Health and freedom


Neric Acosta

For a vast majority of Filipinos, governance is made real or government’s presence manifest in the consistent delivery of basic social services.

Soaring terms like ‘Millennium Development Goals’ or ‘Human Development Index’ are best understood in terms of access to services that address health and education needs or livelihood opportunities.

We leave it to government or multilateral agencies to craft policy, package programs and prepare budgets, or raise the necessary revenue for elaborate mechanisms that reach significant numbers of people and families, but the success or effective reach of any of these programs are hinged on how readily and consistently beneficiaries experience access to or availability of a service.

For health services, this experience translates to having the kind of access to a doctor or medical practitioner even in remote areas of the country, or having the kind of medicines that help address various ailments. In what remains a deeply controversial policy initiative, the recently-enacted reproductive health law, mothers and women in general, especially in underserved or poor sections of the country, are given the access to information and methods to plan families or protect themselves from sexually-transmitted diseases.

All this is made possible or sustainable in terms of health insurance or the provision of larger healthcare schemes. Even in rural or urban poor areas, people are able to have the security—or the freedom—of being able to visit a clinic or see a doctor and have the kind of healthcare that protects their children and families and have the costs for these shouldered or largely subsidized.

This is the context within which the World Health Organization’s paean to President Benigno Aquino 3rd is to be understood. The WHO fittingly lauds the President for his “exemplary leadership” in boldly pursuing health policies that would “literally save millions of lives,” as the Regional Director of the WHO-Western Pacific Region Director
Dr. Shin Young-soo stated.

Not only is reproductive health a state policy now, but so is the taxation of alcohol and tobacco, or the Sin Tax Law, both of which propel the health agenda in the forefront of government action and poverty-reduction and healthcare-funding efforts. For over two decades both laws languished in Congress owing to formidable and sustained opposition from institutional and private sector forces. In the former case, it has been the Catholic Church resisting reproductive health, even challenging the law’s constitutionality before the Supreme Court. In the latter, the tobacco and alcohol lobby had proven intransigent to any measure that levies higher taxes on cigarette and alcohol products.

But this President fiercely bucked such redoubtable obstacles to social policy and utilized political capital where it mattered. The policy results are nothing short of phenomenal—remarkable breakthroughs in a political system long hobbled by special interests. The recent ratings on public trust bear this out patently: an approval rating in of 72 percent for a head of state in the middle of his six-year term.

In his speech before the WHO, the President pointed to the fact that such policies, inseparable from the widespread conditional cash transfers for the poorest segments of the population administered by the Department of Social Welfare and Development, are not simply pro-poor, but represent, in fact, a longer term strategic investment in a healthy, productive citizenry. Framing it in terms of freedom and democracy, the President underscored that health, as with education and employment, is inarguably a fundamental right:

“If we are to build a true regime of opportunities, then the most fundamental freedoms—freedom from hunger, as my father said; the freedom from unease afforded us by a secure nation; or the freedom to actively participate in our democracy—these must all be extended to every citizen, regardless of the circumstances of their birth.”

This is, in fact, an articulation of ‘tuwid na daan,’ beyond good governance, but in the fuller understanding of human development. Conventional economic analyses point to Gross Domestic Product indicators of goods and services bought and sold in a year, supposedly measuring a nation’s wealth. But as Nobel Economics laureate Amartya Sen would have it or as his famous book, ‘Development as Freedom,’ would put it, development ought to be understood in the language and indices of freedom.

Economics can set prices of any basic good or service, but the compelling issues in development are essentially, Sen would stress, about health, education, security, life spans and human aspirations. This returns us to the visceral experience of the rural housewife or the struggling mother in informal urban settlements who may not know the intricacies of public policy or budgetary imperatives, but can all too readily feel government’s presence in the form of Philhealth insurance coverage, or the freedom to visit the nearest clinic and be assured of medicines or inoculation for their children without fear or favor.

All these are about preventive solutions in the shorter term, but the President sees it in terms of sparking a “virtuous cycle of opportunity and inclusive growth” for the future—where children and families secure in their health and basic needs will contribute positively to society in the longer term.


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