What do think of when you hear the words: Universal Health Care?
You might think of 'Utopia'. A place where everything is perfect.
Where quality healthcare is accessible to all, where human beings are all equal, where age,
gender, disability, geography and economic status have no negative impact on your life. A
place where no one is left behind.
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I know a place called ‘Utopia’, it's an Indigenous community in the central desert of
Australia. I actually spent several years working in this area.
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It's a community where Indigenous Australians are more likely than Non- Indigenous
Australians to have Respiratory disease, Cardiovascular disease, Diabetes, Obesity, Chronic
Kidney disease and Mental Health problems with high incidence of teenage suicide.
A place where non-communicable disease leads to premature death.
This is not the Utopia we imagine when we hear: Universal Health Care, particularly when
this community is in a developed country like Australia.
These pictures were taken 10 years ago. Most of these children will not have finished school,
will be in trouble with the law secondary to alcohol abuse or chroming, will be pregnant as
teenagers, will have attempted suicide or suffer with mental health problems, they will have
experienced domestic violence or sexual abuse and almost all of them will die prematurely
due to Non-communicable diseases.
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When we look at Non-communicable diseases ( NCD’s) what do we know?
We know that in developed countries, such as Australia, there are disparities in health
between indigenous and non-Indigenous people;
In Developing countries such as such as Ghana, Zimbabwe and Gambia, Health
disparities also exist amongst the population and that NCD’s are prevalent in low to
middle-income families, and factors such as economic status, geography and lifestyle
contribute to these health disparities.
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We know that based on the NCD Country Profile report from the World Health
Organisation that the percentages of premature deaths from NCD’s are a global issue
and that NCD’s account for premature deaths accounting for:
34% in Gambia
43% in Ghana
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33% Zimbabwe
89% Australia
We know that NCD are chronic health problems that are preventable and
can be linked to culture and behaviour, where obesity in some cultures is considered
fashionable and beautiful.
In some countries, smoking amongst men is cool, manly, and fashionable, and we need to
consider the diaspora when they return to their home countries, what habits they bring back
with them.
We know communicable diseases such as Ebola take precedence in the Health budget of
developing countries, understandable when you look at the statistics of communicable
disease.
We know one of the largest barriers to providing primary health care in developing countries
is Accessibility.
This may be due to a lack of Infrastructure, if there is no clinic or hospital how can the
healthcare workers deliver health care?
Access could be difficult because of Geography, if you live in a rural or remote area it may
be too far or too expensive to travel to access Primary Health Care.
Conflict or unstable environments may also prevent people from getting to a facility.
As a nurse working on the frontline I have seen firsthand what a lack of primary and acute
care facilities, a lack of diagnostic and lifesaving equipment, a lack of medications and a lack
of technology can lead to. Where deeply rooted exclusions and inequalities costs Human
Life
I have felt the frustration of holding a young woman's hand as she took her last breathes,
knowing that her death was preventable if only we had basic emergency equipment and
access to a medical facility.
I have felt the frustration of telling a family that they must now say goodbye to their
grandmother knowing that having access to the right medication could have prolonged her
life.
I have felt the frustration of telling a woman that she has cervical cancer, that has now
metastasized, knowing that with the right equipment and diagnostic tests, the cancer could
have been detected earlier, and given her more time with her children.
I have felt the frustration when a hospital was sending a child home to die with severe burns
because her family had no money and the hospital could not afford to care for her severe
injuries, knowing that in another country this service would be free.
I have felt the frustration of cutting a teenage boy down from a tree where he hanged himself
knowing that if he lived in the city he would have had access to mental health services and
support.
There are so many barriers to accessing Primary Health Care,
And, yet, according to the United Nations Convention, access to health care is everyone’s
human right.
So what do we need to do?
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Governments, globally, need to focus on prevention of NCD’s and need to allocate at
least 5% of the health budget towards this. Non-Government Organisations and
Donors should also consider this when allocating money to projects. 5% is the
example of the goal that Australia to needs to reach.
Developed countries such as New Zealand already allocates 6.4% of the health budget
to prevention of NCD’s, Canada 6.2%, The UK 5.4%, USA allocates only 2.8% of its
budget to prevention of NCD’s and Australia is less than 2% which is reflected in the
figures of premature deaths cause by NCD’s standing at 89%.
Developing countries struggle now with their health budgets and need our help.
Money invested now in ‘prevention’ will create a savings in future costs to primary
health care delivery for NCD’s.
The emerging health problems in Africa require a commitment to prevention as well
as a focus on coordinated acute care and primary health care services. The long term
projected plans should also include capacity building to facilitate preparations for
disasters/emergencies or conflicts.
We need to build Infrastructure that is accessible and inclusive of people living in
rural areas, and being sensitive to the communities needs, to be able to deliver
effective primary healthcare. If there is no infrastructure, or health care facilities for
people to access Primary health care, then early detection, treatment and ongoing
monitoring of NCD’s is not achievable. These facilities need to include quality
diagnostics, use current technologies, vaccinations and medications.
Countries such as Ghana, Zimbabwe and Gambia have existing trained healthcare
workers willing to work and deliver primary health care but there is no facility or
equipment for them to be able to do this, or, there is no funding to hire them to work
so there are existing staff shortages and poor nurse to patient ratios. A colleague from
Ghana told me this week that in a ICU and acute care facility the nurse to patient ratio
was 1:28
There are opportunities as part of future planning around the delivery of primary
healthcare and achieving Universal Health Care, to grow and develop expertise in the
health sector, amongst the community, through education programs linked with the
health care facilities
Africa has an opportunity to develop long term plans to work towards achieving
universal health care. These long-term plans are key to sustaining population health
improvements, over time.
We need to create healthy environments with the community’s best interest in mind
and include women and girls in the development of this. Reducing tobacco and sugar,
and modelling good behaviours will also assist in achieving this.
Achieving Universal health care is everybody’s business, there needs to be a focus on
‘accessibility’ and ‘fairness’ and not equity. We need to access those hardest to reach in
order to leave no one behind, but we can’t do this alone, we must all work together to provide
coordinated care involving long term plans.
Well, all week here at the World Health Assembly, we have been talking. We have discussed
the issues, we have analysed them and we have talked about them some more.
How much more do we need to talk?
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Now, it is time to take Action
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