Developed World paid heavy price for ignoring Public Health, arrogance and over confidence in provision of quality healthcare to its people

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Morbidity and mortality due to Covid19 Pandemic
Developed World paid heavy price for
ignoring Public Health, arrogance and
over confidence in provision of quality
healthcare to its people
Countries which valued Public Health as
Economic Wealth had much better results
Neo-colonial conditionalities attached with
philanthropic funding & multilateral lending
should end if World is serious to help LMICs
to help improve their health indicators

KARACHI: Only a few years ago no one would have imagined that the developed countries in the West will have to face such a serious crisis in healthcare which it had to during the current COVID19 Pandemic. A critical analysis will reveal that the West had to pay a heavy price for ignoring public health, its arrogance and over confidence that they were providing the best quality of healthcare to its people. United States of America the richest country in the world witnessed lacs of death and its health system was almost choked with the increasing number of patients suffering from Covid19 infection. United Kingdom was not far behind and Italy too lost lacs of precious lives which their healthcare system could not save despite best efforts. On the contrary those countries which valued Public Health and considered it as Economic Wealth had much better results. The shining examples are of countries like Vietnam, Cuba and New Zealand which gave due importance to public health and were able to manage this pandemic far better than many much stronger economies.

In an excellent write-up related to “Manifesto for Human Life” series published on the first anniversary of Covid19 pandemic,1 the authors argue that” it was a myth that healthcare is a service which private corporations can provide and for which one must pay to survive.” Covid19 pandemic has blown up this myth. One’s personal health cannot be separated from their neigbours and the world at large. Right to health they believe is a universal right. Everyone’s health is worth no more and no less than their neighbours. Public health and Health of the economy are closely related. It is believed that if the world leaders wish and are sincere to help low and middle income countries (LMICs) to improve their social as well as health indicators, they will have to give up this “neo-colonial conditionalities that come along with philanthropic funding and multilateral lending. This approach strips these countries of their sovereignty over how to fund their health services, privatize health infrastructure as it cripples the social policy provisions”. Privatization of health services, deregulation, Introduction of users charges for the service provided at public healthcare facilities, going for prioritization of imported, high tech services have forced millions of people in Low and Middle Income Countries to the margins, when private health became the norm. Comprehensive primary and community healthcare was neglected which had its own serious consequences.

Despite lot of criticism and lot of deficiencies and drawbacks, public healthcare facilities in many countries all over the world still remain the last ray of hope for millions of people who avail their facilities and benefit, saving millions of precious lives every year while the healthcare professionals work in unsecure, uncomfortable working environment. Over the years, the public expectations has increased manifold while limited funding for health services has put the healthcare professionals in a very awkward positon as they are the one not the health planners, policy makers who have to face the public wrath. There is increasing incidence of violence against healthcare professionals and healthcare facilities during the past few years but authorities have miserably failed to change their strategies in healthcare. They still persist with limited funding for health services without realizing that “a dollar of investment in health in developing countries is estimated to result in two to four dollars of economic return over time.” Countries like Vietnam and Cuba have shown that even with modest health budget, developing a sovereign healthcare system which gives priority to primary healthcare along with preventive care supplemented with robust public health infrastructure can deliver first-rate population health outcomes. It was their policy of investing in public healthcare system which has resulted in better outcomes. On the other hand, since the Western developed countries ignored public health, they had to face the consequences in the form of increased morbidity and mortality. Yet their another drawback was too much reliance on business model of using and listening to health administrators rather than giving importance to the viewpoint of healthcare professionals who were never taken into confidence, in fact they ignored all other stake holders. Now a momentum is building up for a struggle among the healthcare professionals who have decided to take on the Health Administrators who take the decisions about healthcare of which they know very little.

It is high time that the developing world learns some lessons from all this. Listen to healthcare professionals of their countries; take them into confidence while preparing health policies. Public health services should shift from the current donor driven vertical disease control programme most of which is funded in prioritizing the needs of the community. Vertical interventions to eradicate single diseases are often much more costly which have been imposed on Low and Middle Income Countries at the expense of horizontal enhancements of public health infrastructure which would serve the entire population on long term basis resulting in making local healthcare system more resilient. The result of such flawed policies eventually contributes to internal brain drain when skilled healthcare professionals leave public sector to work for international and Non-Governmental organizations which offer much better pay and perks priviliges.

Apart from improving the public healthcare infrastructure, the LMICs also need to improve provision of safe pure water supply, improve sanitation facilities, tackling the communicable diseases with improved immunization and vaccination services. Many countries in the developing world are still busy in controlling infectious diseases like tuberculosis, malaria, lower respiratory infections which is only possible ensuring population access to clean water and good living conditions, improving air quality. The challenges faced by the Covid19 pandemic have also opened a window of opportunity to the entire world to revisit and re-evaluate many myths that is responsible for this fractured system of global health.

During the current Covid19 pandemic if on one hand, world was facing this dreadful infection, spread of lies, misconceptions, conspiracy theories on the social media not only in the developing countries but in the developed West had also made the job of managing this infection much more difficult. It was much later that one saw some positive, useful messages on the seriousness of this infection, precautions to be taken and how to manage patients even at home if hospitalization facilities were not available. This also highlights the importance of using social media for health education. Authors of a well researched paper on “Non-pharmaceutical interventions and the Infodemic on Twitter: published in Journal of Medical Systems have highlighted these issues in detail and shared the lessons learned from Italy during the Covid19 Pandemic”.2

Reference

  1. All Health is Public Health. Progressive International on the net. Accessed on April 15, 2021.
  2. Maurizio Massaro and colleagues. Non-Pharmaceutical Interventions and the Infodemic on Twitter: Lessons learned from Italy during the Covid-19 Pandemic. Journal of Medical Systems 2021; 45:50 Published online March 06, 2021.