23/09/04 Conference on Equity, Health and Healthcare

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Concluding comments of
Most Rev. Diarmuid Martin
Archbishop of Dublin
Kings Inns, Dublin

Only a few days ago, I addressed the diocesan social service agency Crosscare, noting that: “One of the great political challenges, right across Europe today, is how to reconcile strong economic growth with equity. How do we enhance those mechanisms which have shown that they can generate optimal economic growth, while finding way to ensure that the fruits of such growth reach all?”  I posed a challenge to government, to political parties, to professional organizations and economists to address ways of resolving what I called the “growth-equity divide”.

There are few areas where this divide is so acute than in the area of health care.  This is especially so on a world-wide level.   We live in a world, for example, where life expectancy has grown so dramatically in recent years, that we can say that longevity is one of the special gifts of God to our generation.  But, at the same time, in many African countries life expectancy has sunk to below 40 years!  Another example is in the area of maternal health, where well over 95% of cases occur in developing countries.

As your conference notes there is a significant growth-equity divide also in Ireland.  Ireland occupies the first place in Europe in so many economic indicators.  We are not always in the first place regarding access to quality health services, or with programmes to bring back into the mainstream of inclusion those who find themselves on the margins of prosperity.

The challenge is complex. In a market driven society, equity will not occur automatically.  The challenge of achieving equity in access to health care is made more complex by an increased privatization in the health care sphere and by the application of business models, which do not always address the specific situations of marginalized individuals or regions.

Do not misunderstand me!  Market mechanisms can be very successful in enhancing efficiency in health service delivery.  And efficiency is important. Inefficiency in the use of public money, to my mind, is a form of corruption.  Market mechanisms enhance efficiency but there will always be persons who do not have strength on the market place and there will always be fundamental human needs which should not be bought and sold.

The preferential option for the poor is a theological rather than an economic affirmation.  It refers ultimately to God’s action.    But there is a sense in which this has it application in the secular world.  When it comes to health and social services efficiency is not just a technical question of better use of facilities. In the social sphere, the outcome of efficiency should be inclusion, that is, how the public good of health can be embraced by the widest possible sector of our community.

I have consistently repeated my own policy, which I would hope would become a policy of the entire Church in Dublin in the spheres of health, education and social services. Put simply, it is: The poor deserve the best.  For me this is an inderogable principle, even when financial resources are limited.  In the past, both Church and State used inadequate resources as an excuse for providing the poor with poor quality services.   

The principle that “the poor deserve the best” is not just about doing things for the poor.  It means that we recognise the dignity of the most marginalised and take concrete steps to ensure that they can realise that dignity to the fullest degree.  Market mechanisms in health care will only work when the poor have the voice that enables them to exercise choice.

Jesus had a special love of the sick.  Even on the one occasion (Mark 6: 1-6) where he “could work no miracles” because of the lack of faith of the people of his own village, he did not fail to make one exception and “to cure some sick people”.  The faith of the sick places them in a special category.  May this Conference encourage us all to witness today to that special care of Jesus for the sick, and to do so in all circumstances.