Guaranteed Access to Healthcare
A growing chorus of people around the world is insisting that health care is a human right and that it must be guaranteed by the state. The Geneva Conventions and the Universal Declaration of Human Rights of the United Nations provide the legal framework for this fundamental right, while many national constitutions, such as those of El Salvador and South Africa, enshrine it. Grassroots movements like the People’s Health Movement add muscle to ensuring that the right is respected. And where the resources or the political will don’t exist, community networks meet local health care needs themselves.
That guaranteed access to health should constitute an alternative is bizarre; through any reasonable logic, this basis for survival should be the norm. Yet, as the World Health Organization's Commission on the Social Determinants of Health states, “Social injustice is killing people on a grand scale.” The Commission attributes the fact that the majority of the world’s inhabitants do not have the good health that is biologically possible to “a toxic combination of bad policies, economics, and politics."
In most countries, access to health services remains a privilege for those who can pay. Even where governments have made the commitment on paper, the real test is the provision of services, which usually falls far short of the rhetoric. Universal health care is, indeed, a tall order, especially in countries where crises like AIDS and drug-resistant tuberculosis are overwhelming government capacity as they ravage populations.
But often, the real question is how a government chooses to prioritize its spending. And here, governments themselves fall ill in a pandemic which threatens public health: ‘free’ market ideology – what is called ‘neoliberalism’ in most parts of the world – which insists that profit is the principal goal. Michael Moore, the U.S. filmmaker who created the documentary film, “Sicko,” said: “When it comes to taking care of people when they're sick, that question of ‘How will this affect our profit?’ is an immoral question and should never be asked!”
It is possible for a nation to offer quality health care for all. France, a high-income country, and Cuba, a low-income country, show that this is so. They lead the world in guaranteeing health care as part of the global commons. In Cuba, under the government's Family Health Program, a doctor-nurse team provides free care, from pre-natal attention to geriatric medicine, in each neighborhood, – or, in crowded zones, on each block. Babies, for example, get a check-up every week in their first month, then every two weeks for the next three months, then once a month until their first birthday. The family health centers are open eight hours a day for regular appointments and around the clock for urgent cases. These centers are supported by more than 400 decentralized clinics that house a variety of specialists from OB-GYNs to cardiologists and dentists; these clinics are open 24 hours. It’s all guaranteed and all free – though medical supplies have dwindled greatly, sometimes dangerously, under the U.S. embargo.
France’s commitment is premised on the idea that the government has an obligation to the welfare of its people. The French system’s slogan is, “Everyone contributes according to his resources and receives according to his needs.” And this is not just rhetoric; ever since the 1940s, France has made budgetary decisions to turn this dream into reality. All legal residents have access to coverage, and immigrants gain the right to access after three months (though spiraling xenophobia has created restrictions in practice). Those served by the medical system – including the very poor and the gravely or chronically ill – are likely to receive better care than anywhere in the world. Moreover, in France, the sicker you are, the less you pay. Dire illnesses like tuberculosis or cancer, chronic conditions like diabetes, and major operations like open-heart surgery are covered by the state at 100%.
At this moment, an impoverished, undocumented, African, single mother with HIV can still receive excellent care, all completely free of charge. Those who believe that health care should be protected as part of the global commons are convinced that that is just as it should be.
But in France, as in many other countries, the neoliberal sword is now slicing away at universal access. Bernard Teper, coordinator of the National Coalition against Franchises and for Access to Care by All, commented to us, “More and more health is becoming a commodity. We are entering into the logic of the market.” As some in French civil society have realized, a strong health care system can only survive provided that the populace fights to protect it. The effectiveness of a population’s advocacy may be the critical variable in whether or not low-income people get health care.
The French health care movement is still building its strength, but elsewhere, when governments abandon their social responsibility and let corporations and international organizations like the WTO and World Bank take over, grassroots movements have been fierce in taking health policy into their own hands.
South Africa offers a remarkable example. There, government lethargy and international corporate power were met by a highly mobilized civil society, demanding access to HIV-AIDS drugs as a human right. The costs of patented HIV-AIDS drugs, which at US$15,000/year for a typical treatment were prohibitive for virtually all South Africans, contributed to a political climate that made possible the 1997 passage of a cutting-edge law. The Medicines Act allows the government or local companies to manufacture drugs, even if they didn't own the patent for them.
Still, the victory was not won. The U.S. State Department and pharmaceutical companies, concerned that low-cost AIDS medicine in the global South would undermine intellectual property rights and hurt the lucrative market in the industrialized North, mounted opposition. The South African government began denying that HIV causes AIDS and started questioning if medicines would do any good.
In response, the Treatment Action Campaign (TAC) and its allies began a powerful campaign for the implementation of the Medicines Act. Two anecdotes give insight into how the grassroots movement broke down the opposition. First is the case of then-Vice-President Al Gore, who lobbied South African government leaders to reverse their policy of support for producing affordable drugs. As he prepared his bid for the 2000 presidential elections (in a campaign funded in part by big pharmaceutical corporations), TAC’S allies in the U.S.-based AIDS Coalition to Unleash Power (ACTUP) began to systematically protest at Gore’s campaign events, holding up posters reading “Gore’s Greed Kills African Babies!” behind his head during television appearances on the stump. As a result, Gore changed sides and withdrew his opposition to the Medicines Act. In a second instance, when the Pharmaceutical Manufactures Association of South Africa filed a lawsuit against the Medicines Act, protests by TAC, ACTUP, Doctors without Borders, Oxfam, and others were vigorous enough to compel the association to withdraw its suit in 2001. At the end of the day, ongoing demonstrations by the public, together with lawsuits brought by non-profit advocacy groups, won patent battles and got local generic medicines produced in large scale, with 700,000 beneficiaries now receiving these in South Africa.
Another recent mobilization of citizens on behalf of health rights took place in El Salvador, where tens of thousands joined striking health workers in a series of 'White Marches' over a six-month period in 2002 and 2003. Salvadorans were protesting the government’s proposal to privatize portions of the social security health system as a condition for multinational lending. After months of polarization, the government, as well as the World Bank, backed down on privatization plans in June 2003. Another ‘alternative’ to the crisis in health care is not really an alternative at all, but an ancient tradition of community provision of medicine, preventive health, and healing. In many a country, along with the village or neighborhood healer, organized networks of doulas, midwives, and health promoters are making the difference between life and death in community settings. Many community health networks also advocate for health rights with governments and health ministries.