Question

Why it is necessary for wealthier, more developed countries to share needed funds and technology to assist with developing countries’ major health and healthcare problems? What impact does this have on the health of the inhabitants of the developed countries as well as on the developing countries?

Answer 1

The health care challenge: services for those with need

The World Health Organization (WHO) is the premier organization looking at health issues around the world. When looking at the pattern of health care around the world, the WHO World Health Report 2008  found some common contradictions (see p.xiv, Box 1):

Inverse care

People with the most means – whose needs for health care are often less – consume the most care, whereas those with the least means and greatest health problems consume the least. Public spending on health services most often benefits the rich more than the poor in high- and low-income countries alike.

Impoverishing care

Wherever people lack social protection and payment for care is largely out-of-pocket at the point of service, they can be confronted with catastrophic expenses. Over 100 million people annually fall into poverty because they have to pay for health care.

Fragmented and fragmenting care

The excessive specialization of health-care providers and the narrow focus of many disease control programs discourage a holistic approach to the individuals and the families they deal with and do not appreciate the need for continuity in care. Health services for poor and marginalized groups are often highly fragmented and severely under-resourced, while development aid often adds to the fragmentation.

Unsafe care

Poor system design that is unable to ensure safety and hygiene standards leads to high rates of hospital-acquired infections, along with medication errors and other avoidable adverse effects that are an underestimated cause of death and ill-health.

Misdirected care

Resource allocation clusters around curative services at great cost, neglecting the potential of primary prevention and health promotion to prevent up to 70% of the disease burden. At the same time, the health sector lacks the expertise to mitigate the adverse effects on health from other sectors and make the most of what these other sectors can contribute to health.

Health care provision is incredibly complex and many nations around the world spend considerable resources trying to provide it. Many other rights and issues are related to health, inequality being an important one, for example. Education, gender equality and various other issues are also closely related. Viewed from the spectrum of basic rights, the right to health seems core.

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Health as a human right

As noted by the Office of the United Nations High Commissioner for Human Rights (OHCHR) and the WHO,

The right to health is relevant to all States: every State has ratified at least one international human rights treaty recognizing the right to health. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation and policies, and at international conferences.

The Right to Health , Factsheet 31, p.1, OHCHR and WHO, undated

The above fact-sheet also provides a useful breakdown of different aspects of rights to health, describing the relationship between health and

• Inclusive rights,
• Freedoms (from non-consensual medical treatment, from torture and other cruel or degrading treatments or punishments)
• Entitlements (to prevention, treatment and control of diseases; access to essential medicines; maternal, child and reproductive health; health-related education; participation; timely services)
• Non-discrimination
• Accessibility, acceptability and quality of services.

A wide range of factors, or determinants of health allow us to lead a healthy life, including

• Safe drinking water and adequate sanitation
• Safe food
• Adequate nutrition and housing
• Healthy working and environmental conditions
• Health-related education and information
• Gender equality.

Human rights in many of the above areas therefore also overlap with health-related human rights as also represented by this WHO diagram:

Promoting and protecting health and respecting, protecting and fulfilling human rights are inextricably linked. (Source: Health and Human Rights Linkages , from the WHO’s Health and Human Rights section)

Based on these and related principles, most nations strive for universal health coverage.

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Universal Health Care

Universal health care is health coverage for all citizens of a nation.

Does provision of universal health infringe on individual human rights? Some argue that a universal system requires some level of transfer of wealth from those who have to support those who have not. Any such transfer infringes on the freedom of the individual being taxed.

Others argue that providing access to health enables one to enjoy freedom, and as a society it is a shared responsibility (much like sharing the burden of funding a military or providing education for all). As such, social equity and individual freedom do not necessarily have to conflict. (See also this site’s section on poverty and inequality for more about the effects of inequality on all of society.)

At some point the debate becomes ideological rather than practical, and most nations that attempt universal health care, while often supporting individual freedoms see value in a society generally being healthy.

There are numerous ways such a system is provided, for example:

• Government funded (tax paid) national systems
• Government funded but user fees to top up (often at point of use)
• Health insurance systems (funded by governments, citizens, or some mixture)
• Decentralized, private systems run for profit or not for profit

Different parts of the world have used different means for health care and generally, poorer nations have struggled to provide adequate health care.

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Structure of a health service

At a high level, health services fall into different categories of health care:

1. Primary health care
2. Secondary health care
3. Tertiary health care

(Some systems may also have additional levels of separation.)

Primary health care

Primary care is usually the first point of contact for a patient. Primary care is typically provided by general practitioners/family doctors, dentists, pharmacists, midwives, etc. It is where most preventative health can be achieved and where early diagnosis can be possible, which may prevent more expensive hospital treatment being required.

By its nature, primary care involves communicating with patients, developing personal connections with patients, going out into the community, using outreach programs for promoting good health and preventative strategies, and more. As such, it can often be extremely cost-effective.