Gravy for the Rich, Blame for the Poor


Applied Clinical Trials

Amid all the urgent debates about meeting Europe's growing healthcare bills at a time of massive public financing pressures, a new theme is making itself heard among senior EU officials. It is a modern version of the old refrain that "It's the rich what get the gravy, it's the poor what get the blame;  it's the same the whole world over; ain't it all a bloody shame."

Healthcare campaigners have long argued that cuts hit the poorest hardest. And since health inequalities tend to leave the poorest with the worst health, and therefore the greatest demands, those at the bottom of the pile can become victims of a double whammy.

Now that sort of message is being taken up by others with a less obvious political starting point. Even the European Union's urbane health commissioner, John Dalli, recently embraced a similar position. Speaking of the difficult circumstances in Europe at present, he said: "A key challenge we are facing today is to prevent the economic crisis from triggering a health crisis."

This may sound dramatic, he conceded, and "it will be some years before we fully see the effects of the crisis on healthcare systems." But he insisted that "the risk of this should not be underestimated."

Dalli's line of argument is that the political temptation to make cuts in the short term risks inflicting serious damage in the long term. From past experience, "in times of crisis, health outcomes are greatly affected by changes in the resources devoted to healthcare," he told an audience in Brussels in late April. So abandoning prevention programmes, for example, can deliver immediate savings. "But the long-term effects can be serious."

Dalli was addressing a healthcare industry conference, so there were at least two edges to his sword. His concerns for the welfare of the vulnerable in society found an echo too in the hearts of those with a concern for the welfare of the healthcare industry. Cutting healthcare spending will hurt healthcare manufacturers as well. And Dalli has some responsibility—and some avowed admiration—for the healthcare industry. It might also be remarked by those of a sceptical nature that cutting into healthcare budgets will have negative implications not only for the sick and for the industry that supplies remedies, but will also cut into part of Dalli's own empire as health commissioner.

But even allowing for the potential ambiguities of his declarations, it is an interesting innovation to see the longer-term social implications of cuts being brought so explicitly into the European public debates on sustainability of healthcare systems.

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