Michael Moore's Sicko is a wake-up call on health care

Many of your readers will have seen Michael Moore s latest film Sicko , which is showing in cinemas around the country. Despite its critics, the NHS continues to provide a high level of care for all irrespective of ability to pay. On the other hand, Moo

Many of your readers will have seen Michael Moore's latest film 'Sicko', which is showing in cinemas around the country.

Despite its critics, the NHS continues to provide a high level of care for all irrespective of ability to pay. On the other hand, Moore's film illustrates how a privatized health system like that in the United States can deny many their basic right to health.

Like most of Moore's films, 'Sicko' will have its critics, some more thoughtful and justifiable than others. But what is undeniable is that health care can be delivered to all and it is government's responsibility to do so, especially for the world's poorest people.

Sadly this fact is lost upon some of the major aid donors, particularly the World Bank, who have been pushing the privatization of public services in developing countries since the 1980s through conditions on its aid. The World Bank has been joined by some rich country donors in promoting policies that shrink the role of governments in health through contracting out services to the private sector and charities. For the poorest people this is disastrous.

There is plenty of evidence that governments can deliver health care for everyone. Policies that promote the market over the state tend to serve only the wealthier sector of society and, despite popular assumptions, often prove less efficient. The end result is clearly illustrated by

'Sicko': people are forced to make choices between seeking medical care and other essentials including food and housing. Health care is a basic right we should all enjoy - it must be accessible to all and not the privileged few who can afford to pay for it.

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'Sicko' gives strong examples of countries where governments are responsible for significant progress in delivering healthcare - and it isn't just rich countries that can do this. Despite the US government spending 37 times more per person than the Sri Lankan government on health care, the probability of a woman receiving skilled assistance during delivery is almost identical and the immunization rate for one year olds is higher in Sri Lanka than in the USA. Sri Lanka's success has been achieved by prioritizing health care in its national budget, making services free, ensuring services are adequately staffed, ensuring health care is available in rural areas as well as towns and cities; and by making services work for women and girls.

However, the reality for other poor countries is less encouraging. Millions of people in Nepal, Ethiopia and Liberia, for example, can't afford to even see a doctor, let alone get the treatment they need. We can't allow the poorest people in countries to go unnoticed or uncared for. It is a government's responsibility to provide basic health care for all of its citizens. One essential step towards achieving this is to prioritize health care in national budget allocations. It's the donor's responsibility to provide aid that is long-term, predictable and free of harmful economic conditions.

Rather than replicate the mistakes in the USA, which has one of the most unequal health systems in the world, rich countries and institutions like the World Bank should support developing countries in building health care systems that work for the poorest people. Today, good quality, affordable health care is a dream for millions of people. We must make this dream a reality.

Yours sincerely,

Roger Elbourne

Oxfam Campaigns

London, South East & Eastern England

232-242 Vauxhall Bridge Road