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 sub-
Saharan 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.