Five Social Challenges of the Healthcare System in Iran

If we look at the health and treatment issues of Iranian society at the intersection of community and the healthcare system, we encounter five serious challenges that have relatively been overlooked in Iran. These challenges are mainly due to the low level of social capital, the slow and sometimes halted process of socialization, the limited or non-inclusive nature of the socialization process, the weakness of social networks, and the disruption in the socialization process of those working in medical, paramedical, and nursing professions in Iran. The lack of effective health improvement mechanisms: Iranian socialists and Islamists usually, when addressing the healthcare system, immediately refer to class inequalities in treatment and the high cost of treatment for poor households, as well as issues like nutrition or the lack of access to health centers for these households, and pay less attention to health mechanisms. By health mechanisms, we mean the mechanisms that flow within society and help the public health of individuals, both poor and rich. The results of health mechanisms can be seen in the status of the environment, education, and nutrition, none of which are necessarily caused by poverty. Both the poor and the rich can equally destroy the environment or ignore its destruction; they can both be indifferent to health education; and both groups can have poor nutrition if each member of society defines their existence without regard for others. When a person sees themselves as a member of a larger community, a type of support system and social responsibility naturally forms, which will define health as one of its priorities. Unfortunately, such a sense of belonging and responsibility is less evident in Iran. The weakness of support networks: Health and treatment is a social phenomenon, and no one can guarantee their own health and treatment alone. Social support networks (not governmental) play a very key role in this regard; they can fundamentally change individuals' perceptions of health and treatment and also have effective inputs in the process of providing health and treatment. A significant portion of health and treatment institutions in free societies have been established by these networks, while in Iran, these institutions have not grown from the bottom up and are dependent on the government. Religious institutions in Iran have been more concerned with plundering public resources and riding the horse of power than engaging in support networks. The taboo of disability and incapacity: According to reports from the Iranian Society of the Disabled and other related institutions, there are about two to three million severely disabled individuals and approximately six to eight million with mild disabilities living in Iran. The population of disabled individuals in Iran has been increasing, with about 120,000 to 160,000 added each year. This population requires more healthcare and treatment than other social classes, and for this reason, no door should remain closed to them. However, Iranian society, due to its low level of acceptance, does not view this group as a collection of ordinary individuals who should be able to live like everyone else and should be treated normally, with normal living facilities provided for them. Relatives of disabled individuals can easily feel the heavy gazes of others on their loved ones in public spaces. As someone who has a mentally disabled child, I felt these gazes every day during his twenty years of life in Iran, while in New York, I have never faced such looks. Unfortunately, Iranian citizens do not go through the socialization process alongside disabled individuals. The social system separates the disabled from the rest of the population from childhood in society and school, and individuals do not get the opportunity to see this group as a segment like other segments. A person whose physical and mental condition is not considered normal (and their companions) can easily feel the heavy gazes of others. Without normalizing the lives of disabled individuals in society, their problems will not be solved either. Negative perception of the health and treatment profession: The health and treatment profession in Iranian society has, over the past four decades, become a tool for social and economic advancement rather than a channel for a strong connection between the community of caregivers and the people. For this reason, at least part of public opinion does not have a positive view of this group and perceives its members as opportunistic and seeking more wealth. One of the important points for improving the health and treatment status of society is to repair this relationship. The dispatch of doctors to compulsory plans in deprived areas, quotas for Basij members and insiders in medical schools, and cheating in entrance exams for specialized fields have also damaged the relationship between healthcare professionals and the public. As a result of the decline in the level of professional education for doctors, a pessimistic view of scientific exchange with the West, quotas, reduced income for general practitioners, and the injection of 'insiders' into specialized courses, the rate of medical errors in Iran has increased. People who suffer from these errors are less able to receive compensation. The Medical System Organization usually sides with doctors in these disputes. This issue has also damaged the relationship between patients and doctors and the trust of patients in caregivers.