Dear All, 

The pandemic has exposed the bare bones of many countries’ health policies as well as the priorities of their governments. In countries where health is heavily privatised and no proper public health service exists, we have seen huge inequalities in how the virus has affected different sections of society — with the poor and disadvantaged being worst hit.

At the beginning of the year Covid-19 was described as a ‘great equaliser’ and the narrative was that it would not differentiate between the rich and the poor but that narrative was soon modified when people pointed out that, in fact, wealth was able to protect a lot of people from infection as you could do things like isolate on your private island, travel in your private jet or helicopter and generally be a few steps ahead of everybody else in terms of medication and treatment. You could use money to increase your chances of survival substantially: for example, some individuals in Pakistan even purchased ventilators so that they and their family members would be sure to have access to a ventilator if they became infected and needed one. The pandemic, and the way it has unfolded in terms of healthcare and the health of the population, has provided us with a good opportunity to reflect on healthcare and what the goals of providing this should be.

Is a basic level of healthcare the right of citizens or should healthcare be treated as a service to be sold and profited from? What should be the parameters of profiting from other people’s ill health and misery? Should healthcare professionals like doctors be primarily healers or primarily capitalists? Running hospitals is not cheap, it is an expensive matter but what should the limits on profit be and should these limits have a moral underpinning?

Something often gets very skewed when rampant privatisation infects the health and education sectors. The whole ethos of the service changes as money - rather than the ‘public good’ - becomes a motivating factor. Educational institutions start regarding their students and students’ families as ‘clients’ and health services start regarding people as customers rather than patients. Staff are not treated as valuable members of a team working for a noble cause, rather they are viewed in terms of monetary worth — how much income they can generate or else how cheaply they can be replaced.

This basic dilemma in healthcare in the modern era is brilliantly illustrated in an American medical drama TV series called The Resident. I have always loved watching the kind of dramas on television. I may not remember much about Dr Kildare except for Richard Chamberlain’s lovely face and stunning cheekbones but I do remember St Elsewhere, about a rundown Boston hospital, and of course House, about the cases undertaken by the manic but brilliant diagnostician Dr Gregory House. While St Elsewhere focused on various characters and their problems, House was as much about the medical issues and diseases as about the characters. Both outlined many moral dilemmas and highlighted a lot of ethical issues.

The Resident is even better than those two because it is very clearly about the dangers of allowing unbridled greed to be a factor in healthcare. The tension between hospital managements who want to maximise their profits and dedicated doctors who want primarily to heal their patients, without necessarily forcing them to have every sort of expensive test under the sun, is a basic theme in the drama. The show highlights how people’s ill health is regarded as a business opportunity and the callous behaviour that this attitude can result in. This can range from doctors doing unnecessary tests to hike up hospital billing and refusing to treat patients who cannot afford such tests or life-saving procedures to the scandalously high (and rising) prices of the life-saving drug Insulin.

Yes, modern science and modern medical technology costs money but should this field be allowed to be so very lucrative for investors? Is healthcare and medicine about the greater good or is it about the greatest possible profits? My own view is that healthcare and education should not be imbued with a profit motive: the ethos of public health and public education seep through into the society they exist in and this creates a kinder, more compassionate society because of the feeling of collective good and caring for others — whatever their financial means — that underlies these services.

The pandemic has shown us that healthcare cannot be a selfish activity. For a person to remain healthy, their society needs to stay healthy. If we want to be healthy, we need to make sure that those around us are healthy. This means that the government needs to make sure it is not poisoning the food, water and environment (through intensive production methods or industrial activity) and not using people as cannon fodder for medical trials.

This also means ensuring that essential medicines are available and affordable and that money is not the determining factor in terms of disease prevention. Look at the UK today, the Johnson government is under much criticism for a ‘Test and Trace’ system which has been riddled by problems since the outset — it has neither achieved its testing targets nor been efficient — indeed stories abound of lost tests, wrong results and breakdowns of basic information systems. This project was handed to a Tory crony who oversees the expensive consultants tasked with the project instead of being pegged on to existing NHS facilities, networks and experts. Meanwhile, for those who can afford it, private testing is available — at a cost of almost £200.

Covid-19 has reminded us how public health is essentially a collective enterprise — not an entrepreneurial opportunity.

Best wishes 

Umber Khairi