International Public Health Policy and Ethics by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783031399732
Publisher: Springer International Publishing

Poverty and Public Health

In developing economies, where vast wealth cannot be spent on hi-tech hospitals, public health measures are clearly the most important investment in the health of the people. Clean water, adequate sewage treatment facilities, adequate nutrition, and immunizations have the largest impact on mortality and morbidity. To take one example, in Tibet over the last 50 years infant mortality rates have dropped from the extremely high level of 430 per 1000 in 1951 to 35.3 per 1000 by 2000. Life expectancy for Tibetans increased from 36 to 62 years since the 1950s.12 These results are due primarily to general public health efforts. In countries with serious poverty, nothing can fight chronic poverty and affect public health as much as free public schools with free lunches, clinics, and immunizations. Education helps break the cycle of poverty; free lunches help fight malnutrition and keep kids coming back to school; and clinics and immunizations directly fight illness and disease. In developing countries, broad public health measures and universal education should be the focus. In the context of serious poverty, more expensive biomedical interventions simply cannot be the first priority of the national government.

As countries develop and markets and employment expand, however, private insurance markets also take off and are available for the emerging middle classes. I suspect in the context of free markets, the emergence of a two-tiered health care system is somewhat unavoidable. Given the clear advantages of social insurance systems, we can expect that laws and regulations that promote social health insurance funds through mandatory employment-based health insurance are likely to mitigate, and, over time, undermine the degree of inequality in access to health care services. It is an advantage of a social insurance system that it can in this way build a broader health care infrastructure on the backs of a growing employment base. Indeed, this is the history of social insurance in Europe; perhaps we can learn from Europe’s success.

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