PHA-Exchange> WHO Commission on Macroeconomics and Health: Possibility of Collaborative Analysis

[David Legge]

Globalisation on trial
world health warning issued

Report of WHO Commission on Macroeconomics and Health

A high level WHO commission has warned the rich world that unless there is 
a dramatic increase in development assistance for health the legitimacy and 
stability of the current regime of global economic governance may be 
seriously threatened.

The report
The report of the WHO Commission on Macroeconomics and Health (CMH) is now 
available at:
<http://www3.who.int/whosis/menu.cfm?path=whosis,cmh&language=english>
This report will have a big impact on policies and programs in the field of 
health development.  It is a major intervention in discussions about 
official development assistance including the role of the World Bank (and 
PRSPs).

Opportunity
The debate around the report will also provide an important opportunity to 
challenge neoliberal orthodoxy in development policy and to further 
undermine the legitimacy of the prevailing regime of global economic 
governance.
The purpose of this posting is to invite health activists, NGOs and 
academics, who see in this regime of global economic governance the major 
causes of health stagnation in the developing world, to a collaboration in 
developing a strong response to the CMH: building uopn its sombre warning 
to the captains of capital while challenging many of its assumptions and 
conclusions.

Background
The WHO Commission on Macroeconomics and Health (CMH) was established by 
the Director-General of WHO in January 2000.  The Commission was chaired by 
Professor Jeffrey Sachs of Harvard.  It members and helpers included former 
ministers of finance, people from the World Bank, the International 
Monetary Fund, the World Trade Organisation, the United Nations Development 
Program, the Economic Commission on Africa and the Organisation for 
Economic Cooperation and Development.  The Commission was financially 
supported by the Bill and Melinda Gates Foundation, the Rockefeller 
Foundation and the UN Foundation and by the governments of the UK, 
Luxembourg, Ireland, Norway and Sweden.  The CMH presented its final report 
to Dr Bruntland in December 2001.
The Commission set up six working groups, on: health, economic growth, and 
poverty reduction;  international public goods for health; mobilisation of 
domestic resources for health;  health and the international 
economy;  improving health outcomes of the poor;  development assistance 
and health. The reports of the working groups are indexed at: 
<http://www3.who.int/whosis/cmh/cmh_papers/e/papers.cfm?path=cmh,cmh_papers&language=english>
[you may need to reconstitute this URL if it gets broken in transmission]
WHO Director-General Dr Gro Harlem Brundtland welcomed the report of the 
WHO Commission on Macroeconomics and Health on December 20th 2001:  "This 
report is a turning point," she said.  "It will influence how development 
assistance is prioritized and coordinated in the years to come."

A provisional assessment
It is a difficult report to analyse.  The argument is tortuous and quite 
selective in its use of evidence.  In places it stretches fact, logic and 
credulity to the point of combustion.  It is difficult to read the 
strategic purpose of the DG in commissioning the report and that of the 
members of the Commission in framing their presentation.  It is clear that 
the report is meant to be read at several different levels.
The core of the report is this: globalisation is on trial: unless there is 
a dramatic increase in development assistance for health care in low income 
countries the legitimacy and stability of the current regime of global 
economic governance will be seriously threatened.  It is a warning to the 
G8, the Paris Club and the Bretton Woods institutions to slow down on 
globalisation and redirect significant resources to health care in the 
poorer countries.
This is quite a finding, given the members of the Commission - which is 
partly why it is such an important opportunity for engagement.
However it is a big report and is accompanied by dozens of working group 
reports.  There is a lot of material to absorb and consider.  This raises 
questions about how Third World governments, health activists, NGOs and 
academics who had already come to this central conclusion might respond to 
the report.

A global collaboration in analysing and responding to the CMH report?
I have read the report and most of its working group reports and I have 
prepared a preliminary analysis which I have posted at:
<http://users.bigpond.net.au/sanguileggi/PrelimAnalCMHReport.html>
I hope this preliminary review will encourage people to read and think 
about the CMH report.  I hope that the perspectives that I have presented 
may be useful to others in the task of interpreting, analysing and 
critiquing the report.
However, the work involved in considering thoroughly the report and that of 
the working groups is not trivial.  The Commission had the resources of 
Bill Gates and the World Bank at its disposal.  The networks of activists, 
NGOs and academics who might wish to take the opportunity to challenge the 
logic and legitimacy of the current regime of global governance do not have 
such resources.  But we have our own experts and we are in touch with the 
current lived circumstances of different settings and different countries.
So I am proposing a global collaboration around the task of analysing and 
responding to the CMH report.
A global analysis would need a coordinating function; a systematic approach 
to analysis and critique; a coordinated approach to generating alternative 
strategies and policy principles; a process and avenues for dissemination 
and follow up.  I really don't know how these should be organised.

Process and outcomes
As I envisage it the material outcomes of this collaboration would be a 
collection of articles published in a very wide range of websites and 
journals.  They might or might not be identified as arising from this 
collaboration (which might or might not be blessed with an formal name).
I am expecting that through this collaboration people in different parts of 
the world might collaborate in producing different critiques or 
commentaries for different purposes and different audiences.
As a starter I have produced the preliminary analysis addressed above.  I 
would like to publish this commentary but I am not sure where and I would 
greatly appreciate feedback and commentary on the current draft before I do.
Perhaps the commentary might serve as a useful framework for claiming and 
allocating the work which is yet to be done.
Another framework would be the set of working papers referenced above.

A global collaborative critique?
Please read the report and my preliminary analysis and answer the following 
questions:
·       Do you agree that the report of the CMH justifies a strong and 
critical response?
·       Do you agree that we could organise and collaborate in a globalised 
analysis and response through the medium of this and related lists?
·       How does a loosely knit global community of health activists 
undertake such a project?
·       What can you and your organisation contribute to such a process?
·       Are there particular aspects of the report that you would like to 
focus upon?

Best wishes

david legge


David Legge
School of Public Health
La Trobe University, Victoria, 3086, Australia
http://www.latrobe.edu.au/publichealth/references/profiles/dgl4sph.htm
+61/(03) 9489 1934 (hm/ph); +61/(03) 9479 5849 (wk/ph)
+61/(03) 9482 1201 (hm/fx); +61/(03) 9479 1783 (wk/fx)
Mobile phone: 0408 991417
email: d.legge at latrobe.edu.au
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