Sitting in a lecture theatre at the Royal College of General Practitioners at a conference entitled Family Medicine: Global Impact, my mind was taken back to all I had seen during my time in Uganda. The injustice, and the overwhelming feeling that things should not and do not need to be this way. I felt humbled to be surrounded by so many like-minded individuals.
Here in the UK we have the National Health Service, founded in 1948, it aims to provide health care that meets the needs of everyone. It is free at the point of delivery
and is based on clinical need, regardless of a person’s ability to pay. The poorest in society receive the same care as the most elite. Pure and simple.
In a wider context, Global Health focuses on improving health and achieving equity in health for all people worldwide. There are many different perspectives and opinions as to what exactly this means, and even wider debates on how to make a positive and sustainable impact within the countries that need it most.
In recent months, the Ebola crisis in West Africa, has highlighted, once again, the importance of strengthening all health care systems over time. Prevention is ALWAYS better than cure. Out of every crisis comes opportunity, and now more than ever it is important to discuss the true meaning of global responsibility, because one way or another, directly or indirectly what is going on in Sierra Leone, Singapore or South Sudan, affects us all.
Contextually for me, Family Medicine, or the General Practitioner is becoming fashionable worldwide, and Iona Heath amongst others, strongly believes there should be a GP for everyone in the world. Indeed, doctors from all parts of the globe travel to my Royal College to further understand why having a family doctor provides a backbone to deliver the very best care.
Dr Margaret Chan, Director General of the World Health Organization believes that “Primary Care is our best hope for the future. Family doctors are our rising stars.”
I felt like somewhat of a fraud fighting for General Practice on a global scale when it can sometimes feel that we haven’t quite got it right at home. In this country, rightly or wrongly, we take healthcare for granted. Sadly, more often than not, it is undervalued because it is free. But, for now at least, we do have free Universal Health Coverage for all, a luxury not afforded to many of our international counterparts.
This discussion raised big, uncomfortable questions. What is Universal Health Coverage? Should governments provide healthcare for their citizens? Should it be free? Is healthcare a necessity or a commodity? Is it an effective use of resources?
Surprisingly, money doesn’t seem to be the major limiting factor, and there are many that believe that the giving of aid actually has a negative rather than positive impact on a country’s development.
There are 3 main types of aid a country can receive. Non-governmental organizations (NGO) aid which is funded by the public through charities such as Oxfam, and foundations such as the Bill and Melinda Gates Foundation. Bilateral aid is money given by a donor country to another, and this is sometimes criticised as a way of driving political agendas. Thirdly, governments may contribute funds to organizations like the United Nations and the World Bank which is known as multi-lateral aid.
Having worked for NGO’s myself and directly seen the positive impact they can make on a local level, I am in no rush to entertain the notion that they are causing more harm than good. However, I do agree that they can create vertical health systems leaving people wishing they had AIDS or Malaria rather than Diabetes because that is where the money has been invested. A short term fix perhaps rather than a long term solution. Does dependency on welfare actually create more dependency on welfare and not drive reform and change to policy from the top down?
I’m confused, so I can only imagine what others must be thinking. I definitely don’t think stopping any charitable work or donations is the answer. Do we look to our government? The World Health Organization? The United Nations? What role do you or I have in any of this? Do we as global citizens have a moral obligation to raise our voices for those powerless to fight for themselves? I think that answer is yes.
Of course I think that healthcare should be free to all, and family medicine, a specialty that treats the patient holistically, promotes health education and preventative medicine should form the cornerstone of this. For me it is from a moral standpoint, that everyone is born equal and that access to healthcare is a necessity, for others it may be as simple as ‘good health is good business’.
How do we go about it? If I am honest, I’m not sure we will ever know the answer, but for now at least, I think we should continue to make a difference in every small way that we can.