For one to be a revolutionary doctor or to be a revolutionary at all, there must first be a revolution. Isolated individual endeavour, for all its purity of ideals, is of no use, and the desire to sacrifice an entire lifetime to the noblest of ideals serves no purpose if one works alone, solitarily, in some corner of America, fighting against adverse governments and social conditions which prevent progress.
When we talk about fixing healthcare, it is common to focus on the healthcare system in America. Whether it’s because it is natural to try to solve the problems that are right in front of us, or because the inequalities of the American healthcare system are so great, we tend to think our problems are isolated from the issues facing the rest of the world.
They’re not. To fix the American healthcare system, we have to work together to create a healthcare system that works for all of us. We can’t talk about creating a healthcare system that works for everyone while wars are raging often impacting hospitals, the IMF prevents public health funding, and our drug companies profit from selling expensive drugs while contributing little to prevention efforts. These aren’t characteristics of a country that is ready for a better healthcare system, particularly if it comes at the cost of less wealthy nations.
When we’re ready to take on the problem of creating a better healthcare system for all of us, we face a daunting task. It’s not simply a matter of everyone having access to the necessary medical care and drugs. It is vital that we take into account the social determinants of health, which take include the social aspects of health which are not controlled by an individual. At the recent WHO conference on Social Determinants of Health, a group of public health advocates rejected the proposed statement in favor of a more comprehensive one which addresses the root causes of health inequality. From their response: “Protecting the Right to Health through action on the Social Determinants of Health: A Declaration by Public Interest Civil Society Organisations and Social Movements” (PDF):
1. Implement equity-based social protection systems and maintain and develop effective publicly provided and publicly financed health systems that address the social, economic, environmental and behavioral determinants of health with a particular focus on reducing health inequities.
2. Use progressive taxation, wealth taxes and the elimination of tax evasion to finance action on the social determinants of health.
3. Recognise explicitly the clout of finance capital, its dominance of the global economy, and the origins and consequences of its periodic collapses.
4. Implement appropriate international tax mechanisms to control global speculation and eliminate tax havens.
5. Use health impact assessments to document the ways in which unregulated and unaccountable transnational corporations and financial institutions constitute barriers to Health for All.
6. Recognise explicitly the ways in which the current structures of global trade regulation shape health inequalities and deny the right to health.
7. Reconceptualise aid for health from high income countries as an international obligation and reparation legitimately owed to developing countries under basic human rights principles.
8. Enhance democratic and transparent decision-making and accountability at all levels of governance.
9. Develop and adopt a code of conduct in relation to the management of institutional conflicts of interest in global health decision making.
10. Establish, promote and resource participatory and action oriented monitoring systems that provide disaggregated data on a range of social stratifiers as they relate to health outcomes.
These are the types of radical changes needed to create a healthcare system that works for all of us. We need to bring healthcare, and healthy living, within reach of everyone. In a society as advanced as ours, healthcare should be a human right. Not just for me. Not just for America.
Healthcare should be a human right- for all humanity. Will you work to help create a global health revolution?