HEALTH INVESTMENT AND ECONOMIC CRISIS

By Mirta Roses-Periago Reprint | | Print |

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WASHINGTON, Jul 29 2009 (IPS) - The fulfillment of every person’s inalienable right to health and well-being is a pivotal factor in the quest for human prosperity and more inclusive, equitable, and healthy societies across the world. This requires a strong commitment, even in the best of times, and all the more so in a period of economic and fiscal stress and a health emergency.

But there is really no option, since health challenges that test the strength of public health systems arise constantly, as demonstrated most recently by the swine flu outbreak earlier this year. Indeed, it is crucial to avoid social sector spending cuts, the major flaw of past structural adjustment programmes, if we want to overcome the crisis. Curtailing social spending will only aggravate it, setting back societal advances and making the recovery more difficult, slow, and painful.

The Americas have a sad record of insufficient levels of and inadequate distribution of public spending on health. The latter has remained essentially flat over the last 10 years -3.6 percent of Gross Domestic Product (GDP) for 2004/2005- in spite of strong evidence favouring public health spending of between 5-6 percent of GDP as a requisite to achieving universal access to health care services. The lack of mechanisms to ensure that public health spending benefits the most disadvantaged groups is an added problem. These deficiencies are reflected in poor families’ extremely high out-of-pocket health spending as a proportion of their total income. Indeed, health spending, including for medicine, ends up being a significant cause of the impoverishment of families and can rapidly turn chronic or life-threatening diseases into catastrophic situations.

There is a strong case for mitigating both the immediate and the long-term effects of the crisis by preserving the investment in human development and strengthening safety nets for the most vulnerable: a spoonful of prevention is worth a ton of restoration.

Current economic circumstances call for greater attention to the efficient and effective use of resources. The question is how to invest in public health in a manner that achieves wider coverage and strengthens health care systems, while also ensuring the utmost efficiency in the use of resources and the highest return on social investment. We have a historic opportunity to achieve both aims by firmly implementing and strengthening health systems based on primary health care (PHC).

There is conclusive evidence from around the world that PHC-based health systems have better and more equitable health outcomes. They are more efficient, have lower long-term costs, are more resilient to crisis, demographic, and epidemiological changes, and can achieve higher user satisfaction. Even countries with limited resources that adopted a PHC approach have been able to build systems that are universal, equitable, flexible, and sustainable, and that deliver better results and satisfy their citizens. Wealthy nations without a PHC approach, on the other hand, end up having health systems that are extremely expensive in terms of the outcomes obtained and highly inequitable.

Therefore, at a time in which countries in the Americas are facing not only the effects of the worldwide economic crisis but also significant health challenges it is crucial to increase or at least maintain public health spending while at the same time using this opportunity to undertake a strong PHC-based reform of their health systems.

In addition to recognising the contribution of public health both to the hemisphere’s integration and development processes and to the construction of more democratic and equitable societies, this vision will also facilitate more effective solutions to the growing complexity of the public health challenges faced by the countries of the Americas today. (END/COPYRIGHT IPS)

(*) Mirta Roses-Periago is Director of the Pan American Health Organisation.