Politics and change - medicos must engage
On 22 June 1946 at the International Health Conference in New York, 61 sovereign states signed a declaration that would later give effect to the Preamble of the Constitution of the World Health Organization.1 World War II had ended in September 1945, less than 12 months earlier; a war that, like its predecessor, changed the global landscape indelibly. This saw the emergence of two major global agencies, the United Nations (UN) and the World Health Organization (WHO).
Front and center on their agenda was the health and well-being of all individuals, globally. Today, the UN comprises 193 member states. It has one central mission: the maintenance of international peace and security.2 The WHO is the directing and coordinating authority on international health within the UN’s system, and comprises more than 7000 people from more than 150 countries within a network of six regional offices and global headquarters in Geneva.1
The cost of World Wars I and II, together with the many others instances of human conflict, in societal terms, is immeasurable. Such conflict is a tragic dimension of life, and the UN, the WHO and the tens of thousands of other government and non-government organisations are part of our socio-political response. They are responses to, and effector arms of, change. The years spanning World Wars I and II marked a period of great change.
So very much has changed in health care in the 60 years since, particularly in the way we treat illness and infection, with the discovery and use of antibiotics. Antibiotics changed countless lives, and it did so quickly. No sooner had we discovered the power of antibiotics than had we also discovered that micro-organisms bear an equivalent power of their own - antibiotic resistance. The march of antimicrobial resistance is a global phenomenon, with unwelcome change in the way we can, or can no longer, treat some infections. If this is any indication of what might be in store over the next 60 years, it is not easy to predict what’s to come.
Many have said that change is the only constant. This recent history serves as an important reminder of the changing and complicated contemporary world in which we provide health and medical care. How we, as health professionals, keep up with, manage and attempt to get ahead of change, occupies much of our time in practice. There are no shortages of local and global health challenges. Poverty, poor sanitation, prevention and control of infectious disease, access to affordable health care and medicines, and conflict and war, way heavily on our minds and our everyday work. As health professionals our mandate is to respond to the needs of our patients and their communities using the best possible evidence available and the resources we have at our disposal.
History, however, has taught us that health challenges have inherent political dimensions. The reality is there are few aspects to health and health care that are, in the contemporary world, truly apolitical or free of political consequence. It is therefore important for us to be engaged in the broader conversations if we want to be part of any effective solution.
We have professional obligations as advocates for patients, which are all the more important in complicated and constantly changing circumstances. Such obligations require us to adopt a position and commit to a course of action; to contribute to the conversations and debates in meaningful ways.
Positions and actions are of course contextual to time and place, by their nature reflecting a view or outcome at a given point in time. They do not inexorably represent a binding alignment to a particular position or course of action, nor imply binding alignment (political or otherwise) with other agencies that express a similar position or course of action. Likewise, they do not represent binding disagreement with agencies that express contrary positions or courses of action. Particular positions expressed at one time are inevitably called into question as information and circumstances change. If they didn’t, and if it wasn’t for individuals like Pasteur, Flemming and Semmelweiss and many others who each expressed particular positions in their time, we would all be in a very different place today. Vaccines and pasteurisation do prevent disease, antibiotics do treat infection, and infection control is fundamental to our health and wellbeing. Times change, and what we know today will inevitably be different tomorrow.
What is important is that we remain committed and actively engaged in the broader conversation. We must have the courage to lean in to the issues before us, and those issues that confront our patients and the wider community. It is important that informed discussion and debate is permitted to occur, and that it occurs in a way that allows individuals to form their own view, however popular or not at the time, free of duress and undue influence.
Health professionals should be able to, and are expected to, express their opinion professionally when contributing to the discussion and debate. These are hallmarks of a democratic and civilised society, and of developed, informed and scholarly health professions. In doing so, we must recognise the politics of health in the 21st century, and accept that change (as both friend and foe) is the only constant in our pursuit for health and wellbeing for all.
1. World Health Organization. About WHO. 2016; http://www.who.int/about/en/. Accessed 28 April, 2016.
2. United Nations. What we do. 2016; http://www.un.org/en/sections/what-we-do/index.html. Accessed 28 April, 2016.
Professor Ramon Shaban
Professor Ramon Shaban is Clinical Chair of Infection Prevention and Control at Griffith University and the Gold Coast Hospital and Health Service, Australia. He is President of the Australasian College for Infection Prevention and Control, Editor-in-Chief of the Australasian Emergency Nursing Journal, Senior Editor of Infection, Disease and Health, and Temporary Advisor to the World Health Organization on Antimicrobial Resistance.
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