Today it seems perfectly normal to us that there is an organization that tries to ensure the protection of people's health at a global level, however this is still a relatively recent idea in the history of humanity. In fact, it was shortly after the devastating impact on human lives caused by the Second World War became evident – specifically, in 1948 – that the World Health Organization (WHO) was established.
Its primary goal, from its very foundation, was to contribute to health becoming considered an essential right for all people. To remember the importance of this objective, its creation is commemorated every April 7, focusing on the dissemination of a specific health issue. The motto chosen for 2024, "My health, my right", seeks to raise public opinion about the importance of continuing to invest efforts in ensuring that all human beings have access to health services, as well as health education and information. essential to prevent and take care of your physical and mental state. And also – as explained on the website of this United Nations agency – so that they can enjoy the right to “drinking water, clean air, good food, quality housing, decent working and environmental conditions” and not to suffer any discrimination. .
But so that these words do not remain a mere declaration of intentions, the commitment and involvement of all political and social actors is essential. As Raquel González, coordinator in Spain of Doctors Without Borders, points out, “the coronavirus pandemic served to demonstrate the importance of global health on the international agenda, and the need to transform the global health system to face future tensions.”
To do this, we must move, in his opinion, “towards health systems that are truly focused on people, and not on economic performance; that prioritize regional and local attention; and that they ensure the equitable participation of all countries.” His words are aligned with target 3.8 of the Sustainable Development Goals (SDGs), which aims to achieve universal health coverage by 2030. The WHO recommendation to reorient health systems towards an approach based on primary care could reach to save, according to the organization's calculations, some 60 million people and increase average life expectancy in the world by 3.7 years by 2030.
However, the current slowdown in the increase in health services in many parts of the globe, which a few years ago seemed to be evolving at a better pace, may seriously jeopardize the achievement of the ambitious challenge of achieving universality in medical care. at least within the deadline. As the WHO published in October of last year, almost 2 billion people currently suffer from economic difficulties in meeting their health expenses. Of these, some 1,000 million people are in a situation that we can consider “catastrophic”, and another 344 million are directly in extreme poverty, due to the costs derived from medical care.
In the opinion of Dr. Carlos Zarco, medical director of HLA Hospital Universitario Moncloa, in Madrid, and general director of the Espriu Foundation, it seems clear that “ensuring universal coverage is also essential to prevent the emergence of new viruses or resistant bacteria that end up spreading. around the world, to give an example. This implies the construction of a solid surveillance system worldwide.”
Achieving the aforementioned universality in care, however, requires concrete measures that allow all health systems to be strengthened, “such as free access to visits or treatments, decent salaries for medical personnel or a sufficient supply of essential medicines.” ”explains González. In addition to the governments of the countries, for all this to be possible, there must also be “financial institutions such as the World Bank, which are already financing part of the reinforcement of health systems.”
Ethnicity, religion, gender, the degree of cultural training or the social structure in the community can be factors that, in practice, affect the way in which people relate, in certain contexts, with healthcare professionals. health services that must attend to them, or that mark their access to treatments. The exclusion of people from health systems does not only occur in economically depressed countries. Unfortunately, we also often find it in our environment and in contexts of capitalist development. As Dr. Zarco points out, there is an obvious relationship between the economy, access to medical care and health education; Although there are countries, such as the United States, that have made access to many treatments really burdensome, which in practice exacerbates social differences.
The illness itself can also be a cause of discrimination. Since 2002, the Global Fund has invested large amounts in the fight against HIV, tuberculosis and malaria, but – as González points out – “vaccination against these diseases has decreased in various places after Covid-19.” Likewise, there are diseases – several of them endemic in nature – that are neglected due to lack of drugs, because they are only present in poor areas, which causes pharmaceutical companies not to invest in them, as would be desirable. They are so-called “orphan drugs”, intended for health problems that affect a small number of people or patients or countries without the economic capacity to pay for these drugs.
Developing a common pharmaceutical policy or protocols for certain diseases, as the European Union does, promotes global and more equitable health treatment, but the economic context continues to generate complex situations. Speculation with certain treatments – “as happened in Spain with those that were used to combat hepatitis C, which at the time cost around 20,000 euros,” as González points out – also makes access to healthcare difficult, even in the health systems. of health that are considered robust, like ours.
Pharmaceutical companies lead pharmacological research, in many cases, which means that economic aspects have an inevitable impact. The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) safeguards the rights of these companies to exploit their patents for a certain period of time. At the same time, there is the possibility that administrations can make exemptions, and also negotiate with pharmaceutical companies, when their interests collide with people's right to health.
These situations, when they occur, require – as González points out – “political courage on the part of governments.” In short, World Health Day offers us the opportunity to reflect on the importance of extending health coverage beyond our particular microcosm, not only as a way to create a true universal human community that is fully supportive, but also to ensure the eradication of major diseases or the proliferation of future pandemics. As Dr. Zarco explains, “we must have a comprehensive vision that unites human health with the health of the environment and with animal health. In our world everything is connected.”
Also – adds Zarco – we must be able to grant health the relevance that it truly has in our existence. As this doctor with a long and renowned career explains, “we often attach excessive importance to personal or professional aspects, even at the risk of neglecting our health. But this is, without a doubt, fundamental to ensure any other achievement that we can obtain in life. That is why it is crucial to move to a conception of medicine that is more preventive than curative. Because only by enjoying a truly healthy life can we have a better future.”
