PHA-Exch> Health for All or Health for Half?

[Claudio Schuftan]

** <http://www.kabissa.org/>   From: "Wim De Ceukelaire"
<wim.deceukelaire at xxxxxxxx>

Health for All or Health for Half?

The People's Goals go beyond Mediocre and Disappointing Generalities.



The Millennium Development Goals (MDGs) are high on the agenda of summits
and conferences and are heavily influencing the development discourse of
multilateral agencies and NGOs. Health figures prominently in the MDGs as
almost half of them relate directly to health and health is an important
contributor to the other goals. According to Dr. Lee Jong-Wook, the
director-general of the World Health Organization (WHO): "Improvements in
health are essential if progress is to be made with the other Millennium
Development Goals." As health is so important for the MDGs and the goals are
so intimately related with health, we have ample reason to take a closer
look at them and at their background.



Where do the MDGs come from?



The Millennium Development Goals are the result of the United Nation's
Millennium Summit that was held in September 2000. This summit was an
attempt to put the UN back at the forefront of the international political
and economic relations in the new century after the organization had lost
much of its influence during the 1990s. At the end of this meeting, the 147
Heads of State and Government who were present adopted the Millennium
Declaration that is supposed to reflect their commitment to development and
poverty alleviation. This commitment was summarized in eight goals related
to poverty alleviation and development that are to be attained by 2015. For
each of these eight goals, the UN has formulated targets that are made
measurable by a set of 48 indicators.



Although the MDGs are a UN project the origins of the goals are to be found
in an organization that defends the interest of the industrialized
countries. It was the Development Assistance Committee of the OECD, the club
of rich countries, that pioneered the idea of "International Development
Goals" in 1996. After approval of the IMF and World Bank, they were adopted
as the MDGs in the Millennium Declaration. To a large extent, the MDGs are
the goals of the industrialized countries.



Moreover, the MDGs are a rehash and reformulation of development goals that
were originally set (and not met) for the year 2000. For example, in 1990
primary education for every child was set as a target for 2000 but in the
MDGs, the same target is given a new time frame and should be achieved by
2015. Sad to say, the reality is even worse. According to the 2003 Human
Development Report, the target will not be attained before the end of the
21st century.



What is to be eradicated?



Knowing that the MDGs largely reflect the development agenda of the
industrialized world and are a watered down version of earlier international
goals it is not surprising that they are criticized for lack of ambition.
Indeed, a closer look at the goals reveals they are far less ambitious than
it seems. For example, the first goal is to "eradicate poverty and hunger".
According to the corresponding target, however, this will be achieved by
halving the proportion of people living on less than US$ 1 a day and  the
number of people who suffer from hunger by 2015. Take note that the plan is
to halve the proportion of the poor and not the actual number. Because of
population growth, absolute numbers will not be cut in half. Moreover, the
base year is not the year 2000, as one would expect, but 1990, which makes
the plan even less ambitious.



Although they are supposed to be development goals, the MDGs refer to
hunger, poverty, child mortality etc. These are the consequences of
mal-development but that doesn't mean that development will be brought about
by their eradication. The absence of poverty and hunger, even if they would
be possible, doesn't necessarily mean that society is developed, let alone
that a sustainable state of development has been brought about.



Are these development strategies?



The focus on measurable indicators reflects a certain attitude towards
development. It considers development as a 'technical' problem that should
be solved by 'technical' solutions. That is for example the consequence of
the World Bank's US$ 1 a day threshold as a measure of poverty. In theory,
poverty would be eradicated as soon as per capita income exceeds US$ 1 and
yet many people would still be poor. In reality poverty is much more
complicated and is not only a matter of income. Being poor is about a lack
of power, assets, autonomy, participation, security, welfare, etc. Fighting
poverty is about the peasants' struggle for land, about the workers' demand
for regular contracts and about the slum dwellers' rally for an own house.



It is exactly because of this erroneous focus on 'technical' approaches that
the solutions that have been offered are likewise focusing on "quick wins".
In fact many efforts are wasted on calculating how much money would be
required to solve this or that problem as if it is only a matter of money.
In 2001 there was the WHO Commission on Macroeconomics and Health that
called for US$ 27 billion in annual donor funding. In January 2005, Jeffrey
Sachs' Millennium project called for US$ 73 billion extra in 2006, rising to
US$ 135 in 2015 to achieve the MDGs. Recently, researchers in The Lancet
estimated it will cost US $ 5.1 billion to prevent 6 million child deaths,
etc... Is it really just a matter of money?



What global partnership?



It goes without saying that only poor countries are being monitored
scrupulously for their progress with regards to the MDGs. Multilateral
institutions like the World Bank and the IMF are using the MDGs already as a
yardstick and condition for loans and aid. Still, one of the MDGs, number 8,
also refers to the rich countries. They are supposed to join a 'global
partnership' to attain the other MDGs. This goal does not have any concrete
targets, however, but only vague promises. There is no promise of
'eradicating' debt, for example, or even halving it. The rich countries are
only supposed to "deal comprehensively with the debt problem to make debt
sustainable in the long term"--a formulation that means different things to
different people.



The 'global partnership' is touted as the linchpin of the MDGs but it might
be its Achilles heel instead. The governments of the Rich and the Poor
countries are supposed to work hand in hand with the multinationals in order
to bring about a better world. It sounds like a fairy tale and it might as
well be one. Is it really realistic to expect the plunderers to repent and
help their victims?



This kind of reasoning is only possible because the MDGs are focusing on the
consequences instead of the causes. The whole Millennium Declaration does
not make any reference to the causes of poverty and hunger. It is not
surprising therefore that the MDGs fail to provide any hint of a solution.
In reality, the poor and the hungry are the products of historical processes
of marginalization, mal-development and exploitation. Addressing poverty and
hunger requires addressing these forces and processes that are at the roots
of inequity and marginalization.



As the root causes of poverty and hunger are not addressed, the forces of
globalization have only intensified during the past decade. Consequently,
progress for most development indicators has been minimal during the 1990s
and definitely not fast enough to attain the targets. Child mortality
decreased much faster in the period 1960-1990 than in the 1990s when the
average annual improvement of 2.5% slowed down to a mere 1.1%. The same goes
for maternal mortality, and access to potable water and sanitation. For
AIDS, malaria and other diseases, the situation even deteriorated.



The People's Goals for health



In the field of health, there are already millennium goals for more than 25
years. In 1978, at the Alma Ata Conference, ministers from 134 countries in
association with WHO and UNICEF called for 'Health for All by the Year
2000.' The Alma Ata Declaration reaffirmed the WHO's holistic definition of
health as "a state of complete physical, mental and social wellbeing, and
not merely the absence of disease or infirmity." Moreover, it went on to
signal that the "existing gross inequality in health" was unacceptable, that
people have a right to participate in the organization and implementation of
health care, and that primary care should be universally available. Finally,
signaling the responsibility of governments for health, the declaration
launched the ambitious goal of "health for all" by the year 2000.



At the turn of the century it became clear that the world was farther from
this goal than ever and that governments and world leaders had not delivered
on theor promises. For them it was a reason to rehash them and integrate
them into the Millennium Development Goals. Apparently they wanted to forget
Alma Ata as soon as possible and burry the promises in the general MDGs. For
the people's movement, however, the year 2000 was an occasion to come up
with the  People's Charter for Health that reaffirms the principles of the
Alma Ata declaration.



With all the hullabaloo about the MDGs, we have to keep our priorities
right. Of course the promises of the Millennium Declaration are welcome but
they are also too little too late. Moreover, the MDGs should not make us
forget that the people are not contented with health for half when 'health
for all' is possible. The Alma Ata Declaration and the People's Charter for
Health are leading the way.



 **
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20080402/44f8dfc0/attachment-0001.html>