Reflecting on electing
Today, as people queue at polling booths around the country, I wonder how much they will be influenced by the health policies of the main political parties. You would hope that it has a big bearing on people’s voting choices as the NHS is the UK’s biggest employer with a 1.5 million-strong workforce responsible for the health of 60 million people. Both the Lancet and the BMJ have tried to tease out what the different parties are offering over the last couple of weeks.
A Lancet editorial looks at how the three main parties fare in achieving aims of “better services”, “fairer services”, “protecting health” and “advancing health”. It concludes that the Conservatives and Liberal Democrats lead over Labour in terms of “fairer services” but Labour is likely to deliver better services and is ahead in terms of global health policy. There are many similarities between the health manifestos of the three main parties but the more you analyse, the less detail you find, particularly regarding how the NHS will be funded in difficult economic times and how limited resources will be allocated. This vagueness is there in the manifestos of the smaller parties as well.
There have been many calls to bring evidence to the realm of policy making, but it is difficult to find objective evidence-based statements in the policy documents of three major parties. This lack of evidence means that voter decisions are less likely to be based on facts, and are more likely to be influenced by political spin. For example, it is impossible to escape the political football that is cancer care, kicked from Labour to Conservatives throughout this election campaign, but data about how services will be funded, or how the burden of cancer compares with burden of other diseases in the UK is lacking. There is little or no mention of cost-effectiveness of drugs. This information is available in the public domain, but it is barely ever quoted, and, as far as I can tell, evidence-based medicine is not mentioned in any of the manifestos. Instead we get politicised promises of “an appointment within a week” by Labour versus “access to more cancer drugs” under Conservatives. You can only be an informed voter if there is good quality information from all the political parties.
When politics is bad for your health: AIDS in South Africa.
South Africa, with a population of 50 million, has nearly 6 million people infected with HIV — more than any other country in the world. AIDS-related diseases kill nearly 1,000 South Africans every day.
Antiretroviral therapy (ART) has been available since the late 1980s, but even in 2009, ART is not available to many people with HIV/AIDS in poorer countries. Since the beginning of the epidemic, South Africa has been the hotbed for political activism and human rights campaigns to address the massive inequalities in AIDS management in the developing world. For example, the Treatment Action Campaign (TAC), led by Zackie Achmat, successfully sued the Ministry of Health in South Africa in 2002 to ensure access to ART for HIV-infected pregnant mothers, so that mother-to-child transmission was reduced. The TAC even took Merck and other pharma companies to court to force them to make their patents available to generic drug-producing companies so that cheaper antiretroviral drugs could be available in South Africa. This type of action massively forced the price of ART down in the last decade, and meant that generic companies are the main suppliers of ART in this country, and across Africa.
In the past, the relationship between politicians and the public health community of South Africa, particularly relating to HIV/AIDS, has been confrontational at worst, and lukewarm at best. Past President, Thabo Mbeki, famously denied the association between HIV and AIDS and instead focused mainly on poverty as a powerful co-factor in AIDS diagnosis. His successor, the current President Jacob Zuma, went on trial in 2006 for allegedly raping an HIV-positive woman. He earned wide criticism and incredulity when he admitted that he had unprotected sex and stated his belief that showering after sex would prevent HIV transmission. We do not need a clearer illustration of what happens when ill-informed politics and lay beliefs inform health policy and practice, instead of science and evidence. More than 330,000 lives were lost to HIV/AIDS in South Africa from 2000 and 2005, due to the policies of the South African government. In the UK and most countries of the world, we have similar instances of ill-informed health policy based on beliefs or poorly interpreted evidence, which have led to negative impact on health. For example, the Lancet publication of a case series of only 12 patients with autism led to greatly reduced uptake of the MMR vaccine in the UK with far-reaching consequences, even though the research was discredited years later.
Thankfully, a new era is being heralded in South Africa with a huge shift in direction in terms of HIV/AIDS policy. This week’s Lancet describes President Zuma’s change of heart, leading his country with the slogan, “I am responsible, we are responsible, South Africa is taking responsibility”. Unsurprisingly, the story has not received much coverage in the world press, but the message is clear. Good health policy must rest on good evidence and government action to the contrary is irresponsible and often bad for the health of the population.