Health for the Poor

In Quest of Reform for Health of the Poor

The Poor?

In Thailand nowadays, many people are driven to live risky and insecure lives. The situation that well-being is prone to be eroded. This group of people is getting larger and larger along the course of development that wealth and power is skewed toward a tiny group of the privilege. These people generally lack wealth. Not only that, they lack the ability and opportunity to maintain lives they prefer. They are taken away resources for life support, all fundamental necessity to survive whether it be food, shelter, land, forest, etc. They are under stress and their living exposes them to illness without easy access to health care system. They are treated unfairly and with discrimination. They fall victims to a centralized political system that silences their voices. They are without power to master their own destiny but are subject to power beyond their control. After all, they lack energy to protect themselves against economic, political and social structures embedded with unjustice and violence. The structure that is pushing people into their wit's end, poverty, insecurity of well-being - that is into unhealthy lives.

Health as perceived by the poor

When asked about health, at first the poor we are working with thought about hygiene, disease-free, medical care, and the like. But after awhile they started to realize that health is more than that. Health, to them, is synonymous with life. In Thai the word "health", meaning state of happiness, is more like "well-being". So they thought of health in a holistic view. They said, health is reflection of many things. We need a lot of things to assure health. Food, shelter, clothes, medicine, culture, knowledge, family, spirituality, economic, community, natural resources, environment, politics, etc. These make up a so-called "Health System" as defined by the poor. If all these things are in good order, health is secured. Medical or health care is only a part of it.

Health is stepping out of the domain of medical science and public health. But it actually is a matter of life.

Health Crisis

At the surface, health crisis is normally described as an exposure to illness and inaccessible health services but that's the only tip of an iceberg. The poor are forced to ignore themselves, and to place themselves in risky conditions. Their helplessness costs them improper dwelling exposing to disease and plague. Threatened with vocational illness, unsafe and dangerous workplaces, they are disposable for the sake of development and industrialization without proper compensation or even attention. They exhaust themselves for more pay leading to addiction. They live with uncertainty of food and shelter as their land, forest and other ecological properties are taken away. Many are displaced, or left with a contaminated, deteriorated environment. They are indebted as they are dragged into commercial agriculture. Their life could collapse at any minute. Once getting ill, they are at the mercy of the modern medical system with unequal power relations between the one with power of knowledge and the one without it. Knowledge and capital mixed together makes the health service commercial and at the same time bars the one with less fortune from accessing it. This snobby health care pattern has a hostile attitude toward indigenous health care schemes, once was helpful for the poor. All these constraints lead to symptoms of physical and mental disorder, lack of self-esteem, self-reliance and loss of human dignity.

Hence the health crisis of the poor is the increasing possibility that people loose their security of healthy lives as their control over their preferred living is being slipped out of hand.

Reform of Health System

More and more, the issue of health of the poor becomes issue of struggle for power to maintain security of healthy living. The reform of health accordingly is a reform of all existing structures in our society. Only by returning power to people for they can design and maintain community fitted for their living and to guard themselves, the reform is materialized.

Acknowledging the limited capacity of governmental sector to serve all, people must step forward and voice the need for a just and peaceful society. They must address their problem affecting healthy living at structural level. Meanwhile, they must realize their potential, as a community, to take care of themselves. The reform must bring about a society that regards life as important over all kinds of benefit, no matter whether they are political, commercial, or even knowledge. Putting together people's movements at policy level and local level, they can ensure the security of healthy life.

In addition to a just social system that prevents people from unhealthy living condition, the medical system must be reformed too, to be human-friendly and holistic. The narrow perspective of "health" must be challenged. The perception that those without knowledge are subject to the one who knows must be challenged. Subjugation approach of healing must be challenged. Dominance over "unscientific" traditional health care must also be challenged.

Principles of the reform

Forum of the Poor for Health System Reform, including Spirit in Education Movement (SEM), demand that the reform must materialize the following principles.

• Health must be regarded as the first priority, over all kinds of benefit; political, economic, development, medical, etc.
  
  
• Health system must be in diversified forms considering each community's diversified characters and background of culture, tradition, indigenous wisdom, belief and spirituality. There is no one standardized form suitable for everyone.
  
  
• Self-reliance in health must be promoted. Initiatives leading to self-reliance in health by people's organization or community must be encouraged in order to provide alternatives and to free people from centralized power that dominates life and health.
  
  
• True people participation in all kinds of health care management, from policy making, monitoring to penalties. People must have a say, e.g. in managing hospitals, health workers' code of conduct, and services, etc.
  
  
• Health-involved system must be just and non-violent. People organizations and communities must be empowered to design healthy community and to take care of themselves. Their right to protect themselves and choose the way of living so as to ensure security of health must be respected.
  
  

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