While the healthcare debate rages in the US, a broader discussion has been renewed on the international stage that envisions the universal goal of “health for all”. The time is ripe for a global civil society movement to turn this vision into an international priority, writes Adam Parsons …
… Global Health Today:
Today, although global health inequalities have become far greater than they were 30 years ago, privatization and market principles remain at the center of the international health agenda. In recent statistics, the WHO reports that the difference in life expectancy between the richest and poorest countries still exceeds 40 years, and the cost of health care has pushed about 100 million people into poverty each year. As many as 5.6 billion people in low- and middle-income countries have to pay for more than half of their health expenditure themselves. Furthermore, the WHO estimates that an additional 400,000 child deaths per year could be caused as a direct consequence of the financial crisis.
In other words, the ideals of universal PHC, in which state capacities are strengthened to ensure the rapid expansion of free, publicly provided health care, appear to be further away than ever before. But the principles of PHC are, in fact, making a second resurgence.
Alongside the opening up of intellectual space in the United States on the government role in providing health care, a number of civil society groups are exerting a push for PHC on the international level. In December 2000, when governments were originally slated to meet the Alma-Ata vision of “health for all,” the People’s Health Assembly took place in Bangladesh with over 1,400 participants from civil society movements and non-governmental organisations. After more than a hundred sessions, the participants formulated The People’s Charter for Health, which soon became a common tool of a worldwide citizen’s movement committed to making the Alma-Ata dream a reality.
On the 30th anniversary of the Declaration of Alma-Ata in 2008, the People’s Health Movement again reiterated its call. Meanwhile, in April 2008 the Ouagadougou Declaration also called for a renewal of the principles of PHC and its implementation in developing countries. A further impetus was given to the concept of PHC by the publication of three prominent reports in 2008: the WHO’s World Health Report 2008, the WHO’s Commission on the Social Determinants of Health (CSDH), and the Global Health Watch II.
Of these, the final report of the CSDH is of particular note. Following a three-year investigation, the CSDH reported that increased national wealth alone does not necessarily increase national health. In fact, economic growth can even exacerbate poor health unless there is a fairer sharing of its benefits. The structural drivers of health inequality, stated the Commission, are focused in the inequitable global distribution of power, money and resources, which demands a redistributive role of governments to secure the social contract of public health. Some analysts considered the Commission’s findings, peppered with stinging criticisms of globalization and trade liberalisation policies in poorer countries, to be little short of revolutionary.
The U.S. Debate: …
… For many, the WHO’s attempt to foster PHC is inadequate given the prevailing macroeconomic order, in which private actors like the Gates Foundation spend more than double the core budget of the WHO on health care in developing countries. A basic criticism of the Foundation’s work also concerns its bias toward biomedical and technological solutions, and its business-oriented approach to health improvement that has fragmented health systems and diverted resources away from the public sector. As the WHO’s CSDH report concluded, technocratic solutions cannot resolve global health problems unless combined with the political and power structure changes needed to redistribute economic and social resources more equitably.
If the World Bank and international donors had tackled the structural causes of ill-health by adopting a comprehensive PHC strategy, as opposed to reinforcing the privatized and medical-technical approach to health care favored by the United States, the health catastrophe in many developing countries would not likely have assumed such tragic proportions since the 1980s. Still, we are at a different political point at this moment, when the stock market collapse of 2008 has led many to question “markets good, state bad” rhetoric. In light of both the renewed push for Primary Health Care and the crucial U.S. debate over healthcare reform, the time is ripe for a global civil society movement to turn “health for all” into an international priority. (full long text).