This article was written after the release of a new report on European health
If you think that it is a right of pregnant women and children to be able to access healthcare, and that it is one of the most basic, universal and essential human rights, then there is bad news in store. More than half of the pregnant women seen by Doctors of the World (DOTW) last year had not had access to antenatal care. Only one-third of children seen had been vaccinated against mumps, measles and rubella (MMR).
Such are the findings of the International Network of Doctors of the World –Médecins du monde (MdM) who released a European report this month – “Access to healthcare for people facing multiple health vulnerabilities. Obstacles in access to care for children and pregnant women in Europe”. Their survey is based on their face-to-face medical and social consultations with over 22 000 individuals in nine European countries last year, including the UK. It is shocking reading.
I was one of the panel at the press conference to launch the report, as I had drafted a report on “Impact of the crisis on access to care for vulnerable groups”[i] for the European Parliament two years ago. The new DOTW report is important research and it deserves to be noticed and discussed by policy makers. Clinicians are not gatekeepers as some would have them be (nor do they want to be), but they are on the frontline, and we should not ignore their expertise.
Doctors of the World have a simple demand of policy makers: to ensure universal public health systems built on solidarity, equality and equity, open to everyone living in an EU member state. Many would see this as being fully in line with the International Agreements to which we are party.
Among other things, the report makes it clear that ‘health tourism’ is not a reason for migration – despite what much of the media and some politicians claim. Across Europe, only 3% of the foreign patients seen had migrated for health reasons and even for those 3%, it was among other reasons for moving – not the driving force. In fact, as the report points out, on average migrants in Europe have been here 6.5 years before accessing health care. And it should not be assumed that all of those people have an irregular migration status.
I have visited the London clinic of Doctors of the World and met clients who have a clear entitlement to healthcare in the UK but who did not know that. They do not understand the system here, may make assumptions about its costs, or have not registered with a GP (89% of those seen at the London clinic) – or have not been allowed to register. Access to healthcare cannot be portrayed as a ‘pull’ factor for migration.
Another theme from the Report’s launch was the impact of legislation that is driven by the politics of austerity. We have a looming public health crisis and yet the focus is all too often about who ‘deserves’ care, not how to provide appropriate care at the earliest opportunity. Punitive, restrictive legislation makes no economic or policy sense in terms of safeguarding public health, as the evidence from this report clearly shows. A failure to vaccinate children, for example, is a false economy in terms of individual and public health. Universal access to care, free at the point of need, is the cornerstone of the NHS, it is what makes it such a valued and envied service, yet we are hearing of mothers being presented with medical bills within hours of their baby dying: we see migration status and harsh economics driving out humanity and compassion. I cannot reconcile that with what I believe our NHS represents, or what healthcare anywhere in the EU should be doing.
Professor Lesley Page, President of the Royal College of Midwives, was also on the panel and spoke about the fact that 95% of MdM patients had had no previous access to healthcare. She said: “Access to skilled healthcare in pregnancy around birth and beyond should be a fundamental human right for women, yet too often services are either refused or simply absent. Legal, financial and bureaucratic obstacles are placed in their way, which puts many off accessing service. This has to change.” I agree with her.
The EU and its national governments have put considerable investment into the Millennium Developments Goals, including improving maternal health and that of newborns, yet pregnant women face barriers within our own borders, including within the UK. Some link the increase in stillbirths in Greece to the dramatic austerity measures there affecting access to healthcare. We need policy coherence not inconsistency.
DOTW’s report makes the point that we have seen cuts in health expenditure in half of EU Member States over the last few years and an overall rise in people not being able to access medical diagnosis (numbers nearly doubling in Greece and Spain). Restrictive laws are now seen as the main barrier to accessing healthcare among the people seen by DOTW across Europe (e.g. for undocumented migrants and destitute EU citizens, but sometimes even for nationals).
This grim reality asks real and challenging questions about who we are. Are we prepared to be humane, and practice compassion? Can governments deliver on the demand from the European Parliament that cuts to benefits and public services, should be assessed for their likely impact on individuals and on poverty – which is a public health issue. Restrictions on access to essential healthcare are also a public health issue, and should also be fully thought through before Governments turn their medical professionals into immigration officers and our hospitals into border-posts.
If we want to save money in the NHS, we should revisit the costs of PFI, rather than present a grieving, poverty-stricken mother with a bill for her stillborn child.
[i] Impact of the crisis on access to care for vulnerable groups (2013/2044(INI)), Rapporteur Jean Lambert