President Cecilia Sepúlveda Alarcón
Let us Reflect what we want to be
During the last months, a social earthquake has occurred in Chile, voices have been raised from all sectors asking for and demanding respect for their rights. Spaces for conversation, dialogue and reflection have probably been created, through citizen councils and dialogues, or in a more intimate way in our homes, between colleagues, friends. Perhaps, there have been breaks or heated discussions and without a doubt, something has moved.
Soon, as Chileans, we must choose how we want our Constitution to be. We must become aware of the social role of our profession and understanding what it means in-depth to be Dietitians. Looking for ways to achieve constitutional changes in favour of those who encouraged us to continue this career ... our patients and users is very important. But let's go step by step:
In Chapter III, article 19, the Chilean Constitution assures all people of:
1° The right to life and the physical and mental integrity of the person.
9° The right to health protection:
- The State protects free and equal access to actions to promote, protect and recover the health and rehabilitation of the individual.
- It will also correspond to the coordination and control of actions related to health.
- It is the preferential duty of the State to guarantee the execution of health actions, whether they are provided through public or private institutions, in the form and conditions determined by law, which may establish mandatory contributions.
- Each person will have the right to choose the health system they want to use, be it state or private.
10° The right to education:
- Education aims at the full development of the person in the different stages of his/her life.
These three articles directly involve Nutritionists. Nutrition and Food is one of the essential pillars for the integral development of people; being able to affect all areas of life. The Constitution ensures the right to health protection, as well as free and equal access. However, there is a great difference between a public hospital or Cesfam and a private hospital. The difference is abysmal. The public system has undoubtedly improved, but still does not comply with equal access. For example, if a person with FONASA (public health insurance) wants to access professional services of dietitians, the care by FONASA is for people who are overweight or obese or with cardiovascular risk factors by implication, dietitians cannot respond to people with other pathologies that depend on food as a single or complementary therapy. Although this same article of the Constitution clearly speaks of protection and health promotion, still, according to FONASA guidelines, one can only have access to dietitians care if obese. Then, it is a fully assistance-oriented look because when there is an existing disease, there is no health promotion and less prevention.
On the other hand, in public health, there are two controls by dietitians between 0 and 5 years, how can we educate efficiently in this way? It is impossible, and we forget epigenetics, we have gone from malnutrition to obesity, and still, this does not facilitate the promotion and prevention of diseases of nutritional origin. Regarding, article 10 which says ... education aims at the full development of the person; at a public level we have teachers serving 45 children. How will it be possible for them to provide adequate food and nutrition education? The recommendation here, is that the “cobbler should stick to his job”. Can medical doctors do the work of endodontics as well as a dentist? of course not. They must have ad hoc professionals doing what they know how to do. Self-care does not pertain only to drugs, alcohol and sexuality but also pertains to food.
I left the first article from our constitution listed above to be last in this writeup. Our country’s Constitution defends the physical and mental integrity of all Chileans, without discrimination based on creed, politics or money but how can one explain the high rate of obesity in the poorest sections of our economy without a good education. One can see that obesity is synonymous with inequity; I understand this concept as the inequality that can be prevented. Therefore, we cannot ensure health without ensuring access to healthy food although we cannot force anyone to eat healthily because this is exercising autonomy. Still, we must provide adequate and sufficient education and information so that the choice of healthy eating will be made by the individual.
Thus, colleagues, this writeup is a call for reflection, do we want health to be subject to people's monetary resources? Can we practice the right to health without having the right to healthy food? Is it correct to think that 12 years in school is just for preparation for University selection test? We must look forward to see how we can contribute to our society, we need to be more united, then we can answer these questions and generate concrete actions for them.
Cecilia Sepúlveda Alarcón
President, Chilean Dietitian Professional Association