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Our Common Right to Health
8 Apr 2020
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This blog post is part of the UNRISD Covid-19 series, in which authors explore the uneven distribution of impacts of both the pandemic and the crisis response, as well as the social, political and economic drivers of these disparities. The series will engage UNRISD’s networks and draw on its vast body of social development research to provide evidence-based responses to the current crisis as it develops and suggest viable strategies for a future where similar crises are not only less devastating, but also less likely to happen.
🔁 This piece first appeared on Network IDEAS (International Development Economics Associates) on 30 March 2020.
Acute deaths, chronic deaths
The COVID19 pandemic is frightening. The staggering number of deaths in just a few months is numbing our minds and breaking our hearts.
Medical disasters such as the current covid-19 pandemic, or natural disasters such as hurricanes, tsunamis, floods, droughts, earthquakes, or man-made disasters such as nuclear power plant implosions affect a large number of people in one incident. They are acute. They are distressing. They ought to not be happening.
At the same time, despite the enormous morbidity and mortality of the Covid19 virus, year upon year, chronic medical disasters affect far larger numbers people on this planet. But that silent catastrophe is barely mediatised – although the statistics are at our fingertips, thanks to national health observatories and the annual compilations of UN agencies such as the WHO. My guess is that is because it is more difficult to depict their impact and also because the majority of those who perish in chronic disasters don’t have a voice.
Some global numbers for our attention
In terms of preventable premature deaths, in 2015, around 303 000 women died from causes related to giving birth (WHO 2018: 4). Every year, five and a half million children under 5 years die, either because of birth-or post-delivery complications, or because of acute respiratory infections, diarrhoea and malaria (WHO 2018: 5); the “underlying condition” often being severe malnutrition. An estimated 1.7 million persons succumbed to TB in 2016 (WHO 2018: 5). Unsafe drinking water, unsafe sanitation and a lack of hygiene led to an estimated 870 000 deaths (2016) (WHO 2018: 10).
Deaths due to public policy choices are high too. Our abuse of our planet causes preventable deaths: WHO estimates that outdoor air pollution in cities and rural areas caused 4.2 million deaths worldwide (2016) (WHO 2018: 10). Road traffic incidents killed 1.25 million people in 2013 (WHO 2018: 7), due to poor roads and lack of protective gear such as helmets.
Wars too are deadly. Of course, they could be prevented. Approximately 180 000 people were killed in wars and conflicts in 2016, with the toll steadily rising compared to preceding years (WHO 2018: 8). As a result of conflict, and – as is increasingly acknowledged, as a result of climate change effects – 70 million people are now forcibly displaced (UNHCR 2020), living in makeshift accommodation without the handwashing, physical distancing and distance-learning opportunities currently advised so vociferously.
Almost all of these deaths from chronic causes and structural health system deficiencies are premature, and preventable. And they are unequally distributed. They are concentrated in low-income countries, and in low-income households. They predominately affect disadvantaged communities – persons systematically excluded from health services because of their gender, ethnicity, caste, language, culture, faith, their location or status as migrants and refugees, or because of their sexual identity (UNDP 2019). Or because they are children – in many patriarchal communities: girl children – or older people who are considered expendable.
My first point then is that premature, preventable deaths have both the acute and terrifying face of the current Covid-19 pandemic, but also the quiet, continuous, chronic violence of these annual huge death burdens. In terms of numbers, then, the high death toll of the Covid-19 is not “unprecedented”.”
Deaths and health systems
My second point is that many of the anticipated deaths from Covid-19 will be attributable to failings of the health system – the curve needs to be flattened because the capacity line for the health care interventions needed is far too low in every country. As some commentators have been saying, it is not just about stretching the incidence of cases, but also about lifting the line: of raising the capacity of public health systems and of provisions for catastrophes such as pandemics.
The acute medical disaster of Covid-19 is in some ways akin to the impacts of an earthquake –earthquake shocks and aftershocks pulverise buildings and infrastructure that were not compliant to security regulations, crushing and suffocating people caught inside. But not just the acute earthquake of this pandemic, also the quiet, chronic violence of “everyday” deaths needs to be addressed: health systems need to be strengthened dramatically on every level, for every health challenge and for every person.
As Isabel Ortiz and Thomas Stubbs (2020) have pointed out in a radical piece, the weakness of all our health systems is ultimately due to the ideology of austerity and neoliberalism which has eaten into policy makers decisions for the past three decades. For the UK, Watkins et al (2017; UCL 2017) have shown this equally drastically, in an academic paper published already three years ago. One direct effect of this ideology has been the continuous downsizing of health system capacity. Merely looking at wealthy Europe with its welfare states, and their capacity to deal with a pandemic with exponential transmission rates, we see for example that the number of acute care hospital beds have been reduced in every country. So, the current pandemic will indeed quickly outstrip capacity – and of course acute care beds are just superficial proxies for such care which is delivered by physicians, nurses, as well as administrative, cleaning, transportation staff and many others. This is despite warnings since 2005! from the UN’s United Nations System Influenza Coordination (UNSIC) unit to globally ramp up pandemic prevention and response capacity.
Health systems and the right to health
Just a few years ago, the global community – that is the 193 member states of the United Nations – committed to universal health care and decided on the policies necessary to achieve that goal. There is even an acronym that many policy makers have – notionally – adopted: “UHC”. It is goal 3 of the much-cited Sustainable Development Goals (United Nations 2015). Admittedly, the vision is modest: to achieve the right to health only in a decade from now, by 2030. This is timid, given that it has been promised since 1948 in the Universal Declaration of Human Rights, and it is timid in light of global wealth of capital and of knowledge which could deliver UHC and SDG 3 immediately, if politics so decided.
As we tremulously open the newscasts or our inboxes each day to read of the ever increasing numbers of the Covid-19 victims, we need to “instrumentalise” this pandemic for the SDG commitments: stop all preventable premature deaths, be they from acute pandemics or from chronic conditions, build equitable health systems for all everywhere. We can use the 2030 Agenda to frame the polices we need.
PS – Reminder
The SDGs commit: to universal health coverage (UHC) with equitable access to health services; to social protection to prevent deepening poverty in crises and to guarantee a decent standard of living; and to decent work – secure, safe jobs, paid properly and insured; to gender equality and recognising women’s unpaid work as they care for others; and most of all, to the promise that all are equal.
About the Author
Gabriele Köhler is a Development economist; Former UN official; UNRISD Senior Research Associate. Her research, publications and advocacy focus on the UN development agenda and human rights, gender and climate justice, and social and economic policy, notably social protection. She is on the governing board of the UN Association of Germany and of Women Engage for a Common Future.
Sources
🔁 This piece first appeared on Network IDEAS (International Development Economics Associates) on 30 March 2020.
This article reflects the views of the author(s) and does not necessarily represent those of the United Nations Research Institute for Social Development.