PHA-Exchange> A didactic exchange of emails

[Claudio]

> Hello,
I am living in Paris. I'm actually ending my medical studies and working on
the subject of my Ph-D.
> I'm particularly interested in the impact on health of the policies of the
IMF and of the World Bank, as well as the impact on health of the trade
agreements conceived by
the WTO.
>More precisely, I do not want to study the impact of those policies and
agreements on health care systems, as I think that the debates often
concentrate on those
issues, whereas the health determinants are mostly affected by the social
and economics changes.
> I am searching for information. I discovered and read with great
enthousiasm the report  of Evelyne Hong written for the People Health
Assembly, "globalisation and the impact on  health, a third world view".
Through the PHA exchange list, I also came to know about the assessment of
the impact on health of the PRSP process.
> So my questions are:
> - do you have more informations about the ongoing evaluation of the impact
on social issues of the HIPC initiaitive?
> - can you advice me some specific books about the impact on health (and
others social issues) of the SAPs (except the SAPRIN report that I have
already)?
> Moreover, I would be really interested to discuss with professionnals
interested by those problems.
> I thank you in advance,
Julie.

> Dear Julie,
>
> It is good to hear from young people wanting to do research on the impact
on health policies of the IMF, WB and WTO.  Good to know that you are
focusing
on the impact of these policies on health determinants.
>
> In this context, you may wish to consider the right to health as a
fundamental human right.  And you can quote Kofi Annan, UN Secretary General
"It is my aspiration that health will finally be seen not as a blessing to
> be wished for but as a human right to be fought for".  In this context
article 12 of the International Covenant on Economic, Social and Cultural
Rights (ICESCR) is relevant.  This article interprets the right to health as
> an inclusive right extending not only to timely and appropriate healthcare
but also to the underlying determinants of health such as access to safe and
> potable water and adequate sanitation, an adequate supply of safe food,
nutrition and housing, healthy occupational and environmental condition and
> access to health related information.
>
> The policies of WB, IMF and WTO have an adverse impact on all these
determinants of health.
>
> Why is it that the Human Right to Health still remains so far from being
realized?  Why should you fight for it as the UN Secretary General has said?
> Your thesis should give an answer why & how.
>
> The reason in my opinion is that the WB, the newest and strongest player
in  international health, has convinced health policy planners' that the key
obstacles to achieving Health for All are economic.  In this process the WB
> has put into reverse gear the global debate on HFA by focusing on a very
market oriented concept of Human Health.  The World Development Report,
1993, "Investing in Health" described a Master Plan for making health cost
effective.  To support its thesis the Bank created and economic jargon
"DALYS" or Disability Adjusted Life Years".  Very few health planners
> understand this but all including WHO, have accepted it.
>
> I suggest you go through the document, "The Disability - Adjusted Life
Year"  (DALY) Definition, Measurement and Potential Use".  The abstract may
mislead you.  The conclusion on pages 11 & 12 are revealing and you can
download it.
http://www.worldbank.org/html/extdr/hnp/hddflash/workp/wp_00068.html
>
> Another market oriented approach was the Commission on Macro - Economics
and  Health.  Dr Gro Harlem Bruntland a former Director - General of WHO,
> requested Prof Jeffrey Sachs & a team of Economist to assess the place of
health in global economic development.
>
> They produced a report.  This was one more mail on the coffin on the Alma
Ata Declaration on HFA. MedAct has prepared a response you will find useful.
>
> The WB & IMF introduced Structural Adjustment Programme (SAPs) in the1980s
and forced it on to indebted developing countries.  Which developing country
> is not indebted and unable to keep up the scheduled repayment?  Well one
condition for WB/IMF loan was implementing SAPs.  In about five year, the
SAPs reversed all the gains in health achieved by developing countries
particularly those in sub-saharan, Africa over
> the previous 15-20 years.  It took WB/IMF a very long time to accept the
failure of SAPs.  The Economists in WB & IMF invented a more civilized
term - PRSPs.
> These were to be prepared by the countries themselves.  What is not
published is that these are remote controlled in Washington.  A report you
> will find useful is "Pushing the boundaries: health and the next round of
PRSPs" published by WEMOS and MedAct June 2004.
>
> The report attempts to assess whether health has benefited from PRSP
process  launched 5 years ago.  One particular focus in this paper is very
relevant
> to your proposed thesis.  The authors argue that Health cannot be secured
by health sector above.  Health advocates should look beyond the boundaries
of
> the health sector and join others calling for polices that reduce social
and economic inequities.  Contact Wemos for this publication.
> This may be the reference you found through PHA exchange.  These are my
rambling thoughts in response to your request.
> Best wishes,
> Dr Bala