So we had this huge variation in the decentralized standards with respect to testing, for example. In a decentralized approach, we have a lot of variations, considerable disorder, more disarray. It’s a little bit messier. And so these are very different approaches to the way we look at public-health policies at the domestic level.
How have these approaches played out during different epidemics?
A good example of that is what we see on the part of a more centralized public-health policy, which is the case of Taiwan. The Taiwanese learned their lessons from SARS, from the prior major outbreak that we had, and, as a result of learning from that, their approach tends to be much quicker. They’re much more alert, and they’ve been much more proactive to this current threat. In fact, they introduced a series of measures right away when they learned early about the severity of the respiratory illness that was coming out of the situation in China, and they started immediately inspecting passengers. They started some quarantine measures. They sent a team of experts, with permission from the Chinese, to fact-find and understand what was going on a little bit better. There was much more of a command, and a controlled set of actions that were introduced, and things were done very, very quickly. They also used technology, using mobile phones to assess people’s locations, and tracking people, and also to report travel history.
On the other side, you see the United States, and some advantages to what we would call regulatory approach. So we are now learning that some of the origins of the coronavirus came from wet markets in China. And that’s the current state of knowledge that we have. And we have in the United States highly regulated guidelines for the sale of different meat products in our food supply. And so we have an experience in the United States, over time, where we learned that the regulatory process is very effective. And it has been. We’ve had some outbreaks in the U.S. We’ve had E. coli, and we’ve had some salmonella and things like that. But for the most part we have been able to regulate our food supply in ways that have been effective for the public health.
So you’re saying that we don’t have the egalitarianism of care, or whatever the phrase might be, but we do have a certain amount of regulatory structure. Are there some countries that have both?
Sure. We are finding that in the European countries we haven’t seen the major outbreaks that are stemming from this lack of regulation, in markets or other kinds of supply chains. But we also have a more egalitarian set of health systems and public-health policies there, as well. Of course, different European countries are different, but, more or less, in the European Union, you do find countries that have a steep basis of solidarity and reciprocity and, some would even say, rights with regard to health care and health insurance in those countries. And they do have a greater effectuation of equity and equity principles in the health sector and health policy.
Your book also talks about places that are not as rich, specifically the Ebola epidemic in Liberia. What did Ebola teach you about these issues that you’re writing about, and specifically about health disparities?
We’ve learned a number of lessons from the Ebola epidemic. One that I think is very important is the recognition of the importance of public health and health-care systems. We know that, for example, in the United States, we actually did have cases of Ebola, but we didn’t have the extent of the cases, and we also were able to treat the cases effectively. We do have high-quality health care in the United States when you have the ability to purchase it, or if you have a very expensive health-insurance plan through your employer, or other kinds of mechanisms, but mostly employer-related health insurance.
And so having high-quality care is good, and we want that, but we want that for everybody on an equity-based or justice-based system, so we’re able to get people diagnosed and information is shared in a transparent and factual way.
We’ve learned that there are a lot of misinformation campaigns there. Certainly, there was misinformation being spread in the Ebola epidemic, about the way it was spread, and what would happen, and who people could and couldn’t be around, and things like that.
Another set of lessons is in terms of development assistance for health. We know that there has been a rapid increase over decades in the investments in health worldwide. There has been a lot of money going into global health, and going from donor countries, either multilaterally or bilaterally, to countries that have weaker health systems. The question is: How effective is that investment? Where is it going? And is it locally owned? Are countries able to develop their health systems and a horizontal capacity? Not just disease-specific, so not just for tuberculosis, or AIDS, or malaria. Are they able to develop their health systems and their health policy in a horizontal capacity, so that they can adjust the resources that they have for any particular epidemic that confronts them? That is a very important part of what we’re learning and understanding, and certainly what the book addresses.
The last part is the importance of the security piece of it. That’s why we see now a greater emphasis in the sustainable-development goals on universal health coverage and universal health insurance. Again, that’s across the entire health system. It’s not just for a particular disease.
What is your ultimate vision? It seems like it would be some global health system or set of rights, along the lines of the way a lot of people talk about universal human rights, which would be enforced with some sort of international legal system. What would be that vision, and what have you seen so far? Because, obviously, we do have the World Health Organization.
The World Health Organization is an important institution. It’s our main United Nations-based organization focussed on health. It is a state-based organization, so it gets its authority from the states around the world. It’s an international organization, and so states provide their interests and support through the World Health Assembly and that kind of a governance structure.
Unfortunately, the World Health Organization, however, is funded through internal support that is based on particular donors and interests, and seventy-five per cent or so is not based on the multilateral pooling system. So, in other words, the ability to make decisions collectively and to put resources toward those decisions collectively is about twenty-five per cent of what the World Health Organization is able to do. That severely compromises the institution. And what we see is other vested interests and other groups having a lot of power and influence through the organization in a way that is inconsistent with global health equity. So an alternative approach is looking at global health equity from the perspective of all individuals on the planet, over the whole entire seven billion people on the planet, and trying to figure out what kind of a structure, privileges, and conditions that individuals live in, regardless of where they are.