CNS: Unless we end inequities, we will fail to achieve Health For All

“Everyone is trying to apply the human rights lens. But unfortunately on key matters of equity, a lot many communities right now are in the rear-view mirror and not being observed through the lens of equity and human rights. This pandemic is uneven around the world and uneven in its impact. It has peeled away the bandages from old wounds of our society and it has also revealed and driven new equities. We are not doing a good job in ensuring that the basic human rights approaches are being upheld- right to access to health, right to personal dignity. In some cases Covid-19 has been used as a means of denying people their rights. Yes, we have seen great examples of community resilience and people and CSOs coming together in solidarity to fight this epidemic. But, if we are to give grades on how we are doing in leaving no one behind right now we get an F” said Dr Michael Ryan, Executive Director of the World Health Organization (WHO) Health Emergencies Programme, who also leads the team responsible for international containment and treatment of Covid-19.

Dr Ryan was delivering his keynote address at the launch of the important report- “World in Lockdown, Development on Hold: A special CPDE report on the (in)effectiveness of the Covid-19 response”. Justin Kilcullen, Co-Chair of CPDE (CSO Partnership for Development Effectiveness) moderated this global report launch and an insightful session on Covid-19 and its impact on implementing the effectiveness agenda at country level, and whether pandemic responses are respecting the effective development cooperation principle on country ownership, respectively.

closing the gate after the horse has bolted

“It is almost like closing the gate after the horse has bolted. Addressing endemic inequity that is already in place would have been much easier to avoid it in the first place. We failed to prepare for this pandemic. We failed to invest in community resilience, we failed to invest in the surveillance systems, production systems, technology transfers. We knew the pandemic was coming, and we really have been caught in the headlights of the pandemic. And even after 16 months into the tragedy we are still struggling to deal with it, and still struggling to come up with a comprehensive and a coherent response at every level – at community level, national and global level. Many of the issues that matter in terms of human rights – we have seen health systems disrupted beyond the images of ICUs - TB services, HIV services, immunization services, health services for women and girls, we have seen a rise in gender-based violence, we have seen hunger emerge in places where we never thought we will see it as a risk. Communities and individuals are facing risks that go well beyond Covid-19 - the risk to their jobs, mental health, children's education.. What we have witnessed is an absence of societal cohesion, societal investment, and societal fairness, that goes back decades and decades. This is not a civilization that is ready to deal with a universal pandemic or emergency of any kind” said Dr Michael Ryan.

is there an easy way out of the pandemic?

Ryan reflected that “Working our way out of it is not easy because there are deep inequities that are built deep into the system - hardwired – and we cannot deal with those directly right now. We need to remember them, and we better not forget. But if we are to work our way out of this right now - with all those inequities in mind – the single greatest inequity in coming weeks is that the older and more vulnerable people with underlying conditions and health workers are continuing to die in countries that do not have access to vaccine. As we roll out vaccines in hundreds of millions to perfectly healthy adults in mainly industrialized countries, we have got to fix that, or we have no right to try to fix other things. We have no mandate to fix those other things. And the world should wake up to the reality that we are about to preside over massive global injustice. If there is one thing we can do as a symbol for the future, if there is one thing that will give us all is the right to speak about inequity – we work together to fix that today.”

risk of dying of Covid-19 is pre-determined by our health history

“If we look at health systems as a whole and if we look at how health systems are connected globally clearly the impact of this pandemic has been avoidable. If we are going to avoid this in future, stronger public health systems would be needed with a strong community focus. Right now our greatest chance of dying from Covid-19 is not necessarily related to the treatment we receive or the variant, but our outcome of Covid-19 is pre-determined by our health history – whether we have hypertension, diabetes (or other conditions associated with Covid-19 serious outcomes) – whether you have years and years of badly managed underlying health conditions, this is the single most predictive and prognostic markers of whether you will die from Covid-19” said Ryan.

die was cast years ago

“The die was cast…The dice was thrown several decades ago for most people who did not have access to diabetes prevention and therapy, hypertension prevention and therapy and may still not have access. We look at mental health impacts of this now and everyone is affected psychologically. But look at so many unmanaged cases of severe mental illness which have now become more isolated and have even less access. How much better they would have been able to weather this storm if they had access beforehand to proper therapy and proper care,” rued Dr Ryan.

Ryan rightly averred that “We have set the seeds of our own destruction by not having universal access to high quality affordable healthcare as a minimum basic human right for every person on this planet. And we are paying a huge price now in a pandemic for the lack of that basic human right. The seeds of our pandemic destruction have been set in how we have developed and invested in healthcare- which is not very well and not very equitable. And we have to fix that because our ability to cope with an epidemic is almost pre-determined by the strength and resilience of our healthcare system which takes years to build and, as we have seen, just weeks to break if it is not strong. We saw healthcare systems in the most industrialized and sophisticated countries in the world brought to their knees within weeks. Is that the kind of healthcare system we want which runs on a 100% bed occupancy, with a tiny number of high support beds, with absolutely no surge capacity among healthcare workers?”

expanding healthcare workforce: a reality check

“We have just expanded the hours and days of healthcare workers (and 80-90% of them are women), but not expanded the healthcare workforce - getting the same people who have been over-working from before to work more days and hours. That is how we have expanded the workforce. We are paying a price for a poorly articulated and developed health system with a work force that is clearly under-prepared, under-staffed, under-trained, under-protected, and we expect our health workers to go day after day, week after week, into the frontline without adequate protection, training or rest. If we are going to prepare for another pandemic in future and if we are going to deal with all health threats we face, we are going to have to shift for more primary healthcare centred approach. We need to preserve health, the preservation and promotion of health through healthy lifestyles and real focus on prevention, primary healthcare, and less of a focus on tertiary healthcare. Yes, tertiary healthcare is important and needed, but right now, in most countries of the world, the pyramid is the other way around. We focus our investment and all our attention to smallest part of our healthcare system. Countries that have been successful in dealing with the pandemic are often the countries that have invested in the basic community led health enterprises, community led health responses and much better distributed public healthcare infrastructure” said Dr Ryan.

“Universal Health Coverage (UHC) is not only an answer to our health needs but also a major pillar of our resilience for our next pandemic. SDG-3 is not just a priority for human rights, but it is an existential priority for our society in terms of protecting us and our health security” summarised Dr Michael Ryan – words we need to remind ourselves on this World Health Day and everyday now onwards to build a fairer, healthier world for everyone. Our leaders must monitor health inequities and ensure that Health For All becomes a reality for every human being on planet Earth.

Shobha Shukla and Bobby Ramakant - CNS
6 April 2021