Community Health Officer (on the left) supports the health worker during contact tracing for home visits. Photo: © FAIRMED
A world moving towards sustainability and leaving no one behind?
In 2015, just before the adoption of the agenda 2030 with its 17 Sustainable Development Goals (SDGs), Frances Stewart voiced a major concern. “The economic goals and the sustainability ones are not integrated but remain quite distinct. I fear this will mean that economic growth continues to be given precedence, with a hugely damaging impact on sustainability.” (Frances Stewart. 2015)
The central mantra of the SDG’s, leave no one behind, or in its more radical form, first serve those most behind, is a very noble, altruistic and ambitious goal. In health it means a radical shift from the old aim to assure “Health for all” (which actually meant health for most) to give priority to assuring equal opportunities to those left behind; in the broader framework of Universal Health Coverage (UHC).
We already kind of knew that the world is not yet going fast enough towards UHC, that too many people are pushed into poverty through catastrophic expenditure for health. We knew that persistent inequities continue to hinder the fair advancement of neglected people. But that was perhaps hidden in expert and advocacy groups, and the general public, left alone the “conscience of the world” did not own this message yet.
Mali. Photo: World Bank Photo Collection/flickr, CC BY-NC-ND 2.0
But right then, a “simple” virus shows up in Wuhan, proving to be a formidable stress test – not only for health systems. It travels around the world in no time and makes a few things clear:
- For this type of pandemic, one is only as strong as the weakest link in the chain- a virus on the loose in one country will affect all others.
- Very few national health systems provide an adequate response to the epidemic. Shortages of material, equipment, beds, and staff become painfully visible. What is daily routine in many lesser developed countries is a horrible confrontation for societies used to abundance and choice: triaging critically ill patients into those having access to lifesaving equipment, and those without. Countries classified as “most prepared” in the Global Health Security Index 2019 such as US and UK stumble through the crisis with late half-responses and are not prepared at all.
- Scientists and experts live in another world full of acronyms and detached and sometimes incoherent statements, driving people in the arms of quacks and dangerous Donalds.
- Switzerland has ample supply of short-haired efficient leaders with admirable communication styles – as fast as possible but as slow as necessary.
- Most countries are willing to shut down the economy into recession. Huge, wartime-like budgets are mobilized overnight, to support people, sometimes in modalities close to Universal Basic Income, but most of it towards large corporations that face bankruptcy. The same corporations that last year paid millions to shareholders suddenly depend on taxpayer’s money for their survival.
- Suffering through the lo ckdown is very different depending on your perspective. Those left behind suffer disproportionately. A striking example is the 460 Million migrant workers in India, suddenly unwanted and evicted back to their village; walking hundreds of kilometers, some dying underway, most fearing starvation. One said “Maybe when (president) Modiji decided to do this, nobody told him about us. Maybe he doesn’t know about us”. (Financial Times, 3 April 2020)
- Infection rates and mortality are higher in poorer areas, partly based on initial poorer health status. Additionally Covid-19 exacerbates existing inequality, pushing many of the burdens onto the losers of today’s polarized economies and labor markets. (The New York Times, 27 April 2020)
- The war on Corona needs “cannon fodder”, just like real war. Countless health personnel are infected, and many die. Others are gagged (China); commit suicide (UK) or “fall through windows” after criticizing lack of equipment (Russia). Refugees at European borders are further neglected and very limited attention goes towards their most precarious situation. A shortage on meat in the US induced by high corona infection rates in its workers, was “solved” through a wartime Defence Production Act. This Act takes away liability from the employer should more of its workforce contract Corona, and forces workers to get back at work, basically treating them as “modern day slaves”. (The Guardian, 2 May 2020)
- Suddenly, everyone is an epidemiologist and expert in health systems, epidemic preparedness, contact tracing and R naught analysis. Suddenly we all understand what stigma is when in presence of others, we suppress the urge to clear our airways with a decent cough.
People leave Antananarivo (Madagascar) during COVID-19 pandemic. Photo: World Bank Photo Collection/flickr, CC BY-NC-ND 2.0
Broken dreams and the bad old “normal”
A little despicable virus has managed to render painfully visible what was already to different extents known in expert groups – challenges and insufficiencies to our health and social systems are real, and most so for those left behind. Sustainability of environment and livelihoods is threatened by increasing inequity in a world enslaved to economic growth.
Sustainability of environment and livelihoods is threatened by increasing inequity in a world enslaved to economic growth.
The rich part of the world does not care about poverty; unless it affects its own health and economy- then suddenly it is possible to mobilize substantial resources. Decision makers are trapped and entangled in inequity sustaining models.
Covid-19 also inspires people towards empathy and compassion. In the face of their own insufficient resilience and suddenly re-discovered fragility and uncertainty, many people decided to play their part - at least with the symbolic clap in the evening to thank and commemorate the heroes in healthcare and other essential services.
But beyond the immediate crisis response, the lock down, economic survival war chests and tender compassionate outreach to other human beings, people start asking the Big Questions. Observing how badly the before-Corona-normal has prepared our society for what is a simple virus, opposition grows against the simple return back to normal. It is not acceptable anymore. Not. Anymore.
We have to resist going back to the bad old normal, and rather “emancipate ourselves from mental slavery”. Why are we not more alarmed with millions dying from pollution each year in an environmental catastrophy that is pushing earth into irreversible unsustainability soon? Why do we accept the deaths by treatable diseases of the poorest in multitudes of the number of corona deaths?
Why do we accept the deaths by treatable diseases of the poorest in multitudes of the number of corona deaths?
Why is it that if this would have been a real war, there would have been enough bullets, tanks and fighter jets? Isn’t it clear that inequity is the big disease, caused by blind GDP growth slavery? That this inequity is the largest cause of vulnerability and fragility in societies? That combatting inequity, beyond the right moral thing to do, is essential to save humanity? That as long as the poorest have no access to health and social services, nobody will be safe from biohazards like Corona?
"There will be a life after Ebola" - John Sesay. Photo: DFID - UK Department for International Development/flickr, CC BY 2.0
Let´s get out of the corona tunnel
Asking Big Questions has not yet lead to a clear path to the New Normal. Perhaps the corona crisis is not big and chaotic enough to create fertile grounds for a true revolution. Remember, the Black Plague wiped out 20% of the global population, and led to the destabilization of feudalism and initiated the movement to the Renaissance. World War II killed about 4% of the global population and ultimately changed political alignments and social structure around the globe, leading to the birth of the United Nations. The West-African Ebola epidemic killed 0.05% of the population of Guinea, Sierra Leone and Liberia. It remained conveniently quarantined away from the Western conscience until the first case reached US soil. One of its lessons was that you do never just control an epidemic - you learn and prepare for the next ones. Perhaps Corona (so far killing 0.003% of global population) will only serve as the final wake up call for pandemic preparedness - when the Big Brother of SARS-CoV-2 will strike.
As I am writing this, there is a lot of triumphalism of the EU led fundraiser of 7.4 billion Euro for the fast tracked development of a vaccine. Norway leads the pack with a pledge of 1 billion Euro, with its prime minister stating “To protect ourselves, we must in fact protect each other”. And she is right, but we should aim at much more than to win the race for a vaccine in record time. When we think on how to assure that the vaccine is delivered to the 4 corners of the earth, to all 7 billion people and first to those that are most left behind, let’s get out of the corona tunnel and have broad comprehensive vision. We need strong health systems offering universal coverage - as opposed to system damaging single disease campaigns such as polio eradication.
We need strong health systems offering universal coverage - as opposed to system damaging single disease campaigns such as polio eradication.
This is the time to take planetary health serious- everyone exercising their right to good health, quality of life within the relative ecological constraints so that also our planet remains in good health. May corona suffering lead us to perseverance towards social justice - the sine qua non for planetary health. May this perseverance give individuals and whole society a more righteous character, so that we truly leave no one behind, giving hope to all of us.
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