Public Health, Once and for All! - concept note

This concept note provides an overview of the evolving PSI Covid19 Response campaign: Public Health, Once and for All! Check out the first phase of this campaign - "Safe Workers Save Lives" - on our People Over Profit platform.

The global outbreak of COVID-19 is sending shockwaves throughout world. It has impacted virtually all aspects of our lives.Workplaces, schools, places of worship and so many other public places have been shut down by governments, in a bid to slowdown the spread of infection. While this does not excuse the initial lethargy of most governments up till very recently, it cannot be faulted that there is every need for definitive steps to be taken to arrest this pandemic.

Decades of a global model of development which prioritises profit over people laid the basis for today's public health, social and economic crisis of catastrophic proportions. Years of cuts in public spending on health and privatisation undermined crisis preparedness. Informalisation of employment relations and eroded welfare systems have increasingly made precarious work the norm, making necessary steps to curb the outbreak more difficult for millions of people.

This pandemic is definitely a public health crisis. But it is equally a social and economic crisis which shows the dangers posed to humankind when the stock market takes precedence over the state of wellbeing of the vast majority of the human population. Moments of monumental consequences like this are historical turning points. How we respond determines if society sinks or rises.

Governments must do more to protect health workers!

Check out our campaign on People Over Profit

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Contextual background

The new coronavirus (COVID-19) pandemic poses a challenge of historic proportions to humankind. The global spread of the outbreak has been exponential. And, it might still be far from reaching its peak. It is estimated that between 40 and 70 percent of the world population would be infected, if far-reaching decisive steps are not taken with a sense of urgency. With an estimated global case mortality ratio of 5.7%, that means between 118 million and 311.2 million people could die.

Unfortunately, while there have been efforts to combat “the alarming levels of spread and severity” of the pandemic, the World Health Organization has also expressed grave concern at “the alarming levels of inaction”, which we can see in several countries by governments.

According to the World Health Organization Director General, Dr Tedros Adhanom Ghebreyesus; “in some countries the level of political commitment & the actions that demonstrate that commitment don't match the level of the threat we all face.” Many countries are rising to squarely face the pandemic. But, several other governments have failed to put measures in place to adequately protect people’s health, including the occupational safety and health of workers delivering much needed public health and emergency services.

For example, while countries such as South Korea, Japan, Denmark, France, Spain, Germany, Israel and Italy have taken steps to ensure the physical safety and social-economic well-being of residents (including pay for workers quarantined or furloughed in most of these countries, and the requisitioning of private health facilities i.e. by the Spanish government), some of the richest countries in the world have rather taken steps to shield their economy without putting in place adequate health and social protection measures. The United States government alone, for example, quickly committed as much as $1.5tn to save the markets, while it took weeks before passing an inadequate health response bill.

Health Workers: Global shortfall

Key Findings: UN ComHEEG Report on Health Workforce

43mi

workers in the world now 2020

40mi

new workers needed by 2030

18mi

workers shortfall in 2030

To effectively address this crisis and rise after it, we must question the developmental model which brought us here, and provide alternatives which put people first, both in the short and long-term. We must draw and act on lessons from earlier epidemics and the current pandemic. A central lesson is the crucial importance of strong and well-funded public services, including public health systems which are adequately staffed.

This pandemic is the greatest shock to the global economy since the 2008 crash. And one of the reasons why the shock is being so severe is that world leaders went on with business as usual after the great recession. Instead of expansionary fiscal policies to create more and decent jobs, including in the health sector, and universal social protection, governments embarked on a spree of austerity measures. We must rise from this dark hour with the firm resolve for a global paradigm shift to a world order which puts public health and the people’s well-being first, at all times.

PSI is committed to organising a global campaign for this purpose.

Video

Nurse George Poe Williams saw colleagues die when Ebola killed over 8% of the Liberian health force. Now he has a message for governments around the world ahead of #CoronaVirus: #SafeWorkersSaveLives Take part in the PSI campaign here: peopleoverprof.it

"We health professionals must not become martyrs of the Coronavirus"

Not only has needed action within countries been inadequate in several instances, there is also need for greater international solidarity at this point in time. Countries must clearly realise that borders cannot keep out the spread of the virus. Narrow-minded national concerns, such as that which initially hindered response to Italy's call by other countries in the EU, must not be repeated.

Global leaders should not fuel the flames of racism and xenophobia. Comments such as that of President Trump describing the new coronavirus as a “foreign”, “Chinese” virus create a toxic atmosphere of fear and despair. We must all stand against all forms of xenophobic attacks on social media and on the streets, which we have seen meted out against South East Asians in Europe and North America.

In some countries without a universal public health system, and with the growing scarcity of testing facilities, the wealthy are seeking their own protection at the expense of public health. But wealth must not be the basis for testing or access to treatment. Governments must ensure universal access to testing and treatment for an effective response to the pandemic.

Workers, particularly delivering healthcare (and other public) services are those on the frontline of the COVID-19 response. Working under circumstances which in some instances have been like being in the middle of “a world war”, health workers have worked themselves to the bone, testing, triaging and treating vast populations. This is because years of privatisation and austerity measures have left public health facilities underfunded and understaffed. As an example, the still effective Italian public health system has seen a cut of €37 billion in the past ten years, and a consequent drastic reduction of personnel.

Health workers are the backbone of healthcare delivery. It is impossible to provide health for all without having health workers for all. In 2016, the World Health Organization and the United Nations’ Secretary General’s High-Level Commission on Health Employment and Economic Growth (ComHEEG) warned that governments need to massively invest in the global health workforce to avoid a shortfall of 18 million health workers by 2030.

The ComHEEG also drew world leaders’ attention to key lessons from the 2014-2015 Ebola epidemic, pointing out that “with the Ebola outbreak in West Africa, we have seen how inaction and chronic under-investment can compromise human health, and also lead to serious economic and social setbacks”. It further identified investment in health workers as a critical “part of the broader objective of strengthening health systems and social protection and essentially constitutes the first line of defence against international health crises”.

Italy: a warning sign?

(Figures from 19 March 2020)

2,629 health workers

currently infected

8.3% of cases

are healthworkers

35,713 cases

in total

Governments were urged to relax austerity measures in favour of fiscal expansion policies and prioritising investment in job creation to strengthen health systems. The commission was clear with its message; “business as usual is untenable”, if the people’s health is to be ensured. But despite formal commitments to implement the ComHEEG’s recommendations and the Working for Health Five-Year Action Plan which emerged from these and was adopted by the World Health Assembly in 2018, under-investment in the health workforce remained the norm until the outbreak of this pandemic, worsening its impact.

The WHO Director General, Dr Tedros Adhanom Ghebreyesus warned in February that the world may be dangerously unprepared for the next pandemic. He was not talking of the current global outbreak. He noted that “for too long, the world has operated on a cycle of panic and neglect,” adding that governments “throw money at an outbreak, and when it’s over, we forget about it and do nothing to prevent the next one.”

Financing of health continues to be largely shaped in different ways by the market logic aggressively promoted by international financial institutions. IMF conditionalities continue to constrict fiscal policy space, particularly in low- and middle-income countries. And the World Bank securitized public health emergencies by introducing pandemic bonds in 2017, as an ideology-driven policy to get the private sector involved in humanitarian and emergency finance,. But “the money for these bonds could have been better spent in providing the WHO with funds or help strengthen healthcare provisions in poor countries at risk”.

The coronavirus pandemic reveals the deep crisis of the neoliberal model of development and reluctance of governments to take needed actions for achieving the Sustainable Development Goals. As it begins to spread further in developing countries, the impact of the pandemic is likely to become worse. The public health systems in Latin America and particularly Africa have been battered by decades of IMF-inspired structural adjustment programmes which have also undermined what social protection systems there were and heightened poverty.

Governments all over the world have to decisively take far-reaching steps to mitigate the situation fostered by the marketization of healthcare and ensure that never again will we be at this catastrophic point. We cannot solve the current problem or avoid subsequent severe crises with more of the measures which have made the world ill prepared to face the COVID-19 outbreak.

The key solution: more public health funding, more health workers!

In 2016, the UN's High-Level Commission on Health Employment and Economic Growth, of which PSI was a member, issued a report calling for massive increases to health funding and the health workforce.

Check out the report!

The primary role of public sector delivery of social services like healthcare, education and housing have to be brought back. This must go hand in hand with strengthened coordination between agencies and levels of governments and their enhanced accountability to the communities and nations they serve.

The severity of this global public health emergency has reverberated in the world economy and challenged our mental and social well-being. Restriction of individual freedoms have become a matter of exigency, constraining long held democratic culture. While this has become unavoidable to break the chain of the coronavirus’ transmission, governments accountability to the people must remain respected and their extraordinary powers not wielded for anymore time than is necessary.

The people’s 'state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity' must come first now, and always.

Useful resources

Campaign objectives

The "Public Health Once and for All" campaign will mobilise to achieve the following objectives:

  • Safe and effective staffing for healthcare delivery as a central element of the COVID-19 response (safe workers save lives)

  • Manufacturing capacity is geared towards production to support the health system with needed materials including PPE and medicines for the COVID-19 response, and private health facilities requisitioned to meet the surge of patients

  • Strengthen international collaboration that enables solidarity and support for countries without adequate resources to fight the pandemic, including encouraging countries where possible, to make corps of health professionals available for those countries who are more in need as is being done by Cuba

  • Societal dialogue and political commitment to drive appropriate macroeconomic reforms and policies for the full realisation of universal public healthcare

  • A worldwide stand of unions, communities and peoples against rising xenophobia and racism in the wake of the global outbreak

Rosa Pavanelli Public Services International

Coronavirus is exposing the terrible impacts of corporate tax evasion, privatisation and cuts to public services.

Taking action

PSI and its affiliates have been taking action to help protect workers and the general public. They have; promoted general advice, issued educational bulletins, encouraged members to stay informed, provided clinical guidelines, and provided information for different cadres of health workers and advice on the use of preventive personal equipment.

Unions have also, negotiated collective agreements which enable affected workers to receive paid special leave in several countries, including Australia, Denmark, Italy and Germany. And in Hong Kong, the Hong Kong Health Employees Alliance embarked on strike to demand for adequate health and safety measures to be put in place, with solidarity support from PSI.

PSI and its affiliates will build on these and continue to work closely with international organisations, other trade union bodies and the broader civil society to advocate for governments to:

  • Ensure that national clinical management guidelines are built on the World Health Organization’s guidelines, integrating measures from other relevant documents like the ILO’s “Practical and administrative responses to an infectious disease in the workplace” issued during the 2004 SARS outbreak

  • Respect all obligations detailed in ILO Conventions 155, 187 and 161 as well as ILO Recommendations 194, 197 and 171 and Protocol to Convention 155 and strictly enforce the implementation of these by all employers

  • Provide free medical testing for workers, and treatment for infected workers, as well as mental health and psychosocial support (MHPSS) and training for all workers on the emergent medical and sociological issues related to the outbreak, particularly in the health sector

  • Provide comprehensive personal protective equipment (PPE) to any worker who may come into contact with infected people or anyone that has come from an infected area and provide adequate PPE to all workers working in public or highly frequented areas

  • Respect the right of workers to choose not to work when their safety and health may be at risk or when workers or their families have underlying health issues that could be aggravated by the virus

  • Actively involve trade unions (particularly unions representing workers who may be exposed to the virus in the course of their work including health workers and workers in health settings, emergency service workers, workers in airports, airlines and border control, hotel workers and workers in public spaces) in the decision-making process to determine necessary steps to safeguard workplace safety and health and provide transparent and timely information to workers and their unions about the number and location of infections and the most up to date information about the disease

  • Enact legislation and policy which ensure that all workers, including informal sector workers, casual or sub-contracted workers, and platform economy workers are paid sick leave allowances which they can live on during any period of quarantine after potential exposure, exposure with no diagnosis or positive diagnostic test, or when their workplaces or means of livelihood are temporarily closed down to curtail transmission of the infection

  • Adopt and implement the reviewed ILO guidelines on decent work in public emergency services as national policy, to adequately protect workers on the frontline of the coronavirus response

  • Implement the ComHEEG recommendations and WHO/ILO/OECD “Working for Health”: Five-Year Action Plan for Health Employment and Inclusive Economic Growth, and significantly increase funding of public health services including public health research into infectious diseases

  • Institute anti-austerity measures and positive macro-economic reforms necessary to promote the social-economic welfare and well-being of working people and build strong public systems, including public health systems

  • Ensure the rights of migrants and refugees are protected as part of the national COVID-19 response and combat all forms of xenophobia and racism

PSI will further support affiliates action to achieve these by:

  • Making policy interventions to international organisations including the WHO, ILO, OECD, international financial institutions and regional decision-making bodies

  • Dissemination of updated information and advice from the WHO, ILO and other relevant international sources, including regional and national authorities to the workers

  • Promoting members awareness of the “rights, roles and responsibilities of health workers, including key considerations for occupational safety and health

  • Developing joint media and communication actions with PSI affiliates and partners

  • Conducting surveys for evidence-based advocacy to improve the response, defend democratic rights and raise workers concerns

  • Facilitating the sharing of experiences and building of international solidarity in support of struggles by unions in any country for workers and trade union rights

  • Issuing posters, leaflets and flyers, educational materials for action and regular guidance briefing updates

  • Facilitating affiliates' information sharing and organising educational sessions, including webinars

  • Developing and disseminating model collective bargaining clauses, and letters/petitions to decision-makers

Conclusion

The tasks ahead are daunting. But if we seize the time and work in unity, we can stem the tide of the outbreak and redefine the architecture of our global community to ensure the people’s health always comes first. We must forge solidarity in our workplaces, localities, nations and across the world and speak with one voice; people must come before profit to overcome this pandemic and build a better world.

COVID 19 pandemic is proving how fragile our planet and its population are. And it shows the failure of the neo-liberal model to lift people out of poverty and improve living conditions for all. On the contrary, it shows that even the richest economy can be dramatically hurt. This is why the world will not be the same after this pandemic. This is the time to change from a globalisation based on neoliberalism. We must lay the foundations for a new global consensus which puts the health and the well-being of the people first over and above the profit motive.

PSI and its affiliates will work closely with other trade unions, civil society organisations and communities to realise this desirable end. Another world still remains possible, where good health is enjoyed by all as a right, and social inequality overcome. We must create it now.

Appendix

WHO resources for protection of health workers and emergency responders

The protection of health workers is one of the priorities for the response to COVID19 outbreaks. Occupational health services in health care facilities have an important role for protecting health workers and ensuring the business continuity of health care services.

WHO resources for non-healthcare workplaces

Non-healthcare workplaces, such as businesses and enterprises have also the responsibility to protect the health and safety of their workers and those affected by their operations.

Infographics

Prevention COVID-19 at the workplace

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Related

More about occupational health

More about Public Health, Environmental and Social Determinants of Health

https://www.who.int/news-room/detail/09-03-2020-covid-19-for-health-workers