Online Program

Universal health care and the right to health - no gains without community agency

Tuesday, November 5, 2013 : 3:30 p.m. - 3:50 p.m.

Leslie London, MD, MB ChB, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
Current health care debates in the US have centered on the politics of “Obamacare” with primary attention to questions of affordability and political feasibility. In South Africa, efforts to eradicate or ameliorate heightening inequalities in health, principally related to a two-tier public-private division, and the consequent barriers to care for the majority of South Africans, have led the current ANC government to push strongly for fundamental health care reform and the policy goal of a National Health Insurance (NHI). Some lessons from the South African experience may be useful in considering current US health policy reform. Firstly, the preoccupation with financing may undermine the social justice goals of policy reform and of health equity as a value-based instrument; secondly, discussions on health insurance appear to gravitate immediately to health care rather than the more holistic view of social determinants of health. Lastly, the agency of users and communities appear poorly addressed in policy debates of this nature. All three elements – equity as a principle of social justice; health as being more than just health care; and community participation as instrumental to better health – are essential to a rights-based approach to health. Efforts at health care reform, wherever they are implemented, can only advance the right to health if equity is elevated as a social justice principle, if health reform addresses upstream determinants, and if health systems are able to strengthen the voice of those who health is most threatened by structural inequalities.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Describe the similarities and differences in health care reform taking place in South Africa and the US Identify rights-based elements in current health system reform efforts in South Africa Evaluate how these rights-based elements can and are contributing to health policy changes in South Africa Identify potential applications of these principles to health care reform in the US

Keyword(s): Health Care Reform, Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a professor in Public Health at the University of Cape Town and have been invited to participate in public forums on South Africa’s National Health Insurance. I have published on a Human Rights Approach to Public Health Policy formation and head a Health and Human Rights Programme at UCT. Conflict of Interest (COI
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.