PHA-Exchange> bangkok charter :vote for rejection and why

[Claudio]

bangkok charter :vote for rejection and why

Some more comments received on the Bangkok Charter. 


I would recommend PHM not endorsing this charter. Among dozens of points I will just highlight three: those who are  familiar with the arguments will only need to read the titles in bold. Sorry to be so lengthy but I think it is important. 

1. The repeated references to the private sector as "critical to the achievement of health" or as a vital "partner" in health promotion.

The reality is that the private sector means TNCs, which have been clearly identified as major obstacles to Health for All. It is time to state that explicitly and stop repeating these mindless mantras about the importance of involving the private sector. What is important is drastically curtailing the illegitimate influence and control in ALL policy making and removing the private sector as partners (as they do not share the same goals!!!) .  

We have to clarify once and for all some fundamental democratic principles. In this text (as in all othe "lite" "humane" neoliberal texts) society consists of government, civil society and the private sector. Why ? Why not for example the public sector? Why not associations of health workers? Why not the unions or peasant's federations? 

All citizens are involved and concerned in health matters as individuals but for reasons of conflict of interest, various groups are explicitly excluded as partners in public policy making. Note that TNC employees or their CEOs enjoy the same rights as any other citizens but not as representatives of the financial interests of their company. 

Interactions with the private sector are important of course but they take place only under the authority of the sovereign (the people) through their elected representatives (leaving aside imperfections of our "democracies") and this would include consultation to obtain needed information, certain expertise or to discuss provision of services or goods to be delivered etc etc. Never in the formulation of policy.

The private sector has a legal obligation to make a profit for shareholders. This is certainly a critical subject for law reform and perhaps we need to return to the idea of companies having to show that they play a socially useful role and fulfil a public need in order to have the right to operate. However, meanwhile, the private sector is subject to laws and regulations which need urgently to be properly enforced. Legally binding restrictions apply to them as do human rights obligations. Much new legislation is required of course but even today, enforcing what exists would enormously improve the situation of the poor. I would we need to solidly reject the whole concept of social responsibility as a sort of voluntary mechanism and "a plea to industy to be good and nice" and insist on legally binding measures to societal actors who are emphatically NOT partners in public policy making. 

2. The reversal of public health logic and history (again and again this nonsense) 
"Health determines socioeconomic and political development". It simply does not! And this position is promoted in order to avoid addressing structural poverty, inequality and violence which are the direct causes of suffering on earth.  

The relationship between health and poverty is two way but it is not symmetric. Poverty is the single most important determinant of poor health. But poor health is very far from being the single most important determinant of poverty. Poor health exacerbates existing poverty. Both the vicious cycle and the 'virtuous' cycle of health and poverty are misleading images, as they imply equal weight of the two poles of health and economic development. 

No amount of excellent medical interventions delivered to Haitians or Tanzanians today are 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 destabilized by uncontrolled financial outflows, wildly fluctuating commodity prices and outside interference in matters of national sovereignty.   

Haitians and Tanzanians receiving medical treatment today may survive where others die - in very precarious conditions, allowing them to contribute valiantly for a couple more months to gross national product (GNP) - until the next bout of illness. Unless of course, while the medical technology is being delivered, attention is being paid to the underlying causes of the population's poor health status, such as miserable living conditions. 

3. Completely absent from the analysis (if it can be termed as such) are actors, causes and clashes of interests: this text, like all the others emanating from establishment circles is "apolitical" (but supporting the status quo so in fact highly political - just not acknowledgeing it), ahistorical and amoral. The time has come for honest political brokering in which we state our moral values and principles upfront and the political action required to work towards that moral vision. (It used to be called socialism and it needs to be reappropriated from the Blairs and Schroders of this world). 

   
  

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