In this interview, we spoke to Natasha Azzopardi-Muscat from the WHO Regional Office for Europe about why democracies are good for our health, what should be done to counteract the “infodemic”, and why trust in health systems is essential.
Interview: Dietmar Schobel
HEALTHY EUROPE
Director Azzopardi-Muscat, are democracies good for our health?
Natasha Azzopardi-Muscat: Yes, they are. In fully functioning democracies, the rights of all minorities are respected, including the right to the best possible healthcare – across the entire health spectrum. Back in 1946, the constitution of the World Health Organization (WHO) stipulated that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. It also states that the right to health is indivisible from other human rights, including the right to education, participation, food, housing, work and information. And we now have several studies pointing to the fact that democracies tend to score better when it comes to people’s overall health.
HEALTHY EUROPE
But at the moment, many observers are claiming that there is a “democracy crisis” in European and global politics. For example, in its Democracy Index 2023, renowned British journal The Economist stated that the “backsliding of democracies” is continuing. What do you think is causing this?
Natasha Azzopardi-Muscat: In recent years, more and more people have lost faith in the institutions, science and the democratic systems as a whole – including in their health systems. This trend had started before the COVID-19 pandemic, but it gathered speed during this period. With regard to health specifically, heath systems have become increasingly unable to provide services at the right place with the right price – which citizens expect them to do. Right now, public healthcare institutions in many countries have to fight for reasonable budgets. This has led to a situation in which more and more people are forced to seek private healthcare and pay for services out of their own pockets to avoid long waiting times.
HEALTHY EUROPE
Developing highly effective vaccines against a previously unknown infectious disease in a relatively short space of time, and the social measures for containing the COVID-19 pandemic, can be seen overall as a major success for science based on rational findings – one that prevented many millions of deaths worldwide. But rather than putting their trust in scientific evidence, many groups of the population have developed a growing mistrust of expert knowledge. How do you explain this paradox?
Natasha Azzopardi-Muscat: The COVID-19 pandemic suddenly put the question of public health centre stage for the population at large. The decisions taken to implement certain measures such as vaccinations and lockdowns to manage the pandemic were based on the best available knowledge. Even though these were put forward by scientific experts, in many countries they were also turned into a socio-political issue and heavily criticised. In many cases, this was part of targeted strategies aiming to undermine trust in science and state institutions. We can’t afford to be naive about this and as public health experts we need to recognise that there are other forces at play in the wider socio-political context.
“We need to listen to people – online and offline – and to look into what moves them.”
NATASHA AZZOPARDI-MUSCAT, WHO REGIONAL OFFICE FOR EUROPE
HEALTHY EUROPE
What role did the “infodemic” play here during the COVID-19 pandemic? In other words, the flood of information about the new infection available especially via digital media – and specifically “social media” – much of which was misleading or downright incorrect.
Natasha Azzopardi-Muscat: Infodemics can have various negative effects, such as increasing vaccine hesitancy, fear and anxiety among the population or spreading information on supposed possibilities for “therapies” that turn out to be entirely ineffective or in some cases even dangerous to people’s health. Communicating within social media “echo chambers”, where for the most part like-minded people reinforce each other’s views, can have the effect of polarising – or further polarising – society.
HEALTHY EUROPE
What can be done to counteract this?
Natasha Azzopardi-Muscat: “Infodemic management” is the best remedy for incorrect or misleading information. It involves protecting people from harmful health information in emergencies and giving them direct access to high-quality information and services. For this to work, we need to listen to people – online and offline – and to look into what moves them. A resolution by the World Health Assembly from May of this year highlights social participation as a prerequisite for universal health coverage, health and well-being. And in general, it is also especially a question of building up more trust again. This was emphasised in the charter published to coincide with the WHO meeting in Tallinn in December 2023. Trust in health systems is essential if they are to function effectively. Patients need to trust clinicians and care providers, the health and care workforce needs to trust that they will be valued, and policy-makers need to trust that the health system will deliver quality care and do so efficiently if they are to invest resources. They also need to trust the public – and vice versa – in times of crisis. This trust then becomes the glue that binds all key stakeholders together – including when it comes to the dissemination and consumption of health information.
Natasha Azzopardi-Muscat qualified as a medical doctor at the University of Malta in 1995. She is a specialist in public health and Director of the Division of Country Health Policies and Systems at the WHO Regional Office for Europe. Before joining WHO she served as President of the European Public Health Association (EUPHA) from 2016 to 2020, where she was actively involved in health advocacy at European level. She is married to Conrad Azzopardi, a practising physician, and has three children.
FACTS & FIGURES
An analysis of data from the Global Burden of Disease study, published in 2019 in “The Lancet”, shows that democracies in which free and fair elections take place are more likely than autocracies to lead to health gains for causes of mortality such as cardiovascular diseases and transport injuries. Research at the London School of Economics and Political Science – published in 2023 in the Journal of Public Policy – revealed a connection between democratic forms of government and a reduction in health inequalities in European states. According to the authors Joan Costa-Font and Niklas Knust, one of the reasons for this is that democracies are more likely than autocracies to give priority to public health goals and to develop programmes that target individuals who exhibit the highest health needs. This includes promoting universal access to healthcare.