PHA-Exchange> 23 In preparation of PHA 2

[Claudio]

Neoliberal ideology in the World Health Organization: 

Effects on global public health policy and practice 

  

(Part 2 of 4)

Four flawed assumptions

 

a) 'Economic growth is the aim'

 

Economic growth is not necessary related with improvements in health nor with improvements in human welfare generally. However, the international health community continues to present growth --through Globalization and free market policies-- as the aim with the assumption that benefits, including improved health, will trickle down to the poor (even though such a theory has long been discredited).  

 

During the period of Globalization and free market policies predominance, not only have poverty and inequality between and within countries accelerated, but social progress, including in public health, has declined. Neoliberalism fails to distinguish between two periods: 1960-1980 and 1980 -2000. In the latter period, per capita GNP growth has been considerably worse in all countries and the poorest countries experienced negative growth and considerably slower progress in life expectancy and infant and child mortality.  Many authors have stressed that "these results cannot be explained by the AIDS pandemic". This correction is important because the neoliberal establishment has conveniently identified AIDS as the cause rather than the result of the poverty, hunger, devastation and chaos experienced by sub-Saharan and other countries.   

 

Furthermore, economic growth is not synonymous with a sustainable and equitable use of resources which is a prerequisite for peace, social justice and public health. If the international health community is serious about Health for All -NOW, it cannot continue to ignore alternative economics. It should not be forgotten that the Alma Ata declaration in effect endorsed "distribution economics" through its support for a New International Economic Order.  

 

The link between fair and sustainable use of the earth's resources and countries' capacities to meet people's basic needs for health is undisputable in ethical and common sense terms --and as the accumulated evidence shows.  Basic health needs, including a safe environment, can only be met for all the world's people if scarce resources are distributed fairly and produced and consumed carefully. 

 

In the social justice and human rights approach to health featuring a reappropriation of WHO by the people, the economic growth paradigm must be replaced by a fair distribution and sustainable use of resources paradigm as the underlying economic arrangement for needed changes in health and development. 

 

b) 'Health is what you get from health services'

 

For neoliberals, health is achieved and health problems are solved by delivering  technical interventions through health services.  In a great number of UN and WHO documents, there appears to be no recognition that the major interventions required for improvements in public health status lie outside the health sector.  WHO's own figures, year after year, show that determinants of disease in poor countries today are roughly the same as they were in today's rich countries 100 years ago.

 

50-70% of lower respiratory infections, diarrhoeal disease, malaria and measles (the big killers) in childhood are due to undernutrition. 88% of diarrhoeal disease is due to unsafe water, sanitation and hygiene, and 99% of deaths due to these risk factors are in developing countries. 

 

It would appear that classic public health lessons are not regarded as applicable to poor countries today. The international health community has been recommending technologies to fight disease in developing countries for at least two decades - drugs, bed nets, condoms and the like --in short, cosmetic, unsustainable, stop gap measures. 

 

The neoliberal establishment never acknowledges that poor countries today may wish to rid themselves of the scourge of disease reliably and once and for all (just as the rich countries did) rather than for a couple of months --while supplies of donated drugs or vaccines last.

 

It should not be assumed that this is some kind of unfortunate mistake. Like all the policies proposed for poor countries by the international financial institutions, such prescriptions reinforce existing power balances and mostly serve those who design them.  

 

Another peculiarity of the neoliberal approach to health is the obsession with research to develop new technology and to "improve the evidence base".  If the aim is to reduce the greatest burden of disease, which everyone agrees is attributable to unclean water and malnutrition, no new evidence is required. 

 

The interest in developing new technologies is twofold:  It represents an additional diversionary tactic --this time from the simpler solutions that exist-- and it is of considerable interest to transnational corporations especially those in the pharmaceutical products and medical equipment business. 

 

In conclusion, it is argued that the underlying assumption 'Health is what you get from a health service' should be replaced with the alternative approach that states that Health is what you get from meeting basic people's needs,  PHC included.  

 

c) 'International aid is the only way to finance health'

 

A frequent omission from UN and WHO texts on health, poverty and development is the concept of distribution of wealth in the world. A narrow and static vision of economic arrangements in the world is proposed in which there are rich, donor nations and there are poor, recipient countries with no connections made between the two. The social justice approach to health rejects poverty as a fact of life and focuses attention on impoverishment as a process which is inherent to capitalist accumulation and the inevitable concentration of power and wealth. 

 

In neoliberal thinking, the only source of financing for health action in developing countries is international aid or charity. Given the pitiful levels and questionable value of international aid, this perspective is deeply flawed. 

International aid is not designed to change the structure and dynamics of relations between North and South. On the contrary, it is fully integrated into the current international financial architecture in terms of its goals and values. Aid brings more money back to the donor country than is actually 'donated' --and it inevitably results in undue influence if not outright interference in public policy (including national health policy) in the recipient country.

 

There is a striking disproportion between the amounts raised through international aid and the amounts which would be released through simple macroeconomic measures to halt and then reverse the flow of resources from South to North.  International aid totals around US$ 50 billion annually.  In 2001, indebted countries paid out US$ 382 billion to service their debts. UNCTAD estimates that developing countries lose US$ 700 billion annually from unfair trade. And US$ 160 billion could be raised annually if earned income from offshore accounts were taxed.     

 

The social justice approach to health rejects the assumption that international aid is the way to finance health and proposes as an alternative approach: A fair and rational international economic order so that sovereign states may meet the needs of their people sustainably and without external interference. Such an approach is respectful of human rights, national sovereignty and democracy and offers a sustainable and equitable perspective on health and development. 

 

d) 'Representative democracy respects human rights'  

 

Many UN and WHO documents purport to convey faith in democracy, fairness and respect for human rights --as practiced today in rich countries and preached to poor countries. Ironically, many of these texts and in particular those addressing health, poverty and development, prescribe to countries a very particular strategy  in matters which are properly of national sovereignty (e.g., budget levels for health or choice of overall economic policy).  

 

There is a crisis in democracy today (nationally and internationally) which goes far beyond the minor imperfections which have always been acknowledged and are occasionally addressed. The more imperfect our democracies become, the louder our leaders proclaim their attachment to its principles. Behind the scenes, many of them violate its most fundamental principles with increasing impunity.  At the same time, all five of the indivisible human rights (political, civil, social, economic and cultural) are grossly violated by the same forces which are undermining democracy.

 

At the international level, gross interference by the powerful nations, in particular the USA, in the democratic processes of developing countries is well documented. Suffice it to say that almost every legitimate people's movement for democracy in developing countries has been crushed --with violence that ranges from sudden, extreme and overt to slow, long, drawn-out and covert. 

 

It is argued that the neoliberal approach to health is more or less antithetical to a social justice and human rights based approach to health. WHO faces the considerable challenge of reconciling the irreconcilable - namely its own Constitution and the UN Charter with neoliberal ideology and policy as imposed by the IFIs, in particular the World Bank --which is today the major player in global health policy making.

 

The policies the WB promotes (and imposes through other IFIs) are:  a retreat of the state, privatization of national assets, deregulation (which in effect removes key areas of the economy from democratic control), and export-oriented production at the expense of national self sufficiency. They  would all appear to be incompatible with sustainable development and indeed with democracy and human rights. 

 

The assumption that the powerful nations responsible for today's world order are models of democracy and respect for human rights must be recognised for what it is: pure propaganda.  

AK
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20041220/6c172b68/attachment-0001.html>