Interview with Josep Martí Valls by Siscu Baiges
He has been a doctor for fifty years: forty years of clinical activity and health management, and ten years retired as an activist in defense of public health. He is not an epidemiologist and that is why he can speak more firmly, he says, on issues of health and global policy.
Bill Gates had long said that viruses are a great danger to humanity. Has the Covid-19 proven it?
I have also said it for years in my talks and articles on information and health education. The virus will outlive the human species; they are very simple organisms that are capable of making rapid mutations and surviving changes in their environment; in this way they become resistant to vaccines, treatments and human immune defenses. Covid-19 has shown this, but we already had previous examples that warned us (mad cows, Ebola, AIDS, food epidemics …).
How has the Catalan health system faced this Covid-19 coronavirus pandemic?
The Catalan and Spanish health system is a good system to deal with diseases with equity, because it is a mostly a public and universal system, financed by taxes, unlike private systems such as those of the United States and other countries.
Without the budget cuts in various social areas, including health, launched by the Government of the Generalitat chaired by Artur Mas and with Boi Ruiz as counsellor of Health, could this crisis have been much better dealt with?
It was a good system, but due to the neoliberal nefarious policies (remember Artur Mas and Boi Ruiz), taking advantage of the 2008 crisis caused by the financial system, they wanted to use this area of public services to do private business, and the cuts began. The public service was weakened, which made it outsource and privatize resources, make professionals more precarious and lose quality (especially in accessibility, waiting lists of all kinds and resolution). Now, in 2020, the emergency of the Covid-19 pandemic has taken us with thinned services and professionals with poor working conditions. Therefore, without the cuts, with good public service, we would have been better off in this crisis. Still, it must be said that the professionalism and current effort of healthcare personnel is admirable.
Are all health personnel – doctors, nurses … – being asked for excessive personal effort and risk?
I believe that it is requested, once again, to respond professionally, and this is happening (and the public has perceived it) despite the conditions that we have said of precarious services, with lack of equipment and management.
How do you assess the measures that have been taken to deal with this crisis and the rate at which they have been taken?
The measures proposed are based on the uncertainty of the behavior of this new virus, but with all the knowledge and transparency of public health technicians. There may be doubts and protocol changes, it is possible to have a scientific opinion and disagree in the debate, but once the path has been established, citizens and clinical professionals must follow the recommendations and protocols in a disciplined manner. There can only be one captain on a ship to get it safely to port.
How do you rate the open political debate on the performance of political leaders in the face of the pandemic? Is it possible that there are coinciding political approaches between the governing and opposition parties and those that govern in Spain and those that do so in Catalonia? Is it very difficult to achieve unity of action between all of them in this combat?
Politicizing (in the bad sense of the word) for opportunistic partisan, corporate, or personal interests this Covid-19 issue is miserable, and this attitude discredits them. I have already said that you can disagree with scientific criteria (which is difficult, now), but, in the end, the decisions of the current leaders (the democratically elected representatives to govern us) have to be assumed and followed.
What worries you most about the extreme situation that we are experiencing in recent days and that you see coming in the immediate future?
To me, and I suppose that to many people, the one that worries us is the uncertainty of how long this situation will last, and that in the end the economic consequences will fall on the most precariously living people.
Are we at risk that our healthcare system will end up blocking and leaving patients with diseases other than Covid-19 unattended, that the care for those who suffer it will harm the care that people affected by other pathologies have to receive?
I don’t think so, in important processes. In mild processes (in fact every year we have done it with the common flu) perhaps it will be the occasion to be responsible for our personal health and return to Grandma’s remedies.
Will this pandemic make more understandable the idea you have often repeated that health is something more than the lack of disease?
This may be a positive consequence of this situation. A microscopic virus can make us see that what really matters for people is health. Healthcare and clinical healthcare medicine are today listed for the diagnosis and treatment of the disease. Society and life are too medicalized, when the true determinants of health are economic, social and cultural: poverty, prolonged unemployment, poor housing, poor diet, poor education, bad personal habits, gender, environmental pollution, etc. All this conditions health and is a reason for illness and loss of autonomy.
These determinants create inequalities, differences in quality of life and life expectancy. If we do not change the paradigm and assume that what is important is health (personal and collective) and we apply health to all public policies, confronting the business of a few in favor of the rights of the majority, health will continue to be precarious. Epidemics and poisonings will continue to grow and the current healthcare system will become unsustainable to cope.
In fact it is the same as climate change. The cause is the same: neoliberal globalization. Here we also have to say “rebellion or extinction”.
You call into question the current economic and social system. Can you combat a pandemic of these characteristics within the framework of a neoliberal model based on competition and not on solidarity?
Yes, I question the economic and social system (already in crisis), and you cannot combat pandemics and other determinants of health with a sick social model that only thinks about the established disease (business) instead of really thinking in the health of citizens.
A new “social pact” is needed, as happened after the Second World War. Fear of communism, then, resulted in the Universal Declaration of Human Rights, the constitution of the United Nations and the creation of the welfare state (with social and economic rights). Now we also have to take advantage of the fear and awareness of citizens to set the path: de-globalization (local, ecological and sustainable production), selective decrease (not so many economic indicators and more indicators of knowledge), cooperation instead of competition, solidarity instead of individualism, defense of what is common, public, over what is private. You can say that I am a dreamer, but now we are not the only ones.
What recommendations would you consider useful to reach the public in these moments of uncertainty and anguish that we are experiencing?
That they think of the future, of our children, that they make the defense of health and life hegemonic, that they do not sanctify the fight against the disease already established. That they defend, as many years ago our great-grandparents did, in the towns where they lived, “the common”.
It is a question that nobody dares to answer, but that we all ask ourselves: how long can this situation of social emergency last? Will we have to get used to the idea that we will be confined at home for a long time?
I do not know. It can be a long time. But we will have to continue fighting, for life.