Healthcare is a political choice. The statement, presented by the Dossier nº 29 of the Tricontinental Institute for Social Research, launched on Tuesday (9), is based on the crisis scenario deepened by the COVID-19 pandemic in four countries that have suffered the effects of neoliberal governments in recent years: Brazil , Argentina, South Africa, and India.
The study depicts the way in which, during the fight against covid-19, healthcare agents are considered essential, while it is widely recognized that they are not guaranteed many rights. However, the analysis argues that such evident neglect results from a process of dismantling that, due to past crises and policies that privilege the private system over the public one, will be even worse.
Thus, the dossier defends a “no return” to the normality of the current capitalist model, but a continued and prioritized investment in public health. It cites, among other references, a statement by Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO).
“The world operates in a cycle of panic and neglect. We put money into an outbreak and, whenever it's over, we forget about it, and do nothing to prevent the next one. The world spends billions of dollars preparing itself for a terrorist attack, but relatively little preparing for a virus attack, which could be much more deadly and much more damaging economically, politically and socially," said the spokesman, in February 15, at the beginning of the pandemic.
The world operates in a cycle of panic and neglect. We put money into an outbreak and, whenever it's over, we forget about it, and do nothing to prevent the next one.
In an interview with Brasil de Fato, Nathalia Santos, family and community physician, endorses the argument. For her, the current context shows that healthcare "is not just a matter of medical care."
“People's health is related to their conditions of housing, work, access to income, access to healthy food, drinking water, and sewage systems. This will determine what health is,” explains the professional, quoting the World Declaration of Human Rights published in 1946, which states that healthcare must be socially supported.
“Today, in a global context, we have been influenced by the World Bank, mainly in poor and underdeveloped countries, so that these countries adopt policies of flexibilization of investments in health, reducing the State's investment as a public policy, so that it can be substituted for a privatized system,” she continues.
"We have been experiencing the inequality of access, and more and more when poor populations do not die from lack of access, they have to spend out of their own pockets to pay for medical care, medical examinations and medicine, and end up experiencing an impoverishment of their income level," criticizes the doctor.
Divided into three parts, the document also gives a voice to healthcare leaders in countries whose systems have carried out successive cuts destined for the area and, for this reason, are more fragile during the pandemic.
India's response to covid-19, for example, a country that enacted the largest quarantine in history, was only as strong as it was due to the commitment of more than 900,000 workers from the Accredited Social Health Activist (ASHA) network. With a similar function to community health agents, the category composed mainly of women has become the front line in the fight against the coronavirus.
Without sufficient Personal Protective Equipment (PPE) and adequate wages from the far-right government of Narendra Modi, these women workers are constantly exposed to the virus while monitoring the spread of the disease. Given the spread of the disease in the country, as well as the neglect from the authorities, they were forced to improvise their own protection.
According to the dossier, these women workers are not supported by the state and are treated as volunteers. Surekha Rani, General Secretary of the ASHA Workers Union, said that for years the professional association has been working to defend the rights of these professionals, with frequent mobilizations and strikes to ensure that salaries are guaranteed.
Today, faced with a pandemic that has been proliferating at an accelerated pace, Rani regrets that "ASHA workers are sad and demoralized." "They believe that they are responsible for breaking the chain of infection, however, government officials have still not paid attention to their problems," she said to researchers from Tricontinental.
Disregard for health workers is also seen in South Africa. In response to the pandemic, Cyril Ramaphosa, the country's president, announced an emergency package in April, of 500 billion rands (approximately R$ 145 billion), the South African currency. However, according to the dossier, the measure did not provide any resources specifically for health professionals who work to contain covid-19 in the country.
According to Lerato Madumo, president of the Young Nurses Indaba Trade Union (YNITU), workers also do not have extensive tests or available PPE and, after announcing that they would go on strike if their claims were not met, they were threatened by the government. The president told them that they would be committing a crime under the Disaster Management Act, passed in 2002.
Madumo refutes such attempted criminalization and evokes the Occupational Health and Safety Act of the 1990s. “This is not a criminal act, it is simply us saying that our government is committing a crime against humanity. Nurses are human beings. You cannot ask a soldier to fight in a war without protecting him with bulletproof vests; it is simply not correct. If the front line remains ill this means that, by the end of the pandemic, we will have a health system that will not even have health workers,” observes Madumo, in her statement in the Tricontinental document.
Our government is committing a crime against humanity.
The dossier also points out that, in South Africa, 84% of the population seeks care in the public sector while the private sector - which serves only the remaining 16% - hires 60% of the available professionals, overloading the public system.
Healthcare budget cuts have been frequent in Brazil, which according to the most recent data, has registered 37 thousand deaths caused by respiratory disease. Under the government of Jair Bolsonaro (No Party), the country exceeded Italy's numbers, and now ranks third on the list of nations that lost the most lives to the pandemic.
Despite the existence of the Unified Health System (SUS by its Brazilian Portuguese acronym), one of the strongest systems in the world, the hollowing out carried out by Michel Temer's government (MDB) and the current president, has compromised Brazil's response to the pandemic. Professionals also report working with insufficient protection, increasing the risk of contamination.
“Our current response capacity is now, in fact, a consequence of the policies of the past few years. We feel it today when we are faced with the need for more ICU beds, when we are faced with communities where there was a Basic Family Healthcare Unit and now there is none,” comments Nathalia Santos, adding that, even though it is a global hotspot in the pandemic, Brazil is one of the countries that tests the least amount of patients with respiratory symptoms.
The member of the National Network of Doctors and Physicians for the People emphasizes the damage caused by the amendment to the public spending ceiling, which limited investment in the healthcare area for 20 years, further deepening inequalities within SUS itself.
As it is a triple system, which receives funding from the Union, the States and the Municipalities, there is a great geographical difference in the country, since regions in the North and Northeast do not have as much capacity for public investment as the state of São Paulo, for example.
The member of the Network of Doctors and Physicians for the People also points out that according to the Brazilian Constitution, access to healthcare is one of the State's duties, and a right for all. For this reason, in the midst of the pandemic, the use of beds in the Intensive Care Unit (ICU) from the private sector, defended by the ICU beds for All campaign (Leito para Todos in Brazilian Portuguese), is becoming more urgent every day.
When we look at a single line, we treat citizens equally, regardless of their income.
According to information from the National Supplementary Health Agency (ANS by its Brazilian Portuguese acronym) and the Ministry of Health, 75% of Brazilians do not have access to health insurance, while half of the country's ICU beds, about 15 thousand, belong to private establishments.
More than simply an emergency policy, for Santos, the use of private ICU beds is the recognition of health as a constitutional right.
“A citizen who has no health insurance has the same right to having his life protected as one who pays for healthcare. When we look at a single line, we treat citizens equally, regardless of their income. This would be a big step forward when we look at attempts to commercialize health care, leaving those who can afford to pay with more access and those who cannot pay are left more vulnerable, as we have denounced,” she says.
The dossier also talks about Argentina, a country that has just recently emerged from the right-wing government of Mauricio Macri (2015-2019). During Macri's term, according to the Ministry of Economy, the government cut the health budget by 22%, making the situation untenable.
The study also reviews the impacts of the World Bank policy in most countries in South America, which instead of providing universal health coverage, encouraged the creation and strengthening of private systems.
Countries like Chile, Colombia, Peru and Ecuador, which saw the increase in public-private partnerships, and the growth of for-profit healthcare coverage, face harsh consequences today. The Ecuadorian system, for example, has completely collapsed. During a bad stage of the outbreak there, corpses of fatal victims piled up on the streets.
Argentina, which established in its 1994 National Constitution that healthcare is an essential right, also suffered from pressure from the World Bank in the 1990s. The Tricontinental document points out that public institutions were also scrapped and medical care became dependent on private funds, generating an uneven system.
The work of progressive governments from 2003 to 2015, with the help of working-class organizations, has achieved important advances in the defense of the right to healthcare. Feats that were attacked again during Macri's term, who cut the budget for essential programs aimed at combating and treating sexually transmitted diseases (STDs), vector-borne diseases such as dengue, chikungunya and zika, in addition to the discontinuity of vaccination programs.
At the moment, the progressive government, led by President Alberto Fernández, who took over the country in December 2019, is trying to deal with the consequences of the neoliberal policies that were adopted in the country.
What do healthcare workers want?
In the last part of the dossier, the Tricontinental Institute for Social Research publishes a list based on the health workers' unions demands from different parts of the world. Among them:
- Immediately prioritize the capacity of all health services to treat severe cases of covid-19, whether public or private.
- Provide special assistance to regions and communities severely affected by the pandemic.
- Apply policies such as social isolation to contain the spread of the virus, and implement subsidies and necessary policies to allow workers, especially informal workers, to comply with the quarantine in a dignified manner.
- Full supply of high quality PPE and masks, as well as any other necessary equipment.
- Extensive testing of the virus among healthcare professionals, and recognition of the right of leave of absence (LOA) due to an imminent risk to their health or life, if they so decide, based on the International Labor Organization Conventions 155 and 187.
Edited by: Rodrigo Chagas