Glasses for everyone? A bill in Andalusia opens the debate on visual poverty | News from Andalusia

The first thing Salma does when she wakes up is to go get her glasses. She is two years old and this autumn the ophthalmologist, after detecting strabismus, confirmed that she also had hyperopia and astigmatism – 3.5 and 4 diopters in each eye. Wearing them, as her mother, Pepa Fajardo, says, has changed her life: “She walks very well and before she used to fall a lot, she looks at everything because she can see it clearly…” A change that is practically unaffordable for her family. The glasses cost 288 euros, including the 36 for insurance, which is 82% of Fajardo’s salary. That salary is the only one that comes into her life…

The first thing Salma does when she wakes up is go get her glasses. She is two years old and this autumn the ophthalmologist, after detecting strabismus, confirmed that she also had hyperopia and astigmatism – 3.5 and 4 diopters in each eye. Wearing them, as her mother, Pepa Fajardo, says, has changed her life: “She walks very well and before she used to fall a lot, she looks at everything because she can see it clearly…” A change that is practically unaffordable for her family. The glasses cost 288 euros, including the 36 for insurance, which is 82% of Fajardo’s salary. That salary is the only one that comes into her home, where two adults and four children live (her husband is unemployed), and which they supplement with the 850 euros they receive thanks to the Minimum Living Income. After weeks of trying to find a way to pay for them, they managed to cover them thanks to a financing plan offered by the company where Fajardo works.

The idea that optical products should not be a luxury item and should be accessible free of charge to all minors and to the elderly depending on their income is the initiative that has begun to be processed in the Andalusian Parliament through a bill promoted by Adelante Andalucía that, according to the articles of the Statute of Autonomy, would have a state character. An initiative that has been of interest to the Minister of Health, Mónica García, who last week announced that during this legislature she intends to incorporate glasses and contact lenses into the National Health System to guarantee that users do not have to pay for them out of their own pocket.

The law aims to make visual health a universal right and that access to glasses and contact lenses, which are essential items, does not depend on the economic capacity of families. “At the National College of Opticians-Optometrists we are trying to promote in all the autonomous communities and in the National Health System a national visual health plan that integrates visual health as one of the essential elements. The cultural and intellectual development of a child and then the professional development of people depends on their visual efficiency and on their learning through this sense,” explains Eduardo Morán, president of the National College of Opticians, who agrees that budgetary allocations should be made to guarantee visual health.

61% of Spaniards wear glasses or contact lenses, according to the 2022 European Health Survey published by the INE. A percentage that, in the case of the poorest communities such as Andalusia – with the lowest GDP per capita in Spain and the one that uses glasses the least in the entire State – is reduced by up to seven points, showing that the socioeconomic factor influences when it comes to wearing glasses and having check-ups, as denounced by the Andalusian left-wing party. In the case of minors, and according to the calculations made by the Visión y Vida organization in its 2021 report X-ray of childhood visual poverty in Spain —where it makes its own estimates, because the INE only collects data from people over 15 years of age—, 31% have some unresolved visual health problem. These percentages also worsen depending on the degree of poverty in the territory, which led this entity to coin the term “visual poverty”.

In the case of child poverty, the average in Spain is 8.56%, but in Extremadura it rises to 11.52% (the highest) and in Andalusia (the third) it reaches 10.53%. “Poverty rates continue to grow and it is increasingly difficult for families to make ends meet, especially when unexpected expenses arise, such as glasses. For many, they are a luxury item, not because they do not see it as necessary, but because they have to prioritize between putting food on the table or glasses, and then this affects their academic performance,” says Ana Sánchez, head of advocacy in Andalusia for Save the Children. “One in three cases of school failure is associated with poor vision,” explains Elisenda Ibáñez, optician and coordinator of Visión y Vida. “Some families cannot consider buying glasses or changing lenses if their vision problems have increased because they do not have money. As a society we should give them an answer,” she adds.

Fajardo, who is about to finish his contract at his company, is paying for his daughter’s glasses in instalments, after realizing that there was no help for being a large family that would allow him to pay for them. He lives with the anguish that, being so small, the girl could break them or lose them. Wearing glasses and a patch – this one paid for by Social Security – is vital so that her diopters do not increase. “The insurance only guarantees me 30%, I would have to pay the rest and it would be a matter of starting all over again,” he emphasizes. Her glasses are also special because of Salma’s severe lack of vision and because they must be very flexible so that she can manipulate them more easily. Her vision problems require constant check-ups and Fajardo also fears that her prescription will increase and with it the expense of changing lenses. “If the law were to go ahead, she could have a spare pair of glasses in case something happens to them, because if that happens, she would be left with nothing,” he points out.

The proposal by Adelante Andalucía includes small changes to Law 16/2003 on Cohesion and Quality of the National Health System Fajardo, 32, could also benefit personally if the law were to go ahead. He wears glasses, but because of his job at a delicatessen, he needs contact lenses.

The investment does not seem so high. The Andalusian party estimates it at around 710 million euros: around 260 million for minors and around 450 million for adults at risk of poverty. “The cost is perfectly affordable if we take into account that Spain will receive 500 million euros from the European child guarantee funds,” says Ibáñez.

The importance of prevention

Free glasses are only part of the solution to ensure adequate and quality eye health. This is where the national plan Morán referred to comes into play, which involves periodic check-ups. “Eye health should not depend on a pediatrician, there should be guidelines from Social Security and just as there is a vaccination program, eye check-ups should also be scheduled. One should be mandatory before entering primary school, which is when children will start to read, draw…”, says Ibáñez.

When Fajardo began to notice that her daughter was squinting, she went to her pediatrician, who did not see anything in particular. She consulted a second one who did refer her to the ophthalmologist and it was two months later, when they gave her the appointment — “because they processed it as urgent, because otherwise it would have taken four or five months,” she says — when they detected the hyperopia and astigmatism. “The sooner these problems are attended to, the sooner they are stopped,” says the president of the Official College of Opticians and Optometrists of Andalusia, Blanca Fernández.