The latest episode of A Shot In The Arm is out!
The episode was recorded live on April 25th 2019, at The Commonwealth Club in San Francisco. The Commonwealth Club is an amazing venue, with an amazing program, and breathtaking views of the Bay.
This was a special live event, hosted by A Shot In The Arm, and marks the first of a series of live discussions over the next few months to explore in the intersection of global health and human rights.
In this episode, microbiologist Peter Piot and anthropologist Heidi Larson, from the London School of Hygiene and Tropical Medicine share their thoughts on the lessons learned from ebola, measles and HIV for future epidemics. They are the real-life Indiana Jones stars of global infectious disease. I strongly recommend Peter’s memoirs “No Time To Lose.” His life in the former Zaire, now the Democratic Republic of Congo, chasing down ebola is breathtaking. In the second part of the the book, his perseverance in first breaking down the barriers of UN stagnation, creating UNAIDS and then moving the world’s investment in AIDS from millions to billions reminds one of Elizabeth Warren. Heidi is not outshone by Peter. She is founder of the Vaccines Confidence Project, which fights disinformation in the age of vaccines. Her insights into how to engage the “anti vaxxer” movement are telling and inspirational.
This week also sees the United Nations General Assembly meeting in New York to prepare for its Special Session on Universal Health Care (UHC) in September. Thanks to ICASO’s MaryAnn Torres for pointing me in the right direction, I can now doze through sessions in the comfort of my own home, courtesy of the internet.
What is UHC? To be perfectly honest, I am not sure. We can say that it will likely become the pre-eminent global health policy issue of our era. It is deeply intertwined with climate change , as temperatures bring about massive disruptions in populations, clean water access, and the emergence of old and new infectious diseases. As Heidi and Peter remind us, AIDS and measles denialists have chosen deliberately to ignore the facts, placing not only their loved ones, but entire societies at risk. So too with climate denialsts. Their grip on power for the last thirty years will have lasting consequences for humanity.
For right now, we need to recognize that UHC will drive – and unless we deliberately raise additional billions of dollars - absorb existing and new health access, equity and financing initiatives. We must seize the opportunity.
UHC relates to Sustainable Development Goal target 3.8, “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” That there is not a specific HIV goal is a conversation for another time. Since 2017, the World Bank and WHO have sought to raise awareness and action on UHC, as now UCH2030 use the following framework definition “all people having access to quality essential health services, without having to suffer financial hardship to pay for health care.”
It is a helpful, but incomplete definition, and its continued vagueness, while perhaps smart for shorter-term international negotiations, means that the prediction of the funding needed to achieve it remains obscure. Calls for securing further efficiencies in health care delivery do not suffice, and countries have to face head-on whether to expand public expenditure.
The most effective and efficient way of delivering healthcare is through public funding and service delivery, and a proven model was established in the UK in 1949. The National Health Service is (or would be if not for Tory tinkering) publicly-funded health and wellness for everyone from cradle to grave, regardless of ability to pay. My hero, the Health Secretary of the time, Labour’s Aneurin Bevan said “the NHS is the single greatest experiment in social service that the world has ever seen undertaken.” His words resonate to this day.
Disappointingly, there is currently no global consensus that this the way forward.
As we wrestle with the disruptions of climate change to our way of life, I am optimistic that a new consensus could emerge within my lifetime. As Peter notes, a new influenza pandemic could be a game-changer for humanity. As “Spanish Flu” from 100 years ago shows us, pandemics have no respect for national borders, class, creed or income level. Our survival will require us from the same.
In the meantime, the vast majority of healthcare spending in resource-limited settings will continue to come from Out of Pocket Expenditure (OPE), which is a polite way of saying poor people have to pay exorbitant fees for emergency medical services. Over the next few decades, we should expect that “funding source” to grow, largely unaided and unplanned.
What, then, do we do?
At a bare minimum, donors right now (both in the North and South, public and private) need to meet the 6th replenishment goals of the Global Fund to fight AIDS, TB and Malaria. But they will also need to commit to a 7th replenishment, 8th, 9th and so forth…
It would be a significant, if underwhelming achievement, if we agreed to make OPE work better – supporting our poor to move from paying for emergency health costs, to planning for their future health. Governments have to lead the way, with the engagement and oversight of their peoples. Under such a rubric, there are increasingly creative ways for communities and the private sector to make meaningful contributions. These include workplace-based wellness and health programs (in both formal and informal labor markets), low-cost saving schemes for health, co-operatives, and expanded privately and publicly managed health insurance schemes.
At exactly the same time the UK was creating the National Health Service (its real 20th Century jewel in the crown), India and Pakistan were finally free from the British Empire to experience the joys, challenges and sorrows of self-determination. It is not catchy, but it is direct. Amrit Kaur, women’s rights activist, and independent India’s first Minister of Health could have been offering a definition of UHC when she said, “the welfare state is the economic betterment and provision of minimum standards of living essential for a healthy life for all people.”
There is a question and answer session at the end of the podcast. But do not fear, Peter and Heidi will be back in future episodes. So if you have a burning question, let me know, and Ill be sure to ask them.
You might find these links helpful:
And if you want to know more about HIV:
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