Pharmacare: Towards Tommy Douglas’ Vision
When Tommy Douglas envisioned a universal health care system for Canadians, it is doubtful he imagined the reality that exists today. This became clear on a February afternoon at the Ottawa Public Library during a public hearing organized by the Canadian Health Coalition (CHC), an Inter Pares counterpart. Canadians shared stories of the enormous cost of pharmaceuticals to treat their illnesses: a patient diagnosed with AIDS whose medication totals $2,000 each month; a working mother unable to take care of her disabled son, because living together means losing his disability benefits and access to medicine; and a recently retired cancer patient, no longer covered by his workplace drug plan. Such moving accounts revealed that many Canadians are facing economic hardship to finance their health needs.
Canada is one of the few Northern countries without a national plan for medication. CHC’s “More-for-Less” campaign calls for a national Pharmacare drug plan, drawing attention to the economic injustices suffered by Canadians, and highlighting the feasibility of a national, low-cost pharmacare program, which would provide safe and cost-effective drugs for all.
Our health care system has come to view pharmaceuticals as somehow distinct from health services. In response, the CHC has been conducting public consultations across the country to document the stories of Canadians in efforts to influence current policy. By exposing the hardship that thousands are facing, CHC draws attention to a subject often lost in the debates on private/two-tiered health care, doctor shortages, and long waiting times. The Pharmacare campaign seeks to bring pharmaceuticals in line with the universal health care system – serving social needs instead of private profit.
Although some provinces have pharmaceutical provisions for the public, disparity of access prevails across the country, exacerbating economic inequalities. Nationally, drug expenditures have increased at an alarming rate, exceeding $24 billion in 2005. Such massive costs are a result of pharmaceutical companies operating in a largely unregulated environment, able to price their products at their choosing. Without stringent monitoring, drugs are sold as consumer products with high profit margins, benefiting shareholders at the expense of the sick. In this context, Canadians pay significantly more for the same drugs which cost less in other countries. We too can benefit from affordable pricing if our governments negotiate bulk-buying discounts from drug manufacturers, as is the practice in New Zealand. This would decrease the cost of drugs and ensure that sick people’s vulnerabilities are not exploited.
Health should not be treated as a commodity. Inter Pares and our counterparts believe that access to affordable health care is the right of each human being. Despite the grim discussions in Ottawa that afternoon, the crowd was optimistic. The Pharmacare campaign provides hope for affordable, safe and universal access – a prospect that more accurately reflects Tommy Douglas’ vision.
Social Wealth for Social Health
Since the mid-1990s, Likhaan, a women’s health and human rights organization in the Philippines, has worked with community groups in some of the poorest parts of Manila. They have established clinics and trained local community health workers to provide much-needed services, demonstrating that health provision can be both high-quality and affordable.
However, people’s health is affected by many factors other than access to health services. As one woman put it, “I can get cured at the clinic, but then I go back to my house that floods and has no toilet and I get sick again.” There are many social factors that affect people’s health – where they live, the strength of their social support network, and their ability to make decisions over their own lives. Government policy also has a major impact in terms of financial support for services such as health care, water, sanitation and basic infrastructure.
In the last few years, Likhaan’s community health workers in Manila have begun advocating on issues related to these social determinants of health. To strengthen their voice, several community groups made up of women and youth came together, with the assistance and guidance of Likhaan, to form PiLaKK (Unified Strength of Women and Youth). PiLaKK is a federation that is now composed of eleven member organizations, and has developed collective strategies for work at the barangay or neighbourhood level.
In the Philippines, many services such as health care have been devolved to the barangay level. Each barangay must first struggle to obtain its share of the city budget, and then elected officials allocate funds to services they deem important. Last November, after discussion within PiLaKK, women and youth leaders decided to run in the barangay elections for the first time. They called for a more participatory budget process and programs that respond to people’s needs. Lina Bacalando, a long-time participant in Likhaan’s health program, was elected as a barangay councillor.
PiLaKK members have asked Likhaan to help them advocate for financing of much-needed services by training community members on budgeting, where government funds originate, how funds are allotted, how they can influence the budget allocation process, and how they can ensure that local budgets are transparent.
A key element of economic justice is how societies collectively decide their priorities, and then collaborate on financing those priorities in an equitable manner. Although women’s health and human rights remain at the core of Likhaan’s work, their journey has taken them from addressing issues of community health to assisting poor communities in shaping decisions about where and how public resources are allocated. Inter Pares is honoured to support Likhaan on this journey.
| Reviewed May 28, 2008 |  |
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