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Health Background

PSI is concerned with the health of all workers, the special risks faced by health care workers, and the commitment of public service workers to provide quality health services to the populations whom they serve. Health care workers make up 40 per cent of the membership of Public Services International, comprising the single largest constituency of PSI’s 20 million members.
  • Health is a public good, and ill-health is a fundamental humanitarian problem with political, economic and social causes and consequences.
  • Good health is not only a social benefit to individuals and societies, but also contributes to economies because it plays an important role in productivity.
  • Since its entry into force in 1948, the Constitution of the World Health Organization states that “ [t]he enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. There is currently a widely supported movement to modify this assertion and make a health a basic human right to be enjoyed by all, without geographical or economic conditionality as to the standard attainable.
  • Health is best delivered by public services that are accountable to public authorities, based on a public service ethos and the principle of equity without regard to ability to pay. Health delivered in this way is a product of the social contract between the population and its elected representatives, and is founded on the principle of solidarity in the use of resources provided by public revenues.
  • Efforts to reformulate health as a commodity has led to atomization of health care delivery, and outsourcing and privatization of central as well as peripheral components of the health service systems. Although there is a share of non-profit enterprises in health, the transition to privatization has largely involved profit-making.
  • The practice of outsourcing and privatization is based on the belief that the private sector will be more efficient and that public resources will be saved. It is also based on the beliefs that public health service workers are overpaid and corrupt.
  • In reality, privatization is expensive in the medium and long term, upholds profits over other aims, and destroys the social contract and solidarity within a society. The main issue is no longer the health services that a society can afford for its members, but becomes whether each individual can afford the health care he or she needs. Increasing numbers of individuals are priced out of access to health care, whether through the cost of insurance, or the cost of the services themselves.
  • The pay of public health sector workers should be determined by collective bargaining based on negotiation. Corruption of health service workers, which is largely associated with workers who ask for extra payments or in-kind gifts, is most often due to underpayment of the workers.
  • In numerous countries, the wages of health service workers are grossly inadequate relative to the qualifications that they bring to the job. In addition to corrupt practices, this stimulates the push to migrate to countries where wages for health care workers are higher. Nevertheless, the fact of health worker migration maintains a downward pressure on wages in the health sector in receiving countries.
  • The occupational health and safety of health care workers are unevenly protected and promoted; international standards need to be more widely ratified, national standards implemented, and specific protective practices included in collective bargaining instruments at the workplace or branch level. These efforts must be made in opposition to the general contrary trend to reduce occupational health and safety as a savings measure.
  • Shortages of staff, inadequate skill mixes at the health delivery point, and under-practiced teams are occurring increasingly due to cuts in public spending and/or private sector efficiency drives. These shortages, cuts and efficiencies lead to longer wait-times for patients and stressful workplace environments for health workers. Violence ranging from harassment and verbal abuse between health staff to physical assaults by members of the public is increasing in frequency in many different types of services, and the phenomenon is observed worldwide. Zero-tolerance policies must be developed, implemented and enforced for the sake of all.

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