Health preservation as an assignment on the state and global scale

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Health preservation as an assignment on the state and global scale

Utiuzh, Iryna

Zaporizhzhia State Medical University (Zaporizhzhia, Ukraine)

Spytsia, Natalia

Zaporizhzhia State Medical University (Zaporizhzhia, Ukraine)

Mehrelishvili, Mariia

Zaporizhzhia State Medical University (Zaporizhzhia, Ukraine)

Pavlenko, Natella

Zaporizhzhia State Medical University (Zaporizhzhia, Ukraine)

Abstract

Анотація

Пандемія, спричинена COVID-19 назавжди змінила світ, примусила його звернутися до цінностей, які за умови глобалізованого капіталізму активно втрачали свою питому вагу. Трансформація має відбутися на засадах ідеї збереження і турботи життя, тому, особливої актуальності набуває питання суспільного здоров'я. Пандемія ще раз підтвердила, що суспільне здоров'я є елементом національної безпеки кожної країни. В статті досліджується соціально-філософська специфіка суспільного здоров'я, яка дозволяє визначити і проаналізувати ризики та фактори, що впливають на стан і процес відтворення системи суспільного здоров'я в Україні. Зазначено, що ефект від протиепідемічних заходів залежить від особливостей культури, ментальності певної країни (регіону) та від дій керівництва. В той час, коли багато розвинутих країн створили посткапіталістичну систему розвитку медицини, в якій держава бере на себе відповідальність за збереження здоров'я своєї нації, українська держава має формувати сильну протекціоністську національну політику задля підтримки суспільного здоров'я і, відповідно, національної безпеки. Мета дослідження - з'ясувати стан суспільного здоров'я у контексті соціальних, економічних та інших змін, спричинених пандемією COVID-19. Завдання для вирішення: 1. У статті розглядається проблема суспільного здоров'я та особливості функціонування системи охорони здоров'я в контексті пандемії COVID-19. 2. Висвітлюються питання впливу ментальності, культури загалом на дії керівництва країн та пересічних громадян під час пандемії COVID-19 (на прикладі українського суспільства). 3. Аналізуються зміни, що відбулись у суспільному бутті під час пандемії COVID-19 і, як наслідок, вплинули на життя та соціальне здоров'я індивідів. 4. Аналізуються проблеми системи охорони здоров'я в Україні. Методи, які використовувались в науковому дослідженні - метод сучасної соціально-філософської традиції, постструктуралістський підхід, герменевтич- ний підхід. На сторінках дослідження автори презентували роботу міждисциплінарного та трансдисциплінар- ного методів. Висновки дослідження. 1. Сучасна пандемія COVID-19 дійсно оголила цілий комплекс проблем, серед яких медичні, соціальні, економічні та управлінські, що властиві всьому світу та українському суспільстві зокрема. 2. Більшість країн створили посткапіталістичну систему розвитку медицини, в якій держава бере на себе відповідальність за збереження здоров'я своєї нації. 3. Сучасна українська медицина, в особі медичних працівників прикладає максимум зусиль для ефективного функціонування медичної системи. 4. Суспільне здоров'я, яке передбачає гармонійне функціонування людини у всіх основних видах взаємодії, є тією самою первинною профілактикою, яка не базується тільки на медицині. 5. Система охорони здоров'я не зможе дати відповідь на виклики різних загроз, якщо буде постійно підлаштовуватись під ліберальні настрої ринкових інтересів транснаціональних фармацевтичних концернів. epidemic health social

Ключові слова: суспільне здоров'я, пандемія, національна безпека, глобалізація, капіталізм, посткапіталізм

УТЮЖ, И.Г. - доктор философских наук, профессор, зав. кафедрой общественных дисциплин Запорожский государственный медицинский университет (Запорожье, Украина)

СПИЦА, Н.В. - кандидат философских наук, доцент, доцент кафедры общественных дисциплин Запорожский государственный медицинский университет (Запорожье, Украина)

МЕГРЕЛИШВИЛИ, М.А. - кандидат философских наук, доцент, доцент кафедры общественных дисциплин

Запорожский государственный медицинский университет (Запорожье, Украина)

ПАВЛЕНКО, Н.В. - кандидат философских наук, преподаватель кафедры общественных дисциплин Запорожский государственный медицинский университет (Запорожье, Украина)

СОХРАНЕНИЕ ЗДОРОВЬЯ КАК ЗАДАНИЕ ГОСУДАРСТВЕННОГО И ГЛОБАЛЬНОГО УРОВНЕЙ

Аннотация

Пандемия, вызванная COVID-19 навсегда изменила мир, вынудила его обратиться к ценностям, которые в условиях глобального капитализма активно утрачивали свою значимость. Трансформация должна произойти на основе идеи сбережения и заботы о жизни, поэтому, особенно актуальным становится вопрос общественного здоровья. Пандемия еще раз подтвердила, что общественное здоровье является элементом национальной безопасности каждой страны. В статье исследуется социально-философская специфика общественного здоровья, что позволяет обозначить и проанализовать риски и факторы, которые влияют на состояние и процесс воспроизводства системы общественного здоровья в Украине. Указано, что эффект от противоэпидемических мер зависит от особенностей культуры, ментальности определенной страны (региона) и от руководства. В то время, как большинство развитых стран создали посткапиталистическую систему развития медицины, в которой государство берет на себя ответственность за сохранение здоровья своей нации, украинское государство должно формировать сильную протекционисткую национальную политику для поддержания общественного здоровья и, соответственно, национальной безопасности. Цель исследования - выяснить состояние общественного здоровья в контексте социальных, экономических и других изменеий, произошедших в результате пандемии COVID-19. Задачи исследования: 1. В статье рассматривается проблема общественного здоровья и особенности функционирования системы охраны здоровья в контексте пандемии COVID-19. 2. Освещается вопрос влияния ментальности, культуры на действия руководства стран и граждан во время пандемии COVID-19 (на примере украинского общества). 3. Анализируются изменения, которые произошли в общественном бытии во время пандемии COVID-19 и, как результат, повлияли на жизнь и социальное здоровье индивидов. 4. Анализируются проблемы системы охраны здоровья в Украине. Методы, которые используются в исследовании - метод современной социально-философской традиции, постструктуралистський подход, герменевтический подход. На страницах исследования авторы презентовали работу междисциплинарного и трансдисциплинарного методов. Выводы исследования. 1. Современная пандемия COVID-19 провозгласила целый комплекс проблем, среди которых медицинские, социальные, экономические и управленческие, которые присущи всему миру и украинскому обществу в том числе. 2. Большинство стран создали посткапиталистическую систему развития медицини, в которой государство берет на себя ответственность за здоровье своей нации. 3. Современная украинская медицина, в лице медицинских работников, прикладывает максимум усилий для эффективного функционирования медицинской системы. 4. Общественное здоровье, которое подразумивает гармоничное функционирование человека во всех основных видах взаимодействия, и есть той самой первичной профилактикой, которая не базируется только на медицине. 5. Система охраны здоровья не сможет реагировать на вызовы разных угроз, если будет постоянно подстраиваться под либеральные настроения рыночных интересов транснациональных фармацевтических концернов.

Ключевые слова: общественное здоровье, пандемия, национальная безопасность, глобализация, капитализм, посткапитализм

Problem statement in general and its connection with important scientific or practical tasks

In 2020, the COVID-19 pandemic changed the lives of people in most countries of the world dramatically. Depending on the epidemiological situation, national legislation and mentality of the population, governments have taken and continue to take manifold measures to avoid the worst case scenario of this disease rapid spread. The development of COVID-19 vaccines gives hope for overcoming the pandemic, but the issues of providing the population of different countries with the vaccine and, last but not least, the people's trust in it remain unresolved. A survey conducted by the Gallup International Association (GIA) in late 2020 found that "more than two-thirds of people worldwide say they will agree to be vaccinated if it is publicly available and considered safe and effective. However, a quarter of the respondents are likely to refuse COVID-19 vaccination. ...In Ukraine, 65 % are ready to be vaccinated against coronavirus" [14].

COVID-19 has clearly shown that the world is able to jointly and quickly operate in order to change all aspects of society and economy, from education and health to social arrangements and new working conditions. Therefore, the main issue on the agenda is the retransformation of modernity, which is based on the idea of preservation and care for life. The recent geopolitical meetings (Davos 2020) only confirm the implementation of this idea. Thus, the problem of healthcare and public health is becoming more relevant than ever. To be fair, not only has the coronavirus pandemic united the world in the fight against the disease, but also clearly showed the unpreparedness of the healthcare systems of most countries, even of the highly developed ones [1].

Therefore, the socio-philosophical study of the phenomenon of public health enables determining and studying the risks and factors affecting the condition and reconstruction process of the public health system in Ukraine. It should be noted that public health is an element of a state's national security, while national security should be considered as the state of a social system. The Constitution of Ukraine recognizes a person, his/her life and health, honour and dignity, inviolability and security as the highest social value. In the progressive ideologemes of the post-capitalist reality of most civilized countries of the Western European geopolitical space, health is a human capital, investing in which is both the work and responsibility of an individual and a state.

Analysis of recent research and publications, which initiated the solution of this problem and which the authors refer to As the basis for the research, the authors use both the theoretical developments of other scholars on the health issues, pandemics, health systems, etc., and the sociological studies of the international (the Global survey conducted by the Gallup International Association in the late 2020) and Ukrainian experts (the Sociological monitoring "Ukrainian society-2020" conducted by the Institute of Sociology of the National Academy of Sciences of Ukraine).

The aim of our research is to reveal the state of public health in the context of social, economic and other changes caused by the COVID-19 pandemic.

The objectives of the research are as follows:

1. To examine the problem of public health and peculiarities of the health system functioning in the context of the COVID-19 pandemic.

2. To reveal the issue of influence of mentality, and culture in general, on the actions of the countries' leadership and ordinary citizens during the COVID-19 pandemic (on the example of the Ukrainian society).

3. To analyse the changes that occurred in public life during the COVID-19 pandemic and, consequently, have affected individuals' lives and social health.

4. To investigate the problems of the healthcare system in Ukraine.

The research methodology involves a poststructuralism approach, which, being a method of the modern socio-philosophical tradition, enables the analysis of capitalist society problems and provides opportunities for overcoming the crisis caused by the capitalist mode of production. A hermeneutical approach is used to adequately assess and analyze the changes occurring in absolutely all aspects of our society and economy, from education and health to social arrangements and new working conditions. On the pages that follow, the authors attempted to present the work of an interdisciplinary and transdisciplinary methodology, which, in an adequate way, revealed the causal mechanism of development of public health, vital tools for society survival and national security of the state.

Presentation of the main material of the research with substantiation of the obtained scientific results

An average person usually thinks of his/her own health and starts to take care of it only when being ill (even Arthur Schopenhauer pointed out this unfortunate circumstance). However, he COVID-19 pandemic has forced a certain number of people to reconsider their habits and lifestyles, since it is not only about their own life and well-being, but also about the health of others. In this case, health preservation is not an individual's own business, it, without exaggeration, has acquired national significance. Overall, "almost three-quarters of the respondents from around the world express their willingness to sacrifice some of their human rights if it helps prevent the spread of the disease. A quarter of all the respondents share the opposite opinion. However, there is a clear tendency to reduce the willingness to sacrifice human rights. It seems that people around the world have overcome the initial shock caused by the new disease and are now increasingly reluctant to give up some of their rights. According to the first waves of global polls conducted in the spring of2020, the willingness to sacrifice human rights around the world reached 80 %" [14].

On the one hand, pandemics create or make more visible the problems existing in various spheres of society; on the other hand, some problems fade into the background. Pandemics test the strength of national healthcare systems as well as effectiveness of governments and parliaments in making tough and unpopular decisions. Therefore, the question arises about the extent, to which national governments and supranational organizations (WHO) are able to find adequate responses to the challenges caused by COVID-19 [12]. Every day, the media and social networks publish new articles saying that the pandemic has exposed an incredible number of social problems. Symposia and conferences on COVID-19 are held, with scientists, doctors, and politicians focusing on the same issues: "It became clear early on that the pandemic was more than a health crisis; it is a socio-economic crisis, a humanitarian crisis, a security crisis, and a human rights crisis. It has affected us as individuals, as families, communities and societies. It has had an impact on every generation, including on those not yet born" [9, p. 5].

According to the domestic and foreign scientists, health is defined as a factor of a citizen's comfort of life, joy of life, family happiness as well as a significant share of spiritual well-being [7; 8; 11; 13]. However, we should note that in the context of the crisis of capitalism and neoliberal reforms of healthcare in Ukraine, the COVID-19 pandemic showed that the state's need to develop and preserve public health of the nation was replaced by market expediency. As Jennifer Cohen rightly states: "In the COVID-19 pandemic, market-rewarded self-interested behaviour has been exposed as a source of mortality and morbidity. Profit- motivated behaviours can keep people from accessing necessities for health thereby harming individuals and possibly damaging population health. The profit motive can also undermine healthcare system capacity by maldistributing goods that are inputs to healthcare" [8, p. 176].

The pursuit of profit in the doctor-patient-state- business system obviously undermines the potential of the healthcare system, and it is clear that profit is the starting point of capitalism. In order to remove this contradiction, which is associated with social capital, the state must assume the responsibility of fair coexistence and redistribution of resources. The improper distribution of resources within the market provides justification for the state's responsibility for health, which is a public good. In this relation A. Svintsitskyy argues: "The main goal of the state in the area of healthcare is to provide conditions for achieving the maximum terms of natural life expectancy, high quality of spiritual and physical health, and effective reproduction of a healthy nation. The state protects its citizens and their environment by creating a developed legislative and regulatory framework, based on the Constitution of Ukraine, international conventions and other agreements on protection of human rights, health and dignity" [13].

Overcoming a pandemic is a complicated, multidimensional and complex process. It contains the level of organization, that is joint decisions and actions with regard to the necessary restrictions taken by heads of government of an array of states, a certain state, region, specific enterprises (including the temporary termination of certain activities), and the level of self-organization, that is actions of average citizens, who agree/disagree and are willing/unwilling to follow the advice of doctors and requirements of the state leadership, and show a responsible attitude both to themselves and others [2]. Therefore, the effect of anti-epidemic measures depends both on the characteristics of the culture and mentality of the population of a certain country (region), and on the leadership actions (democratic or authoritarian methods of solving the problems). In such a situation, the leadership knowledge of the population's opinion on various aspects of solving the problems related to the pandemic and adequate response to this opinion is an important condition for overcoming the crisis.

Considering the attitude of the population to the COVID-19 situation in the Ukrainian society, we cannot but cite a well-known sociologist E. Golovakha, who, analysing the data of the 2020 Sociological monitoring of the Ukrainian society, states: "Global studies show that although the pandemic has become the main factor in the deterioration of people's psychological state worldwide, in Ukraine, this factor ranks fifth or sixth" [4].

He also provides the explanation for this phenomenon: "The Ukrainians fear... unemployment most. Then go increased prices (65 %), whereas the concerns related to the external aggression account for 43 %. The coronavirus pandemic shows the same index of 43 %. The interesting fact is that only 28 % are afraid to get sick personally, that is Ukrainians are afraid of the pandemic as a social phenomenon, but not as a real threat to themselves. In my opinion, the reason is that Ukrainians are big fatalists: they believe that what must be, will be, no matter what you do. This is not only our problem, but a kind of East Slavic syndrome. We need to combat it, otherwise we will not be able to develop the self-discipline necessary to overcome difficulties" [4].

At the same time, according to the Gallup International Association (as of the end of 2020), Ukrainians have one of the highest levels of dissatisfaction with the government's actions in terms of managing the COVID-19 crisis (77 %) [14].

Thus, the problems currently existing in the Ukrainian society are more significant for the population, and the fear of losing a job overcomes the fear of getting sick and dying, thus resulting in numerous violations of the quarantine regime. The population is not afraid of the high morbidity rate and high mortality rate, which are inherent in this disease. Moreover, the mentality (fatalism, according to E. Golovakha) in a certain way prevents Ukrainians from taking the existing problem seriously: even in the situations, in which they can easily protect themselves by putting on a mask and disinfecting their hands, some of them ignore these elementary requirements. At the same time, the country's leaders are representatives of the same population with the same mentality. In the eyes of

Ukrainians, the violations of the quarantine regime by representatives of the pro-government party and governing bodies legitimize a superficial attitude to quarantine requirements.

The enforced quarantine (for a large number of people, it is a certain period of self-isolation), restrictions of some human rights, natural economic downturn and distrust of the actions taken by the leadership from many in the population actualize social health issues. One of the possible definitions of social health that does not raise any objections is the following: "The state of harmonious functioning of a person in the main types of interactions: social, economic, political, ideological; the state that creates comfortable living conditions . Thus, social health manifests itself in the social activity of a person, level of professional and general culture assimilation, ability to harmonize relations with oneself, other people, and the nature. Social health is one of the main indicators of prosperous life and harmonious development of a society, its cultural level" [6, p. 76].

During quarantine and/or self-isolation, both social interaction and performance of professional duties undergo significant changes. In order to maintain social distance and avoid unnecessary contacts, even traditional greeting gestures have changed (avoiding hugs and kisses, in the cultures where it is customary, shaking hands, etc.).

Social interaction is now primarily implemented through the Internet. Education, trade, and all types of activities that can be performed online have started to function remotely. People were suddenly deprived of their usual leisure time: going together to theatres, museums, fitness rooms, stadiums, and restaurants, doing the shopping, etc. It is clear that all these can be compensated in one way or another using the Internet, but direct communication, "live" communication was put on pause. For many people, various forms of leisure are certain traditional activities that allow them to relax with their friends and family, switch off from their daily work routine, and feel the fullness of life "here and now". The transfer of such traditional actions to the "online" mode has affected social health of the population, and different categories of the population have suffered from this in different ways.

In this case, the elderly are the most vulnerable population segment. Not only are they at risk due to the possibility of having a complicated course of COVID-19 (or not surviving it), but for many representatives of this category TV and phone have become the only means of communication with the world due to their inability to use modern gadgets (inability to master most of their functions) or not having modern smartphones. After all, even if such a person is not alone, he/she should avoid "live" contacts.

T Litvinova emphasizes the importance of the professional factor in the functioning of social health. She writes: ".. .satisfaction with professional activity is an important indicator of human social health, which affects the state of the body's functional systems determining the way one feels as well as the level of working capacity" [10, p. 36].

Among the elderly, the majority are retired people who no longer work, thus this factor in maintaining social health is irrelevant for them. Not all of them were able to fully fulfil themselves outside of work and enjoy the benefits of retirement - having free time, taking up certain hobbies, traveling, either because of a poor health or low financial support. Consequently, communication with their families and friends was one of the feasible and affordable factors for maintaining social health. But, in the context of the quarantine, we can observe the situation, in which violation of social health has become the condition for maintaining physical health.

It should be also noted that the burden carried by working parents of schoolchildren, especially women, has increased. In the context of distance education (or partially distance one) and telecommuting, they should simultaneously not only continue to perform their official functions, but also pay much more attention to the education of their children. Under usual living conditions, most of the working adults' daytime was completely devoted to work, and they knew for sure that their child was at school at that time, and his/her studies were supervised by teachers. In the traditional school education, teachers explained difficult material and immediately checked in class how clear it was for students. In the context of distant education, parents should have time to monitor their children's learning (whether the child is connected to the lesson, performing the task given by the teacher rather than playing computer games) and explain much more educational material to their children. Constant stress, physical and mental exhaustion of parents undermines their health.

In the fall of 2020, the UN proposed three components of the strategy for responding to the current situation, among which there are the need for a coordinated health response (availability of treatments, active vaccine development and implementation, etc.); the priority of safeguarding human life and sources of livelihood (addressing the socio-economic and humanitarian problems) as well as the global reconstruction based on the transformation process "that leads to a better post- COVID-19 world by addressing underlying fragilities and identifying opportunities for transformative change towards more just, equal and resilient societies and economies" [7, p. 6]. The strategy text that follows stresses on the need for transformations in various spheres of life: the environmental situation improvement, solution of the social insecurity problem, ensuring of universal health coverage based on the principles of sustainable development. All the problems and solutions would seem to be as clear as possible. The UN Secretary-General calls on the countries to end hostilities, makes a global appeal to the countries of the world to stop aggression and violence, and consequently, many countries are making new commitments and including a number of measures to prevent violence, etc. into their state programs.

In such a situation, it is difficult for many people, who understand the cause-and-effect relations that have led to numerous problems in the era of the COVID-19 pandemic, not to adopt the attitude of cynicism. Reading the WHO and UN documents and declarations carefully we realize that the cause of all the above-mentioned problems is the leading system of the global community in the XXI century - long time ago the capitalist relations determined which problems would be leading for the globalized world of our time. More than a decade ago, the London journal International Socialism published the article "Capitalism, class, health and medicine" by Mike Haynes, in which he gives an extensive explanation of the relationship between health and capitalism that has been radically changing the healthcare system in the world and provides the examples of those transformations in the UK during the second half of the 20th century and early 21st century [3].

The capitalist system and liberal, sometimes ultra-liberal, governance have created favourable conditions for the whole world to talk about a row of crucial problems.

In the Ukrainian society, there is the illusion created long ago of only having two ways of development, namely the ultra-liberal one and the path of state socialism. The reforms implemented throughout the entire period of independence are a kind of ugly hybrid of ultra-liberal reforms and the worst approaches of the Soviet-era bureaucratic system. The ultra-liberal trends were accompanied greatly by the loss of state control in all the areas strategically important for the state. The "Sovietism" of the system is represented by the bloated bureaucracy and centralization, which mainly help to implement corrupt schemes, as well as by populist social promises perceived as successful by a large number of older people. Unfortunately, in the Ukrainian reality, many reforms have resulted in the fact that law-making actively protects the clan- oligarchic structures and capital of trans-national corporations, which is unlikely to benefit the Ukrainian people.

Mike Haynes declares that if the system makes you ill, it is logical that you should solve the problem starting with its cause. However, in capitalist realities, especially in those of liberal governance, which is not designed for rapid adaptation in alarm conditions, there is a huge temptation to only focus on the consequences, while getting a good material benefit - for example, procurement of new drugs, special technologies, and implementation of high- cost therapies. Referring to the paper published in 1979 [15], Haynes claims that for about a century, there has been a certain division of medical workers into those who realize the noble goals of the medical profession, including directing their activities to remove the social causes of diseases (the so-called missionaries) and those who use the healthcare system to get personal material benefits (the so-called mercenaries). In the modern world, mercenaries have also been supplemented by the managers "who have benefited from the commercialisation and privatisation of health and who tell us that the way forward is health markets that they can run jointly with the mercenaries" [3]. In the Ukrainian society, we observe even a more rapid course of events: under the influence of liberal reforms, the number of missionaries is decreasing, while mercenaries and managers are becoming almost the most typical phenomenon in the national healthcare system. In this context, the liberalization of the healthcare system, which automatically excludes state control, leads to a critical level of medicine commercialization, which, in turn, makes it completely unable to mobilize its forces, for example, in a pandemic situation. Consequently, in order to avoid direct responsibility, politicians cannot but accuse the population of their country of negligent attitude to their health and practitioners of negligent attitude to their duties at the time when neither citizens nor employees of this particular field - doctors, have decent mechanisms of social protection.

Most people in Ukraine are experiencing constant stress - the state liberal system with a huge international monetary debt, low GDP and dilapidated economy is a serious ground for the exuberance of the every-man-for-himself attitude. Permanent concern about the future, uncertainty about maintaining employment, meagre wages make the life of the country's common citizen not only full of fears and worries, but also of diseases, since there are quite clear parallels between the socio-economic problems of countries and growth of mortality and morbidity. The psychological and social pressure, lifestyle (nutrition, physical culture, an opportunity not only to earn decent money, but also to have a good rest) and, last but not least, social relations (support of relatives and friends) - all these constitute a complex system that affects public health.

In his work The Great Escape, Angus Deaton argues that emotional well-being is also part of what we call health [5]. The feeling of happiness can be quite subjective, even if a person claims that everything is more or less fine with him/her. The author gives the map of happiness in different countries of the world [5, p. 71], where there is also the indicator for Ukraine, claiming that the countries on the territory of the former socialist camp, namely the countries, which emerged after the collapse of the USSR, are among the unhappiest countries in the world. Perhaps, this is also related to the fact that older generations of the post-Soviet territories' residents remember the times of lower expectations, when the average level of well-being and relatively primitive prosperity met the needs of the majority, with the healthcare system being completely concentrated in the pro-government sector. Over the period of independence, the conditions of artificially constructed needs have been created, expectations have grown exponentially, and the liberal policy of the healthcare system transformation has led to the fact that you have to strike out for yourself, that is, you have to worry about where you will get money from for treatment and whether you will be given due attention when it comes to saving your life and health.

A healthy society exists on condition of primary prevention, when everything that makes us healthy and happy is not yet subordinated to the healthcare system. A healthy society is formed on the basis of a full-fledged socio-economic system, sustainable development and internal confidence in the future of its citizens. It is a mistake to assume that with the changes in the healthcare system, which at the moment can only be based on the principles of a capitalist system, where everything tends towards commercial benefits, we will be able to improve the health of citizens. After all, the healthcare system, to a greater extent, solves the issue of consequences, not causes. Therefore, the COVID-19 situation is not a matter of an ideal healthcare system, but a matter of the state's national policy. Within the framework of state budget programs, the expenditure on healthcare may grow, but this is unlikely to be the key to better healthcare for everyone, since, in most cases, new healthcare expenses are new schemes implementation by certain circles for making profits. Thus, it is necessary to change the political background for medicine and create a healthcare system based on protectionist national policies. Primary prevention, which is a basic value for public health, is not a healthcare sector issue, but a purely political one. The globalized world of market relations is doing everything possible to prevent the strengthening of national healthcare systems, since such systems will become economically disastrous for large multinational corporations and pharmaceutical giants determined to dominate regional markets. But an adequate understanding of what public healthcare should look like is based on the principles of fairness and accessibility (which is what the UN and WHO programs call for). Public health turns out to be a phenomenon that is categorically ambivalent about what should be and what really exists. There should be a national system that is minimally dependent on external influence, able to quickly mobilize its forces and respond to the various challenges of the present (they are likely to continue arising after the end of the COVID-19 pandemic due to new diverse biological and man-made threats), the system that ensures the level of primary prevention and minimization of the population morbidity. However, the system, which exists, is coordinated at the global but not a national level, where commercial interests play a primary role. An interesting idea is expressed by Mike Haynes in relation to the National Health Service of Great Britain (NHS): those who destroy it should be in the dock as serial killers, since it is because of them that the death rate in the country is increasing [3]. In the Ukrainian context, those who have actively liberalized the healthcare system, depriving it of its viability, should be automatically considered to be serial killers.

Conclusion

The COVID-19 pandemic has revealed a whole range of problems, including medical, social, economic and managerial inherent in the whole world and the Ukrainian society in particular. Most countries have created a post-capitalist system of medical development, in which the state assumes responsibility for safeguarding the health of its nation. As for the situation in Ukraine, the modern Ukrainian healthcare represented by medical professionals makes every effort to promote effective functioning of the healthcare system. However, if you only rely on the enthusiasm of people, the country will not last long in the unhealthy capitalist competition. Public health, which provides for the harmonious functioning of a person in all the main types of interaction, is the very primary prevention that is not based on healthcare alone. It is primary prevention that the protectionist national policy of Ukraine should be concerned about, guaranteeing decent work, decent wages and a decent life in general to its citizens. The healthcare system will not be able to respond to the threats that emerge if it constantly adapts to the liberal mood of the market interests of multinational pharmaceutical companies.

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