PHM-Exch> Donors urged to tackle leading killer of under-fives (3)

[Claudio Schuftan]

From: Slim SLAMA Slim.Slama at hcuge.ch


Interesting and important debate, indeed. I see that after having played
a leading role in the evolution of health promotion, Canada seems to
take the lead in this discussion.

Commenting on the last post from Ronald Labonte: "we must always try to
frame our health arguments around the historic and contemporary
practices of power and privilege that allocate wealth and health to
some, and poverty and disease to others. Regardless of disease."

To understand comtemporary practises, it is interesting to look at how
major donor countries have themselves engaged into the debate in their
own countries. Currently doing my MSc in Public Health at LSHTM, I have
the opportunity to better understand how the recent neoliberal reforms
within the NHS have contributed to reshape the debate both locally and
abroad. The important point of entry is what Ted Schreker' refered to as
the  "scarcity rhethoric".

In UK, since the Griffith report and the adoption of the 'new public
management' within the NHS, the current debate pretty much focuses on
priority setting (or more emotionally worded) rationing, assuming that
resources are "naturally" finite and scarce. Having set these
boundaries, the debate moves then to discuss whether rationing should be
made explicit or not. Whether resource scarcities could result from
policy choices or other unfair social arrangements doesn't enter the
equation.
Instead of challenging the policy choices that were responsible of this
unbalanced distribution, many public health practitioners concentrate
their analysis on how to establish a  fair process for priority setting
(what Norman Daniels and Jim Sabin have called "The accountability for
reasonableness" (BMJ 2000;321(7272):1300 (25 November), doi:10.1136)

More worrisome, frontline workers, PCT directors  and communities finish
to bargain within this given framework, negotiating access at the
margins rather than struggling for more resources according to their
needs.

The call for rationality and objective assessment through the creation
of specific commissions or institutes (NICE) doesn't  seem to have
resolved the ethical dilemma. The last avatar of these reforms, The
World Class Commissioning (new form of commissioning health services in
UK)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085148
)
will not change anything to the problem.
A sobering situation shared by many OECD countries that tend to export
their problems when dealing with resource allocation issues.
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