Another public health is posible
We talk about “another possible world,”
that “another economy” is possible,
that “other politics” are possible.
What has to change, nationally and internationally,
to make “another” public health possible?
The author lists four features of “another health”
inside “another economy.”
Teresa Forcades I Vila
Threateningly and ferociously, capitalism tells us that my freedom ends where yours begins. In contrast, Martin Luther King, Jr. told us that “until all are free, none are free.” This maxim, adopted by both anarchists and feminists, constitutes the very framework of what the new economy and its idea of health should be: “Until we are all healthy, none will be truly healthy.”
Only by getting beyond the dichotomy separating “I” from “we,” overcoming chimeric solitary self-realization, does it make sense to speak of public health in an alternative way. As I see it, the four main features of this “other public health” are: independence from commercial interests, de-medicalization, multiple treatment options within the highest scientific standards and a dialogical model for comprehensive patient care.
Independence from commercial interests The World Health Organization (WHO), the United Nations agency that oversees health at a global level, was established after World War II based on a free association of member countries pledging to provide it sufficient funds for the proper and independent exercise of its functions. In recent years, as the neoliberal crisis developed and national budgets were being gradually dwarfed by some mega-multinationals’ net profits, private capital has provided the WHO with such generous donations that it now accounts for over half of this key organization’s funding. One of the companies providing the most financing is Microsoft, through the Bill and Melinda Gates Foundation. In most cases, the groups of experts advising the WHO have been entirely established and funded by the pharmaceutical companies.
More than 75% of the financing for the European Medicines Agency (EMA), responsible for authorizing the marketing of drugs in the European Union and for watch-dogging the post-marketing appearance of any adverse side effects, comes from the very same pharmaceutical industry, which benefits from getting new drugs on the market as rapidly as possible and their slow withdrawal when the existence of adverse side effects is proven. The EMA is committed to maintaining a publicly accessible database on the side effects of drugs marketed in Europe but in practice it’s impossible to get useful information from this institution.
Medical schools, specialized medical journals, scientific conferences and basic clinical research now increasingly depend on these companies and their private economic interests. The alternative is to radically separate health from the market. Health isn’t a commodity, it isn’t bought or sold; it’s a person’s right and concerns society as a whole.
However, it’s not for the government or society as a whole to impose a healthy lifestyle, however reasonable that may seem. Driving without a seat belt or helmet, being sexually promiscuous or consuming alcohol, tobacco or other drugs shouldn’t be crimes in the new economy.
Why should we agree to the collective financing of lifestyles hazardous to health? Because these lifestyles would be completely viable economically if the speculative profits derived from marketing health were removed and because allowing them is the proper infrastructure for freedom in a trusting anthropology that doesn’t assume human beings should be controlled first and foremost, but rather should be empowered and encouraged. Those who should be controlled are the companies, not the people.
De-medicalizationIn the modern era, disease retreated as medicine advanced. Today, as medical advances proliferate, disease is increasing to the point where it’s now “normal” for even children to be diagnosed as having one or other named disease, and to take medication, have regular check-ups or accept lifestyle restrictions due to this label.
In the United States, 45% of adolescents have at some time taken psychoactive drugs for depression. In Holland, 10% of schoolchildren take psychoactive drugs for hyperactivity and attention deficit disorder. Social problems such as economic injustice are labeled as medical problems—depression or anxiety—and thereby depoliticized, individ¬ualized and pharmacologized.
De-medicalization occurs through dismantling the health-market relationship but also through changing our way of thinking about the meaning of life. To live longer can’t be a goal in itself; the goal is what you’re living for. Where does the WHO definition that “Health is a state of complete physical, mental and social wellbeing” leave the prophets? In what sense can we say the prophets have “complete social wellbeing”? Beware the danger of labeling social dissatisfaction as “unhealthy”! According to the WHO definition, Jesus of Nazareth would, in fact, be sick and so would all those who criticize hegemonic thought with “cognitive dissonance.”
Multiple treatment options Disconnecting public health from private interests will allow multiple treatment options, far more than currently exist, to emerge naturally. Acupuncture, neural therapy, homotoxicology, homeopathy, naturopathic medicine and a lot more should be studied with greater interest and should be fully integrated into the public health system, given their potential to solve or improve health problems and improve patients’ quality of life.
These treatments are currently reserved for people with higher purchasing power. The spurious debate between “conventional medicine”—pharmacologized and led by economic interests—and “alternative medicine” is to be avoided at all costs; as if only conventional medicine is scientific and the so-called alternatives are based on obsolete traditions that can’t stand up to rigorous research. This isn’t true. Evidence Based Medicine (EBM) has shown that more than 70% of treatments championed by conventional medicine don’t have sufficient scientific basis to back them up; they are used either as a matter of routine or through associated commercial interests. Science and scientific method must remain one of medicine’s essential arms; the other being the art of medical practice.
The dialogue model of patient careThe respect due to everyone just because they exist should be even more powerful in the case of sick people, because they are the most vulnerable. It isn’t utopian to organize health services so they prioritize personalized care; it’s the basis of satisfaction for both the health professional and the patient.
Being sick and dependent can be an enriching experience, both personally and communally. There’s a painting in the doorway to the infirmary of the Bose monastery in Italy showing a young monk carrying an elderly monk on his shoulders. The inscription accompanying this painting reads: “Who’s carrying whom?”
Because they only value monetary wealth, current debates on public health totally rule out the possibility that sick people or elderly dependents are a source of wealth for society. In monasteries, and in many homes that have not yet been merchandized, experiencing sickness and dependence can still be an opportunity for growth, not only for the sick person but also, and especially, for the caregivers.
How do we look at an elderly or sick person? What message do we give him or her? In the new economy the sick or dependent person can never be seen as just or even mostly a burden because, in a privileged way, the depth of a person’s dignity is revealed in him or her, an anthropological dimension open to transcendence that, independent of productivity and utilitarian criteria, gives dignity to human beings.
In the words of Sister M. Nativitat, who was 100 years old when she died in my convent: “This body is of no use but it’s mine and I love it.”
Teresa Forcades I. Vila is a Catalan Benedictine nun, public health doctor and theologist. This text appeared in the World Latin American Agenda for 2013 under the title “La salud pública en la otra economía.”