PHM-Exch> Food for a deadly thought

[Claudio Schuftan]

Human Rights Reader 226



*IT IS NOT INEQUALITIES THAT KILL PEOPLE; IT IS THOSE WHO ARE RESPONSIBLE
FOR THESE INEQUALITIES THAT KILL PEOPLE.* (V. Navarro)



People that happen to be poor need jobs and a livelihood;

to agonize about inequality is, for them, a luxury. (M. Klein, World Bank)



1. Both Structural Adjustment and the forces behind Globalization have
fostered a polarization in a direction opposite to greater equality in
health and thus opposite to the human right to health (RTH).



2. Levels of income are lower today in more than 70 poor countries than in
the 1960s. The chronic stress arising from the resulting social exclusion is
as damaging to health as are meager income and poor access to services.
Today, around 1.3 billion people still survive on less than $1 a day.
Inequalities in health manifest themselves primarily in decreased access and
utilization of services by people who happen to be poor. In this respect,
1.6 billion people are worse off today than they were 30 years ago. But
these indicators only tell part of the story of inequality; we do not
routinely *measure other.**

*: Here is another piece of information you may use: The richest 1% of the
world’s adults, 60 million people, with assets at least half a million
dollars, own 40% of the global assets/wealth.



3. Our inaction on equality and RTH issues is explained by pure
procrastination; we simply cannot ignore the underlying
power-play-of-politics behind inequality since this would denote ‘evidential
nihilism’ (M. *Petticrew)**; we simply have to deal with the underlying
power issue.***

**: We note here something that has become one more of those iron laws,
namely that maintaining things the-way-they-are requires no good reasons
but, when presenting a better idea, efforts to shut it down brings-on tons
of ‘reasons’. (A. Caliari)



4. Globalization does not have a human face; power differentials are at its
crux. It is a process we cannot wish away. Markets reward those with
purchasing power or commodities or services to sell; people and nations that
happen to be poor have neither.



5. At a time of shrinking government expenditures in health in those
countries, the World Bank has them pushing for a greater role of market
forces in the production and distribution of health: the solution is to
commercialize, commoditize and privatize health. Market forces alone (with
people paying for their own care) have failed to deliver minimum acceptable
health care anywhere. Because people are already paying for care, the WB
assumes people are willing to pay. But willingness does not mean ability!



6. In the fee-for-service system, equality is clearly being sacrificed in
the name of a not-yet-proven-greater-efficiency. Providing health care on
the basis of need is being replaced by a system based on a
never-really-achieved cost recovery where exemptions targeted at poor people
have not worked. Safety nets are nothing but a way to manage poverty and
‘ill-being’ (as opposed to wellbeing) by attenuating social unrest.



7. Therefore, health policy makers can no longer make decisions that
conflict with the equality goal. The choice is a moral one and cannot be
made by the medical establishment only. The politics of health will override
all other efforts to bring us Health for All and respect for the RTH. (Keep
in mind that equality is the forgotten central thrust of Alma Ata).



8. We need to develop a framework for action; the costs of inaction are
enormous. We also need to demystify medical knowledge --for people
themselves to deal with health and disease.



9. It is in the interest of the RTH to counter the forces of Globalization
rather than looking for an accommodation to-fit-greater-health into an
inherently-inequitable-system. This means that a renewed commitment and
resolve to foster empowering community-based activities will have to guide
our actions. What will count are not our words, but our deeds. Growth and
equality need not be trade-offs, but progress does not come simply from
liberalizing the economics of health. The current brand of liberalization is
morally unacceptable and economically inefficient. We need to adopt new
approaches that can break the current unequal state of affairs. Claim
holders have to stop thinking that combating inequality is a luxury.



10. Perhaps the most pressing issue for claim holders to work towards the
RTH is for them to demand a universal coverage public health system in which
those who pay for it are those that have more, i.e., a progressive (as
opposed to a regressive) tax-based system.



Claudio Schuftan, Ho Chi Minh City
cschuftan at phmovement.org
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