Today I’d like to talk to you about the woman in the picture behind me. Her name is Hosepha. And she was born in Cuba several years before the communist revolution. The late 1970’s, she would then decide to leave everything she knew behind, determined to give her family a chance at a better life in the US. She also happens to be my grandmother and one of the most important figures in my life as I was growing up.
Some of my happiest childhood memories were simply getting to come home, every day from school, to be given a huge big hug from my grandmother. But that hug would one day turn my life upside down. You see, as my head brushed up against a side of hers, I felt a big lump. When I asked her what it was she said it was nothing, but I would later go on to overhear my family talking about a tumor and cancer. I can’t begin to describe to you what I felt in that moment.
My grandmother was my whole world and as I stood in that doorway listening I was paralyzed with fear. I begged and pleaded with my grandmother that she’d go to the doctor, but the harsh reality was that my family simply couldn’t afford it. And in my young mind the concept of my grandmother’s life hanging in the balance over a question of money didn’t make any sense to me. It was perhaps the first time in my life I had ever felt powerless. Powerless over my circumstances, powerless at my inability to do anything for someone that meant so much. And I remember desperately wanting a way out. Sometime later, that way out would come thanks to the chanced generosity of a family friend, to whom I’ll forever be thankful for what he did for my grandmother.
But, are we comfortable with that? With the notion that a person’s life potentially hinges on the means they have? That wealth so directly determines something as basic and fundamental as health? At the time, I never questioned that reality. As a kid, I simply internalized my experience and became intensely focused on the only thing I felt I had any control over, my education. It wasn’t until many years later, upon arriving at Stanford, and taking a health policy course that I would come to feel empowered to revisit and question that reality.
For ten weeks I sat in class horrified and fascinated by what I learned. Horrified by the scale upon which I saw my own family’s health struggles writ large across our nation. But fascinated by the potential of policy to have such far reaching positive effects on the lives of so many people. I began to wonder if the current state of health care was truly inevitable, or if a different reality was possible. And my search for an answer to this question would lead me to work over the last four years in five countries, spanning Europe, Asia and Africa.
And today I’d like to take you on that journey to three of those places. First on my list was France, which I had learned had been ranked as having the best health care system in the world, by the World Health Organization in 2000. And what struck me the most, working in a Parisian hospital, was not only how accessible health care was for everyone, but how universally agreed upon it was among the French that it should be. This is something that I would later go on to know about the Japanese health care system, while I was living and working in Japan for one year.
Here was a country with some of the world’s best health outcomes, longest life expectancy, one of the lowest rates of infant mortality, had managed to achieve universal coverage at a time when Japan was still rebuilding itself, after World War II. And yet manages to spend half of what the Unites States spends on health per capita. As I reflect on these experiences with you, I don’t mean to oversimplify the issue or lead you to believe that I think that what has worked in one country is directly adaptable or transferable to another. The more countries and systems I’ve had the opportunity to study the more I’ve come to appreciate just how truly complex the issue of health care is.
But I’ve also come to believe that what’s possible in terms of health care access is largely dependent on what societies choose to value and make possible for their populations. The best example I can think of this is Rwanda, where I recently worked with the Clinton Health Access Initiative. A country ravaged by genocide less than 20 years ago. 10% of its population murdered, with more than half of its population still living in poverty. The house I lived in didn’t have running water or direct access to paved roads.
I was fortunate to have electricity, the only house in the district to have it. And yet, even in the absence of so many resources and basic necessities, they felt it was so indispensable that everyone should have a basic minimum level of health care that they chose to make it possible.
Now I’m not saying that I think that Rwanda’s health care system is perfect. Much work still remains to be done. But considering that they have an annual health budget of $56 per person I’d say they are doing pretty well. And the world is taking notice. Something that seemed so impossible just a few years ago, the notion that developing nations could achieve universal coverage, is now not only increasingly being regarded as feasible, but as the next step in continuing to make sustainable global health progress. That perhaps has been the biggest take home lesson for me. Where there’s a will there’s a way! In the US, this doesn’t seem to be a question of resources.