Let’s turn dissatisfaction with the existing public healthcare policy into a plan to preserve health and healthcare system


Photo: Matija Jovanović

The political concoction of destroying public healthcare and bad climate policies is deadly. Organizing workers in the public sector and connecting them to social and green struggles is key to preserving health and public healthcare system.

The coronavirus epidemic is the first global public health crisis in the last hundred years. The way countries around the world deal with it – that is, in general, the withdrawal or capitulation of “profession before politics” – makes us wonder if we can expect similar scenarios of public health system collapse in the not too distant future, when the effects of climate change and pollution cause increasing public healthcare crises.

In fact, research points to a specific connection between these two phenomena. Air pollution makes the population more susceptible to pneumonia, which is why the consequences of coronavirus are more severe in more polluted areas. Public health policy is the terrain that connects the current pandemic and the challenges that lie ahead.

Climate change and the potential collapse of public healthcare

The overload of public healthcare, such as the one we have continuously witnessed in recent months, could be repeated a potentially infinite number of times due to the fact that climate change causes health problems – most severely threatening the respiratory tract and the cardiovascular system – similar to covid-19.

A document entitled „Climate Change Adaptation Action Plan and Vulnerability Assessment“, issued in 2015 by the Secretariat for Environmental Protection of the City of Belgrade, indicates the different types of health problems caused by particular consequences of climate change, which in turn can increase the burden on healthcare.

The most urgent and immediate threat are certainly heat waves, which, in addition to drastically increasing mortality from cardiovascular diseases, are accompanied by an increase in pollutants (pollutant materials) in the air. Polluted air (which, due to larger number of allergens, causes stronger and more frequent allergies in humans) will also occur as a consequence of extreme cold, when there are more “ice days” without wind in a row, and as a consequence of droughts. Droughts and floods form fertile ground both for the development of allergies and for the spread of infectious diseases, due to water contamination. The Action Plan for Adaptation to Climate Change also states that during the previous heat waves, an increase in mortality was observed – in July 2007, by as much as 76%.

Furthermore, the consequences of climate change and air pollution have the potential not only to overburden the health system but also to produce a domino effect in production, and thus in the overall functioning of society. For example, heat waves and extreme cold are a huge burden on the energy system, and in turn affect the increase in air pollution, while droughts and floods can cause serious problems in water supply and sewerage. Also, for now, there is no data on whether health care institutions in Serbia can physically bear the burden that high or extremely low temperatures, if they last too long, can cause.

Photo: Marko Rupena/Kamerades

The pandemic has postponed for some time the urgency of dealing with the effects of climate change, including the United Nations Conference on Climate Change (COP26), and superpowers such as the United States have taken advantage of the new situation to confront environmental regulations.

For example, Trump signed an executive order allowing federal authorities not to apply environmental regulations to infrastructure projects such as highways and pipelines, under the pretext of speeding up economic recovery.

Such extreme examples show that the most important lesson we can learn from a pandemic is that the much-needed voice of the profession will not be respected until the profession itself fights for it. In other words, there is no natural disaster whose consequences will in themselves make certain scientific knowledge or decades of scientific work become part of the collective consciousness and influence political decision-making. For that, first of all, it is necessary to organize workers in the sector that bears the greatest burden in the rehabilitation of every natural and humanitarian disaster – and that is the public sector.

Who doesn’t do their job?

When it comes to environmental protection and climate catastrophe prevention, the non-governmental sector is often the most visible to the public. As for Serbia, reports from both regional and local initiatives agree that air pollution from the Nikola Tesla and Kostolac thermal power plants is the cause of 1940 premature deaths a year, several thousand cases of bronchitis, and that the total cost of treatment requires up to 4.98 billion euros of public money per year.

Meanwhile, the state is simulating activity in this field, and only under public pressure. Namely, in January this year, when the public reacted strongly to the figures showing the degree of particulate pollution (PM 2.5 and P10 are particles formed by burning fossil fuels which can penetrate deep into the lungs and cause breathing problems, as well as cardiac disorders), the Government formed a Work Group for the systemic solution of air protection issues, whose president is Ana Brnabić. However, budget allocations and legal procedures flatlined.

As the report of Coalition 27 shows, there were no capital investments for communal infrastructure and environmental protection in the budget for 2020, although there was room for increasing investments according to the estimates of the Fiscal Council. As for the role of the state in the field of legislation, environmental compensation is not legally binding, and the number of indictments against “investors” and “strategic partners” who pollute the environment is negligibly small.

Moreover, strategic documents such as the Air Protection Strategy or the Law on Environmental Impact Assessment have not yet been adopted, although this has been awaited for years. Hence, the state’s moves – such as the establishment of the Air Protection Working Group – whose task is to “monitor, analyse and consider the most important issues in the field of air protection” – which are actually legally defined tasks of the Institute of Public Health – can be understood only as a populist trick.

Who actually pollutes: inequality and climate change; Photo: YellowstoneNPS/Flickr

A special sphere of problems related to the protection of the environment and public health is the relationship between the public sector and state bodies. In the author’s Report on urban air pollution in the Republic of Serbia measured within the network of public health institutions for 2019, Dr. Branislava Matić Savićević from the Institute for Public Health Dr. Milan Jovanović Batut concludes that “the trend of low representation of particulate pollution monitoring continues, but even the existing numbers show that pollution is increasing”. As some of the key problems, Dr. Matić Savićević points out the abrupt abolition of measuring points, and the untimely announcement of tenders, and thus the untimely conclusion of contracts on the analysis of particulate pollution between local governments and public health institutions.

The role of local self-governments, as determined by the Law on Public Health, is to be participants, i.e. partners to public health institutions, while the institutes and institutions for public health are the bearers of activities. This means that, without proper political will, the situation on the ground often implies a hostile attitude of state bodies towards the public sector. Some of the mechanisms by which this is achieved are, for example, the increasingly frequent abolition of the environmental budget by local governments or the ignoring of experts. As a reminder, there is no information on the implementation of the Action Plan for Adaptation to Climate Change, although five years have passed since its publication, or whether the Expert Statement from 2015, in which doctors from institutes and institutions for public health throughout Serbia, as well as the Faculty of Medicine in Niš, Novi Sad and Belgrade, indicated an alarming increase in particulate pollution, reached those responsible. Of particular concern is the competitive attitude of the Environmental Protection Agency, which responded to (Institute) Batut’s report by claiming that the number of pollution measurement sites has actually increased, and that only the Agency can provide a wholesome and complete picture of pollution, referring to the Institute’s report.

The last claim is almost absurd, since the monitoring of pollution is the task of the Agency, while the task of the Institute is to enable the analysis of pollution data, and to formulate recommendations and measures in accordance with them.

Collectivization of responsibility

Another important lesson learnt from the public health crisis caused by the coronavirus epidemic is that the ones responsible for decades of systematic neglect of public good will try to justify themselves by exaggerating the personal responsibility of every citizen.

In that way, two facts are pushed out of public space. First of all, that ordinary citizens cannot in any case be responsible for decisions made by the people in public office, and that such “collectivization” of responsibility actually means covering up the systematic destruction of common resources such as natural resources and healthcare. Secondly, that there are people in public institutions who use their professional authority and expert knowledge every year to contribute to the preservation of the public good. This means that the joint struggle of public sector employees and “ordinary people” should focus on deciding the experts who will be entrusted with public health policies and the type of control over them.

Since climate change and environmental protection are first-class problems in the field of public health, this means that long-term success requires organizing that includes all actors – from the local health centre to the institute of public health. As these issues also concern the management of public infrastructure (green areas, drinking water), it means that an important role in the fight against climate change will be that of the neighbourhoods who join forces and the local communities who organize “from below”. The potential solidarity and organizing of these two groups can represent an envisioned goal, from which one could start thinking about how to turn dissatisfaction with the existing public health policy into a plan for preserving health and public health system.


Translation from Serbian:  Iskra Krstić

This article was originally published in Serbian on Oct 30, 2020.


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