"The Challenge of Pragmatism
In politics ideology, by force of circumstance, gradually gives way to pragmatism.
The meaning of the word pragmatism –'the doctrine according to which practical matters are the criteria of knowledge, as opposed to intellectualism' – speaks for itself.
In fact, politics is increasingly concerned with issues affecting people's everyday lives, such as health, education and social security, among others. As an example of this, US President Barack Obama's health reforms played a central role in the latest presidential elections in the United States. Also in EU health systems, reforms will be the core of political agendas in many countries.
Pragmatism prevents health policies from being irreversibly affected by ideological and ephemeral aspects, by the '-isms' that have brought about so much tragedy in the entire world, and drives health away from the most adequate solutions.
When debate becomes a partisan dispute, depending on budgetary and electoral cycles, solutions are compromised or postponed.
The Challenge of Transversability
According to the World Health Organisation, 'health promotion activities are carried out on a daily basis and comprise initiatives involving social, personal and physical resources, in addition to disease-oriented interventions'.
The global improvement of health conditions must rest on basic factors, such as reasonable income levels, good living conditions and adequate nutrition, as well as access to information, the acquisition of social skills, the presence of a market offering healthy products, services and equipment, and economic, social and environmental conditions for the advancement of health.
Today, we observe that the most common non-communicable diseases, such as cardiovascular conditions, cancer and chronic respiratory disease, share several risk factors like tobacco use, alcohol abuse, sedentary habits and inadequate diets.
These risk factors are determined by economic, social, gender, political, behavioral and environmental factors and call for multi-sectoral answers that national health services must be able to coordinate.
They are also a huge public health problem due to their prevalence and incidence in every region of the world and, as in all diseases, they affect less-privileged and socially marginalised populations. These chronic diseases, together with technology, lack of information and an ageing population, lead to growing tension within the health systems of the world's most developed countries.
And these tensions, which leading to restrictions of the services provided by public health systems, do not depend on their efficacy or efficiency. It is therefore necessary to look at health in a transverse way and from different viewpoints, which take into account other sectors like education, social action, civil education and the economy as a whole. Will European governments face up to this reality?
The Challenge of Accountability
I am convinced that the challenges societies are facing all over the world, such as health, education and social security, are not only a matter of finance but also a matter of civil and educational awareness. It is necessary to develop pedagogical activity among the population, in order to make people aware of their rights and duties.
I think that at least part of the debate and the solution has to focus on the issue of accountability, not only to define everyone's rights, but also to develop a reciprocity mechanism regarding the duties of those involved in defining a policy for our health systems, as well as the duties of the entire society, of users, of decision-makers, and of all health professionals. Lack of accountability is a real cancer in health systems.
The Challenge of Sustainability
Providing everyone with the right to health protection demands a change of several paradigms, such as making people deeply aware that health care is not free. Today, this is a perverse notion in terms of sociological behavior. However, health services are indirectly funded by all, or at least most of us, through our taxes.
The health of the European model depends either on political leadership or on our capacity to live with real European citizenship!"