National priority is contrary to public health
There is broad institutional and academic agreement that among the main objectives of a fair healthcare system, the concept of equity must be included; that equity, in the field of health, means that people with the same health needs should have the same access to healthcare, and that, on the contrary, people with different health needs, with inequalities, should have unequal access to healthcare, which is nothing more than the application of the Marxist concept of “to each according to their needs”. This is the meaning of the current vision of public health: health policies should not be limited to treating diseases, but should also reduce the social inequalities that generate them. And associated with this vision, the idea of justice.
But it seems that not everyone sees it that way. Recently, Vox has put on the table in its negotiations with the PP, and as a main condition for their support in forming regional governments, the idea of “national priority”, which they interpret as the demand that Spanish citizens have absolute preference over foreigners in accessing the benefits of public social policies, such as jobs, housing, social services, and also, healthcare.
Allow me some considerations on this matter, from my public health perspective.
Firstly, regardless of the ethical considerations in this regard, the concept of “national priority” is poorly formulated according to its correct meaning; in reality national priority means deciding which health problems the State wants to address to achieve a greater benefit in terms of health for the whole country. The question that national priority answers is "what should we do?" and not "to whom should we do it?", as is clear from Vox's vision. A correct definition corresponds more with the idea of “welfare chauvinism” –welfare chauvinism–, widely spread among far-right political groups everywhere, which argues that the benefits of the welfare state should be restricted solely to citizens of one's own state, excluding foreigners, immigrants, justifying it on the belief that the progressive deterioration of the welfare state is caused by the abuses of immigrants, who benefit from it without contributing to it. It is not “national priority”, but “nationalals' priority”.
On the other hand, the existence of minorities excluded from the healthcare system can pose serious risks to the health of the rest of the population. Let's link this to the concept of “social determinants of health”, those circumstances in which people are born, grow, live, work, and age. These determinants are collective in nature, not restricted to social, racial, or economic groups; they account for up to about 80% of our state of health, far above the healthcare system, and are the main causes of inequalities. And these inequalities will translate into an impact on society as a whole in terms of health due to the effect of certain diseases – such as infectious ones – on the decrease in the productivity of the labor force – composed, in large part, by these excluded groups –, on demographic balance, or on social cohesion. What affects one part of our community, even if we want to exclude it, will end up affecting the whole of society and, therefore, also the "citizens" by right.
It should also be considered that many public health problems transcend national and social boundaries. COVID-19 and all pandemics show us that pathogenic microorganisms do not recognize borders or, as we have said before, differences between social groups. Nor do the effects of antibiotic resistance, pollution, or climate change, for example, understand border or social limits, and they require international collaboration and multilateralism.
Pragmatic considerations. I am not entering into ethical issues. But it must be remembered that equity and justice are fundamental values for the progress of society. Equity and what they call national priority do not go hand in hand. And, in the end, as the saying goes, “he who spits in the sky, it falls on his face”.
