Redeeming The Silence In The World Of Health

REDEEMING THE SILENCE IN THE WORLD OF HEALTH P. Aris Miranda, M.I. The present global health situation reveals a stark contrast between the scientific advancement in the field of medicine and the immense inequities of health status among highly developed and developing countries. Remarkable improvements have been made in health status worldwide over the last century, but these improvements have not been shared equally. The gap between rich and poor nations has widened, as have inequities within countries, between urban and rural, men and women, and young and old. The recent World Health Report 2008 by the WHO has affirmed that, while globalization contributes to the improvement of the global health condition, it is also “putting the social cohesion of many countries under stress, and health systems, as key constituents of the architecture of contemporary societies, are clearly not performing as well as they could and as they should.”1 Why this is so? What causes these iniquities? There are no easy answers to this complex global health situation, unless one grounds himself into the reality, examines it with a critical eye and responds to it with a creative compassion. It is a clear invitation to redeem one’s prophetic vocation as real ministers of the infirm. It is then, a challenge to build ones commitment with burning passion to love and care for the poor sick even in danger to ones life. Since last year, almost everyday I passed by via del Corso in Rome on my way to the university. The place is very historical and significant for us Camillians since the hospital of St. James of the Incurables where St. Camillus founded our Order is located. But in September, I was surprised to see a big banner spread from the roof to the ground of the hospital where it is written “SALVIAMOCI L’OSPEDALE” (Let us Save the Hospital). The place that used to be the savior of all the wretched, vagabonds, and abandoned sick in the society is now in need of a savior. It has been closed. Though it can’t be denied the fact that after four centuries since the time of St. Camillus in this hospital, an immensed change of the situation took place. What it was then, now becomes a memory and a part of the human history and testimony. St. Camillus has revolutionized (the new school of charity) once the operation of this hospital by putting first the person of the sick above anything else. He did everything for the patient even amidst criticisms of the ecclesiastical and civil authorities because he saw in the sick, the person of Christ and realized himself to be the bearer of the merciful love of Christ to the sick. Everything in the hospital is subjected to the person of the sick and not the other way around. Closing down of public health institutions, rationalizing its operation, privatizing its management, transforming it into profit-driven investment, etc. are just the toppings of the worsening global health politics brought about by monopoly global economic system. The global economic crisis becomes the pretext of several States both in the developing and in highly

developed countries to lessen their responsibility of strengthening the public welfare services such as health, access to water and affordable medicines, and converts these institutions into profit-oriented institutions in the name of rationalization, efficiency and redemption of the ailing national economy at the expense of the majority who lives with less than $2 a day. According the WHO annual report, the annual government health expenditure varies from as little as $20/person as to over $6,000/person. More than 5 billion people in the world drew out their health expenses from their own pockets. This accounts 91% of their total health expenditure. About 150 million of them or more suffered from catastrophic health care costs every year. Catastrophic spending are expenses on health coming from their own pockets, that pushed them to the margin of society and live much beyond the poverty threshold. In simple terms, sickness pushes them to extreme poverty and an inhuman condition of life. The differences of life expectancy between the richest and the poorest countries now exceed to 40 years. In the low income group there are only 5 physicians and 10 hospital beds per 10,000 population and while in the high income group there are 28 physicians and 59 beds per 10,000 populations. In terms of maternal mortality, the ratios of deaths per 100,000 live births are the following: 9 in highly developed countries, 450 in developing countries and 900 in subSaharan countries. In terms of HIV+ cases, one in every three people in the world living with HIV lived in sub-Saharan Africa, a total of 22.5 million, 4 million in South and Southeast Asia, 1.6 million in Eastern Europe. It is estimated at 6,800 persons infected with HIV everyday and about 6,000 died everyday.2 The following picture of the global health condition shows gross shortcomings of health care delivery particularly in the low and middle income countries. These shortcomings are revealed by inequalities in health care. There is a situation of an “inverse care” which means that people whose needs for health care are minimal and has the means, consume the most, while people with less resources and have greater health needs consume the least. There is a phenomenon of “impoverishing care” where people lack social protection and payment for care is pushed to the margin of extreme poverty. According to the study done by the National Association of County and City Health Officials (NAACHO) in USA, “the so-called disparities in health status among different population groups are unjust and inequitable because they result from preventable, avoidable, systemic conditions and policies. If health inequities are unfair, effective action to eliminate them demands a perspective and conceptual framework grounded in values of social justice.”3 If the major problems are systemic in nature, why is it that the States failed to address this perennial predicament? If the States can procure greater budget for arms and defense (for high income countries) and foreign debt-servicing (for low and middle income countries), why is it not reasonable to procure more for health and promotion of life? Globalization of politics and economy places more control of the flow of capital and world’s resources into the hands of the few multi-national

corporations that incapacitates national governments to influence their own economic policies. According to the Nobel Memorial Prize awardees and a former chief economist of the World Bank, Joseph Stiglitz commented, “that American and other western drug companies could now stop drug companies in India and Brazil from “stealing” their intellectual property rights (IPR). But these drug companies in the developing world were making these life-saving drugs available to their citizens at a fraction of the price which the drugs were sold by the western drug companies.”4 Commercialization of health becomes the trend of the day. Health ceases to be a basic human right, and now consider as a lucrative commodity. Mission hospitals, non-profit health institutions and public hospitals are tied up to the dynamics of cost recovery system and shifted the cost of services to the end-users (patients) in an attempt to compensate for the chronic financial situation of these institutions. As Fr. Healy remarked in his speech during the 56th General Chapter: “… institution tend to take on a life of their own. Rather than to care for the true needs of the people for which it was founded, the institution serves its own needs especially the needs of its own bureaucracy. In this process right relationship are undermined the balance of justice tilted and the common good forgotten.”5 The people wants healthcare that heals more the person as individuals with rights and not as mere targets for programs or beneficiaries of charity. Health is an integral part of how they and their families go about their daily struggles in life towards better living and perfection of ones vocation to holiness. Centuries ago, St. Camillus was fully convinced of these principles in his life, because he lived and suffered with the sick and saw in them as the true sacrament of Christ’s eternal presence. In order to translate these convictions into reality, as the WHO proposes, one must engage in health activities that promote universal coverage, access and social protection; that organize itself around people’s needs and expectations; that promote participatory and negotiation-based leadership; and lastly, one that upholds the values of social justice and right to better health for all.6

1WHO, The World Health Report 2008: Primary Health Care, Now More Than Ever, WHO, Switzerland, 2008 p. xi. 2Ibidem, pp. 2-13. 3NAACHO, “Creating Health Equity through Social Justice”, 2002 p. 16, at http://archive.naccho.org/documents/healthsocialjusticepaper5.pdf. 4STIGLITZ J., Globalization and Its Discontents, Penguin Books, London 2002, p. 8. 5HEALY S., Justice in a Changing World, in MINISTERS OF THE INFIRM – Documents, n. 20 (2008), P. 448. 6WHO, The World Health Report 2008, pp. ix.