미얀마의 보건의료 현실과 ‘국가-사회’ 관계의 동학:시민불복종운동의 함의로부터
A Study on the Dynamics of ‘State-Society’ Relations and Healthcare in Myanmar: Focusing on the Implications of the Civil Disobedience Movement
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초록
2021년 미얀마 군부가 감행한 쿠데타에 맞서 공공병원 의료진이 전개한 시민불복종운동은 코로나19에 따른 보건위기보다 쿠데타가 촉발한 정치적 위기가 이 나라 국민의 안위와 건강에 더 치명적이라는 인식을 보여준다. 실제로 미얀마의 보건의료체계는 군정이 지속된 과거 50여 년간 퇴행의 길을 걸었다. 미얀마는 매우 일찍부터 보편적 건강보장을 목표로 한 제도와 정책을 마련해갔지만, 현실과의 간극은 컸다. 오히려 희소한 보건의료 자원을 ‘국가 안의 국가’로 군림하는 군이 독점적으로 전유하며 정치적으로 활용함에 따라 대다수 국민의 건강권은 심각하게 침해당했다. 그 폐해는 공공의료의 지속적인 약체화와 오늘날까지도 전체 보건지출 중 70%가 넘는 재난적 수준의 개인 의료비 지출 등과 같은 문제로 나타나고 있다. 이 논문은 바로 이러한 문제가 근본적으로 미얀마의 정치위기로부터 기인한 것이라고 진단하고, 그 배경으로서 독립 이래 미얀마의 보건의료정책이 시행된 배경과 주요 특징, 한계를 고찰한다. 이를 바탕으로 미얀마의 보건의료 현실을 타개하기 위해서는 무엇보다도 오랫동안 갈등으로 점철되었던 다층적인 ‘국가-사회’ 관계를 재정립하는 데서부터 출발해야 한다고 강조한다.
Abstract
The civil disobedience movement launched by medical staffs at public hospitals in response to the coup conducted by Myanmar's military in 2021 shows the perception that the political crisis triggered by the coup is more fatal to the safety and health of the people of this country than the health crisis caused by COVID-19. Myanmar's healthcare system has gone backwards over the past 50 years under military rule. Myanmar has established systems and policies aimed at universal health security from a very early age, but the reality has shown a big gap with it. Rather, most people’s right to health has been seriously violated as the military, which reigns over the people as a ‘state within a state’ exclusively monopolizes scarce healthcare resources and utilizes them politically. This situation had undermined public health system and resulted in catastrophic out-of-pocket expenditures accounting for more than 70% of total healthcare spending of this country. Therefore, it can be said that Myanmar's healthcare crisis is fundamentally caused by a political crisis. By examining the implications of the civil disobedience movement and the characteristics and limitations of Myanmar's health care policy, this article emphasizes that the improvement of Myanmar's poor healthcare should start with resetting the multi-layered 'state-society' relations, which has been marked by long conflicts.
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