PHA-Exch> Statements PHM finds positive and important in the exec summ of the CSDH Report

[Claudio Schuftan]

From:  katz.alison at gmail.com and  cschuftan at phmovement.org

 Here are snippets picked from the exec summ of the report. Even if taken
out of context they convey a message. See if you agree.

  *Page 1:*Systematic differences in health judged to be avoidable by
reasonable action are unfair.

A matter of social justice...

An ethical and political imperative..

Social injustice is killing people on a grand scale.

CSDH was set up to (….) and to foster a global movement to achieve it
(health equity).

Health equity . . . is affected significantly by the global economic and
political system.

The poor health of the poor, the social gradient in health within countries
and the marked health inequities between countries are caused by the unequal
distribution of power, income, goods and services, globally and nationally.

 *Page 2: *This unequal distribution of . . .  is the result of a
combination of poor social policies and programmes, unfair economic
arrangements and bad politics.

The global community can put this right.

Deep inequities in the distribution of power and economic arrangements
globally are of key relevance to health equity.

Growth by itself without appropriate social policies to ensure reasonable
fairness in the way its benefits are distributed, brings little benefit to
health equity.

 *Page 3: *Tackle the inequitable distribution of power, money and resources
- the structural drivers of those conditions of daily life, globally,
nationally and locally.

This requires a strong public sector that is committed, capable and
adequately financed.

 *Page 6: *Address rural land tenure and rights; ensure rural livelihood.

 *Page 7: *Initiatives that strengthen the representation of all workers.

 *Page 9: *The Commission considers health care a common good, not a market
commodity. Virtually all high income countries organize their health care
systems around the principle of universal coverage.

The Commission advocates financing the health care system through general
taxation and /or mandatory universal insurance. Public health care has been
found to be redistributive in country after country. The evidence is
compellingly in favour of a publicly funded health care system.

Health care systems have better health outcomes when build on PHC - that is
both the PHC model that emphasizes locally appropriate action across the
range of social determinants where prevention and promotion are in balance
with investment in curative interventions and the emphasis on the primary
level of care with adequate referral to higher levels of car according to
need.

 *Page 10: *Set up universal coverage of quality health care services
focusing on PHC.

. . . . ensuring universal access to care regardless of ability to pay.

Inequity in the conditions of daily lives is shaped by social structures and
processes; the inequity is systematic, produced by social norms, policies
and practices that tolerate or actually promote unfair distribution of and
access to power, wealth, and other necessary social resources.

 *Page 12: *Public finance to fund action across the social determinants of
health is fundamental to welfare and to health equity.

Evidence shows that the socio-economic development of rich countries was
strongly supported by publicly financed infrastructure and progressively
universal public services.  The emphasis on public finance given the marked
failure of markets to supply vital goods and services equitably, implies
strong public sector leadership, and adequate public expenditure. This is
turn implies progressive taxation - where evidence shows modest levels of
redistribution having considerably greater impact on poverty reduction than
economic growth alone.

 *Page 13: *Health is not a tradable commodity. It is a right and a public
sector duty.

The commercialization of vital social goods such as education and health
care produces health inequity. Provision of such vital social goods must be
governed by the public sector, rather than being left to markets.

There needs to be public sector leadership in effective national and
international regulation of products, activities and conditions that damage
health or lead to health inequities.

The Commission views certain goods and services as human rights - access to
clean water, for example, and health care. Such goods and services must be
made available universally regardless of ability to pay. In such instances,
therefore, it is the public sector rather than the market place that
underwrites adequate supply and access.

* **Page 14: *Conditions of labour and working conditions are, in country
after country from rich to poor, all too often inequitable, exploitative,
unhealthy and dangerous.

The Commission urges that caution be applied by participating countries in
the consideration of new global, regional and bilateral economic  - trade
and investment - policy commitments.

. . . allowing signatory countries to modify their commitment to
international agreements if here is adverse impact on health or health
equity, should be established at the outset with transparent criteria for
triggering modification.

 *Page 16: *Social inequity . . . .signals not simply difference but
hierarchy and comparative advantage and reflects entrenched inequities in
the wealth, power and prestige of different people and communities.

Any serious effort to reduce health inequities will involve changing the
distribution of power within society and globally, empowering individuals
and groups to represent strongly and effectively their needs and interests,
and in so doing, to challenge and change th unfair and steeply graded
distribution of social resources (the conditions of health) to which all, as
citizens, have claims and rights.

 *Page 18: *Dramatic differences in the health and life chances of people(s)
around the world reflect imbalance in the power and prosperity of nations.

. . . alarming stagnation and reversal in life expectancy in sub-Saharan
Africa and some of the former Soviet countries.

. . . as global economic policy influence hit social sector spending and
social development hard.

. . . it is imperative that the international community re-commits to a
multilateral system in which all countries, rich and poor, engage with equal
voice. It is only through such a system of global governance, placing
fairness in health at the heart of the development agenda, and genuine
equality of influence at the heart of its decision making, that coherent
attention to global health equity is possible.

 *Page 20: *The role of governments through public sector action is
fundamental to health equity.

 *Page 21: *Supporting equitable participation of Member States and other
stakeholders in global policy making.

Setting goals on health equity and monitoring progress on health equity as a
core development objective between and within  countries.

Underpinning action on the social determinants of health and health equity
is an empowered public sector based on principles of justice, participation
and inter-sectoral collaboration.

 *Page 22: *Strengthening revenue through improved progressive domestic
taxation.

We think, we would NOT have found many of such statements in the Sachs
report.

We must now focus on the logical conclusions of the above in terms of issues
for implementation. The exec summ is quite a bit more shy on these.
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