Most studies with regard to health are typically undertaken within the field of biomedicine. The relationship of biomedicine and social sciences, as in the case of the Philippines, is one that is characterized by mutual exclusivity. An inescapable fact, however, is that health or the lack thereof is a matter of socio-political inquiry inasmuch as it is a biological one. Since health is strongly connected to society and its cultural and economic environment, its ambit goes beyond the medical laboratory. I would like to highlight this point by retelling a true-to-life story which a Filipino physician shared in this article. There was once a coffee farmer who had experienced difficulty in swallowing. Because of discomfort, he went to a hospital and consulted a physician. After the examination, it was found out that he had cancer and tuberculosis. The doctor then advised him to undergo a series of therapies and medication. Taking into much consideration the possibility of being medically indebted for life and the future of his nine children, the farmer walked out of hospital and preferred to evade medical expenditures than be treated.
In this brief article, I aim to analyze the political economy of health through the lens of conflict theory. The political economy of health, as defined by York University’s Dr Jaime Llambias-Wolff, refers to “analysis and perspectives on health policy for the understanding of the conditions which shape population health and health service development within the wider macroeconomic and political context.” If taken in this light, the conflict view of health stands on two grounds. First, health is a valuable resource and is therefore unequally distributed throughout society just like other highly valued resources. Second, a country’s healthcare system is shaped by the competition over this resource. While access to highest attainable standard of healthcare is recognized as a right throughout the world (see Article 25 of the Universal Declaration of Human Rights), it can be challenged by factors such as the affordability of healthcare service, supply of medical practitioners, and availability of the health facility. How these factors intertwine will determine if health in a society tends to become less of a right and more of a privilege.
Health as a valuable resource
The coffee farmer whose story I shared with you in the introduction personifies the issue of inequalities in health especially in less developed nations. For someone to have good health, two conditions need be met: (1) One’s living conditions should not induce disease, and (2) One should have good access to healthcare. Good health is linked with labor productivity and income generation. People who are sick will not be able to perform their duties well and, in some cases, will be advised to seek professional help. This relief of duties in an implied period of time has consequences, the most obvious being income loss. Absence in work entails a salary deduction. In the case of the coffee farmer, being not able to plow the field for a day means loss of a day’s worth. A common aphorism among Filipinos states, “Walang karapatan ang mga mahihirap na magkasakit.” (The poor have no right to be sick.) For the underprivileged, income loss even just for a day is burdensome.
Health as an unequally distributed resource
Patterns of health and disease follow the line of social stratification. As income distribution and poverty rate vary across countries and social classes, access to healthcare varies from one person to another. People in higher classes are more likely to enjoy a quality, personalized healthcare than those who are in the lower classes. Those in higher classes enjoy good education enabling them with adequate knowledge of diseases and its symptoms and how to properly take care of their bodies. Also, the poor has the higher tendency than the nonpoor to live in unsanitary conditions making the former vulnerable to all types of health risks.
These patterns are much visible on an international scale. Through the world systems paradigm, we understand that a large portion of the world’s health resources go to wealthier nations while the poorer nations suffer from dire insufficiency. The appalling health conditions in less developed nations are chiefly caused by indirect effects of poverty and overpopulation (e.g. poor hygiene, malnourishment) and lack of health medical facilities, among others. Conflict theorists argue that many of the contagious diseases that kill a significant part of population in poor countries could be easily cured or totally eliminated if resources were just made available to them. Because of these stark differences, people living in impoverished countries are the ones who have low life expectancy rates and high infant mortality rates in comparison with people living in affluent countries.
Health as an object of power relations
Health is not only about identifying symptoms of a disease but also studying the intricate power relationships within the society concerned. In some countries, healthcare is considered a basic social service; in other words, it is provided by the government either for free or at affordable cost. In others, it is a commercial enterprise where medical goods and services are sold for profit. The evident disadvantage of the latter is the unequal delivery of health services, as those who receive the best healthcare are the ones who could pay for it. Its advantage, on the other hand, is the development of an advanced healthcare system, as the competition among health institutions spawns various research initiatives in technologies of treatment. It must be not construed however that launching health innovations can be done solely and effectively by the medical free enterprise. For instance, Cuba is regarded as one of the best healthcare systems in the world and produces the world’s most competent health practitioners, yet theirs is a healthcare system run by the public sector. Through the system, people regardless of social standing enjoy quality healthcare service and access to wide range of medical goods and services.
By and large, health is an issue which deserves the attention of both the medical and social sciences. In my next article, I will be tackling in length the relevance of social sciences to the field of medicine and the need to de-compartmentalize the two fields.
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