Correspondence
Social movements are key towards universal health coverage
iStockphoto
The printed journal includes an image merely for illustration
For the People’s Health Movement see http://www. phmovement.org/
Laurie Garrett and colleagues (Oct 10, p 1294)1 rightly underscore that neither the nature of the financing scheme nor the amount of health spending are critical for achieving universal health coverage, but the political will of national governments. Historical experience— eg, that of European welfare states after World War II—shows that (near) universal coverage has often, if not always, been the result of pressure from below, by trade unions and other social movements.2 Moreover, these achievements were undermined by European Union policies, implemented by national governments and taking advantage of civil society’s weakening vigilance.3 The struggle for universal health coverage has always been part of a broader movement for health equity and social change. The Commission on Social Determinants of Health likewise embedded the goal of universal health care in much broader strategies: improving daily living conditions, tackling the inequitable distribution of money, power, and resources, and measuring and understanding the problem of health inequities.4 Our own experiences and field research confirm that popular pressure through organised communities and people’s organisations can affect power relations and pressure the state into action towards realising the right to health.5 Since similar ideas can regularly be heard in circles of the People’s Health Movement—a grassroots-based advocacy network for the right to health—there seems to be a wealth of experience of social movements on this matter. The academic community can do its part through more empirical research to make the movement for universal coverage more effective. We declare that we have no conflicts of interest.
1888
*Wim De Ceukelaire, Pol De Vos
[email protected] Partnerships and Policy Department, intal, 1210 Brussels, Belgium (WDC); and Public Health Department, Institute of Tropical Medicine, Antwerp, Belgium (PDV) 1
2
3
4
5
Garrett L, Chowdhury AMR, Pablos-Mendez A. All for universal health coverage. Lancet 2009; 374: 1294–99. Navarro V. Why some countries have national health insurance, others have national health services, and the United States has neither. Int J Health Services 1989; 19: 383–404. De Vos P, Dewitte H, Van der Stuyft P. Unhealthy European health policy. Int J Health Services 2004; 34: 255–69. Commission on Social Determinants of Health. Closing the gap in a generation.Geneva: World Health Organization, 2008. De Vos P, De Ceukelaire W, Malaise G, Pérez D, Lefèvre P, Van der Stuyft P. Health through people’s empowerment: a rights-based approach to participation. Health Human Rights 2009; 11: 23–35.
pass on their expertise to the younger generation: they were mostly not professors. I declare that I have no conflicts of interest.
Charles Warlow
[email protected] University of Edinburgh, Edinburgh EH4 2XU, UK 1
The Lancet. Tomorrow’s doctors: an improvement if evaluated. Lancet 2009; 374: 851.
Tomorrow’s doctors The incentives for UK clinical academics, encouraged by their universities, are large research grants and papers in high-impact journals. So why encourage them to teach, as in your Editorial (Sept 12, p 851)?1 There is an immediately available alternative source of good teachers: the large numbers of National Health Service (NHS) consultants and general practitioners, and their junior staff, who spend much more time seeing real patients. Of course the contracts for NHS staff should reflect any teaching they do, and of course the universities should pay them, or their employing authorities, for their teaching time. And the universities must also ensure their teaching competence. For better or worse, many clinical academics are gradually divorcing themselves from care at the bedside and are no longer necessarily the best role models—or teachers—of tomorrow’s doctors. Just because a clinician is a successful researcher does not necessarily make him or her a good teacher, even in the (good) old days, let alone now. My best teachers were busy clinicians absorbed in their practice and eager to
Department of Error Konstam MA, Neaton JD, Dickstein K, et al, for the HEAAL Investigators. Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial. Lancet 2009; 374: 1840–48—In this Article (Nov 28), the fourth name listed in the Endpoint Adjudication Committee should have read “Costantina Manes”.
www.thelancet.com Vol 374 December 5, 2009
