Tonight I attended International event numero 4, a talk co-hosted by IAS, African Studies, Anthropology, and a group for the study of Africans and African American culture. The presentation was about the exceptionalism mentality surrounding HIV; the interplay between perceptions of HIV, perceptions of Africa, and perceptions of Ebola; and a smattering of other African health systems topics. The presenter, Dr. Adia Benton has a book out, “HIV Exceptionalism”, which I, unfortunately, have not read. Her talk focused on the failings of international NGOs, institutions, and African countries at building and maintaining a health infrastructure that equitably gives treatment and effectively manages disease. HIV is seen as the most important matter to control so it receives the most outside funding, leaving other common, equally lethal diseases untreated. Additionally, in responses to crises like Ebola, we can see the remnants of colonialism and racism in the way outside countries portrayed and reacted to the outbreak, and obviously, we can see the shortcomings of not only African countries’ health infrastructure, but in the method of data collection and sharing in public health.
What I want to write about (and, in the process, think about), then, is the idea of healthcare as a right:
As a pre-medical student I hear it thrown around all the time, healthcare is a right. I think a lot of us accept it, take it for granted, don’t even really think about the consequences of that idea. It sounds great, right? I mean how could healthcare not be a right? No one asked to get sick. No one can control their cancer diagnosis, their congenital blindness, their HIV positive status. Why should they be punished for this when treatments exist that can end or ease their suffering? That’s inhumane. That’s inequitable. As a doctor, if someone comes to me with a dire sickness I can treat, I feel like I have a duty to help them or at the absolute least get them help even if they cannot pay for it.
How can we say, though, that healthcare is a right when the vast majority does not have access to healthcare, or at least does not have access to reliable, affordable healthcare? It can’t be considered a right if only a privileged few have it – that’s a privilege, and we’ve all declared its not a privilege. If healthcare is to be a right, it needs to be accessible everywhere and affordable for everyone. And this isn’t just an international issue or just a domestic issue. It is most certainly both. And I don’t think any country has gotten it fully right yet. Public health systems like in the UK, while they do give access to all at little to no cost, also grow huge lines in hospitals, waiting lists for life saving surgeries, and a culture of quantification of health (economics over care in some instances, it seems). Private and mixed public/private systems like here also have obvious flaws in that many are left out of the elite who can afford health insurance and its basically unimaginable that one could afford a medical crisis, even a minor one, without health insurance. Then there are countries in the developing world where the idea of health insurance is funny because there are problems so much more basic than that that need to be addressed first. While we say healthcare is a right, with the state of global health today, we clearly have yet to put that ideal into practice and I think that is a problem that needs to be rectified.
That sounds great, right. Healthcare is a right. We can all agree it, let’s all implement it, we’ll be fine. Except that it is super expensive, super time intensive, and needs lots of talented doctors to even have a chance at success. Realistically, I think the best we can hope for in the foreseeable future is universal primary care- that is doctors like general practitioners and pediatricians everywhere to provide quality preventative care and general healthcare. While this will still leave a lot of the world without reliable access to difficult surgery, etc. it will at least be a start.
There are additional questions to consider, also, though. In an international sense, who should have the power to implement these new health institutions? How much power should outside forces be able to wield in these sovereign states? Additionally, in the case of countries that can not currently afford this standard of care for all their citizens, who will pay for it? How will this many doctors be recruited into primary care and how will they be educated?
So I’ll just leave that there for us to think about. I certainly don’t have all the answers, but I do think these are important questions and I think we should really evaluate the state of healthcare in the world today.