What we want
Health and wealth are inextricably linked. Across the world, poverty is the single biggest cause of avoidable death, illness and injury. So any plan to make access to health more equal must also address issues of wealth, tackling the most fundamental inequalities that exist in the world economy.
First, then, a “new world order” should deliver the basic human rights to clean water, affordable food and decent housing. The absence of these three “goods” condemns anyone to poverty and serious ill health. It is up to the west to lead the way in righting this wrong. That will entail western governments, corporations and NGOs talking to governments, community groups and local leaders in developing countries about how best to deploy a decent proportion of the world’s wealth, so as to secure access to the basics for all who currently exist without them.
Above and beyond this, we also need changes to the delivery of healthcare. Access to basic services – not necessarily to high-tech hospital care, but to someone who can employ day-to-day preventative and curative medical techniques – should be guaranteed. Even the world’s richest nations are far from achieving equal access to such primary care. In the west, we need a limited shift of resources from the hospital sector to community health services and, in some countries, a more equitable system for financing healthcare. Elsewhere, the shift may have to be more fundamental still.
First, access to medicines must be more closely related to need. In Africa, commercial interests must not be permitted to restrict access to vital medicines for HIV and Aids. Where it is demonstrably in the interest of the global community for a medicine to be available to a group of people at a lower cost than the market would support, we must take action to secure it. That may mean supporting domestic production of a licensed copy of that medicine, and paying compensation to the original manufacturer from a World Medicines Fund. Beyond that, we may need to regulate the pharmaceutical industry globally – for example, to protect consumers against exploitation in clinical trials.
Second, we need a new cadre of health professionals. Rather than relying solely on expensive medical training to staff health services, we need to invest in people with health visiting skills. Volunteers from the health professions – perhaps recently retired people – could train others in basic healthcare techniques and outreach skills. Those people would then be responsible for training others in their own communities. Further, a change in the way doctors are trained and paid would encourage them to focus more on community medicine and less on acute medical specialisations.
Third, we need to change the way mental illness is tackled. Global economic change and warfare have put pressure on the mental health of millions. Health systems worldwide, and the industries that serve them, need to gather evidence on how best to prevent and treat mental illness.
We need two further cultural shifts. First, there can be no equity in the world until women’s health needs are addressed adequately. Access to contraception, family-planning advice and protection against sexually transmitted diseases are vital for all women everywhere. Antenatal care, including advice on healthy living as well as medical support, should be a universal right. Our health systems should ensure that young families receive help in coping with the many difficulties they face in the first five years of their children’s lives.
Second, western medicine must accept that it does not hold the answers to all ills. The medical traditions of China, the Arab world and others may hold the answers to some problems with which western medicine has long struggled. A single body, working over the internet to verify the effectiveness of treatments from different medical traditions, would be a useful step.
This is an ambitious agenda. It means thinking about health as more than just the absence of disease. It means giving life to the World Health Organisation’s basic principles of fair financing, equitable access and guaranteed quality of healthcare in all nations. Above all, it would show that the west is serious about creating a fairer world order, because it will only happen if health is seen as a global human right worthy of significant shifts in resources from the rich to the poor.
Julia Neuberger is chief executive of the King’s Fund