Published on STWR, July 22, 2010.
… Health For All Now!
In calling for ‘Health For All Now!’, the Charter describes the social and economic conditions that have undermined people’s access to healthcare and other social services, summarised in terms of neoliberal political and economic policies together with “the unregulated activities of transnational corporations”. Governments and international bodies, it states, are “fully responsible” for the failure of ‘Health for All by the Year 2000′. In response, participants called for a “people-centred health sector” that prevents “the exploitation of people’s health needs for purposes of profit”, outlined with a comprehensive list of recommendations to reform trade and the governance of the global economy. Spelling out its vision, the Charter states: “Equity, ecologically-sustainable development and peace are at the heart of our vision of a better world – a world in which a healthy life for all is a reality… There are more than enough resources to achieve this vision.”
In 2008, on the thirtieth anniversary of the Declaration of Alma-Ata, the Peoples Health Movement again called for governments, the WHO and the international community to renew the commitment to achieving health for all as articulated in 1978. It is an “achievable goal”, they reiterated, that governments could meet within a generation. Around the same time, the WHO released its World Health Report 2008 titled ‘Primary Health Care: Now More Than Ever’, shortly before publishing the final report by the WHO’s Commission on Social Determinants of Health (CSDH) called ‘Closing the Gap in a Generation’. 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. The CSDH final report’s analysis, peppered with stinging criticisms of globalisation and trade liberalisation policies in poorer countries, was considered by some analysts to be little short of revolutionary.
While these prominent UN reports were a positive sign of a shift in the right direction, there is still a long way to go before a PHC strategy can be put into practice. Although the WHO is again attempting to foster PHC, there are no adequate global initiatives and no sufficient coalitions of global institutions to address the social and economic determinants of health. The WHO itself is long criticised by civil society for being too ‘disease-focused’ and supportive of selective, vertical interventions that undermine its own PHC vision. In a health policy landscape dominated by the more powerful World Bank, IMF and WTO, the WHO was conspicuously silent during the market-driven health sector reforms of the past few decades, and is often lambasted by analysts for its lack of transparency and accountability.
In recent years, an alternative world health report has been created by an alliance of civil society organisations working in the health sector in order to highlight the root causes of poor health and to critically appraise the actions of key institutions and governments (see the Global Health Watch 2008). What the alternative report makes clear is that sweeping reform of the UN agencies, in particular to free the UN from the influence of big business whilst giving it a stronger mandate to monitor the practices of transnational corporations, is a prerequisite to achieving ‘health for all’. In calling for the WHO to act in its proper capacity as a ‘global health conscience’, the first Global Health Watch report stated; “Radical changes are needed within the organization – a wider variety of health professionals, more social scientists, economists, pharmacists, lawyers, and public policy specialists, more representation from developing countries, stronger regional offices run by experienced professionals, and greater transparency and accountability leading to a more collaborative way of working.” Uncertainties therefore remain on how the WHO can transform its operations and build coalitions with other development agencies, and thus work towards the colossal reforms of the global economy that are envisioned by its Commission on Social Determinants of Health.
Various country-specific examples are often cited to show that good health can be achieved, even in the absence of economic growth and with only modest financial investment. Thanks to the documentary Sicko by Michael Moore, Cuba is now well known for having a population as healthy as those of the wealthiest countries at a fraction of the cost, and for enabling any citizen to see a doctor in their own neighbourhood, as well as being the only country with a permanent medical corps on standby for overseas aid. Sri Lanka, Costa Rica and the Indian state of Kerala are further case studies that reveal how poorer countries with less inequity can have better health indicators than wealthier countries with higher levels of inequality. By focusing on the PHC common rules of socio-economic and health policy measures combined with public health and medical interventions, these countries have shown that redistributive and pro-equity policies are the foundation for health improvements. Kerala, for example, combined its curative and preventative health services with strategies on land reform, education, universal access to housing and sanitation, and effective social safety nets. The promotion of social and economic equity, as both the WHO Commission and civil society organisations have made clear, is central to respecting human rights obligations in health.
Inequitable distribution of resources: … (full text).