In sickness and in health

I was tempted to substitute the headline with Her Majesty’s Ambassador Vaccinates Princess Alice. That was a real event as I joined in the month long vaccination programme for children undertaken by the Department of Health in Makati. Princess Alice was my first tearful vaccine recipient. A donation of 5 million measles vaccines organised by HRH Prince Charles enabled us to make a direct contribution. In Britain, our 66-year-old National Health Service has treated royalty as well as other citizens. Princes William, Harry and George were all born in St Mary’s Hospital in West London, the very same place where I came into the world. As part of Imperial College, this medical facility is also one of the top universities in the world.

Despite its great success, the UK’s National Health Service is constantly evolving. Whether health spending by government each year is over P135,000 per person in the UK or P2,500 in the Philippines, the challenges are the same. Complex diseases, longevity and higher patient expectations place ever increasing demands on our systems.  The easy part for governments is to pledge free care to patients. But that does not necessarily result in quick access to doctors, availability of all medicines or holistic treatment. In Britain, we remain committed to universal health care provision. Healthcare that just caters to the few who can afford it, is not sustainable. On top of the impact on people, the economic costs are also high.

The British National Insurance contributions, PhilHealth, Indigent Person card or the revenues from hypothecated taxes on sin are all part of the revenue mix that can bring primary care and some specialist treatment to all citizens, but the capacity constraints are very real even in the most comprehensive systems. Private insurance and co-ventures with the public sector are models that some have pursued. In fast developing countries, the gap between excellence and inadequate provision is exposed more obviously than a country like the UK where the architecture looks solid but structure is under stress. All countries should attain the health standards of the Millennium Development Goals. Vaccination, mother and infant care, hygiene and access to clean water are basic priorities. Public information and prevention measures are as important as clinics, doctors and nurses.

Health care businesses carry a responsibility too. High ethical standards cannot be compromised.   Pricing mechanisms should be flexible enough to widen access to medicine where affordability is a critical factor. Drug prices in the Philippines have come down and yet that has not resulted in a significant increase in the number of people taking the right medicine in the necessary doses. There is a need for a targeted and regularly updated national list of essential medicines. The Philippines has 627 on its list, half of that of Malaysia.  If we are to win the fight against diseases like cancer, businesses need to recover high costs of research and development and health authorities need to be wary of actions that penalise innovation. Bureaucratic obstacles and the lack of capacity to approve new drugs should not get in the way of getting urgent treatment to patients. In the EU, if a drug is approved in Hungary it is good enough for the UK. There is more to gain on preventing fake medicines than in blocking drugs that work.

Wellbeing cannot be attained by drugs alone. I have seen how the family comes to the aid of those in need in many parts of the Philippines. The UK has only recently discovered the virtues of care in the community for people suffering from mental illness. Free medication for mental health patients is not yet a reality and it is the Filipino community that has sustained support for the most vulnerable. In my only formal charity role as a board member of the Child Protection Network and as I visit areas affected by natural disasters, I know that effective treatment for the mentally ill is a more formidable challenge here.

Filipino health care workers in Britain have a well earned reputation for professionalism and kindness. The UK has made its contribution as a source of innovation; aspirin, stem cell transfer, small pox vaccines are just some examples. In an increasingly mobile world, we face new challenges. Ebola and MERS-COV need coordinated international action and the transfer of knowledge. Bird flu, swine flu and HIV-AIDS at one time seemed like onset of Armageddon. It was through the efforts of each country stepping up to the plate that we pushed back and won many battles.  In sickness and in health, for richer or poorer, we need to work as partners.

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(Asif Ahmad is the British Ambassador.)