframing of the health sector as a profitable site of privatization and deregulation. The introduction of user fees and prioritization of imported, high tech-fixes forced millions of poor people to the margins, as “private health” became the norm. Provision in the form of “minimum packages” took priority over comprehensive primary and community health.

Public health, then, requires public ownership – a form of ownership that can deliver transparency and foster citizen participation in the delivery of healthcare services. Public sector clinics, homecare companies, and biomedical enterprises should be built to assure the production and distribution of essential medicines and medical technologies as well as healthcare services.

Free from the structural constraints of shareholder primacy and profit maximization, these enterprises will be able to prioritize preventative and curative technologies, fill gaps in existing treatments, and provide products at or below cost where necessary to meet public health needs.

Excerpted: ‘All Health Is Public Health’

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