Doctors must play greater role as health advocates: Kubheka

Laying bare the facts still facing the majority of South Africans when it comes to the accessibility and affordability of health care in her talk on “Society, Health Equity and Human Rights” at the outset of the Gauteng General Practitioners Forum (GGPF) conference at the weekend, Dr Brenda Kubheka, of Health IQ, made the point that high-income inequality is one of the root causes of health inequality and because of this, health justice now requires that healthcare needs of all societies are met fairly within resource constraints.

“Accepting that there is a social gradient of health outcomes, with large differences existing between social divisions,” Kubheka acknowledged, “it becomes clear why those in the lowest social classes are more likely to die at a younger age and those in the lowest social classes are more likely to experience greater ill-health across their lifetime.”

Putting poor communities and health inequalities in South Africa in context, Kubheka reminded her audience that medical aid membership was still dominated by whites at 77, 7% compared to 45,1% of the Indian/Asian population, 19, 9% of the coloured population and 9, 3% of African blacks.

Private health expenditure still amounted to 84% serving only 20% of the population and breaking this down further, she was able to show, for example, that private hospitals enjoyed the privilege of 84% of the country’s ICU and high care beds, with those in public hospitals amounting to only 23%.

Probably more worrying, GGPF delegates were told, was that the medical practitioner-to-population ratio in the public sector was 1:4219 while only still at 1:243 in the private sector.

Kubheka concluded by expressing her serious concerns about the state of youth mental health in the country. Points she raised in this regard included:

·         15.3%  of school children have experienced some violence at school

·         48% bullying in no-fee schools compared to 25% in other schools

·         17.6% of adolescents have considered attempting suicide

·         Over 20% of 18-year-olds have attempted suicide

·         Negative impact of corporal punishment and other traumatic events

·         18 beds for 100 000 people available and 1% reserved for children and adolescents

·         No child and adolescent mental health policy in SA

For these and many other related healthcare issues, health justice had to address the equality of opportunity: “Design healthcare to advance equality of opportunity and remove discriminatory barriers to access, universal access to appropriate care,” said Kubheka, once again stressing the need to correct the negative impact of past injustices – and importantly, to address the impact of unfair distribution of risk for developing disease.

“And finally, I cannot overstress the significant role general practitioners have to play as health advocates, especially on issues related to social determinants of health and their relationship with human rights!”