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Medics For The People Has A Radical Plan To Rebuild Health Care

Above Photo: MPLP.

Medics for the People has been providing primary health care to people in Belgium for more than 50 years.

They recently launched a new mission statement outlining their main streams of work for the upcoming period.

Medics for the People (Médecine Pour Le Peuple, MPLP) marked 50 years of providing health care to people in Belgium in 2021. The network of health houses currently employs more than 200 health workers in 11 health centers across Belgium, providing care to approximately 25,000 patients. This May, they launched a new mission statement in which they outlined their vision of how the healthcare system in Belgium can be changed in order to better serve the needs of the people. People’s Health Dispatch spoke to Janneke Ronse, President of MPLP, to learn more about the role the mission statement will play in the organization’s work and what effects it will have on the people who access healthcare services through MPLP’s health houses.

People’s Health Dispatch (PHD): First of all, can you tell us why the new mission statement is important for MPLP?

Janneke Ronse (JR): Well, MPLP was established in 1971 by a group of physicians who were also members of the Workers’ Party of Belgium (PTB/PVDA). They did this because they felt the need to translate words to action, to ensure that healthcare is accessible to the people who need it, and this included a way of providing people free health consultations. They started the first health house in Antwerp, and since then, we have managed to establish 10 more health houses, guided by the same ideals from more than 50 years ago. There are many more health workers working with MPLP now, too, and not only physicians: nurses, psychologists, they’re all part of our teams now.

But of course, during this time, a lot of things changed: the impact of social determinants of health developed in one way, the pharmaceutical industry changed a lot, and so on. Because of this, the guiding principles of MPLP’s work had to develop as well, and this is represented through our mission statements. The last statement we had was from 2009, and in 2020 we began thinking about how it would be good to update it, and add the knowledge and observations we accumulated in that decade. Needless to say, 2020 proved to be a more testing year than anticipated, but although the pandemic prolonged the process we wanted to begin, it also pushed us to deepen some of our insights, to think about how do we approach the problems that exist with healthcare, and what we can do to respond to them. Knowing these things is important for the work that we do on the ground, but it’s also important for the health workers who make our teams: when it’s clear what we are doing and why we are doing it, it gives us all a sense of belonging and it gives us inspiration to work on forward.

PHD: What did the process of drafting the statement look like? How did you decide on which topics to take up and focus on in the next years?

JR: As I mentioned, the Covid-19 pandemic prolonged the process of drafting the mission statement, so it took us about two years to come up with the version that we presented in May. In 2020, the year when the pandemic really came head on, we mostly mapped out ideas. Then, in 2021, when things in Europe started to stabilize a bit, we began writing those out. More than 50 people participated in writing the actual text of the statement, and it really means a lot to us that the content is based on so many testimonies from comrades, and so many examples from the ground. It makes the text very accessible, and this is extremely important to us. We did not want to have an intellectual text, something that you have a look at, think how nice it is, and then put it in a drawer and forget about it. We wanted to have something that we can really use in the everyday work we do, something that will ensure that that work is meaningful and has an impact on people’s health.

Once we had a first version ready in February, we went back to having conversations with people who we work with – health professionals, experts, civil society. We really wanted the document to be made through a democratic process, where our research team took on a leadership role, but worked with many other people and teams to ensure that what is written is based on the situation on the ground. It was a long process, but once we had the final result, we were all very happy. I really think this mission statement is going to be very useful in our work, also because it helped us go through some stages of planning and strategizing that are very important if you want to implement something successfully. For example, while we were drafting the statement, we already had to find that fine balance between making sure that the content was radical enough and that it was real enough to implement in the short term. Talking to different kinds of people and organizations, like trade unions, non-profit health insurance providers, and civil society organizations helped us strike that balance, I feel.

PHD: Are there any specific points from the statement that need highlighting?

JR: There are basically four main components of the statement: social determinants of health, healthcare proper, access to medicines, and empowerment. We felt strongly about adding a chapter on empowerment in this statement because it’s a dimension that appears in all the work we do, and without it, things are not likely to work out. But let’s start with social determinants of health, which are often forgotten in today’s health systems although they have a bigger impact on people’s health than health systems do. Many of the patients we meet are impacted by bad housing conditions, racism, poor working conditions, and poverty, among other things. It’s part of our work to raise consciousness about this, and to highlight that the neoliberal system in which we currently live bears the blame for bad health and illnesses that arise from poor living conditions. 

One particular focus that we have in the mission statement is regarding working conditions. This is partly because working conditions are often overlooked in health policies, but if you think about it, we all spend so much time at work, how are our working conditions not going to influence our health? Sadly, the responsibility for the harm that workers are experiencing from bad working conditions is actually being shifted on them. The government’s approach is one focusing on personal responsibility for health, and boils down to people having to fill out questionnaires and feeling bad because they don’t have enough time to work out or enough money to access nutritious food. People are penalized if they don’t toe this line. For example, if a worker on health leave fails to fill out a questionnaire that the government wants filled out, they lose 2% of their income. At the same time, employers are not held responsible for making people work in poor conditions. If a worker’s health evaluation says that they should be given an adapted workplace not to suffer more health damage, the employer can simply say they don’t have such jobs available and fire the worker without any compensation. This happens in seven out of 10 cases where workers’ health evaluation gives this result. The responsibility here really has to shift – workers’ cannot be blamed for the working conditions employers enforce. Currently, we have half a million people at home, unable to work because of such working conditions, and it’s not their fault. Their situation really points to the contradiction of the social and the neoliberal elements in our society, and we have to make sure that the social is given priority over the neoliberal.

PHD: You also mentioned healthcare as an important segment of the statement. How is the health system in Belgium able to cope with the problems arising from social determinants of health and other causes of poor health?

JR: If you look at the budget of our health system,  the fact that jumps out is that 98% of it is allocated to curative medicine, while only 2% is reserved for preventive services. So, our system is not completely bad – it’s good at curing people, but it’s not good at preventing illnesses. That’s a problem. Even where there are funds for prevention, they are often used at a very high campaign level. The materials that come out are good, but they don’t actually reach the people, so the use is extremely limited. There are very poor regional preventive capacities, in some places there are none at all. We have experienced this during Covid-19, when contact tracing was outsourced to commercial call centers because there were no regional institutions ready to take on the role. Expectedly, this did not work out so great, we noticed very early in the pandemic that the people who were doing the tracing were not trained for that, and the people they were talking to were not willing to engage with them. So MPLP started its own contact tracing program which included professionals, but also volunteers. This was a much more successful attempt of contact tracing, and we were able to build trust with people much more effectively.

Now that Covid-19 is not on top of the news any more, we still think the experience of that pandemic showed us a lot of what we need to have to address other epidemics. I mean, Covid-19 is not the only pandemic there is right now – we have to think about air pollution, mental health, obesity… These are also pandemics, and we need to invest in preventive medicine to address them. Based on our experience during Covid-19 and the research we have done, our approximation is that if we had even five preventive care workers per 100 thousand people, it would make a significant difference in addressing current and future public health challenges.

PHD: Another chapter of the text deals with access to medicines, a topic which has been discussed a lot before the pandemic, but then attracted even more attention because of the procurement and distribution of Covid-19 vaccines. What is MPLP’s take on that topic?

JR: Previously there was a lot of talk about the so-called “kiwi model”, a model of public procurement that is supposed to decrease the pressure on public budgets by promoting competition among pharmaceutical producers when generic medicines are concerned. This is supposed to drive the price down. But what we have seen lately is that most of our budget for medicines is not going to these kinds of medicines. Instead, it’s being spent on new, expensive drugs for rare diseases, which are still under patent. Currently the pharmaceutical sector can basically set the price of these drugs, and there’s very little space that we have where we can act on it. The negotiations on the prices are even held behind closed doors, so there is no way we can know the difference between what Belgium is being asked to pay in comparison to, for example, Croatia. Such an approach is causing even more stress for social security systems, and it’s imperative that we find a way to change it.

During our discussions, we focused on the possibility of displacing research and development of medicines from the private to the public sector. That would allow us to focus on need, not profit. Very recently we have seen Pfizer stopping research into therapeutics for Alzheimer’s disease because they found it “not promising enough”. Similarly, years have passed since new antibiotics were developed, all because of Big Pharma’s eternal chase for profits. At the same time, a lot of the actual research is already being done in public institutions, universities, research institutes etc. But then big companies come in and privatize what has been developed by public money – and then charge whatever they want for it. So what we are saying is, let’s use the money we’re now paying Big Pharma for developing an European-level network of public research institutes. Let’s pool our resources, bring our researchers together, let them work. Let’s encourage sharing knowledge and resources alike. The pharmaceutical sector could still play a role in production, but their role would be minimized, and their leaching of public budgets would fall down as well.

In our statement, we refer to this plan as Salk Institutes, because when they asked Jonas Salk who would own the patent for the polio vaccine he had discovered, he said the people would, asking, “Could you patent the Sun?” This is exactly what we think is important to reintroduce in the field of medicines research and development, and one of the key values that should be included in the network we have in mind – the medicines that are developed there could never, ever be patented.

PHD: You mentioned how important the empowerment dimension was for MPLP. How is that reflected in the mission statement?

JR: Essentially, without empowerment, how could we implement the other three things we’ve just talked about? Empowerment is really part of everything that we do. It’s part of how we talk with patients, how we involve patients in making decisions about their health, it’s part of how we engage with the communities that come to the health houses. Without empowerment, people will keep thinking it’s their fault they’re ill, and it’s not! We try to empower our patients by bringing them in groups who share similar health problems, but also by inviting them to join campaigns. For example, we invited our patients to join a big trade union demonstration addressing the cost of living crisis on June 20. We want people to raise the issue of the parallel rise of living expenses and the freeze of salaries that we’re facing. 

We work quite closely with PTB/PVDA on this kind of activity, as we have a shared vision of society. Working with them also helps us to move away from that mainstream narrative that health is not political. Health is very political, and it’s important to ensure that there’s an exchange between people working in health with people from the left who are in parliaments. We call this the “street to parliament to street” approach.

PHD: Finally, how are you going to use the mission statement?

JR: As I said before, MPLP is not a theoretical organization. The statement will only become a good text as we put it into practice. One of our focuses will be finding ways for everyone from our teams to participate in the implementation. We’ll definitely start working on establishing the prevention houses, the regional preventive capacities that I mentioned before. We want this to be introduced systematically, but sometimes it’s best to lead the way and pressure the institutions by putting things into practice first.

In the context of social determinants of health, especially links between working conditions and health, we’re coordinating with trade unions. It’s likely we’re going to be looking into the recognition of professional diseases. The process of doing so is very complicated at the moment, but there is a possibility of recognizing some diseases as professional diseases in particular professions. For example, one of our past presidents managed to push this in the case of dockworkers and lower back pain, which is now recognized as a professional disease in this category of workers. I anticipate there will be much to do in the field of health and work, also because as the age for retirement is shifted, older people are forced to remain or return to the workplace, and that is having very bad effects on their health.

Finally, we’ll also continue thinking and reaching out to people in other places about the Salk Institutes, to build an international network that could push this on an European level. And of course, the things that are included in the statement will be an important part of the actions and campaigns we carry at the local level, in order to be able to link them with national and international actions which are going to come up.

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