On June 21st, the World Health Organization published The World Health Report 2000. The most remarkable fact about the report does not concern its results, but rather the underlying premises that guide the organization and that led to such results.
The results of the WHO’s “ranking of the world’s health systems” show the US in 37th place, lagging far behind poverty stricken countries like Costa Rica, which came in 36th, Morocco in 29th, Cyprus in 24th, Colombia in 22nd, Greece in 14th, and Oman in 8th.
Of course, it is hard to take this ranking seriously. How many people can honestly believe that medical care in these countries is better than in the US? So what is going on?
The simple answer is that the WHO “created” three new “performance indicators” to measure the quality of health care systems. None of them gives much weight to people’s health.
Two of them, the “fairness of financial contribution” and the “distribution of financing” indicators, reflect the relative amounts of money taken from the rich and the poor to finance a country’s health system. If a lot is taken from the rich and little or nothing from the poor, the financial distribution is considered “fair.” The greater the inequality in amounts taken from rich and poor, the higher the indicators get.
This is why Colombia was the top-rated country in health care by one of these indicators, followed by Djibouti (!) in 3rd place. The WHO explains: “Colombia achieved top rank because someone with a low-income might pay the equivalent of $1 per year for health care, while a high-income individual pays $7.6.”
The other novel indicator created is the “distribution of health” among the population. This indicator assesses inequalities in the health of rich and poor, as well as in the health care given to rich and poor. A high score is achieved if similar levels of health and health care service exist for both groups.
Note that the three new indicators take no consideration whatever of absolute quality of health care. Two of them refer to the relative financial contributions made to the health system, while the third refers to the relative financial distributions allocated by the system.
These indicators bear no relation to the availability and quality of hospitals, clinics, labs, medical equipment, treatments, drugs, doctors or nurses. Nor do they assess patients’ lifetime health and longevity.
The three new indicators used by the WHO to assess the quality of health systems are ideological indicators
. They measure how close health care systems are to the WHO’s own moral and political ideals. But what are these ideals?
The moral ideal is altruism. Altruism holds that sacrifice is a moral duty, and that the more values one has, the more he should sacrifice for others who don’t. This is why the WHO created the “fairness of financial contribution” and the “distribution of financing” indicators: to measure altruism. Both hold that the ideal health system is one where the better off take the greatest burden of costs, while the worse off take the greatest share of benefits.
The upshot of altruism is egalitarianism, which holds that existential equality is a moral ideal. And this is why the WHO created the “distribution of health” indicator: to measure egalitarianism. High ratings are assigned to systems where everybody gets equal health care and has equal health conditions, regardless of what these are.
All over the report egalitarianism surfaces: “The objective of good health is
