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Review of the third day of the Hooked on Health Care session examines the role of civil society, public authorities and health justice
The third day of the Hooked on Health Care session examines the role of civil society, public authorities and health justice.
Advocates, watchdogs and service providers - the many roles of civil society
Civil society organizations come in many sizes, from small community groups to large-scale national service providers. They also fulfill many different roles – some all at the same time.
Different types of interventions are needed for different sectors of society. For the general population, civil society groups can advocate upwards and provide information throughout. For groups of peers – be they people affected by the same condition or disease, affected families, or people living in the same community – civil society can help organize them for action and support. For the most vulnerable, isolated individuals, civil society provides services that the state either cannot or will not. For some of the most vulnerable in society – especially those who have felt under-served, abandoned or even betrayed by the state and public sector, civil society can provide valuable outreach and support.
In resource-constrained countries, such as Zambia, one Fellow explained, civil society organizations fulfill the vital role as watchdog – ensuring that the limited available funds are correctly and responsibly used. They also advocate on behalf of communities for these resources to be allocated. Civil society groups in developing countries are also providing a critical and vital voice to ensure global agendas such as the MDGs and SDGs are being implemented by their government (the latter of which many developed nations seem to have forgotten apply to them also).
Civil society action is most successful when they engage with the local community. Ideas that are developed within the community are more likely to succeed than those imposed from outside. Community-led health initiatives also help improve local social cohesion and these relationships also have positive health impacts.
For all the roles it fills, civil society should not be a replacement for the state (“Something that has been forgotten in the UK” with the advent of “Big Soceity,” one Fellow lamented). Even the biggest civil society groups can still be financially vulnerable as the case of FEGs in the US and Kids Company in the UK can attest.
Despite best efforts, some of these initiatives will fail. As one Fellow reassured the group, working with underprivileged communities “is messy, uncertain but it’s absolutely vital.”
The right to a “good life”
How do we define health justice? How does an understanding of capabilities influence or approach health? What are the key measures of health equity globally and nationally? Also what policy initiatives are necessary to address inequity and the most significant social determinants of health? These were just some of the questions facing both the panel representing three continents and the room full of public health, civil society, and business leaders.
Discussions began with the overarching knowledge that the concept “health justice” in itself is huge, with many factors relating to it, including social justice.
The UK was used as an example because even while the country has Universal Health Care (UHC) through the Natioanl Health Service (NHS), disparities exist; despite having equal access to health this does not mean health equity. The social determinants of health are still applicable in a UHC system.
Wealth, especially in the context of health equity, is inadequate to solve issues of social justice, with one Fellow stating: “Social progress isn’t just about getting richer, it’s about improving the quality of life for everyone.” Work should be done to improve people’s capabilities to live a “good” and healthy life because everybody has a moral claim to live a “good life,” and measurement of such shouldn’t mean simple increased wealth.
Another Fellow highlighted that health requires global justice with an emphasis on how we can influence governments around the world to ensure a right to health for all citizens. One Fellow questioned having a narrow focus when it comes to improving health saying that, “Focusing on one disease only leads to fragmentation of health and a loss of concept of the global right to health and life.”
The case for coalitions & political opportunities
How do we convince national government departments, regional agencies and local public authorities to turn the knowledge we have acquired into actionable policy that can actually have a positive impact on the public’s health and wellbeing? That was the question facing the opening panel of the third day Hooked on Health Care: Designing Systems for Better Health.
Taking inspiration from action on climate change in the UK, the advice offered to the room was to seek the best political opportunity. Internal rivalries within the UK’s then-ruling Labour party led to climate change moving up the agenda, especially when an ambitious young parliamentarian took up the cause. The leader of the then-opposition party also adopted a progressive stance on climate change as a way of attracting new voters. (Climate change is not a left/right partisan issue as it is in the US.) Public health advocates should look for similar champions to take up the mantel of health over health care, it was suggested.
In absence of an obvious political opportunity, broad coalition building can prove useful. In Peru, over 200 organizations came together to promote the agenda of tobacco control. Local action is also important if there is an impasse at the national level.
What should be avoided however, is the building of parallel systems, especially when Western governments are investing aid to improve health in developing countries. This can lead to siloed approaches that disproportionately promote the treatment of one disease over another, rather than improving population health as a whole. A non-siloed approach would also be best for ensuring the implementation of the SDGs, but no country appears to have set up a single agency to tackle this yet.
To ensure a broad, non-siloed approach to public health, more government bodies besides the Ministry of Health need to be engaged, which again raises the issue of reframing the conversation. As one Fellow reminded the group: “To get health taken up by other departments, we need to work with those not used to our world, our debates.”
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The Salzburg Global session Hooked on Health Care: Designing Strategies for Better Health is part of the multi-year series Health and Healthcare Innovation in the 21st Century. The session is being held in partnership withThe Health Foundation and the Robert Wood Johnson Foundation. More information can be found here:www.salzburgglobal.org/go/559. You can follow all the discussions on Twitter with hastag #SGShealth.