Our Minister of Health, Dr Aaron Motsoaledi, has raised the ire of many in South Africa on his proposals to place severe curbs on alcohol and an even harsher approach to smoking. Every argument, from the Constitutional freedom to economic activity to the rejection of a 'nanny state', have been hurled at him from outraged citizens to powerful vested interests. But is he wrong? Maybe not.
I have just returned from speaking at a World Bank conference on the subject of constituency feedback, unravelling the DNA of building an active citizenship and understanding the meaning of democracy.
On the first afternoon in Washington, recovering from a cold, I draw the curtains shutting out the setting sun’s glimmer of warmth and flick through the innumerable channels on offer. There are hundreds, but nothing catches my attention. The news channels blare out sound bites on the debt crisis, the immigration fury, Republic Party paralysis, gun control and gay rights debates.
And then I am struck by a pattern I see. It’s the advertising. It is saturated and pervasive. This is brainwashing, an onslaught on the senses. I think of vulnerable kids and adults who sit for hours in front of TV screens. They do not stand a chance. It is relentless and disempowering. The American model – we have an instant solution for any problem you have.
Nearly half of the advertisements are on drugs. It sits comfortably alongside junk food glitz. This must be the greatest obsession here in the US. The nation spends a stupendous $2,7 trillion on health care. That’s nearly 18% of the GDP and more than 20 times SA’s national budget. There are drugs for erectile dysfunction, cardiovascular diseases, hypertension, depression and diabetes. In advertisement after advertisement we are introduced to the world of drug control. Interspersed is the smart legal firm advertising class actions for drugs that have failed.
Much of what I see is treatment regimens for lifestyle diseases; ill health that could be easily addressed by a holistic approach to health care based on diet, exercise and healthy living. But what is being advocated here is a disease management system.
This is an industry gone haywire with Band-Aid medical care based on a philosophy that we are all sick and are powerless to change the course of or lives. It is inevitable that we will suffer heart attacks and the wrath of disease. Resistance is futile. Learn to live on drugs because we will invent a drug for any problem you have. Disease prevention is not the objective here.
This cartel of pharmaceutical companies, insurance companies, technology providers and private hospitals will resist any attempt by government to regulate them. I can understand why every president in US history has failed to reform health care. America’s healthcare industry has spent hundreds of millions of dollars to block the introduction of public medical insurance and stall other reforms and have successfully watered down Obamacare.
The healthcare industry heaps cash on politicians: drug and insurance companies reportedly spend $1billion on lobbying the Congress. Industry lobbyists swarm over Capitol Hill – literally six registered for every member of Congress – an insider in the most powerful lobbying firm in Washington acknowledged that healthcare firms’ money “has had a lot of influence” and that it is “morally suspect”.
Expensive technology with perverse economic incentives pushes operations that are not necessary, often rewarding physicians to do procedures and tests that treat symptoms rather than the causes. It’s about vested economic interests and profits.
So what is the impact of this most expensive health care system in the world where the average citizen spends and average of $8,000 per annum, compared to $3,000 across the rest of the developed world? The United States is at or near the bottom in infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies and life expectancy. The US Census Bureau reported that nearly 50 million residents, 16.3% of the population, were uninsured in 2010.
A 2004 Institute of Medicine (IOM) report said: “The United States is among the few industrialised nations in the world that does not guarantee access to health care for its population. Recent studies have found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence.”
It is estimated that health care costs for chronic disease treatment account for three-quarters of national health expenditures. Lifestyle diseases, especially obesity, are expected to cost the US over $1trillion annually.
A UCLA study suggests that consumer television advertisements of prescription drugs may be influencing Americans to believe they are sicker than they really are and this could lead to taking more medication than they actually need. Approximately $2.4billion went to ad spending by the pharmaceutical sector in 2011, according to Nielson. Americans watch up to 16 hours of TV ads about prescription drugs per week.
The study is published in the current edition of the Annals of Family Medicine, and shows people that have “lost control over their social, emotional or physical lives without the medication; and they minimise the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.”
Dr Frosch, a scientist, says: “We’re seeing a dramatisation of health problems that many people used to manage without prescription drugs,” and adds that the “ads send the message that you need drugs to manage these problems and that without medication your life will be less enjoyable, more painful and maybe even out of control.”
This is why I fully endorse Dr Motsoaledi’s holistic approach to health care; after all, the State will have to pay the price for unhealthy lifestyle in higher health costs. Today we know the there is a scientific link between unhealthy nutrition and bone diseases, hypertension, diabetes and cardiovascular diseases. We know that healthier lifestyle with an emphasis on nutrition, diet and exercise is our biggest defence against illness. I expect the Minister of Health to do what he is proposing; that is his duty and responsibility.
One thing I am convinced of is that ban on TV advertising by pharmaceutical companies must be enforced and that industries like tobacco, junk food and alcohol must be severely circumscribed by government regulation. These industries are the incubators of a pandemic of lifestyle diseases we see globally if left to market forces alone.
What we need is a return to the Hippocratic Oath, the dedication of Florence Nightingale, which guided the evolution of the first health care systems in the world – our moral conscience that health was about social solidarity and our shared humanity. The medical profession has a long way to end its prostitution on the marketing of pharmaceutical products and place the patient’s interests at its core outcome. Regulation on the marketing of drugs in doctors’ rooms should be made a lot tougher. And we need a greater emphasis on prevention education that starts in the doctors’ rooms, our schools and a media campaign, especially on our public broadcaster, on what we can do as individuals to promote wellbeing.
While I believe that a mixed system of public and private sectors should co-exist, I am convinced that governments cannot be allowed to abandon the majority of the vulnerable to the vagaries of the market. It is an overwhelming challenge to curb the power of the market and corporates who dominate the US and, increasingly, the global health system.
Quality health care is a fundamental human right, and price should never be allowed to bar citizens from this right. DM