MEP Dalli: “In the Context of Universal Health Coverage, the EU Should Not Be Explaining but Reacting”

Why have you decided to become a champion of the EPF campaign?

I decided to give my voice in tackling avoidable and unfair differences. While the actions of governments, stakeholders, and communities can be addressed by public policy, there are instances where it needs to be underlined that differences are not an individual choice but circumstantial social, economic and environmental variables that are largely beyond individual control. I am fighting for social justice.

Within the campaign, you champion the action area on ending discrimination and stigma that patients are facing in healthcare. In your experience, are there specific gaps in this regard?

The challenges in the healthcare system at an EU level cover (unintentional and intentional) discriminatory and unfair treatment on the grounds of older, younger, refugee, immigrant, disability, rural, poverty, sexual orientation, etc. The issue lies in knowledge, attitude and skills of healthcare professionals in this context. According to DG SANTE, more than 60 thousand doctors (or 3.2 % of the workforce) are expected to leave the profession each year by 2020. The future shortage of doctors will thus lead to shortages in certain medical specialisation or geographic areas, increasing less accessible healthcare, longer waiting lists and, as a result, giving rise to discrimination once again.

EPF’s 2016 survey on access to healthcare revealed that a majority of patient and informal carers are reporting experience of stigma while seeking or receiving healthcare. How can we ensure that the right to equal treatment in healthcare, ‘regardless of economic, social, cultural or personal status or any other factor that could lead to discrimination’, be truly implemented in healthcare?

Access to healthcare as a fundamental right determines a framework of interaction. The complexity of interaction relies on environmental, social, cultural and political factors. To fight heteronormativity, heterosexism, minority stress, victimisation, institutional discrimination and stigma there is a need for understanding of these specific groups.

Cultural awareness can be supported by public policy. We need a dedicated research to address all structural and individual inequalities together with tangible legislation. On the international level, the EU has recognised the existence of multiple discrimination in a number of binding secondary law instruments, but we need to push the implementation of all EU directives in national law with appropriate provisions. We need a set of standards for all countries to achieve universal and equitable quality health system that will meet the physical and mental health needs for whole populations. We should empower our governments to regulate corporate health actors based on data from health systems that are universal, impartial, efficient and effective.  

Do you have examples of recent actions to raise awareness of discrimination in the area of healthcare and of good practices that exist to tackle it?

The United Nations Convention on the Right of Persons with Disabilities (UNCRPD) that entered into force in 2011 states that people with disabilities calls for assessable and equal access to services and thus participation in society, encouraging good practice and participation in legislation and policies while respecting diversity of all people without discrimination. To date, 25 EU Member States and the EU itself have ratified this, but apparent lack of progress on an equal treatment Directive is missing, although Member States have been encouraged to extend protection against discrimination on the grounds of disability.

In context of Malta we have a beautiful example of adoption of the Gender Identity, Gender Expression and Sex Characteristic Act (GIGESC Bill), which can be seen as a break-through for the right of trans and intersex persons not only in Malta but in Europe as well. The Bill regulates healthcare provision, prohibition of normalising genital surgeries on intersex infants and reform public data collection.

How can we encourage all Member States to replicate health status provisions already existing in antidiscrimination law of some Member States across all EU countries, to protect persons with chronic conditions from any discrimination on the basis of health status (similarly to persons with disabilities)?

In the context of universal health coverage, Member States must ensure coverage for everyone residing within their state, regardless of their status. Thus the national governments should strive towards full realisation of the “right to health for all”. Governments should also fight to end administrative barriers and discrimination within healthcare services. Also to ensure easier access to healthcare we need to raise awareness of rights and entitlement amongst patients and healthcare workers, which can include training and information campaign. Further, we need to develop outreach policies to increase coverage at community level in order to access excluded people, including cultural mediators within health services. And finally, reinforce the first line of care with an integrated medical, social, and psychological approach.

Poor information about health rights, a lack of comprehensive information and complex administrative procedures are a serious barrier to accessing healthcare. Are there any actions that can be taken up at EU level, to ensure the right to high quality information for patients and their carers, in accessible formats?

There is proof that specific groups of healthcare users are less aware of available healthcare services and their entitlement to use them. This barrier was explicitly mentioned in relation to migrant status, ethnic background, age and disability, as well as intersectional disability.

The medical, bureaucratic and administrative systems that characterise the national health services in the EU Member States are complex, culturally specific institutional forms, and all users have to be ‘socialised’ in order to use them in a culturally appropriate fashion. The EU should establish the monitoring agency that will follow the structural challenges and changes in health services.

How can Member States adapt health systems to the needs of diverse and vulnerable populations?

In order to bridge the linguistic and cultural gap in communication between health professionals and service users, the Member States must address this issues on both national and European level concerning linguistic barriers, socio-cultural barriers, ethnic barriers, and lack of culture competence. This is achievable if the EU supports the training of intercultural mediators and also encourages the accessibility of interpreting and intercultural mediation services.  

Healthcare professionals are vital partners in the fight against discrimination in healthcare. How can we integrate fundamental rights and non-discrimination principles in the training of healthcare professionals in order to improve their ability to provide quality care to culturally- and linguistically-diverse communities?

The training should not be focused only on cultural information but should transform thinking and enhance sensitivity. EU Member States should adopt measures to further the right to health on an equal basis such as free linguistic assistance. This includes translation and mediation services for those who do not speak or understand the language as well as ‘signed’ languages and other forms of support for people with sensory or intellectual impairments.

Europe should be leading the way in ensuring that the human right to access healthcare is not violated for anyone, but persistent inequities undermine this EU’s fundamental value. Universal health coverage in Europe is failing and even more so for people in isolation, housing precarity and for vulnerable groups.

In this context the EU should not be explaining but reacting! The principle of free movement and residence of EU citizens should be extended to a right to health. The EU should strive towards establishing legal framework that will ensure access to healthcare for all EU/EEA migrants regardless their condition.

What can the EU do to reduce these inequities and inequalities and make sure that healthcare benefits all patients in the EU?

The key issue is the lack of reliable data that will show the full picture of the intersection of different grounds. In order to alienate the difficulties we need to define them. Thus the improved legislation can reflect on on-going challenges and establish a monitoring system. Hence on the European level, it is crucial to address the lack of data by continuing to fund Member States’ cooperation and research in public health, health inequalities, and healthcare system to enable European-wide solutions.

Any final message for our readers?

The European Union has a leading role to play in ensuring that all persons have equal access to healthcare services and it is the duty of each Member State to ensure that the provision of its healthcare services are accessible to all. Likewise, NGOs and citizens must be active in pushing for change, reforms and the implementation of the legislative tools that ensure non-discrimination.