| Diocese of Texas takes the lead in breast health initiative | St. Luke's Episcopal Health Charities (SLEHC) in Houston is taking significant strides forward in its 'research informed grant making'. Established in 1997 by the Diocese of Texas, the agency is focused on evidenced based interventions in communities that are underserved by medical facilities. Its mapping and data collection systems are designed both to provide portals for access to health information and to identify data for public health interventions. In this it has become the lead agency within the metropolitan area of Houston, drawing together city, county and state authorities alongside foundations and other organisations concerned with public health.
SLEHC's most recent initiative was to focus on the distribution of breast health services. Its mapping tools identified areas in the city where women were most at risk of late diagnosis. The difference in survival rates can as high as 28 times between one community and another. Working with a range of breast health agencies and with the support of major foundations such as Avon, SLEHC has overseen the development of a breast health portal. This provides women with information on the range of services offered in their particular district. Partners in this project have used the mapping information to improve the distribution of mobile clinics and screening so that women in the poorest communities have ready access when they recognise a problem.
This level of leadership and innovation in faith based health care is a major inspiration for others. It promotes the value of data collection and management, and shows how Anglican agencies can take the lead in responding to needs that show up as a result. To see how this was achieved, follow this link to a short video that tells the story: http://www.youtube.com/watch?v=m3QUNibUgqw Check out the website on: http://www.slehc.org/
Paul |
| Health Systems Financing - what future for insurance | Oxfam recently issued a report criticising Ghana's National Health Insurance Scheme. The report's authors denounced it as inefficient, corrupt and inequitable. They question Ghana's statistics of around 60% membership and estimate that this could be as low as 18% of the population. They propose that the scheme be replaced by a tax funded health system free at the point of delivery.
Reports from colleagues in Ghana suggest a mixed picture. Clearly the scheme is far more successful in towns and cities where health facilities are located. The rural poor are not so easily covered. There have been problems with the administration of the scheme for those church hospitals that service claims. Some have had to wait 6 - 9 months for the scheme to recompense them for services rendered to the insured. This has caused acute cash flow difficulties. But otherwise, our Ghanaian colleagues seem fairly optimistic about the future potential of incorporating everyone into a scheme that combines personal contributions with tax revenues to ensure that health services are more widely available.
There is no doubt a healthy dose of idealism behind the Oxfam report. Many in the global health community feel instinctively drawn to a simple tax funded health system where everyone can get access to health care without the interference of financial systems. Health professionals are not generally drawn to medicine in order to get mixed up with market driven economic planning. Like priests, they simply want to be able to get on with their job of caring for people in need. But health is an expensive business. And even in the UK's National Health System, medics have to respond to concerns about cost and efficiency. Yet another wave of reforms faces them in order that expenditure on health might be controlled by new means.
As it happens, the issue of health systems financing was the theme of the World Health Report published by the WHO just before Christmas. It made reference to the Ghana health system as an example of the benefits of combining tax revenue, donor support and individual contribution into a membership scheme that has thus increased the resources available for health care. Most importantly, the report says, the Ghana scheme has offered financial protection to those who formerly paid user fees for their health care.
Rwanda has made the most progress with a national health insurance scheme in Sub-Saharan Africa. Other countries such as Kenya are at an earlier stage of rolling this out. It remains to be seen how many states in the poorest parts of the world can manage such large schemes successfully. Having lived in the UK and Switzerland I am aware of the strengths and weaknesses of insurance based health systems in comparison with tax based health systems. I do not subscribe to an ideal one way or another. The state surely has an innate responsibility to ensure that its citizens have access to health care. How it facilitates the infrastructure to both fund and deliver this care is a matter for trial and error. Statist or free-market ideologies do not offer idealised solutions.
AHN is supporting a market-based microinsurance project in Tanzania and India. But equally it supports colleagues in Ghana in their partnership with the state system. There is only one absolute: user fees for health services must be abolished one way or another. Everyone agrees with that. Unfortunately too many Anglican health services are delivered still under a regime of user fees. We must work hard together in these various contexts to protect people from financial risk in accessing health care, and at the same time improving what health care they can receive.
Paul |
| Brent Hospital prepares to celebrate its centenary | The Episcopal Church of the Philippines has long been committed to offering health services to the people it serves. It has a range of hospitals and health programmes that serve people irrespective of their creed. The Diocese of the Southern Philippines has supported Brent Hospital since its inception in 1914. Through this time the hospital has grown and developed its expertise and now is looking expectantly to celebrating its centenary in two years time. To help set the scene for this important moment, they have produced a video that reveals much of the character and values of the hospital. You can watch this video on YouTube on this link: http://www.youtube.com/watch?v=KlK7Yovzac8
Here is yet another example of the belief within Anglican communities that providing health care remains a fundamental element of the mission of the Church. The integrated nature of prayer, teaching and healing seems natural in so many settings. We wish the diocese every blessing as they make further preparations to celebrate their valuable work.
Paul |
| Health and Equality | Does social inequality have inherent health impacts? If the gap between rich and poor is wider, does that mean the poor are going to experience distinct biological impacts that negatively impact their health? This question is a growing area of study. A British academic, Richard Wilkinson has built his career conducting studies that address the epidemiological differences of relative equality in different societies. Looking at the health patterns of the more equal societies of Nordic countries and Japan, Wilkinson makes a comparison with the health of populations in the United States and United Kingdom. He draws evidence to suggest that lower levels of oxytocin may be generated by lower neighborliness in a more competitive society. This combined with increased levels of cortisol generated by the resulting stress may increase susceptibility to ill health.
However, his thesis is questioned by some who give other factors greater precedence. For example, a higher murder rate in the US may be more associated with its gun culture than with inequality. They ask how higher divorce and suicide rates in more equal societies should be taken into account. There may be factors related to ethnic homogeneity. Do smaller countries with lower immigration rates manage the health and social cohesion of their populations more effectively than large countries with high diversity? Is the underlying issue a cultural one, drawing from the various pressures individuals experience in the more competitive consumer societies?
This is a serious area of study that should be of particular interest to Christian communities that seek to support the health and well being of their neighbors. However, the obvious challenge with this line of enquiry is its immediate relation to political philosophy. It swiftly becomes caught up in the age-old debate between capitalism and socialism. Nevertheless, if there is a significant health impact caused by inequality, then questions of public policy cannot be avoided. Public health practice suggests that society-wide structural changes are more effective than employing more doctors and nurses to address increased levels of ill health. Witness the example of tougher regulation on smoking.
Christian theorists and activists offer the concept of justice to test public policy choices. Will a certain systemic change bring greater well-being or it will it bring greater harm? This is a good basis for theory, but it is hard to demonstrate relative impacts and hard to express any clear idea of what justice means between those of unequal standing. This debate will roll on, but as Christians we are determined to side with the poor. That is the overwhelming call of our faith and tradition.
At the sidelines of political process is a debate that emerges from psychosocial and biomedical studies of inequality. This is a matter of concern and should inform our thinking on public policy. However, it is not yet clear how the evidence will stack up. And even when that becomes clearer, it will require courage and creativity to find solutions that are best for the health of all.
Paul |
| Compassion, human rights and health care | The most common question put to me as I promote the work of Anglican health facilities is why the Church should still be involved in providing health services. Throughout the world the state and the private sector have come to varying accommodations to ensure that health care is available. People ask me why the Church should not now just get on with its core business - which presumably in their mind means prayer and moral guidance?
I wrote about this recently in a newsletter produced by the Africa Christian Health Associations Platform. I offer an extract as a taster, and hope you might follow this link to read more:www.africachap.org/x5/images/stories/14th edition english .pdf
Christian compassion dictates that the strong should help the weak and that the wealthy should subsidise the needs of the poor. We call this ‘charity’; a term which expresses the love we are commanded to have for our neighbours. It is a spiritual and practical corrective to the inevitable disparities that emerge in market societies, whether ancient or modern. In the idealised setting envisaged by the laws of the Pentateuch, the surplus of one person provides for the needs of another. The Jubilee principle dictates that no-one should become too dominant, and that no-one should be left in slavery and destitution.
This may have been applicable to the pre-modern rural setting where the transactional nature of this subsidy was personal, but what about this diverse and dynamic world of 7 billion neighbours we have now? Here there needs to be a more professional and universal system to ensure that resources are shared effectively. But does this then mean that interpersonal acts of compassion are no longer significant? Does it imply that government rather than local religious community should manage safety nets and redistribution systems? Or to conceive of the question in another way: Does the enlightenment notion of human rights supersede our religious vocation to express charity?
These quasi-political considerations have implications for Christian health mission. Can the ‘right to health’ be fulfilled to any extent by the ‘charitable’ sector, or is it by nature only government that can manage a comprehensive health system? In answering this question, Christian activists have to decide whether to focus on persuading governments to execute their task more effectively, or whether to expand their own services to those who are underserved by the public system.
Of course, the answer to these dilemmas is not going to lie at one of the polar extremes. If we discard the many outlets for compassionate care of our neighbours, we become less than the human persons into which God breathed loving existence. We are driven by divine commission to help those in need. On the other hand, if we think we can effectively transform the needs of society through some idealised divine kindness, we are blind to the limitations of our capacities. We are not yet in Heaven. We are still seeking the Kingdom. Laws and authorities will help direct societies to bring health and hope to all people, without prejudice or omission.
These are grounds for a positive partnership between Church and State. Working collaboratively, the energies of faith and the mandates of law can ensure a stronger human society, blessed by the underlying experience of compassionate love. Various alignments of responsibilities between Church and State can be adopted. Varying cultures can adapt the relationship as required. The goal of complementarity can be progressed to best effect.
Paul |
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