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This article was exclusively written for The European Sting by Mr. Asi Alkoronky, 23, a sixth year medical student from Sudan. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.
It has been forty-one years since the Alma-Ata deceleration and yet legitimate public policy concerns of social justice in global health still rampage. The socioeconomic bounties produced by late 20th century’s blossoming economic and technological growth, that has propelled life expectancies in developed countries and many developing countries, has failed to produce the Alma-Atan inspired ideal of health for all.
That there has been stagnation and maybe even an increase in health inequity is obvious in most reports, a consistent medical elitist pattern is observed between and within countries.
Health has been accurately defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. To conduct a productive discourse on “health” inequality, shouldn’t the state’s social and economic paradigms that compulsively produce these results be the focus?
One of the major mistakes of previous approaches to practically implement vision of Alma-Ata was the launch of “selective primary health care”.
This tunnel vision approach that focused on improving health statistics through women and child-health programs assumed that targeting diseases i.e. physical approach to health will ensure the health for all. This approach totally missed the point! Alma-Ata requires social rather than a disease intervention, focusing on improving life expectancy through disease eradication is of much less relevance than to remedy the colossal differences between health outcomes between the rich and poor.
Alma-Ata’s promises has failed to deliver the ‘Health For All’ by 2000 that it claimed, however it has been very influential in transforming global health trajectory. Universal Health Coverage is a direct result. A health-system focused model.
An inherent issue that I see with Universal Health Coverage is its’ embracement for the private sector and legitimising it as a method for ensuring universal coverage. It should be of question when neoliberal intrusions are esitmated to be compatible with equality. Privatisation equals out-of-pocket payment.
To make private is to exclude, which private care always does despite the bureaucratic insurance schemes. Health For All’s gigantic scope is severely underestimated. Where can the unemployed, prisoner, destitute or homeless fit? or even the unofficially employed labourer? To the contrary, privatisation plays an immense role in sustaining this unequal dynamic, marginalising the very people whom are in greatest need.
I submit that it is the purchasing power of the individual and the state which mainly dictates these differences. It explains the repeated patterns seen in outcomes between developing and developed countries and rich and poor. From my viewpoint inequality is a natural state. These differences will always exist because finances are the main indicator, yet it is the prime responsibility of the state to neutralise that factor which may involve deconstructing neoliberal ethos.
Private companies have to reap profit first, the rest is secondary. Its’ role is merely substitutive; it fills in the gaps when the state is not robust enough to fulfil its’ role. Universal Health Coverage’s omnipresence in global health discourse is the rightful trajectory, which however might need some technical adjustments. It is also necessary to emphasise that public health investments, although crucial, does not correspond to a healthy population in its totality. To advance health does not correspond with achieving equity. Health advancement is a function of public health, it is purchasing power however that determines health inequity.
About the author
Asi Alkoronky, 23, is a sixth year medical student from Sudan. He was affliated with the Standing Committee on Human rights and peace in his country, where he held administrative position and coordinated human-rights related projects as well being an IFMSA human rights trainer. Also interested in research, he has produced various research articles which were accepted at a number of conferences. IFMSA Delegate to the 72nd World Health Assembly, Asi plans to find the balance between global health, clinicial work and research.
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