Tuesday, February 28, 2017

Good health or good healthcare?

How much does it cost to ensure that every Kenyan is in good health? Who should bear this cost? There is a school of thought that argues that your health is your own affair and that the government should expend the minimum amount of national revenue to address your healthcare concerns. There is another school of thought that argues that it is the responsibility of the government to ensure that every Kenyan is in the best possible health.

We should begin by defining what "good health" means. Article 43 states that we are entitled to the highest attainable standard of health, including healthcare and reproductive healthcare services. But that is not the definition of "good health", is it? Good health is an outcome of very many factors, from environmental factors such as clean water and clean air to dietary ones such as how much food one consumes, the quality of that food, and the dietary value of that food. It includes where we live, where we sleep, the physical and mental stresses we undergo, the stability of our immediate and extended families, the availability of recreational facilities including playing grounds, parks, bars, libraries, cinemas, restaurants, discotheques, swimming pools and bicycle lanes.

The healthcare "system" is an important factor in our continued good health but it is not the only important factor. Some healthcare models emphasise prevention of ill-health over treatment of illnesses or diseases. Public policy in these instances is geared towards encouraging healthier lifestyle choices. For example, the campaign to reduce cigarette smoking attempts to modify human behaviour regarding this addictive habit. High taxes, a ban on advertising and restrictions on packaging design are all tools that governments have employed to reduce the total number of new cigarette smokers, make it difficult for habitual smokers to persist in the habit, and reduce the overall number of new patients suffering from health problems associated with cigarette smoking such as lung cancer, mouth cancer, emphysema, asthma, diabetes and low sex drive.

The healthcare system of hospitals, doctors, nurses, dentists, pharmacists and other specialist medical practitioners such as radiologists, urologists, podiatrists, ophthalmologists, psychiatrists, orthopaedists, oncologists and cardiologists is frequently called in to deal with the outcomes of poor health. It is set up to treat patients in poor or failing health. It isn't set up to encourage healthier living. And if it were, it would have to do so hand in hand with a cleaner environment and restricted access to substances that harm health such as cigarettes, alcoholic drinks, saturated fats, carbonated beverages, untreated drinking water, uninspected meat or meat products, processed sugars and vehicle exhaust emissions.

Good health is not simple to attain; it requires the concerted efforts of both the government and the individual, public institutions, private sector organisations and consumers, a balance between civil liberties and public laws. Reducing good health to simply what doctors can and cannot do is dangerously deluded. And the same goes for a healthcare system. Sooner or later, as the conflict between doctors and the government continues, we must ask whether or not our efforts have led to good health, and if they have not, whether or not our efforts have led to a good healthcare system, and if they have not, whether or not the outcome of the negotiations between doctors and the government will lead to both good health and a good healthcare system.

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