PHM-Exch> Privatised Health Services Worsen Pandemic

[Claudio Schuftan]

Decades of public health cuts have taken a huge human toll, now even more
pronounced with the pandemic. Austerity programmes have forced countries to
cut public spending, including health provisioning






*Privatised Health Services Worsen Pandemic*

By Anis Chowdhury <http://www.ipsnews.net/author/anis-chowdhury/> and Jomo
Kwame Sundaram <http://www.ipsnews.net/author/jomo-kwame-sundaram/>

*SYDNEY and KUALA LUMPUR, Aug 17 2021 (IPS) *- Decades of public health
cuts have quietly taken a huge human toll, now even more pronounced with
the pandemic. Austerity programmes, by the International Monetary Fund
(IMF) and World Bank, have forced countries to cut public spending,
including health provisioning.
*‘Government is the problem’*
“India’s COVID crisis: A deadly example of government failure
<https://independentaustralia.net/politics/politics-display/indias-crisis-a-deadly-example-of-government-failure-,15051>”,
“Government failures
<https://www.theguardian.com/world/2021/jun/27/government-failures-still-hamper-our-covid-19-response>
still
hamper [UK] Covid-19 response”. Such headlines have become commonplace as
the pandemic rages on, with no sign of ending soon. Their godparents
deserve due recognition.

UK Prime Minister Margaret Thatcher claimed, “no government can do anything
<https://www.margaretthatcher.org/document/106689> [good]… people look to
themselves first… There is no such thing as society … quality of our lives
will depend upon how much each of us is prepared to take responsibility for
ourselves and each of us prepared to turn round and help by our own efforts
those who are unfortunate”.

US President Ronald Reagan declared, “government is not the solution to our
problem; government is the problem
<https://avalon.law.yale.edu/20th_century/reagan1.asp>”. Inspired by them,
government capacities and public sectors have been decimated in recent
decades, ostensibly to liberate entrepreneurship and progress.

Four decades of defunding, delegitimization and demoralisation of
governments and their personnel since Thatcher and Reagan have taken their
toll. Unsurprisingly, most governments have failed to respond more
adequately to the pandemic.

To justify social spending cuts, politicians of various hues the world over
have been parroting mantras that government is too big and bad. ‘New
Democrat’ US President Bill Clinton proudly declared the “era of big
government is over
<https://edition.cnn.com/videos/politics/2013/02/11/memorable-sotu-clinton.cnn>
”.

*Neoliberal reforms worse*
This ‘politics of small government’ legitimised privatisation of public
assets and services. Authorities have tripped over one another to privatise
potentially lucrative public sector duties and activities, while reducing
taxes and expenditure.

COVID-19 has revealed the nature and purpose
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670110/> of neoliberal
health spending reforms. New policies have included privatisation and
contracting out public services. Social spending has not only been cut, but
also used to pay private suppliers.

Health system failures highlighted by the pandemic have been long in the
making <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670110/>. Four
decades of neoliberal policies — including marketisation, or
commodification of healthcare — have greatly increased private provisioning.

Private healthcare provisioning in low and middle-income countries (LMICs) took
off in the 1990s
<https://www.tandfonline.com/doi/full/10.1080/09692290.2019.1624382>. It
gathered pace after the 2008-2009 global financial crisis with more hedge
fund and other investments
<https://onlinelibrary.wiley.com/doi/10.1111/dech.12517> in hospitals and
allied health services.

Such provisioning
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00342-1/fulltext>
now
accounts for most health services in many LMICs
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00344-5/fulltext>,
catering mainly to medical tourists
<https://www.degruyter.com/document/doi/10.3138/9781487515904/html>
and patients
with means <https://pubmed.ncbi.nlm.nih.gov/23581671/>. Thus, profit
considerations and financial markets have remade LMICs’ national health
systems.

*Unhealthy reforms*
Increasingly privatised and outsourced, public health systems in developing
countries have been underfunded, undermined and understaffed. Fractured
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30242-2/fulltext>
health
systems, with poor governance and regulation, have become even less able to
respond well <https://prospect.org/economy/austerity-abet-ebola-crisis/> to
new challenges.

Such changes have been promoted by new aid-sponsored financial
arrangements, such as public-private partnerships, as urged by the World
Bank. The pandemic has exposed the results as grossly inadequate,
ill-suited and vulnerable.

Profitable private services remain parallel to and separate from the public
system. The reforms have not only undermined public health systems, but
also weakened governments’ ability
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218352/> to cope. Even in
rich countries, about 40% of health spending is now for private services
<https://prospect.org/economy/austerity-abet-ebola-crisis/>.

Neither <https://pubmed.ncbi.nlm.nih.gov/15563995/> privatisation nor
commodification have improved the quality of care, equity and efficiency of
public services. Thus, deregulation, privatisation and liberalisation
have squeezed
health access, raising morbidity and mortality
<https://www.sciencedirect.com/science/article/pii/S0277953619304897>.

Meanwhile, donors have been diverting aid from governments to
non-government organisations (NGOs), especially ‘international’ ones. But
patchworks of foreign-run NGOs are no substitute
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504287/> for integrated
national public healthcare systems.

*Austerity kills*
Analyses of economic shocks around the world, from the 1930s’ Great
Depression to the 2008-2009 Great Recession, show fiscal austerity kills
<https://www.youtube.com/watch?v=EkfsCZZraoo>. In England since 2010,
austerity has been linked to 120,000 more deaths and over 30,000 suicide
attempts <https://bmjopen.bmj.com/content/7/11/e017722>.

Despite declining alcohol <https://www.bbc.com/news/health-39785742> abuse
and smoking
<https://www.theguardian.com/society/2016/sep/20/number-of-uk-smokers-falls-to-lowest-level>,
and without counting flu and other epidemic fatalities, 100 ‘early deaths
<https://www.theguardian.com/commentisfree/2018/aug/08/austerity-kills-life-expectancy-standstill-britain>’
daily were expected in the UK, even before the pandemic. Social security
cuts
<https://www.theguardian.com/society/2017/jun/28/social-care-cuts-to-continue-in-spite-of-1bn-boost-english-councils-say>
have
also been devastating.

Despite growing patient demand and rising healthcare costs, during
2010-2020, the UK National Health Service suffered the “largest sustained
fall <https://www.kingsfund.org.uk/blog/2015/10/nhs-spending-squeezed-never> in
… spending as a share of GDP in any period” since its creation after the
Second World War.

Earlier, Greece
<https://www.nytimes.com/2013/05/13/opinion/how-austerity-kills.html>’s
2010 austerity package required cutting its national health budget by 40%.
Infant mortality rose 40% after some 35,000 doctors, nurses and other
health workers lost their jobs.

As Greeks avoided routine primary healthcare due to long waits and rising
drug costs, hospital admissions soared. Meanwhile, mosquito eradication
programme cuts led to a resurgence of malaria.

Austerity also worsened Ebola
<https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70377-8/fulltext>
in
West Africa. Cutting public health spending from 1990, Guinea, Liberia and
Sierra Leone further weakened their already poor health systems,
undermining their ability to cope with emergencies. Thus, in the year
before the Ebola outbreak, Guinea spent more on debt repayment than public
health <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504287/>.

Meanwhile, austerity-driven funding cuts to the World Health Organisation
(WHO) by the US, UK and European governments critically delayed responses
to the Ebola outbreak, worsening it
<https://www.theguardian.com/world/2014/oct/09/ebola-who-government-cuts-delays-in-dealing-with-outbreak>.
Funding shortages also set back needed WHO efforts to respond to future
global health crises.

*Government not main problem*
Health threats posed by the pandemic have not been well addressed by the
reforms of recent decades. Some have been made worse, with LMICs
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670110/> particularly hard
hit by COVID-19. Unsurprisingly, confidence and trust in governments
everywhere <https://www.oecd.org/gov/trust-in-government.htm> have dipped
<https://www.pewresearch.org/politics/2021/05/17/public-trust-in-government-1958-2021/>
.

In fact, public health investments before the pandemic were projected
<https://www.nytimes.com/2013/05/13/opinion/how-austerity-kills.html> to
yield three times as much in economic growth. Thus, such spending would
have not only saved lives, but also accelerated economic expansion.

With COVID-19 endemic, and most government pandemic containment and fiscal
capacities in the global South limited, the pandemic will drag on, further
setting back progress and worsening inequalities.

Meanwhile, Thatcher and Reagan still haunt us all until the world exorcises
their ghosts forever.

*Related IPS Articles*

·                How to Sustainably Finance Universal Health Care
<http://www.ipsnews.net/2021/08/sustainably-finance-universal-health-care/>

·                Developing Countries Struggling To Cope With COVID-19
<http://www.ipsnews.net/2021/02/developing-countries-struggling-cope-covid-19/>

·                Why Some National Health Care Systems Do Better than Others
<http://www.ipsnews.net/2020/05/national-health-care-systems-better-others/>

·                Hospital PPPs Undermine Healthcare
<http://www.ipsnews.net/2019/01/hospital-ppps-undermine-healthcare/>

·                Big Business Capturing UN SDG Agenda?
<http://www.ipsnews.net/2018/12/big-business-capturing-un-sdg-agenda/>

·                PPPs Likely to Undermine Public Health Commitments
<http://www.ipsnews.net/2018/01/ppps-likely-undermine-public-health-commitments/>

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