PHA-Exchange> "Let Us Live and Let Them Die" -- ISIS on Katz

Thu Apr 12 08:51:14 PDT 2007

This article can be found on the I-SIS website at
http://www.i-sis.org.uk/

?Let Us Live and Let Them Die?
*****************************

A WHO staff member's parting salvo to the international
health agency and its neoliberal approach to health.
Sam Burcher

  Social scientist, Alison Katz has left the World Health
Organisation (WHO) after 17 years of devoted service,
condemning its ?Let us live and let them die? attitude,
which sums up the neglect of millions of people over the
past three decades, suffering and dying from diseases of
poverty, including notably HIV/AIDS [1]. She is the second
AIDS researcher to leave within the past 12 months (see On
Quitting HIV [2] this series).

?For over twenty years now, the international AIDS community
has persisted in a reductionist obsession with individual
behaviour and an implicit acceptance of a deeply flawed and
essentially racist theory.? Katz writes. She believes that
the narrow and totalitarian approach to AIDS by the WHO not
only has had negligible effect, but also has betrayed public
health principles and perversely forbidden exploration of
any alternative perspectives. Like many others, Katz
questions the exclusion of a plethora of co-factors known to
increase biological susceptibility to infection by all
disease agents, including HIV, among which are under-
nutrition, poverty, powerlessness, and the basic necessities
for a healthy and dignified life.

She believes that the WHO has fallen victim to neoliberal
globalisation, and by default, to the economic interests of
powerful nations and the transnational corporations. In an
open letter dated January 2007 [3] addressed to Dr. Margaret
Chan, the incoming Director-General of WHO, Katz set out
seven key points to steer her focus back to serving the
public, including the critical importance of addressing the
commercialisation of science, and the close relationship
between industry and academia as highlighted in ISIS'
Discussion Paper Towards a Convention on Knowledge [4].

The neoliberal approach to health
---------------------------------

There is a strong tendency in the neoliberal approach to
health ? and particularly in relation to HIV/AIDS, to blame
victims, Katz says [5], for their faulty or irresponsible
behaviour. Demeaning stereotypes, coupled with flawed
analysis, and ineffectual policies do not appear to have
contributed to any significant decrease in infection rates
in the worst affected regions such as the continent of
Africa. Furthermore, the world's first global sex survey
published in The Lancet in 2006 found that multiple sex
partners were more common in industrialized countries where
disease incidence is relatively low [6]. According to Katz,
the dominant neoliberal perspective reinforces the
structures of hegemony that create poverty and powerlessness
which are themselves the root causes of avoidable disease
and death. (Poverty eradication must be central to change
and the narrow focus to the problem is being challenged by
women in Africa (see Women Confront Aids in Africa SIS 34
[7]).

Eileen Stillwaggon, an associate Professor of Economics at
Gettysburg College USA, says that [8] the ecology of poverty
must be understood, as populations that lack access to
medical care and are already coping with parasitic and
multiple other infections, are more vulnerable to other
diseases, regardless of how they are transmitted. In this
respect, HIV/AIDS is no exception. The public health
principle, neatly summarized by Pasteur as ?the bacteria is
nothing; the terrain is all?, applies to all the diseases of
poverty. The focus on individual sexual behaviour is itself
highly stigmatising - in addition to being unscientific. On
an optimistic note, Stillwaggon observes that solutions to
the problems caused by almost all the co-factors exist, and
institutions, like the WHO are well placed to advocate for
them among vulnerable populations. ISIS has proposed many
affordable and patent-free alternative treatments to the
disease and its' co-factors in Unraveling AIDS [9]).

In order to neutralise the entrenched neoliberal bias within
international agencies Katz believes that the WHO must
return to its founding principles and advocate for attention
to root causes ? the social and economic determinants of
health and disease. In today's world, this implies
denouncing unfair rules of trade and commerce, the
exploitation of national resources, and ruthless
liberalization foisted on developing countries, all of which
have been shown to have devastating effects on the health of
populations. Furthermore, the WHO must take the lead in
providing scientific research with independent scientists
free of vested interests. To achieve its mandate of ?Health
For All?, the WHO must support serious science based on
sound evidence. Millions of people's lives are at stake.

Political prejudice within the WHO
----------------------------------

Katz worked for 12 years in the division of WHO dealing with
family, community, sexual and reproductive health, and 8
years in the HIV/AIDS department. In 1999 she responded to
an Internet discussion posting from the perspective of
biological vulnerability to HIV infection and racist
assumptions underlying current policies and strategies. Her
supervisor, on instructions from the executive director,
immediately censored her by sending an email instructing
that she must not debate this issue. At the same time she
received a request from the editor of the African Journal of
Aids Research to write up her ideas in an article [1].
Shortly after that, she was isolated from all technical work
within her department for 18 months.

Following her isolation, Katz's contract was not renewed, so
she submitted an internal legal appeal against the WHO for
reinstatement and for a proper contract after serving 11
years on 37 temporary contracts. She won the appeal on
condition that she leave the HIV/AIDS department. As a
working mum supporting three children, she had no choice but
to accept the Director General's offer.

Efforts on Katz's part to discuss alternative approaches
with the WHO HIV/AIDS programme director and the UNAIDS
executive director have consistently been declined, even
after the publication of the Lancet series, mentioned above,
which supports the perspective she is advocating.

Independence of international civil servants to fulfil WHO's
mandate
------------------------------------------------------------

Katz's concerns expanded to the question of independence of
international civil servants, which is seriously undermined
by neoliberal influence exerted through powerful member
states, private sources and extra-budgetary funding.
Pressures at this level have resulted in a repressive,
authoritarian and hierarchical management style, which
discourages free debate. Katz joined the staff association
to fight for proper contracts for all long term ?temporary
staff? - some 55 percent of the workforce. The success of
this action was limited. A very small proportion of ?false
temps? were regularized into proper contracts and then
through a major, costly ?restructuring? exercise, many of
these long serving staff then lost their jobs, often to
inappropriately qualified appointees with better
connections.

These struggles took place against what she describes as a
background of nepotism, cronyism, corruption, harassment,
financial mismanagement and chaotic, highly discretionary,
human resources management [5]. Furthermore there is an
under representation of Africans, Asians, Latin Americans,
or Eastern Europeans within staff departments. The
predominant influence of the UK, USA and Canada, as well as
Australia, and New Zealand; whose representatives are
invariably white, male, Anglo-Saxon Protestants linked by
powerful networks prevails.

WHO's first strike and out
--------------------------

Together with a small group in the staff association, Katz
organized a one hour work stoppage, the first industrial
action in WHO's history, in which 700 staff participated.
Her post was abolished three weeks after the work stoppage
and three weeks before the normal renewal of her 2-year
contract. Swiss unions and staff association lawyers qualify
this as interference in the right of association; the WHO
administration qualifies it as a ?coincidence?.

Katz believes that the WHO must respect international labour
standards, including negotiation status for the staff
association, in line with ILO (International Labour
Organisation) covenants; to provide workers with formal
power, adequate funding, and strong links to a bona fide UN
umbrella union. WHO staff should be held accountable to
WHO's 1978 constitutional mandate, to the Alma Ata
principles underlying Health for All, and to the UN Charter
and should fully understand the duties and responsibilities
of public service.

WHO's challenge to achieve Health for All
-----------------------------------------

Katz calls for a return to a basic needs and rights-based
approach to health [1] in order to provide a sustainable and
meaningful response to AIDS that is simultaneously a
response to all the diseases of poverty. An alternative
political strategy for AIDS and its co-factors would embrace
macroeconomic reforms for a fair, rational and sustainable
international economic order so that democratically elected
governments may reasonably meet people's basic needs,
including health, without external interference.

In her open letter [3], Katz urges WHO's newly elected
Director General, Dr Chan, to address the following major
issues in order to fulfil her vision. A focus on inequality
rather than poverty; holding meetings and consulting with
the poor rather then the rich; a solid, equitable tax base,
nationally and internationally, rather than public-private
partnerships; knowledge for the public good rather than
corporate ?science?; respect for ethical values and an
appropriate balance between loyalty to WHO's constitutional
mandate and loyalty to current governments of powerful
member states and current office holders.

Read the rest of this article here
http://www.i-sis.org.uk/LULALTD.php

-- 
Wim De Ceukelaire, coordinator of intal's international partnerships
wim.deceukelaire at intal.be | tel.: +32 2 209 23 55 | fax: +32 2 209 23 51
| mobile: +32 484 119231 | skype: wimdeceuk
intal – http://www.intal.be | http://www.g3w.be – Globalize Solidarity!

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