Can Violence in Healthcare, a Public Problem, be Solved?

Dear friends, getting used to the news we hear frequently and listening to it as if it were ordinary news actually creates a social insensitivity to very important issues that concern our future. If a real public problem is trivialized in these news reports, it becomes even more difficult for it to have a response in the eyes of the public. It is also not possible to start a public policy process for the solution of a public problem that does not resonate with the public. Therefore, society is accustomed to living with this chronic problem, perhaps with the desperate awareness of a very small section of society. Failure to acknowledge the existence of this public problem may seem to give certain individuals and groups an advantage in the short term, but in the long term it can lead to disruptions and even stoppages in the provision of basic public services. Deficiencies in basic public services have long-term negative effects on the social and economic life of societies. Over time, the country's international competitiveness decreases and prosperity declines. The primary task of a country's administrators is to have the scientific and cognitive competence to perceive this complex structure.

Another dimension of the problem is the legitimacy of political power. Failure to provide a public service as required can lead to serious consequences that can call into question the raison d'être of the state and create a problem of legitimacy. This does not happen all of a sudden. Just as cancer starts to progress in one part of the body when it first appears and can spread throughout the body if no measures are taken, the situation is similar with public problems. Every unresolved public problem carries the risk of spreading to all segments of society like a cancer cell. There is a criterion that sheds light on political powers in solving public problems. This criterion is the public interest. If there is a public interest, a public policy process is initiated to solve the problem, resulting in legal texts that take into account the public interest. Violence in health is one such problem area. Not recognizing violence in health as a public problem has the potential to create a national security problem in the future. 

Why is health as a public service important?

Health care is an administrative public service (which the state must provide itself) that all nations prioritize. The social and economic prosperity of societies can only be realized through the provision of an effective health service. In other words, although health service provision seems to serve the purpose of protecting and improving the health of individuals, it basically protects the health of the society. Therefore, preventive health services are cost-effective and cannot be economized on. While curative services focus more on the health of individuals, preventive health services focus on the health of the whole society. 

So why is public health important? The whole world has seen the answer to this question over and over again during the pandemic period. In societies with insecure health, it is unthinkable for the economy to function effectively. As a result of both individual labor losses and closures, the economies of all countries have come to a standstill. Countries have distributed money to the society to cope with this. In addition, tax revenues have suffered great losses. Logistics channels did not function properly and people had difficulties in accessing basic products. Supply chains were broken and speculative pricing of some products emerged at the global level. In short, the cost of the pandemic to world economies has been much higher than expected. However, the factor that prevented this cost from growing further was the health services of the countries. In some countries, health systems have almost collapsed due to organizational and general health policy mistakes. 

These problems have drawn attention to another major problem. Health workers have been worn out to a great extent under excessive workload. As a result of many health workers suffering from illnesses, the workload increased and some services became unavailable. It was not possible to eliminate this intensity in a short time. Health workers are not unskilled labor that can be procured from the labor market when needed. Their training requires both time and high costs. All countries that have been able to use public wisdom have learned very important lessons from this process. In the short term, I expect all countries to experience very important changes in the field of workforce planning in health. I also foresee that this process has brought the importance of preventive health to the forefront and that in the next few years, many countries may experience significant changes in their health policies in the field of preventive health. To put it briefly, health care is not a public service that can be considered in a narrow scope to be associated only with health. It is a very important service area that concerns the welfare of the whole society. In addition, it is directly or indirectly linked and interrelated with many other fields. 

What has happened in our country? 

When we look from the perspective of our country, health workers have experienced many of the same problems as their colleagues around the world. Beyond that, they had to face many problems specific to our country. In the first phase of the pandemic, there was a delay in making appointments to vacant positions despite the increasing workload. Healthcare workers not only struggled with the increased workload, but also did not even have time to take care of their own relatives due to lack of personnel. During the lockdown period, while all public employees were on leave, health workers were on duty. Following this process, they experienced problems such as being complained about by citizens who applied to health institutions, being mobbed by their supervisors and, on top of that, being subjected to violence. As a result, many health workers chose to resign from the public sector.  The appointment system no longer provides appointments for many branches in many hospitals. In short, at this point, the disruptions in health service delivery have become chronic and violence plays a major role in this. 

The opening of city hospitals in this period creates the impression that no lessons have been learned from the pandemic process. Although the importance of easily accessible small-scale health institutions is understood all over the world, the insistence on city hospitals seems really difficult to understand. On the other hand, while public wisdom calls for special emphasis on preventive health services, the entire health system has evolved into a treatment-oriented and high-cost structure. This has not only increased the share allocated to health expenditures in the budget, but also increased health expenditures out of individuals' pockets. This should be taken into account as a factor that increases dissatisfaction among those receiving health services.

In addition to all these, almost every day, the news of health workers who are subjected to violence in a health institution is reflected in the press. Perhaps this is the situation that makes consciences bleed the most. Of course, health workers work subject to the rules that they must comply with since they are public servants. From time to time, there may be health workers who lose their sense of empathy. But all of these have legal repercussions. In fact, they often face this legal consequence. Moreover, empathy is not a one-sided emotional state. While citizenship defines the right to benefit from public services, it also imposes responsibility on the citizen. Citizens are obliged to comply with the rules set in service provision. No justification can excuse violence against a public servant. Especially in the field of health, public personnel are almost completely vulnerable to attacks as they are trained to help people's health. At this stage, the state is expected to provide a defense shield for public officials providing health services through legal regulations and the monopoly of the use of force. In other words, the person involved in the act of violence should face severe penalties, as in developed countries. Because uninterrupted and effective provision of health services is the reputation of the state. Just as the state punishes tax evaders, it should punish violence against health workers in the same way.  No one wants to work in a service provision without physical security. This situation will also negatively affect work performance. Of course, economic and social life will suffer.

Conclusion

Active citizenship requires not remaining silent about the images of violence against health workers that are frequently seen in the media. Active citizenship is a result of the existence of organized civil society. The public problems that you remain silent about today may leave you unable to receive services tomorrow. In fact, most of the problems in health service delivery in our country are related to the phenomenon of violence in health. I must also state that I chose the word "phenomenon" deliberately here. This is because this is a social phenomenon to the extent that it cannot be seen as a judicial incident created by a few unprincipled individuals. At the same time, this social phenomenon has turned into a public problem that must be solved in a short time. Since I have touched upon different dimensions of the issue in my previous articles on this subject, I do not need to repeat it. In this context, we can answer the question we asked at the beginning. Violence in health, which is a public problem, can definitely be solved. The whole problem here stems from the fact that the political power cannot afford to lose votes over health care. However, in the long run, the situation has the potential to create more negative consequences than the political power expects. In short, the political power must recognize violence in health as a public problem. But how will this happen?

One of the most important functions of civil society organizations is to draw attention to public problems and help form public opinion. Political powers may sometimes tend to see a public problem differently than it is for various reasons. This is where civil society organizations, professional associations and universities come into play and explain the problem to the public in all its dimensions. This is expected to happen at the beginning of policy processes in all democracies. Public sector unionism in particular is a relatively new type of unionism all over the world. This is because the employer is the state itself. Perhaps the most important task of public sector unions is their capacity to draw the attention of political powers to the problems in their own sector. If it does not/can not do this, then unionism is nothing more than a field that creates new statuses and honeyed salaries. If the structures that call themselves unions do not take action with all their organs when a health worker is subjected to violence, it is up to the worker to end his/her membership in these virtual structures and take part in a structure that he/she believes will truly represent him/her. Similarly, associations, universities and professional organizations are also responsible for taking action. If violence against health workers is not perceived as a public problem, this cannot be seen as the fault of the political power alone. In democracies, if those who should speak do not speak, little gods emerge (1). This makes society unable to escape living on the lines of tension. It leads to a loss of energy and prosperity.

(1) See my blog post titled "Creating Little Gods". https://www.blogger.com/blog/post/edit/6437777967896832870/307276427416113669