Report from the UN: Community Health Care

  • Date / 11 February 2010

Social justice is a matter of life and death. It affects the way people live, their consequent chances of illness and their risk of premature death. A girl born today can expect to live for more than 80 years if she is born in some countries, but less than 45 years if she is born in others.

About 90 percent of the world’s health resources are spent on less than 20 percent of the world population living mostly in wealthier countries. You can expect to live about the same number of years, until the age of 78, if you are born in Costa Rica or the United States today, even though Americans on average are four times as rich. If you are born in South Africa, your life expectancy drops by 27 years to 51, even though it is on average as rich as Costa Rica.

What’s the difference? Social and health services and inequality. Poor Costa Ricans have more access to clinics and other social services. Once a country reaches a per capita income of about USD$10,000—currently true of Costa Rica—education, social services, preventive health care and local access to treatment when you are ill, is more valuable for the average citizen than a bigger economy.

In 1978 the World Health Organization (WHO) promoted the strategy of Primary Health Care (PHC) which stresses local participation in managing health services, the use of local clinics and the training of local people in performing basic treatments that do not require a doctor. It stresses health education and prevention. Complex cases are referred to the next level of care.

Some governments and international donors were unhappy with the concept of community control over health. It also didn’t appeal to the medical establishment. Some communities associated quality care with big hospitals. PHC was often under-funded, re-enforcing the idea that it was second-rate care.

Sadly, as countries became richer they tended to skew health spending toward big-city hospitals and specialist care and the chance to expand primary health care was lost. People in rural areas around the world often travel hours to get basic services. WHO estimates that empowering communities could reduce disease globally by as much as 70 percent.

WHO is again promoting primary health care. It is more important now than ever. Firstly, the cost of the current approach is not sustainable. Furthermore, there is an extreme shortage of doctors and health workers. The global shortage of health workers is about 4 million. The solution isn’t to accept and train medical students from poor countries. Doctors and other health professionals naturally go to richer countries where working conditions and the pay is better, leaving poor countries in dire straits. There are more doctors of Ethiopian decent in Washington, DC, than in all of Ethiopia.

In one study of 42 countries, accounting for about 90 percent of child deaths worldwide, 63 percent of these deaths could have been prevented if good primary health care had been available. Government policy that focuses on medicine for the rich–enriching providers–is deadly for the majority of the world’s population. The United Nations is fighting for their lives and needs all our support.

Equity and social justice is more important than ever.

Dr. Sylvain Ehrenfeld, representative to the UN from the International Humanist Ethical Union, with Temma Ehrenfeld. Dr. Ehrenfeld writes a monthly column reporting on developments at the United Nations.

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