A review of David Granger’s ‘Public health is a public good: Risk and response in a small state.’

DAVID Granger’s Public health is a public good: Risk and response in a small state, highlights the dilemma which post-colonial states often face in balancing the need for universal public health coverage with guarantees of quality healthcare and enhanced responsiveness to emerging health threats.

Transnational communicable diseases – such as Chikungunya, Dengue, COVID-19 coronavirus, Malaria, Severe Acute Respiratory Syndrome (SARS) and Zika – are among those emerging threats. The Guyanese President has had the foresight to recognise the dangers these diseases pose to his country’s population and public health system.

Transnational communicable diseases often inflict unsustainable burdens on the slender budgetary resources of small states. This can lead to diversion, or reduction, of resources from other areas of the public health system. Access to, and the quality of, healthcare can decline as a consequence. There are similar consequences when countries have to stretch their slim budgets to finance universal public health coverage.

Developing countries, however, have little alternative than to pursue the goal of universal public health coverage. Primary health care often is not readily available to all sections of the population and meeting this basic need becomes a public health necessity.
Universal public health coverage has become the centrepiece of his country’s national health policy. David Granger has set his sights on ensuring universal public health coverage. He wants every citizen, in every region of his country, to have easy access to primary healthcare.

His book, ‘Public health is a public good: Risk and response in a small state’ highlights the emphasis which he attaches to ensuring universal public health coverage. The book consists of the texts of four addresses he delivered over the past four years.

The first was at the commissioning ceremony of the Georgetown Public Hospital Corporation’s staff quarters on February 19, 2020. The second was delivered at a Dinner and Awards Ceremony to celebrate Guyana’s 50th Independence Anniversary, hosted by the Pan American Health Organisation-World Health Organisation, on May 14, 2016. The third address was delivered at a health exposition, hosted by his Ministry of Public Health, on May 30, 2018. The fourth address was delivered at at the inter-faith service for the 50th anniversary of the Ptolemy Reid Rehabilitation Centre, on January 19, 2017.

The President iterated his concern about transnational health threats, the most recent of which was the outbreak of the COVID-19, at the commissioning ceremony of the Georgetown Public Hospital Corporation’s staff quarters. He argues in favour of his government’s policy of universal health coverage while noting the burdens which these threats can place on the country’s health systems.

The Constitution of the Cooperative Republic of Guyana guarantees free medical care to all citizens. This is a key goal of international community also. He acknowledges that universal public healthcare coverage requires “…resources and a system that are acceptable, accessible, affordable, appropriate and manned by competent medical professionals, including doctors, nurses and other trained professionals.”

The President may well find that the cost of delivering universal health coverage can come at the expense of quality healthcare, as other countries which provide free medical care to their citizens have discovered.

The President’s address to the Dinner and Awards Ceremony hosted by the Pan American Health Organisation-World Health Organisation to commemorate Guyana’s 50th Independence Anniversary, was dominated by references to the threats posed by vector-borne diseases. The President, in his stirring address, proposed a practical approach to halt the transmission of vector-borne diseases.

He argued for these diseases to be considered not only as a public health problem, but also an environmental threat since it was the abuse of the environment which often provided breeding grounds for vectors. The President, in recommending this approach, suggested that a ‘green’ trajectory of development can effectively limit the spread of vector-borne diseases. It is sound advice which should be reflected more in his country’s public health policies.

Guyana’s healthcare system functions at three levels, – national, regional and neighbourhood. The President, in his address at a health exposition, urged that quality, reliable and inclusive healthcare services be provided at all three levels. Resource scarcity, however, can impede the achievement of this objective.

The country can be proud of its past record of overcoming epidemics, however. British Guiana overcame two major poliomyelitis epidemics between 1957-58 and 1962-64. An institution was established in 1967 to provide rehabilitative care to those who survived the epidemics.

The institution, now known as the Ptolemy Reid Rehabilitation Centre, celebrated its 50th anniversary in 2017 and the occasion was commemorated by a ceremony which was addressed by President David Granger. He highlighted the important contribution which the institution has made to rehabilitative care and its expansion of such services over the years.

Universal health coverage, including providing facilities for rehabilitative healthcare is costly. David Granger is not discouraged, however. He has set his sights on ensuring that, at the minimum, every citizen can have access to primary healthcare. Guyana may emerge as a model health provider in the Caribbean if his resolve can be matched by his health ministry’s responsiveness.

‘Public health is a public good: Risk and response of a small state’ should be read with this in mind. The book defines the direction in which Guyana’s public health policies are proceeding.