Aser García Rada: Spain’s healthcare revolution

Aser Garcia RadaSpain’s state run healthcare system, one of the best in the world according to the World Health Organization, is facing a serious threat. In the face of growing privatisation, cuts seem inevitable, especially after the overwhelming victory of the conservative Popular Party (PP) in the latest regional elections on 22 May. Since then the PP have issued countless warnings about the insustainability of the healthcare system, to prepare the population for what they are about to do. 

Over the past year, the private sector, also hard hit by the economic crisis, has continued to take advantage of public funding. The private companies’ goal is to re-establish tax breaks for people who take out private insurance. This will mean taking away more resources from public funds and will further aggravate what is already a difficult situation, owing to the severity of the crisis and inadequate public efficiency policies.

So far few have spoken out against this disastrous drift, while Spain’s health professionals’ organizations, medical societies, and trade unions waste their time trying to maintain their power. They haven´t yet sent a solid message to the public that they will protect the public health care system. “The day when most of the middle class opt for private healthcare will be the end of our state healthcare system, because it will then have become a welfare system,” says Gaspar  Llamazares, president of the Congress’s cross party health committee. And that is where we are heading.

As stated by Tiago Villanueva in a recent blog, in the wake of uprisings in north Africa and the Middle East, an unexpected, peaceful, and exemplary civic revolution is invading Spanish streets and squares, which is also spreading to other countries.

At the Puerta del Sol camp, the so called 15M movement started with a large demonstration on 15 May. The protests are continuing. Though basic demands concern the regeneration of our democratic system and bringing back the power to the people, from politicians, banks, and “the markets,” some specific working groups have been created for the debate and proposal of concrete claims.

The health working group of the 15M is open to anyone, but so far it consists mainly of a broad spectrum of health professionals. We are currently debating four key elements:

1 . Public state run healthcare should be available for all people, regardless of their legal situation, or similar such concerns. That also means re-orienting a system that has so far been focused on dealing with acute diseases. When our modern healthcare system was set up, around three to four decades ago, the population’s mean age was younger, and the main aim was to treat acute diseases, but now the population has grown much older, and there are many more people with chronic diseases, and the system is not well prepared for that. Our hospitals are prepared for acute patients, but are not prepared for having an old man with a brain stroke who has to remain there for weeks or months. The system needs to be changed to a model that will strengthen the role of primary care and should focus on health promotion and prevention.

2 .  Individual and collective active participation in health:  This means improving the evaluation of and transparency in reporting health systems data, and promoting health education so that people take ownership of  their own health and that of their community.

3 . Health is not a business, or something to trade with. Private concerns prey on the public health system. Public resources should be optimised, for example by getting doctors to work evening shifts, which are non-existent in most parts of the country at the moment. We do not accept copayment as a solution, and we demand the implementation of a central purchasing system to cut costs. We want the pharmaceutical industry to be more transparent and better controlled.

4 . “Health in all policies” This is a new demand coming from public health professionals here in Spain, meaning that any new policy that is implemented has to take into account its potential impact on health. Differences in health due to economic, environmental, social, or gender inequalities are unfair and avoidable. Therefore it is necessary that any public policies –such as education, social policy, environment, urban planning, labour and immigration, or economics and finance- analyse, and evaluate the health impacts that they will have on the population before they are implemented.

It would be naive and arrogant to think that the 15M is the solution to all our problems, but in the context of immobility, it is a fresh voice reflecting a general dissatisfaction with mainstream social policies that are contrary to people’s welfare.

Healthcare professionals should play an active and visible role to protect our healthcare system and welfare, and this applies to all healthcare workers worldwide. As healthcare professionals we should set an example to the inhabitants of our country, and our personal interests should not interfere with what we are trained to do: to defend people´s health from any threats. As we undergo budget and social policies cuts, we have the feeling that banks, and “the markets,” are deciding things for us, and forcing  politicians to make decisions that are contrary to the welfare of the country.

Although the problems we face in Spain or Europe are not comparable to those faced in poorer countries—such as hunger, war, or living under tyrannical regimes—our globalised world clearly needs a global change. But that collective change can only be the result of individuals’ decisions and actions. In the Western world many of us seem to have forgotten that our responsibility for the population’s health also entails a responsibility to prevent the deterioration of our healthcare systems. 

“Be the change you want to see in the world,” Mahatma Gandhi said. Everyone knows what kind of change needs to be done, and no one else can take care of the environment around us.

Aser García Rada is a paediatrician at the Hospital Infantil Universitario Niño Jesús in Madrid, Spain, and a freelance journalist.