Hallo Axel
I do think the point Alex is making is a serious one and deserves a serious answer. Of course the Rio Declaration doesn't tell governments HOW to provide a "universal, comprehensive, equitable, effective, responsive and accessible quality health system" (NB: not just a "quality health system"). It says, in effect, that whatever system governments choose for, it should have those properties.
Alex believes, along with many others, that the Health and Social Care bill is not going to give the UK a health system with those properties. If that is correct, then it is inconsistent for the government to support both the Rio Declaration and the bill. If you disagree, then presumably it's because you disagree about the likely effects of the bill. This is a very important issue and it somewhat surprises me that there has been so little serious discussion about it on this list.
To my mind, the debate about the bill in the UK has been handicapped by an oversimplified contrast between market-based and state-regulated health systems. A competitive internal market for service provision could, if properly regulated to avoid 'cherry-picking' and other excesses, improve health system performance. The system which the Dutch introduced in 2006 is an intricate combination of market-based and state-regulated structures. It is too soon to say whether it has fulfilled its promises, but it hasn't thrown health care into an abyss of cut-throat profiteering (not yet, at any rate). This is because it still contains a strong component of state regulation. Unfortunately, I don't think the commercial interests that are behind the UK bill would ever settle for a comparable degree of regulation.
Nevertheless, the Dutch system does illustrate the limitations of marketisation when it comes to guaranteeing equity. My own specialisation is health care for migrants and ethnic minorities: for these groups, government policy used to be to promote equitable care provision by leading from the top. After the change of government in 2003, the new health minister announced that reducing disparities was no longer a responsibility of government, but would be left to the insurance companies, service providers and 'consumers' in consultation with each other. Unfortunately, minority 'consumers' - for well-known structural reasons - have a very weak influence on policy. As a result, the drive to improve care for migrants and ethnic minorities collapsed. What has now happened is that enterprising firms have set up categorical service providers to cater for dissatisfied minority patients, in effect introducing a segregated care system. Nobody wanted this, nobody even argues that it's a satisfactory solution to the problem, but this is what the free play of market forces has led to.
This story illustrates, to my mind, that equitable care provision can only be guaranteed by government - in the UK case, by ensuring that the Secretary of State for Health continues to be responsible for it. Equity is not an outcome that anyone should expect a market-based system to deliver. Can anyone explain how the opposite could be true?
Best wishes,
David
http://www.ercomer.eu/researchers-2/prof-dr-david-ingleby/
-----Oorspronkelijk bericht-----
Van: The Health Equity Network (HEN) [mailto:[log in to unmask]] Namens Axel Kaehne
Verzonden: maandag 24 oktober 2011 11:50
Aan: [log in to unmask]
Onderwerp: Re: The Rio Political Declaration on Social Determinants of Health
Alex
International declarations can only provide mutually agreed goals and aims. HOW governments reach those is up to the nation states themselves and their parliaments. That is a critical aspect of democracy since otherwise internationally unaccountable organisations such as the UN could set government policy in individual countries.
So, if you read it carefully you will notice that the passage does not say anything about HOW governments need to provide a quality health system. If it did it would make prescriptions that is left to democratically elected parliaments to determine. So, that's why there is no contradiction between the Rio Declaration and the Health and Social Care bill. Whether or not we agree with the content of the bill and its provisions is of course a different matter.
Best wishes
Axel
On 23 Oct 2011, at 16:07, Alex Scott-Samuel wrote:
I'd be grateful if you could tell me who, if anyone, signed this declaration on behalf of the UK Government. The declaration states that 'Good health requires a universal, comprehensive, equitable, effective, responsive and accessible quality health system'; but this is precisely what the Government's Health and Social Care Bill seeks explicitly to remove and to replace with one in which universality, comprehensiveness, accessibility and quality are determined by the vagaries of the market.
Best wishes, Alex Scott-Samuel
World Conference on Social Determinantds of Health
Rio de Janeiro Brazil, October 21, 2011
Available online at bit.ly/q5anfm <http://t.co/i5PE90sG>
The Rio Political Declaration on Social Determinants of Health expresses global political commitment for the implementation of a social determinants of health approach to reduce health inequities and to achieve other global priorities. It will help to build momentum within WHO Member States for the development of dedicated national action plans and strategies.
Process of development
On 15 August 2011, the text was circulated to Geneva-based Permanent Missions of Member States. The first meeting of Member States, convened by the Government of Brazil, was held at WHO headquarters on 7 September, 2011. This was followed by a series of informal consultations attended by representatives of Permanent Missions. The text of the declaration was finalized during the conference in Rio de Janeiro on 19-21 October, 2011.
https://www.twitter.com/eqpaho <https://www.twitter.com/eqpaho>
Dr Axel Kaehne
Welsh Centre for Learning Disabilities
School of Medicine
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