The question is how to reconcile the need for health care reform with little fiscal space and high levels of debt in Latin America. We talk about the old quarrel between health and money. In case Latin America commits to development, average lifespan should be 10 years longer, average boy should be 7 centimeters taller, cancer survival should triple, mortality from heart attack should be cut in half, and maternal and infant mortality should be history. To achieve these lofty ideals we need another economy, impossible to get without healthy people. So we need a new health-care system.
Certainly, the prospect of Health Care Reform has been aggravated by the pandemic. More than 3 million deaths in the region, the economy dropped by 7 percent. Slowing growth. Informal economy representing a third of the GDP. An unmatched increase in sovereign debt. More than 200 million people live in poverty. Habitat rapidly deteriorating. Some 116 million people live in slums. Biodiversity vanishes. Brain drain, poor facilities, and corruption, are other limiting factors. We face an unfavorable scenario for reform, hence we must be innovative, scientific, and deeply rooted.
Regional and national health goals should be established and reviewed periodically so that they form the basis of health planning and accountability. Local scientific research is a critical component of reform to accelerate implementation, increase impact, and create a competitive culture and leadership. Patents and funding must be redesigned. The latest resolution of the World Trade Organization on vaccines is to be welcomed.
New health care organizations are indispensable. We envision a network of redesigned organizations based on a regional perspective, rooted in team building and scientific evidence, and strongly committed to technology diffusion, efficiency, community action, and impact. Corruption must be controlled through extensive technological systems. Without control of corruption in health care, a reform would be simply impossible.
Local production of biotechnology is another priority. We have to focus on the medical technology that would be massive, efficient, cheap, easy-to-use, and cost-effective. Until now, medical technologies frequently destroy budgets, indebt countries, too many times are a waste of money, and are a privilege for a few. Thus, the challenge is to rethink the problem.
Without reform, fiscal space will continue to shrink and debt levels will stay rising. And this holds true for poor and rich countries alike. But we need an ethics of ends. Human Beings deserve to be treated as ends in themselves and not as mere instruments.
As the German philosopher Max Horkheimer said [1], there is a process of instrumentalization in the way that man and money are related. Human Health is a reasonable end in itself, and does not need any reference to some kind of subjective gain or advantage, because the Human Being is an end in itself. Then health resources, money, medicine, research and politics, are for the good of the Human Being and not the other way around. An ambitious health reform in the region could only be undertaken under the influence of this guiding principle.
The pandemic showed that nothing is more wasteful than disease. It is worth reflecting on the extent of the economic damage from millions of other currently neglected diseases. In order to face the essential health reform in Latin America, it is first necessary to change mentality and then innovate with determination.
We have to capitalize on the response to covid-19 to respond to forgotten and re-emerging diseases
The first way to capitalize the response to COVID-19 is to learn its many lessons. The first lesson from the pandemic is that health-care is better for people when it is free of charge. The second lesson learned is that prevention is better than cure. Third, cooperation is everything. The same cooperation now threatened by the confrontation between security issues and cross-border university research relationships. Fourth, the truth is hard and many prefer a well-explained lie. Five, inequalities matter. Six, Covid-19 has allowed the State to once again become the supreme entity, as it was the only one able to coordinate crisis management[2]. Seven, for Latin America it is also imperative to promote its biotechnological Industry through innovation. Chemical production alone is no longer enough, we must attract innovative companies as well[3]. Lastly, “Hope is more the consequence of action than its cause¨, as Roberto Mangabeira said. The experience of the spectator favors fatalism, but the experience of the agent produces hope[4].
Back to Horkheimer: “the pioneers of bourgeois civilization, the spiritual and political representatives of the rising middle class”, were unanimous in declaring that reason plays a leading role in human behavior, perhaps even the predominant role. For the founders of Democracy, Reason was supposed to regulate our preferences and our relations with other human beings and with nature. “Reason was held to be the supreme arbiter, the creative force behind the ideas and things to which we should devote our lives”. Today we let particular or sectorial interest to be the arbiters of truth; and that is irrational. That is an invitation for irrational powers to regulate Human coexistence and, obviously health-care too.
The global health crisis could probably send us back into a world of self-interest, conflict, and oppression, as long as we don't learn from it[5]. Allow me to finish with a poem of Jorge Luis Borges[6]: After painful experiences “you start to learn…./That kisses are not contracts and gifts are not promises,/and you start to accept defeat with the head up high/and open eyes,…” “…Over time you will learn to forgive or ask for forgiveness,/say you love, say you miss, say you need,/say you want to be friends, since before a grave, it will no longer make sense. But unfortunately, only over time…” you start to learn. Let´s hope that time has arrived.
The article refers to Dr. Regazzoni's contribution to the panel discussion "Health and SDGs: Making Cooperation Alive" of the Global Policy Forum 2022, held on June 21, 2022.
[1] Means and Ends. In: Max Horkheimer. The eclipse of reason. New York 2004, Oxford University Press, Ch. I, pp. 7ss.
[2] Pierre-Guive Yazdani. Le “big reset” fiscal, le réveil des Etats ? Portail de L’IE, Le 2 juin 2021
[3] Tiphaine Dieudonné. L’industrie de la santé en France aujourd’hui, entre risques économiques et perte de souveraineté : une nécessaire reconquête de puissance. Portal de L’IE, Le 13 janvier 2022
[4] Roberto Mangabeira Unger, The Future of American Progressivism: An Initiative for Political and Economic Reform
[5] Le temps retrouvé. En: Au-Delà du COVID. RAMSES 2022
[6] Jorge Luis Borges. “Learning”. (Poem)
