PHA-Exchange> Food for a thought that twists the logic (3)

[Claudio]

Human Right Reader 112

 

The Sachs Macroeconomics and Health Report: Investing in health for economic development or increasing the size of the crumbs from the rich man's table? 

(Part 3 of 3)

 

Justifying the reversal of logic: 

 

35. We consider it a reversal of logic that attention in the Report is directed primarily to a few highly prevalent diseases of poverty hoping that conquering them will revert the sorry situation we are in now and that that will ultimately create prosperity for all; this is perhaps the central thesis of the Report. It somehow would have us believe that the recommended health interventions will 'jump start' the economies of poor persons in poor countries. 

 

36. But we counter-argue:

·         Poverty is very likely to make poor persons ill repeatedly of a host of many diseases --and the chances are quite high that one of these, together with malnutrition, will kill them prematurely. 

·        When poor people are in good health, and live in miserable conditions, this is usually only a temporary state. 

·        Neither health nor illness make countries rich or poor; it is way more complex than that.

·        Mainly targeting the main killer diseased is not a sustainable solution to the poor countries' health problems. It will take more than "each time a person falls ill, they will get the appropriate medicines". 

·        In short, health may rhyme with wealth, but unfortunately it is not wealth. Good health does not automatically lead to wealth.

 

37. The problems that really need to be addressed are mediated through mostly macroeconomic measures that the Report was supposed to address more frontally, but doesn't:  international transfers (e.g., debt, unfair terms of trade and Northern protectionism, tax havens and capital flight, free trade zones); SAPs and PRSPs; direct foreign investment; intellectual property rights and TRIPS; the brain drain; and finally, as aid earlier, aid itself.  It is important to add here that there is a striking disproportion between the sums which could reasonably be raised through international aid --usually not exceeding millions-- and the sums which would be released through simple macroeconomic measures --that is billions.     

 

38. The losses incurred through unfair terms of trade have been devastating, for example.  The rewards of liberalizing world trade are immensely skewed towards the rich..and we want to concentrate on killer diseases? 

 

39. Need another example?  Take ATTAC (Action pour une Taxe Tobin pour Assister les Citoyens); it fittingly reminds us that the major bankruptcies of the capitalist world have been absorbed by the state --in other words have been paid for by the people. 

 

40. Not being facetious, debt provides the North with the political and economic leverage that makes it far too valuable for cancellation. For every dollar received in aid, three go back to rich countries to service the debt. This is how debt itself --which can be seen as bonded labour at the level of nations-- becomes a major impediment to development.  So, debt is actually an obstacle to development that the North continues to impose on the South. As Groucho Marx would have said, the North tells the South: "These are my principles. If you don't like them, I have others". 

 

41. Ethically, we are for asocial justice approach to health. For us, ends are only justified through the use of certain means. A characteristic of an ethical principle is that it is absolute. It can neither be diminished, modified, nor disproved with formulae, models or diagrams, all these so cherished by mainstream economists. Economic reality cannot be fitted into diagrams or econometric models (perhaps in an attempt to make principles more attractive to investors?).

 

42. But in the Report, growth, market economies, competition, decentralization, cost containment, foreign investment --even public private partnerships-- are all presented unquestioningly as desirable. But all of these are means to an end, one that is never made explicit. 

 

43. The Report's dubious incursions into the field of ethics reveal at best a shallow grasp on international affairs, but at worst, an inexcusable ignorance or simply arrogance.

    

Asking the ultimate question: Why this Report?

 

44. This question only brings-on some more questions; a response evades us.

 

45. Is a discussion of the structural determinants of poverty and inequity and, in turn, of ill-health and preventable mortality threatening to the Report's authors? Or, Does it threaten the existing order?   

 

46. Did the Report start out just to provide modest relief to the poor so as to defuse a potentially more dangerous situation? Misery is destabilizing, we know that much. If the proposals set forth dampen that spark, will they have served the status-quo? They certainly would not serve the cause of global social justice and human rights.     

 

47. We are worried; worried that the espousal and promotion of a bad set of solutions can inflict great suffering on a large number of our fellow human beings. Was blind faith or blind self interest the driving force behind this Report? Whatever the answer, it is our duty to reject its key prescriptions and embrace the alternative thinking and strategy here sketched. 

 

Playing god? 

 

48. Clearly, the era of hidden agendas is over. If today the purportedly apolitical and ahistorical discipline of macroeconomics explicitly promotes and legitimize corporate-led capitalist globalization --including its application to the health sector-- it behoves us to speak up forcefully. This is what these three Readers have attempted. 

 

49. Today, the struggle for health as a right is a struggle against the mechanisms, structures and processes of impoverishment and deepening inequity. 

 

Claudio Schuftan, Ho Chi Minh City

claudio at hcmc.netnam.vn   

Extracted, adapted and paraphrased from the article by the same name by Alison Katz. 

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