PHA-Exchange> 22 In preparation of PHA II

[Claudio]

Neoliberal ideology in the World Health Organization: 

Effects on global public health policy and practice 

  

(Part 1 of 4)

Introduction

The infiltration of neoliberal ideology in WHO today is an undeniable fact and this is despite WHO's Constitution and many founding and key documents since then, which are explicitly oriented towards social justice as a solution to health problems.  The WHO/UNICEF Conference on Primary Health Care held in Alma Ata in the former Soviet Union in 1978, represented the flowering of this vision but the movement was swiftly silenced as early as 1980.  

 

There are contradictions between WHO's founding principles and the policies which have been implemented by current office holders and their predecessors over a 25 year period. A re-appropriation of this UN agency by the people only requires a return to its founding principles and values. Nothing needs to be reinvented. 

 

Moreover, there are new developments which need to be taken into account. These include massive increases in inequality between and within countries, accelerating environmental degradation, and the threat represented by the General Agreement on Trade in Services (in health and in water services, for example).  However, the fundamental principles, objectives and functions set out in WHOs Constitution (1948) and above all in the Declaration of Alma Ata (1978), are still valid today.  

 

But neoliberal approaches to health ignore root causes of both poverty and disease, betray fundamental public health principles and produce cosmetic and unsustainable results. 

 

WHO's constitution: health for all through social justice 

 Let us be reminded:

"Health is one of the fundamental rights of every human being . . ." 

"The health of all peoples is fundamental to the attainment of peace and security . . .

"Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger . . . 

"Governments have a responsibility for the health of their peoples".   

 

The principles set out in the preamble to WHO's constitution are critical to a re-appropriation of this UN agency by the people in their (genuine) effort to achieve Health for All - NOW.  Indeed, there is tremendous potential today for people's health movements call WHO to account and challenge it to respect its own mandate. Of particular interest today is the reference to governments' responsibility for the health of the people which is a principle ignored or rejected by neoliberal ideology. 

 

Alma Ata and the hijacking of Health for All 

 

The Declaration of Alma Ata clearly identified the social and economic root causes of preventable ill-health and mortality. It placed the debate squarely on international power structures and insisted on a broad public health perspective which addressed non-health sector determinants of health.  

It said:

"Economic and social development based on a New International Economic Order is of basic importance to the fullest attainment of Health for All" . . .

"Primary Health Care is the key to attaining this target as part of development in the spirit of social justice." . . . 

PHC involves "in addition to the health sector, all related sectors and aspects of national and community development. . .  and includes promotion of food supply and proper nutrition, an adequate supply of safe water and sanitation . . ." 

 

The Declaration has never been repudiated although its principles have often been disregarded during the period of neoliberal influence. The revolutionary implications of the Alma Ata Declaration and the threat that it represented to the established order were not lost by the rich and powerful. Within a couple of years, primary health care (PHC) was declared "costly and unrealistic" and was replaced by "a selective" version reduced to a few high priority technical interventions determined not by communities, but by international health experts. This allowed governments and health professionals to avoid dealing with the social and political causes of poor health and thus to preserve the inequities of the status quo.

 

Neoliberal and social justice approaches to health: a comparison 

 

      Neoliberal approach to health 

       

       

      Underlying assumptions 

       

      1.     Economic growth, within a globalized "free" market is the aim 

      2.     Health is what you get from a health service 

      3.     International aid, with conditionalities to enforce certain policies, is the only way to finance health

      4.     Democracy is alive and well in the developed world and is the model for the developing world

       

       

      Key features 

       

      ·        Addresses symptoms, short term

      ·        Promotes 'silver (medical) bullets'

      ·        Promotes interventions delivered through health services

      ·        Identifies charity and international aid as only sources of funds for health

      ·        Maintains the status quo of extreme concentrations of wealth and power 

      ·        Focuses on individual behaviour and tends to blame victims.

       
     Social justice/human rights 

      approach to health 

       

      Alternative assumptions 

       

      1.     Fair distribution and sustainable use of resources is the aim  

      2.     Health is what you get from meeting basic rights

      3.     Sovereign states must  provide for their people's rights without outside interference 

      4.     Democracy is in crisis everywhere. Self determination of nation states and a rules-based system of international governance are required 

       

      Key features 

       

      ·        Addresses root causes, long term

      ·        Promotes the meeting of people's health  rights 

      ·        Promotes public works to free people from miserable living conditions 

      ·        Identifies income redistribution and economic justice as sources of funds for health

      ·        Demands a fair and rational international economic order

      ·        Focuses on structural poverty and violence and finds the causes of them in the system.
     

 

Neoliberal reversal of public health logic and history

 

In the neoliberal approach to health, focusing on a few major diseases is said to resolve key public health problems.  But as Pasteur said: "The bacteria is nothing: the terrain is all".     

 

The relationship between health and poverty is two way but it is not symmetric. Poverty is the single most important determinant of preventable ill-health. Conversely, poor health is very far from being the single most important determinant of poverty! Poor health exacerbates existing poverty. 

 

No amount of good medical care delivered to Haitians or Tanzanians today is going to make them or their country prosperous tomorrow if the national economy is strangled by debt, unfair terms of trade and the continued pillage of natural resources and is destabilized by uncontrolled financial outflows, wildly fluctuating commodity prices and outside interference in matters of national sovereignty.   

 

On the other hand, substantial and sustainable improvements in public health are achieved by meeting the basic material needs for food, water, sanitation and shelter, as well as basic social needs for education, employment, access to land, safety and security --i.e., addressing the root causes of preventable ill-health and death. However, meeting basic needs for health requires redistribution of resources and a radical transformation of economic and political arrangements the world over. This is, of course, deeply threatening to powerful elites. 

 A.K.

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