The right to health has a special standing within basic human rights and is directly linked to the foremost of those rights, the right to life. However, the right to health is also impacted by various factors making up the natural life of individuals, their relationship with the environment, and opportunities of accessing its resources. But this clashes with the prevailing economic order and, thus, subject to the great disparity in standards of living among different countries and social classes within the same country.
Such disparities were clearly absent from the considerations of authors of international charters and conventions, in which all signatory countries recognized their commitments to the protection of the rights of their citizens in general. They did not pay attention to the fact that such commitments are, in effect, practiced within a reality governed by an economic trend, which increasingly pushes states to withdraw from their role as the main actor in creating the nature of their citizens’ lives. Ultimately, we find ourselves facing a side maintaining its commitment to an issue on which we can hold accountable, but where its capacity to fulfil this commitment is constantly being eroded. Moreover, this capacity is shifting to several sides such as the business and finance community in each country and global transnational corporations, whose impact on people’s’ livelihood is on the rise around the world. Yet, these entities are neither associated with any clear commitments towards people’s basic rights, nor in a position to be held accountable if they violate those rights.
The fact is that states are barely able to provide such conditions, with the growing control of the private sector on health care and its provisions, especially medicines and intellectual property rights restrictions on its manufacture.
This problem is clearly evident when it comes to the right to health. Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) states, “The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” However, development, especially industrial development, is a primary factor in altering the environment and thus has a major impact on the health of human beings. Entities that currently have the biggest share of the management of development are those based on private property. They are governed by laws that differ between different countries and are not clearly committed to any general obligation towards the health of humans who are impacted by their business. On the other hand, when it comes to items related to the right to treatment, the same article of ICESCR requires from states to take measures towards the “creation of conditions which would assure to all medical service and medical attention in the event of sickness.” But the fact is that states are barely able to provide such conditions, with the growing control of the private sector on health care and its provisions, especially medicines and intellectual property rights restrictions on its manufacture.
Naturally, Egypt does not deviate from this general context of the declining value of states’ commitment to protect their citizens’ rights in a changing world. Many of the aspects of the changing role of the Egyptian state towards the provision of health care can be understood through its increased openness towards the international economy in the past few decades and the resulting general direction towards more privatization of health services and pharmaceutical production in specific. However, the nature of transformations witnessed by Egypt, especially during the three decades of Mubarak’s rule, added new dimensions to the problem. In most cases, these resulted in a sharp increase in the impact of changes in state health care policies on regular citizens. The most important of those dimensions are, namely, a deteriorating and highly corrupt government apparatus and the reduction of allocations for spending on health as a proportion from general spending, which in turn is witnessing decreased levels compared to the GDP. This is in addition to contradictions in the policies of successive health ministers, concerning mechanisms of healthcare provision, leading to great disarray in the form and nature of such mechanisms and creating a gap between various segments of citizens in terms of their access to healthcare services. On the other hand, the low level of real wages for the majority of public and private sector workers and the low level of income for the great majority of citizens is an important factor in their financial inability to access alternatives to public healthcare services. Ultimately, this meant that regular Egyptian citizens’ chances to access health care diminished to a large extent in the past few decades. This was at a time when health risks increased, due to rising levels of environmental pollution and the decline in the situation of the built environment, which is the home of the great majority of Egyptians. This was demonstrated through the significant increase of the proportion of those suffering from chronic and serious diseases, such as hepatitis and all kinds of cancer.
Health is one of the rights of Egyptian citizens, which cannot be achieved outside state public policies
Actions to confront the deteriorating situation of the right of Egyptian citizens to health, especially their right to adequate health services, should take into consideration all the aforementioned elements in the aforementioned brief. In particular, it should be clarified that the recent recourse by ministers of health to reduce the problem of Egyptian citizens’ health into illusive projects to extend the umbrella of social security to new segments of the population is merely an extension of their pre-revolution counterparts. This often leads to more privatization of healthcare services, under glossy headlines, such as the differentiation between the service funder (the state) from the provider (the private sector). This is no more than a cover to provide for particular interests and is not a tangible solution to the crisis. Therefore, creating a new integrated policy for healthcare, whose philosophy is based on the fact that it is a basic human right and has the priority among the various state obligations, is an vital entry point to address the current situation.
Before anything else, health is one of the rights of Egyptian citizens, which cannot be achieved outside state public policies which is inclined towards giving the priority to the interests of the great majority over those of a narrow minority of particular segments. The headline of this list is the demand for social justice, whose framework would organize the various objectives, including the creation of a social contract committing investors and the business community with a legal responsibility towards the rights of citizens, if their activities result in their violation. The law cannot merely oblige business owners with specific environmental conditions, for example, to avoid the dangerous pollution of industrial development. Such stipulations will only address the the expected outcomes and do not take into consideration other effects that could occur due to the interference of various factors, such as lack of discipline in practice, and so on.
The relation between the general theme of social justice with solving the crisis in health care might seem weak at the beginning. However, it becomes clearer when noting that the main gateway to improving healthcare services would be to raise public spending on health in the state’s budget. The Abuja Declaration obliges signatory states, which include Egypt, to set 15% of their general spending on health. However, the average allocated in Egypt’s state budget in the past year did not exceed 4.8%, most of it going to cover salaries, which spending on facilities, buildings, equipment, and other needs is quickly dwindling. There is no hope in reaching the target without increasing the resources of the general budget. This requires the amendment of various financial and economic policies and, most prominently, tax policies, as a tool for the redistribution of wealth in society.
On the level of health policies, in particular, there is an urgent need to put an end to the current chaos in the state health care service instruments. While public hospitals and health units providing services for all citizens are considered to be the main instrument, the Health Ministry is dealing with different types of hospitals with different systems. They include health insurance hospitals, university hospitals, and specialized hospitals. The basic principle is to have diversity as an additional element to the original and not an independent parallel entity. In other words, the Health Ministry should adopt one type of hospitals, providing services to all, and finance the service through health insurance for those under the umbrella. They should also include specialized services and provide educational services to medicine faculties, etc. With the increased attention to public hospitals and health units, as a basic instrument for providing medicinal services. This will enable work on closing the coverage gaps in these hospitals and units, in light of the increased citizens needs of their services, following a long period of not keeping pace with the urban expansion and significant population increase that require the establishment of more services.
On the other hand, services, such as treatment at the expense of the state, are, in reality, a tool to circumvent state responsibility to provide treatment for citizens. The basic principle in treatment should be free, meaning at the expense of the state, to all citizens. Those who wish to resort to the private sector for their services would do it at their own expense. In reality, the identification of particular segments of citizens deserving treatment at the expense of the state is a violation of the constitution, which prohibits discrimination between citizens in any text and stipulates that health care is a right guaranteed by the state to all its citizens. Furthermore, mechanisms to verify whether citizens deserve treatment provided by the state is an additional and unjustified expense imposed on the already low health budget. It also sets the path for more corruption.
Health care in Egypt cannot be uncoupled from the crisis in medicines, whose main cause was the privatization of the Egyptian pharmaceutical industry to the benefit of international companies, which, in many case, replaced local products with their own products, whose intellectual property they control. Intellectual property rights agreements, on the other hand, created an obstacle for Egyptian factories, in producing local alternatives affordable to the majority of Egyptians. A review of state policies concerning the production of medicines is a main component in any strategy aiming at the fulfilment of commitments towards the rights of its citizens to health and treatment. This strategy should encompass the return of the state to the financing of expansion of the pharmaceutical and medical devices and equipment manufacturing. The same applies to the review of agreements signed by Egypt, which, in reality, might be detrimental to its citizens’ rights.
In reality, the identification of particular segments of citizens deserving treatment at the expense of the state is a violation of the constitution, which prohibits discrimination between citizens
Also, expansion in the establishment of new medical and nursing faculties and raising the level of the existing ones should be a priority in higher education policies in Egypt in the next phase. Contrary to claims that Egypt has more graduates with higher degrees that needed by the job market, especially with doctors, in reality, the percentage of doctors to the general population in Egypt is one of the lowest in the world. The reason for not being absorbed by the job market is related to the imbalance in the market, which witnesses narrow growth limited to the private sector, constrained by the proportion of those who able to afford its services. In the meantime, the rate growth of health services provided by the state and, therefore, its demand for new doctors has been almost zero in recent years. In this context, effort should be exerted to raise the salaries of doctors and nursing staff in public hospitals and health units.
The aforementioned points are some of the important examples of the question of Egyptian citizens’ lack of right to health care. While most of them are demands requested from the state, based on its responsibility as obligated by the constitution and international charters and conventions, it would be naive to assume that the state would voluntarily agree to bearing such responsibility. This is especially true in a political situation continuously steered by a ruling class, which puts it interests and those of its allied social segments above the interest of the great majority of the people. Thus, activating the role of civil society and building a popular pressure entails setting government accountability mechanisms and pushing the government to adopt policies that serve the interests of all citizens and protect their rights, as the only practical solution to achieve these interests and protect these rights. The popular mobilization, which erupted in the form of two popular uprisings in the past two and a half years and let to the overthrow of two presidents, is a suitable environment to steer the popular momentum into addressing direct needs and basic rights.