International Pharmaceutical Students Federation

There is no doubt that the accessibility of healthcare services to people all around the world is a human right that should always be part of global advocacy toward a better healthcare system. Having a sustainable and applicable approach to providing free services helps transform overall health and break down barriers to health equity. Currently, 43 countries worldwide offer free or universal healthcare to at least 90% of their citizens.¹ To achieve free healthcare, stakeholders such as governments, insurance companies, and health sectors are involved. There are also several frameworks for how countries might provide free healthcare. Some examples include National Health Insurance and The Beveridge Model.1 In this article, we aim to discuss the importance of a transactional approach towards making healthcare systems better for human beings through providing free healthcare and the role of pharmacists in reducing healthcare costs.

On Human Rights Day 2017, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), said that “The right to health for all people means that everyone should have access to the health services they need, when and where they need them, without suffering financial hardship. No one should get sick and die just because they are poor, or because they cannot access the health services they need”.² It is with great emphasis that people need free healthcare services to not only survive but also to ensure that they are secure about the basic requirements of human needs. People die every day because of poverty, lack of services, ignorance, unavailability of healthcare awareness, and lack of medications. Putting this into account, the provision of a dynamic and planned approach to easily access these services is considered a global priority.

To protect the right to health, we must examine the causes of the gaps in access to healthcare and what essential role education plays in protecting this essential right.

1. Social determinants of access to healthcare
Many factors are at play in the complex monster that is access to healthcare. Like any puzzle, solving this dilemma requires understanding it from all angles. As such, we use the tools of the social determinants of health to describe the multiple factors that compose this enigma. By examining these factors, we come to understand that health is multifaceted and can only be obtained by acting on all these determinants at the local, regional, and global levels.

Social determinants of health refer to non-health-related elements that influence health outcomes and healthcare accessibility. These include the social and physical environment, education, food safety, income, social status, gender equality, etc. Social determinants of health serve to highlight the gaps in health determined by environmental, social, and cultural gaps. It is worth noting that many populations around the world who are part of different socio-economic groups face discrimination in the accessibility of healthcare services.³ A relevant recent example is the disparities highlighted by COVID-19. According to a recent WHO report, lower socioeconomic status is associated with poorer disease outcomes as they have difficulty accessing sanitization, live in crowded environments where it was not possible to put in place preventive measures and work in jobs requiring higher mobility. Other essential determinants were housing conditions, work conditions, the social stigmatization of certain groups, and lack of social protection within certain environments.

Not acknowledging the impact of these means refusing to consider the need of specific populations and thus pushing them outside of the coverage of healthcare. To act on health, we have no choice but to act on these factors as well. In the next section, we will look more deeply into the reason why protecting the right to education is intrinsically tied to the right to health.

2. Increasing healthcare through education a. How education affects health
Not only as a determinant of health in itself, but education also impacts other determinants such as childhood experiences and habits, employment and working conditions, and income and social status among others. Education is therefore an essential component of health and health access. As old as 1989, Feldman and al⁴ have noted the impact of education on mortality and general health in high-income countries. This has been corroborated in many more recent studies that demonstrate a higher rate of chronic illness, worse general health, and disability in association with education levels across all ethnic groups.

Education not only creates opportunities for better health but also has a lot of benefits on a social and psychological level. With education, income and resources tremendously improve. For example, employability, earnings, and availability of resources for better health. Higher earnings allow individuals to have access to better food, water, and a sanitary environment which are crucial for the prevention of many diseases. Education also affects stress levels as it helps people overcome social and economic hardships. It develops skills and fosters traits that are significant throughout life and may be important to health, such as conscientiousness, perseverance, a sense of personal control, flexibility, the capacity for negotiation, and the ability to form relationships and establish social networks.⁵

In low-and-middle-income countries (LMIC), the direct effects on health access are even more felt. Low education levels are directly in link with child mortality rates. Poverty resulting in poor nutrition in women leads to low-weight and preterm babies. Furthermore, a lack of accessibility to schooling reflects lower vaccination levels for children and a lower understanding of public health instructions. In a systematic review by Girmay and al., children with mothers having completed high school education were 31% less likely to experience death.

Furthermore, education heavily impacts an individual’s abilities to make consensual health decisions, understand health counseling and follow therapeutic regimens drawn out by health professionals. Following this vein, we find two branches: health literacy and human rights education. In other words, a lack of education stops individuals from using health resources.

b. Health literacy
Health literacy deeply affects or refers to the ability of individuals to obtain, understand and use information and services to make adequate health decisions. More than ever, in our era of wars on information, health literacy is required for individuals to be able to take full advantage of the health information transmitted to them, follow care instructions to appropriately manage treatment, and make fully-informed decisions.

Low health literacy is also associated with less participation in disease detection activities, riskier health choices, more work accidents, and increased morbidity and premature death due to poor adherence to medication. Low education and low socioeconomic status is strongly associated with lower levels of health literacy. One of the main solutions to increase the understanding of health and healthcare in populations is building a quality education system that teaches health information to children starting from a young age.

Health literacy highlights not only the right to education for the youth but also lifelong learning as many older adults are also affected. Increasing health literacy does not only rely on increasing education among children but also providing adequate educational materials and teaching across all ages to adequately address all health problems.

c. Human rights education
Human rights education in healthcare can build knowledge, and empower advocacy. A study that was conducted to show how education has transformative potential in human rights, especially in patient care, approved that human rights education is at the top of the most basic and fundamental institutions of society. These institutions include the health care system, and the guardians of that system, the health professions. As there is no better place to begin healthcare accessibility and& transformation than in the world of patient care.⁶

As essential health workers, pharmacists also play a role in reducing healthcare costs by reducing inappropriately prescribed medications and health disparities by improving health education. In outpatient settings where physicians might not have enough time to provide all preventive and chronic health services, pharmacists fill in the gap and assess medication adherence and provide chronic disease management. In the inpatient setting, pharmacists attend clinical rounds with a multidisciplinary team, ensure the safety and effectiveness of medications, and contribute to the transition of care.⁷ Through these roles, pharmacists help reduce healthcare costs by eliminating unnecessary medications and shortening hospital stays.

Overall, healthcare services are basic human rights and everyone should have access to them. While there are barriers to free healthcare services, pharmacists continue to play a crucial role in reducing healthcare costs. Together, we can break the barriers and achieve free healthcare services to target health for all.