Wednesday

19th Sep 2018

Opinion

Paying a high cost: EU's role in Spain's painful health cuts

  • 'I take [fewer medicines] than what the doctor prescribed me … I try to use less… in order to make them last longer. What's happening, it is shocking' one 44-year old cancer patient told Amnesty International (Photo: Gusset/Flickr)

In a new report, Amnesty International showed how austerity measures, introduced into the Spanish healthcare system in the wake of the global financial crisis, have had a severe impact on the right to health in the country.

In interviews with more than 100 users of the public health system and more than 70 health workers, Amnesty heard how austerity measures have made healthcare less accessible and less affordable.

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Typical is Maria (not her real name), 44, who is recovering from breast cancer, and also has arthritis, spondylitis and Crohn's disease.

"I take [fewer medicines] than what the doctor prescribed me … I try to use less… in order to make them last longer. What's happening, it is shocking."

Like many people in Spain, especially those with low incomes and long-term health problems, Maria has been hit hard by the Spanish government's austerity measures.

She told Amnesty International how, despite the seriousness of her conditions, she is often forced to ration her medication to save costs.

The quality of healthcare has also deteriorated notably, with many people expressing concerns about longer waiting times, shorter appointments and poorer-quality equipment.

The Spanish government began to cut spending on healthcare in 2009.

Austerity measures - notably introduced through a Royal Decree law - included shifting some costs of medicines onto individuals, limiting access to healthcare for irregular migrants, and cutting spending on health workers, equipment and infrastructure.

Austerity measures can threaten a range of economic, cultural and social rights enshrined in international law, including the right to health. To prevent or reduce the potential of a negative impact, the UN has developed international guidelines on how states can develop and implement austerity measures in way that doesn't breach their human rights obligations.

However, Spain has failed to follow these guidelines with resulting serious and widespread human rights impacts.

Amnesty International found that Spain has failed to comply with its obligations in several ways, and that the right to health in Spain has been seriously impacted as a result.

For example, the government implemented austerity measures before all other options had been exhausted, and it did not conduct human rights impact assessments or hold adequate consultations and ensure the participation of affected persons first.

In addition, many of the changes introduced to the health system remain in force years later, despite guidelines stating that austerity measures should be temporary.

This failure has had a disproportionate impact on some of the most vulnerable people in society.

Amnesty heard how financial pressure has forced people like Maria to make impossible choices.

Another woman who had recently finished breast cancer treatment said she skipped some of her pills so she could afford a special prosthetic bra.

Above average waiting times

The report shows how health workers are being stretched to their limits, buckling under an unsustainable workload.

The report heard from people who are left waiting in pain for months as they face unbearably long waiting lists to access key services; and people seeking mental health care who are making do with five-minute appointments.

Many of our findings echo other existing research, including by the EU.

For example, the EU's 2017 Country Health profile on Spain said that average waiting times for elective surgeries "are well above the level in other EU countries such as Italy and Portugal".

A recent EU report also noted that the increased difference in unmet health care needs between the lowest and highest income brackets in Spain between 2008 and 2014 was "significant".

However, the role played by the EU itself in the implementation of austerity by member states needs to also be highlighted. In the case of Spain the EU steered the government to implement austerity measures without assessing the potential consequences for people's rights.

This is despite the fact that EU institutions have human rights responsibilities.

EU leadership?

The EU needs to show leadership by taking these responsibilities more seriously, and ensure that all steps are taken to avoid negative impacts on people's human rights, including's right to health, in the future.

As a starting point, EU institutions should acknowledge their role in how austerity has impacted people in Europe, including in Spain, and commit to conducting human rights impact assessments of all member states' economic reform programmes.

The EU should also either conduct, or ask states to conduct, assessments of country-specific recommendations to ensure that the implementation of austerity measures does not result in reduced human rights protections.

Finally, future recommendations and targets for fiscal consolidation from EU institutions should not undermine states' ability to support strong public health systems and fulfil the right to health.

Sanhita Ambast is a researcher and adviser on economic, social and cultural rights at Amnesty International

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