UNHEARD, UNSEEN, AND UNTREATED:
Health Inequalites in Europe Today
The European Network of Médecins du Monde/Doctors of the World (MdM) have for several years published updated Observatory Reports on the state of Universal Healthcare Coverage (UHC) in European countries. The current version, published at the end of the second year of the coronavirus disease 2019 pandemic, not only documents the continued exclusion of thousands of children, women, and men from healthcare services in seven European countries (Belgium, France, Germany, Greece, Luxembourg, Sweden, and the United Kingdom); but also reminds European societies, politicians, and health professionals – again – of the enduring discrimination against some of the most vulnerable members of our societies that, with the current pandemic has become even more salient. The 2021 Observatory Report makes an important further step by highlighting what is probably the single major determinant of all the varied modes and shades of exclusion and avoidable harm: the severe lack of attention for and interest in those who live at the margins of our European societies.
When people and their needs are unheard and unseen, their pain, suffering, and concerns will remain unattended and untreated. Inattention prevents people from enjoying the highest attainable standard of physical and mental health.
This report throws light on how the exclusion through neglect works in seven European countries, all with health systems of different kinds and structures. We have to acknowledge: independent of the type of system; independent of “Bismarck or Beveridge”; of health insurance or tax funded models, similar factors and forces drive the dynamics of exclusion. Inside health systems and services, it is the sustained disregard for responding to the social and cultural diversity of our populations, and the absence of a clear and coherent commitment to health equity that excludes and harms. The report shows language barriers still present a major obstacle, despite all the initiatives and projects that have conclusively shown the need for and feasibility of linguistic and cultural mediation in health services. The same applies to the lack of information on entitlements and access to preventive and curative healthcare, as well as to financial barriers. This is a sad diagnosis for European countries, health systems, and policies after close to two decades of talking about and promoting migrant inclusive health services.
However, the major obstacles for advancing health equity and UHC in Europe are not to be found inside health services, systems, and policies, but beyond. It is about politics, narratives, and the persistence of what is currently often called “colonial” patterns of thoughts that – in contrast to the universalist conception of human rights – are ready to accept different levels of human dignity and entitlements to fundamental rights. This report conclusively attests that the disregard for universal human rights – when “everyone” no longer means “everyone” independent of legal status, country of origin, or any other social category – has detrimental effects on the health of those most in need.
This report reaffirms the critical role of migration policies and laws in determining the health, wellbeing, and personal fate of refugees and migrants. The recommendation to review migration laws according to the duty of states to protect and fulfil the right to health is paramount. We should not permit that instead of advancing “Health in all Policies”, migration politics become the ruling force “in all policies”, including health. At the same time, this report shows that it is not only an issue of migrants, or of foreigners. The exclusion from health services is a much broader issue, and the reality of the people seeking assistance in the programmes of MdM is often much more complex than what politicians, policymakers, and the people in charge in health and social systems may assume.
Equity starts with evidence, and the particular quality of this report is to convey the dire reality and the mechanisms of neglect. I am grateful to all the active members of MdM in the seven European countries for their enormous commitment and, in particular, for doing the extra work of documenting and “bearing witness” that makes this report possible. The evidence and data from the programmes are what makes this report conceivable and gives it its particular strength. The people have to be attended and cared for, their stories have to be told, and the structures impeding their right to health have to be analysed and dismantled – this is the pathway to change.
Dr Michael Knipper
Assistant Professor for Medical History, Anthropology, Ethics and Global Health
University Justus Liebig, Giessen, Germany