PHM-Exch> Is this something to be denounced and opposed? (3) PHM statement re-posted

[Claudio Schuftan]

*A statement from the People’s Health Movement for*

*Making Partnerships Work for Health*

*World Health Organization *

*Geneva**, 26-28 October, 2005*



The People’s Health Movement has been invited to present briefly on
innovative partnerships within the track of this meeting called Making Every
Woman and Child Count. The position that we present today applies to all
areas of health.



PHM identifies exploitation and marginalization of the poor as root causes
of preventable disease, malnutrition and death and in this and many other
respects, women and children are particularly vulnerable. This awareness
guides all of our work including our position on partnerships for health.



We start with *a simple observation.  Partners in any endeavour must
genuinely share a common goal. * If they do not, the interaction is not a
partnership and its precise nature must be made clear for its real value and
the real risks it may pose to public health, to be properly evaluated.



With that in mind, we look first at interactions that are called ‘public
private partnerships’, because they are *increasingly portrayed not just as
a possible arrangement – but as an innovative and unavoidable policy
paradigm *– to address global health problems.



The Cuenca Declaration, issued at the Second People’s Health Assembly in
July 2005 in Ecuador, states: “We oppose public-private partnerships because
*the private sector has no place in public health policy making”.* We will
elaborate on this here.



The extraordinary power of the private sector, and in particular of
transnational corporations (TNCs) and pharmaceutical houses under the
neoliberal, corporate-led globalization process, has been identified as *the
major obstacle to achieving social and economic justice and therefore, also,
Health for All.  *



TNCs already exert enormous power over governments and International
Financial Institutions (IFIs). *Through PPPs, they are becoming* *major
players* *in many areas of public policy making*, including health.



Let us clarify some *fundamental democratic principles.* All citizens are
involved and concerned in health matters *as individuals* (including
employees and Chief Executive Officers of TNCs). However, until recently it
has been considered an unacceptable *conflict of interest* to include TNCs
as decision makers in public policy.



WHO has always interacted – and often collaborated - with private sector and
other non-state actors. What is currently subsumed under the term
partnerships with the private sector includes such diverse activities as
corporate donation, sponsorship, research collaboration, negotiation or
public tenders, and contracting out of selected health services. It also
includes global health alliances, such as GAVI, GAIN and the Global Fund for
AIDS, TB and Malaria which involve *high level policy interactions between
UN agencies, corporations, and private foundations which propagate a
business philosophy. *

* *

Many of these interactions are not fundamentally new; others are social
experiments. Some, such as the outsourcing of public health services, the
funding of international public health and UN agencies through corporate
charity and the GAVI style health alliances are highly problematic.

* *

*What is new – and of serious concern in most current PPPs - is that
industry is invited as a ‘full partner’ in decision making processes on
public issues.*



Today, the UN Secretary-General’s Report on Enhanced cooperation between the
United Nations and all relevant partners, in particular the private sector,
states that it offers to the private sector through engagement in
governmental processes “opportunities to have its voice
heard.”[1]<https://mail.google.com/mail/html/compose/static_files/blank_quirks.html#_ftn1>



PHM argues that, in terms of both process and outcome, these developments
are *incompatible with democratic decision making, economic justice,
emancipatory development, human rights including the right to health – and
therefore the achievement of Health for All.   *



A second simple observation is that TNCs have a legal obligation to make a
profit for shareholders. *The raison d'être of private companies is
completely different from that of organizations and groups working for
Health for All and the meeting of **people's basic needs for health as a
human right.  ***

* *

We have only time to present the briefest summary of some of the risks to
public health that this difference implies.



Public private partnerships:

* *

   - Allow private interests to set/influence the public health agenda.
   - Sacrifice broad public health goals of prevention of disease,
   protection and promotion of health, and tackling of the underlying social
   and economic determinants of avoidable disease and death.
   - Prioritize technological interventions, cosmetic and unsustainable,
   which generate profit for a minority.
   - Favour short term, vertical approaches and privatization of essential
   public services rather than horizontal, comprehensive and sustainable public
   services.
   - Provide legitimacy to corporations' activities through association with
   UN agencies (blue-washing); blur roles and real interests.
   - Compromise public agencies, including UN agencies, and make them ‘call
   the tune’ for private interests of a tiny privileged minority rather than
   for 6 billion people.



*As a policy paradigm, then, the PHM regards PPPs as fundamentally
flawed.*It thus follows that the actual evaluation of the
effectiveness of
particular PPPs in practice is of limited interest. PHM cautions that almost
any project can demonstrate "effectiveness" within a narrow context using a
specific set of indicators - if enough money is thrown at it by powerful
actors, over a short space of time.



Evaluations of selected PPPs have been undertaken - though few of these have
considered risks and harm in the widest sense - and the results have been
variable. PHM’s conclusion is that *PPPs are ideology-driven rather than
evidence-based. *If one takes privatization of health services as an example
(as this is prominently promoted through PPPs), no serious studies have yet
shown that privatization of health services is either efficient or
effective. A wealth of evidence exists, however, to show that national,
universal, publicly run and funded health services are significantly cheaper
and produce far better health outcomes.



So what kind of partnerships does PHM recommend?  PHM promotes a broad based
holistic approach to health which involves common struggles in a spirit of
solidarity. *Individuals and groups with whom WHO could work as partners
need to share goals and represent people's interests in terms of their right
to health.*



This would include health workers, public service workers, trade unions,
teachers, community workers, indigenous people's movements, landless
peasants' movements, community groups, solidarity movements, public interest
NGOs, civil society organizations, social justice political parties,
professional associations and many more.



We support solidarity between groups and organizations serving the *public
interest *within, across and beyond the health sector in order to address
the major determinants of preventable disease, malnutrition and death *because
it is through such arrangements that human rights and the right to health,
which only some of us enjoy, have been won.*



We must never forget that these rights have been won painfully and slowly,
with much suffering and loss of life for the poor – and against formidable
obstacles in the form of powerful, private interests.

* *

We cite as examples the efforts undertaken by various groups working in
solidarity towards Health for All to address the lack of food and water,
bearing in mind that:

a) these two factors together account for well over 60% of preventable
disease and death,

b) mothers and children are always the primary victims in times of shortage,
and

c) that women are largely responsible for the provision of these daily
essentials.

   - Access to water and to essential services has been won through
   partnerships between public sector workers, their unions, local community
   groups and health workers in countless places the world over, most notably
   in Cochabamba, Bolivia.
   - The struggle for food sovereignty, critical to adequate consumption of
   high quality food, is the joint struggle of landless peasants' movements,
   opponents of liberalization of the agricultural sector, and the tremendous
   worldwide movement for social and economic justice that has been meeting at
   the World Social Fora.



Such solidarity struggles involving collaboration between public interest
groups confront the formidable and overwhelming power of TNCs that are
behind the neoliberal restructuring of our world and increasing poverty and
inequality – the first causes of poor health.



Referring now to this meeting at the World Health Organization:



Why are agencies and organizations with public responsibilities adopting
these arrangements? For the simple reason that, today, *the private sector
is considered the only untapped source of funds*. The term PPP encompasses
essentially the hope to access funds of corporations and some hyper-rich.
Under neoliberal economic regimes, public sector budgets have been slashed
and tax bases destroyed. These developments are themselves the result of the
influence of TNCs on governments and the international financial
institutions.



*The solution to this problem is not for public bodies to go knocking at the
doors of the private sector,* nor of the foundations of celebrity
philanthropists from industry. The solution is economic justice, including
an *adequate tax base, both nationally and internationally, to cover all
public services, *as well as *proper funding of public institutions such as
WHO* through regular budgets so that it may fulfill its international
responsibilities unimpeded by corporate interests.



In relation to ‘Making Partnerships Work for Health’, we urge the World
Health Organization to keep to the *founding principles set out in its
Constitution.* In particular the following parts of the preamble:



*"Informed opinion and active cooperation on the part of the public are of
the utmost importance in the improvement of the health of the people." *

* *

*"Governments have a responsibility for the health of their peoples which
can be fulfilled only by the provision of adequate health and social
measures."*



The *PHM urges WHO to claim its rightful place as the international health
authority* and to ensure, with governments, accountability to the people,
not to private interests - in all matters of health. Our message is simple:
*Work with the people, for the people!  *

* *

*Together, we can achieve Health for All. *

* *


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[1]<https://mail.google.com/mail/html/compose/static_files/blank_quirks.html#_ftnref1>
UN
(2005). Enhanced cooperation between the United Nations and all relevant
partners, in particular the private sector. Report of the Secretary-General*
,* A/60/150,* *10 August, para 20
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