Los recortes en salud, un riesgo para enfermedades hasta ahora controladas

Health Cuts, a Risk for Controlled Diseases


The policy on budget cuts is threatening the existence of the Spanish National Health System as we know it.  To put it bluntly, cuts mean more disease and more premature deaths and they represent a significant risk in terms of diseases we thought were under control.

Tuberculosis is a good example. With proper treatment, tuberculosis can be cured; if not treated, it can lead to serious public health problems. It is a disease associated with poverty, weak healthcare systems, and deficient health policies. When cuts mean that certain population groups experience difficulties accessing health care and the situation is exacerbated by the work overload caused by reductions in health care personnel, the result is fewer and less accurate diagnoses. This in turn can lead to an upswing in the number of cases of diseases that we thought were under control in developed countries.

A few weeks ago the media reported the case of Alpha  Pam, a Senegalese immigrant who died of tuberculosis in Mallorca. The fact that Alpha Pam had no health card, which according to many sources was the reason he was denied medical care, has sparked fierce debate in the media.

Some reports have said it was the first death that could be attributed to health cuts and the changes in the law regulating the provision of health care to illegal immigrants. The health authorities have denied that the patient was refused medical care, although indirectly they have acknowledge that the quality of the care received was deficient and that on his last visit to the doctor the patient was prescribed only anti-inflammatory medication.

I lack the necessary information to decide whether the version of the story most often reported accurately reflects what actually happened, but it appears clear that there were irregularities or chains of errors. Otherwise, it would be hard to understand why no chest x-ray was obtained to rule out the possibility of tuberculosis in this patient, who was seen twice,
or why all his friends and fellow citizens are planning to look  for some kind of compensation.

A recent article by several colleagues published in the prestigious  British Medical Journal drew attention to the impact of the current economic crisis and austerity cuts on the quality of health care in Spain. Regardless of which version of the story of Alpha Pam comes closest to the reality of what happened, the change in policy on the provision of health care to immigrants who are not registered as residents (Royal Decree Law 16/2012) is a clear example of this impact. If a person who is not formally registered in our country is aware of this change in policy, he or she will avoid going to a health centre at all costs. First, because they know they will have to pay a sum of money which they probably do not have. Second, because they may fear that any contact with officialdom will betray their illegal status.

What surprises me most is the argument that has been put forward that “these urgent conditions or diseases that might have repercussions on public health are covered universally in all patients”.  Give me a moment to work that one out. Are we being told that the authorities expect all patients (and particularly those who do not enjoy the benefits offered by the health system, who are often people with a low educational level) to know whether their illness (which, by the way, has not yet been diagnosed) will or will not have an impact on public health before deciding whether they can seek medical care?

While acknowledging that it is extremely difficult to decide where to make cuts in such an adverse economic climate, I count myself among those who think that there are areas in which budget cuts would not undermine the welfare of the population so drastically—all of us can think of a few.

[This post was published simultaneously in the Spanish edition of the Huffington Post.]

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