Rethinking public health

Esprit 498 (2023)

How to stop disillusioned health professionals leaving the sector; and why health budgets must shift from treatment to prevention. Also: a black book of Assad; and America’s comeback as global good guy.

If there is one area in which the notion of ‘post-pandemic’ should make sense, it is the health sector, write the editors of Esprit. After all, history shows that health crises bring progress in public health. But in France, the debate has been slow to take off.

The weaknesses in the system exposed by COVID-19 were there before the pandemic: social and geographical inequalities in accessing healthcare; exhaustion among health workers; mental health issues among younger generations particularly. And while the shock was largely absorbed, doubts remain: ‘It seems a long time ago that the French were sure in having “the best health system in the world”.

Attractivizing health-work

Four top-level health professionals address the crucial question of how to make the healthcare system more attractive to professionals. Shortages in healthcare staff is a growing problem globally: the WHO predicts a shortfall of 18 million by 2030. The structural reasons are complex and varied, from aging populations to changing attitudes to work and shifting perceptions of healthcare. The professionalization of care and the introduction of more economically efficient management approaches have led to ‘an erosion of compassion’, creating a ‘Weberian logic of “disenchantment”’.

In a post-COVID world where flexible hours and remote working have become the norm in the tertiary sector, the healthcare sector is struggling to retain disillusioned workers who want a better work-life balance, better pay, and less hierarchical working environments. Although ‘these demands are broadly legitimate, the hospital system was not built with them in mind and is struggling to adapt’. Measures must be taken across society, with collective acceptance of the cost of reorganizing healthcare and broad social measures to make healthcare professionals’ lives easier, from cheaper accommodation near hospitals to 24-hour public transport serving healthcare facilities.

‘The desire for flexibility must be reconciled with the need for stability’ and continuity of care, by identifying and properly compensating workers able to do night or weekend shifts and allowing others, for example those with young families, to be more flexible. ‘Making public hospitals attractive to staff does not mean returning to some hypothetical golden age: it means working together to identify and create the conditions for “caring well” in the twenty-first century.’

An apple a day…

Rémy Slama looks at another aspect of healthcare: prevention. Health is a product of multiple factors, but the system tends to focus narrowly on individual aspects and ignore the primary, environmental causes of diseases. The result is a wildly inefficient health budget that prioritizes treatment, despite prevention being three times more cost effective at the population level.

The fight against climate change represents a unique opportunity to improve public health. For example, a shift towards eating more vegetables and less meat and dairy would reduce both agricultural greenhouse gas emissions and some of the most burdensome chronic diseases, including cancer, cardiovascular disease and obesity. The healthcare system itself is responsible for 7–10 per cent of greenhouse gas emissions in France, largely because of the high carbon footprint of medications and medical equipment. As a result, refocusing on prevention instead of treatment would benefit the environment as well as improving public health in the long run.

The black book of Assad

Hamit Bozarslan reviews a major new collection on Syria under Assad: Syrie, le pays brûlé, edited by members of the collective Comité Syrie-Europe Après Alep. It places Assad’s deliberate destruction of Syrian society in a long-term context, with a mixture of in-depth analysis, detailed surveys, eyewitness accounts, images, and poetry. Contributors call out the inaction of the West, which ‘quickly reconciled itself to the regime’s brutality’, and its far-reaching consequences – not least Russia’s full-scale war in Ukraine.

Many contributors emphasize that Syria is not an isolated case: ‘“The civilizational malaise” of a country apparently outside our civilization is a “civilizational malaise” full stop’. Although ‘difficult, harrowing, even painful to read at times’ writes Bozarslan, ‘this book is an essential reference for Syrian history since 2011’.

Return of the good guy?

Blandine Chélini-Pont asks whether US can revive its role as ‘godfather of the free peoples and guarantor of international rules’ through its support for Ukraine, or whether its ‘good guy’ persona has been permanently damaged.

Rooted in its founding providential myth and an unshakable faith in the inherent virtue of its constitution, the US has always felt authorized to preach to other nations and to mix in their affairs. But Chélini-Pont’s overview of US foreign interventions throughout the 20th and 21st centuries shows a consistent discrepancy between its moral rhetoric and its real motivations.

After a high point in the early twentieth century, when the US drove the development of a rights-based international order that emphasized self-determination and international law, the Cold War saw its ‘defence of rights and freedoms contaminated by the messianism of Soviet containment’. Violations of international law were justified by the mission of destabilizing the USSR, leading to increasing anti-US sentiment in the 1980s and ultimately to the birth of al-Qaeda, the war on terror, and the illegal invasion of Iraq.

Despite winning the Nobel Peace Prize, Barack Obama refused to act against Assad’s criminal regime and prioritized economic relations with China over human rights abuses. But since February 2022, US moral rhetoric has reinvented itself: ‘Russian anti-westernism is so intense that it is smoothing over cultural divisions between Europe and the US,’ writes Chélini-Pont. Biden’s defiant stance against Russia has made the US more credible as a moral force: ‘Not since Franklin D. Roosevelt has the US’s moral stance corresponded so closely with its promises.’

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Published in cooperation with CAIRN International Edition, translated and edited by Cadenza Academic Translations.

Published 14 June 2023
Original in English
First published by Eurozine

Contributed by Esprit © Eurozine

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