Written by Goh Choong Yong
Harnessing knowledge to secure a universal and equitable entitlement to health: The afterthought.
Health as everyone knows is a commodity and is a universal right. It's almost of rule that everyone, regardless who they are, where they are, have the right to access some sort of health services. However, this right to access, though universal, is a challenge. I was privileged to attend a global health oration by Prof. Dr. Timothy Evans entitled harnessing knowledge to secure a universal and equitable entitlement to health courtesy of the Jeffrey Cheah Foundation and Monash University Pharmacy Society. In summary, he defines what universal and equitable health coverage is all about and later focuses on the challenges and change necessary to allow for the proper implementation this universal and equitable health coverage. Finally, he ends his oration with the necessity to harness knowledge and technology to achieve this goal.
The afterthought.
In this insightful oration,many issues pertaining to universal health coverage was brought up.One of importance in my opinion, is the need to combine the clinical sciences and public health. Health professionals tend to indulge more on the sciences, working or researching on preventions, treatments, guidelines and many more while not much thought is given on public health issues such as how to increase access to health information, how to improve primary care or how to increase health care penetration in low income areas. Basically, thought is only given on how to treat the disease not on how to actually help the patient to get affordable treatment for the disease!!
Furthermore, public health itself alone is a challenge due to 3 reasons brilliantly stated as the 3I’s by Dr.Evans: Individual,Institution and Infrastructure.
1. Individual: There’s lack of people taking up or working on public health issues. It’s easier to do research in something clinical rather than public health because its more prestigious and people tend to care about how to cure a disease rather than how to increase access to the cure of a disease.
2. Institution: The lack in public health schools. And it’s not helping as this fuels the lack of individuals taking up or studying public health. Hence,the lack of expertise. Also, as public health is not viewed as something as illustrious as medicine or pharmacy (despite its importance!!). Thus, it is not profitable for a school or university to start such courses.
3. Infrastructure: The lack of support and financial backing in the public health. To achieve anything in public health,support is necessary for the implementation of its policies and financial investment is necessary as well to implement those policies. For example,let’s take the access to drug substitution therapy for all drug users. There is a need for support from the public, patients, NGOs, government and health care professionals to implement this therapy. Besides, it’s necessary to put aside some funds to kickstart this therapy. Now here lies the problem. Although healthcare professionals may see drug addiction as an important medical issue rather than a social disorder issue, the public may see this policy implementation as a fueling a social disorder. To put in blunty, the public would argue that money should not be wasted to give drug addicts free drugs.They are drug addicts, let them get high and die!! Then again, this is an important issue because we want a universal health coverage but we condemn drug addicts of their therapy because they are drug addicts. So if this is done, how do we define universal? How do we define “public” health? Where do we draw the line?
The Pharmacist: Step Up.
With all this talk of universal health coverage, where do we as pharmacist come in to secure a universal and equitable entitlement to health? This is a tough question because even in the health oration, there’s no mention of pharmacist (if you don’t count healthcare professionals); and most policy makers tend to be physicians as they are “deemed” to know more on how healthcare actually works. To my surprise, Dr. Evans mentioned something really interesting when a question on doctors as policy makers cropped up. Thailand is considered a leader in public health because when they sit and discuss public health policies, everyone: healthcare professionals of all kinds, politicians, the public, NGOs, you name it, all come to debate on the various policies to be implemented. This, he states, is great because we can come to consensus on what needs to be done and define the various opposition or conflicts that crop out during the debate to see what needs to be done in order to address those oppositions and turn them into solutions.With that, various policies can be thought of and implemented as it is agreed by everyone and there’s the necessary support.
So again,where do pharmacists come in?
As a primary care provider to patients,we know our patients probably more than any of our other collegues. Our ability to engage them and provide health services is invaluable in universal and equitable entitlement to health. Now, before I move on let’s reflect on universal health coverage as a topic. How do we define universal health coverage? In 2005, the member states of WHO adopted a resolution encouraging countries to develop health financing systems aimed at providing universal coverage. Then, WHO defines universal health coverage as securing access for all to appropriate health services at an affordable cost.
Wait what?? Appropriate health services at an affordable cost? Pharmacists give counselling for free in Malaysia regardless if anything is purchased!! That’s + 1 for us in securing universal and equitable entitlement to health!! Our ability to know our patients and their medicines allow us to be a part of this. We who they are, their diseases and their medications. So using our clinical knowledge and knowing our patients financial
background, we can advise them on what medications they really need and dispense them the cheaper but as effective generic drugs. Furthermore, they can engage us anything if they need any information because pharmacies are easily accessible and nearly everywhere compared to a clinic or hospital. On a public health scale, we can engage in policies pertaining to quality use of medicines and actively engage in ways to promote health penetration because we are primary care providers, we know what’s going on out there, we know what drugs is in demand from sales data and this allows us to shape drug registries and save huge costs in healthcare financing especially in funding for medication. And as we move away from dispensing as technology advances, with medicines ready packed for sale and dispensed is done automatically or through aid of robotics and computer system, we can move out of the counter and actively engage people through counselling and health education. As a result, we reduce unsafe care and increase the public’s access to healthcare information. This is important as Dr.Evans mentioned nations with the lowest access to healthcare information have the highest death rates. So step up pharmacists. Step up.
In conclusion, this is such an insightful health oration by Dr. Evans. I totally regret not asking him about how the global economic meltdown will affect the harnessing of knowledge to secure a universal and equitable entitlement to health and universal health coverage as a whole. I can go on and on to write this topic but that’s all I have to say for now. If anyone wants to discuss this with me, feel free to discuss though preferably over a cup of coffee or tea during the holidays.
Now where did I place my cup of green tea?
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