Justice in healthcare

Justice in healthcare

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Equality in Healthcare: Are we being fair?

One of the major themes of Islamic teaching is AdlwalIhsan, which refers justice with fairness and mercy. It is stated in the Qur’an:

“Allah commands doing justice, doing good to others, and giving to near relatives, and He forbids indecency, wickedness, and rebellion: He admonishes you so that you may take heed.” (Quran, 16:90)

Adl represents the most vital position of Islam and exemplifies the highest objective of the Maqasid Shari’ah. However, ‘adl (justice) alone is not sufficient in delivering the rights of the community.

Islam promotes ‘adl along with ihsan (benevolence) in ensuring fairness prevails
in human life. Such a principle is reflected in the abovementioned Qur’anic message that orders both ‘adl and ihsant o be executed in tandem to enshrine the tawhidic ideal of ‘justice and fairness’ in all aspects of human life.

Justice in healthcare is usually defined as a form of fairness. As Aristotle once said, “give to each that which is his due.” The fair distribution and allocation of healthcare in society requires that we look at the role of entitlement.

The question of distributive justice hinges on the fact that some medicines and healthcare services are in short supply. As there is not enough to go around, some fair means of allocating scarce resources must be determined.

“Justice in healthcare is usually defined as a form of fairness. As Aristotle once said, “give to each that which is his due.”

We should even the playing field by providing resources to help overcome the disadvantaged eg children, women, the handicapped and the elderly. As a society, we should be fair and merciful and provide some decent minimum level of healthcare for all citizens, regardless of ability to pay.

In this context, the WHO’s Expanded Program of Immunisation (EPI) is a relatively inexpensive intervention yet a powerful equaliser of the inequities that exist between children worldwide.

One clear example was the pneumococcal conjugate vaccine (PCV). Prior to its introduction in the US in 2000, the rates of invasive pneumococcal disease (IPD) among Navajo Indians were 240/100,000, compared to only 70/100,000 amongst Caucasian children.

With the introduction of the PCV, the rates dropped drastically to about 20/100,000, which was similar between the two distinct groups of children. Similar results were illustrated between the disadvantaged Alaskan Eskimos versus Caucasian children in the US, and the indigenous Australian Aborigines when compared with Caucasian Australian children.

“As a society, we should be fair and merciful and provide some decent minimum level of healthcare for all citizens, regardless of ability to pay.”

If all the basic vaccines in the EPI programme (egHib, MMR, DTP, Polio, Hepatitis B) and more of the newer vaccines (eg PCV, Rotavirus) are made available to developing countries, there is an opportunity to save more children’s lives and prevent disability. It would contribute towards a 25% reduction of the United Nations’ Millennium Development Goal 4 (MDG4) whose endpoint is improving the survival of children and decreasing the Under-5 mortality by two-thirds.

The herd immunity conferred by immunisation also benefits society. Fewer children and adults become ill, with significant reductions in disease outbreaks, hospitalisations, expensive treatments, permanent disabilities, absence from work and loss of productivity.

This also translates into economic benefits for the nation. In developing nations, a 10-year gain in life expectancy translates into an additional 1% increase of annual growth of income per capita.

Vaccine-preventable diseases are still responsible for 2.5 million infant deaths annually. If currently available vaccines are better and more comprehensively distributed and utilised, there is potential to save more lives, prevent more disabilities, accrue more societal and economic benefits and enhance national
and global security.

Justice means every child should have ready access to routine vaccination against serious childhood diseases, which should be a global priority for all governments and international health agencies.

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