Sun. Jan 26th, 2020

Knowledge and social commitment: the pillars of our health system | Society

The way we protect people's health defines us as a society. The collective effort that we invest in the fight against diseases is a transparent and unequivocal signal of the level of respect for human life in a society like ours, whose aspiration must always be a greater level of justice and equality. Also before the tribulations of life.

Our health system was built on the pillars of knowledge and social commitment. Our young democracy raised it with great effort, thanks to the energy granted by the great ideas of progress. This transformative impulse provided the system with great inertia, allowing it to cope with the recoil forces that have subsequently endangered it, especially in the wake of the great economic crisis experienced since 2008. Using an analogy of elementary physics, when An object of enormous mass moves at high speed. It is necessary to apply an enormous energy to stop it. And, indeed, they have failed to stop it; that's why our National system of health It remains one of the best in the world.

However, the risks are real; The fundamentals that made our health excellent have been neglected and questioned. One of these essential elements was respect for knowledge in its broadest and most ambitious dimension. Almost two decades after the process of health transfers to the autonomous communities culminated, it is painful to see how the lack of investment in research and the lack of professional consideration of science by those responsible for the different health systems have weakened the generation and knowledge transmission and have hit with impetus the efforts previously made to incorporate researchers in hospitals in a stable and sustainable way. Scientific careers in the health field have become precarious until they face the abyss of disappearance. The protection of the right and duty that professionals have to incorporate into their clinical practice the knowledge generated in the academic field has been banalized and commercialized. Globally, the practice of Medicine and other health disciplines has been impoverished and corseted into simplistic schemes of service provision, which leave neither space nor time for creativity, innovation or human encounter with patients, who are the ones who need the Answers that are not yet in the books.

The other pillar, the necessary commitment to each and every person, also trembles, deaf and muffled. The Government of Spain, currently in office, took a decisive step in the recovery of the universality of Health just over a year ago, an essential turning point in a path where work must continue. But beyond the necessary universality, we must also remember the commitment to guarantee fair access to the best prevention, diagnosis and treatment techniques. Those that exist and those that are yet to be discovered. Exclusion and inequality take on forms that are not always evident, but they grow continuously in our National Health System. Thus, unattended and invisible vulnerability linked to age and other factors, social inequalities in health, or the helplessness perceived by people with rare diseases, place us in front of an awkward social mirror that returns us an image that is far from the values that many defend as individuals and on which the collective construction of our democracy and our health system was based.

It is time to consolidate what has been achieved, rebuild the lost and solidly prepare the future. For this, a rigorous and thorough analysis is necessary, fleeing from improvisation and rejecting the effective reactivity, ignorance, and lack of purpose. The rigor in the approaches, the imagination, the spark of genius and the indefatigable dedication, which grow spontaneously under the protection of science and its teachers, are indispensable tools in the exciting process of transformation of health care to which We just started to peek. Science and medicine have walked together since ancient times and have grown fed by common roots that sink into humanistic values, so that they cannot be understood without each other. However, this reciprocal interaction of enormous wealth, in which lies the hope of patients with diseases that we believed incurable, requires protection, investment and confidence to be able to develop in the right direction.

Large pharmaceutical companies have taken advantage of this wealth, generating unquestionable advances in the fight against diseases and, simultaneously, economic growth. However, by their very nature, companies must be guided by commercial interests and these do not always allow to respond to the need to protect the health of each and every citizen. When it is necessary to respond to situations of inequality, vulnerability, exclusion and neglect in the development and access to medicines, generated within a system dominated by the market, the responsibility must necessarily be public, that is, of all citizens , through the powers and institutions that represent us. With this purpose, the Carlos III Health Institute (ISCIII), the main public body that promotes biomedical and health research in Spain, has launched this summer a call for independent clinical research grants with advanced medicines and therapies with the greatest reach and economic endowment of the last 10 years. This action seeks to offer resources to hospital researchers so that they can independently carry out clinical trials with medications of high health interest but with little commercial interest, as well as clinical research projects in special and vulnerable populations not adequately represented in clinical trials. of the pharmaceutical industry.

If applied in isolation, this action would be a tiny step compared to the enormous task necessary to face the great challenges of public health, but at the same time it exemplifies a vision that must be cultivated, cared for and extended: generating knowledge is a part essential and an unavoidable responsibility of the National Health System. Promote it, with the help of a scientific and health community eager to return to society the fruit of that knowledge, will mean higher levels of equity, efficiency and sustainability of the system for the benefit of all citizens. Investigating, betting on creativity and facilitating the transformative impulse in hospitals is not an option, an ornament, or an entertainment. It is the best way to protect the health of all people, without exclusions. And this is what defines us as a society.

Rachel Yotti, is a cardiologist, clinical researcher of the National Health System, and currently general director of the Carlos III Health Institute.

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