PHM-Exch> IS PRIMARY HEALTH CARE POSSIBLE IN A GLOBAL NEO-LIBERAL ERA?

[Claudio Schuftan]

*IS PRIMARY HEALTH CARE POSSIBLE IN A GLOBAL NEO-LIBERAL ERA?*

*Joachim  Kreysler      **(excerpts)    <jokreysler at hotmail.com>*



There is no doubt in the continuing Iraqi war that disaster capitalism works
by dispossession of the poor in weak nations - and mainly by direct force.
Naomi Klein’s new paradigm of Disaster Capitalism, also named The Shock
Doctrine, is superbly described in the early chapters of her new book,
detailing economic disasters in the Latin American ‘Cone’ (Chile, Argentine,
Bolivia…) and in other such diverse countries as South Africa, Poland,
Russia and China, rising to a crescendo in the Iraq case, where essential
core assets like health, water and security are being privatized.1 Eminent
scholars like Joseph Stiglitz suggest that Naomi Klein’s thinking might be
infected by conspiracy theories, starting her book with the description of
Ewen Cameron’s notorious electric shock experiments at McGill University -
and suggesting that Milton Friedman was aware of these CIA-inspired studies,
when and while developing his ‘neo-liberal economic shock therapy’ in
Chicago. Stiglitz says in his critique of the book: “There are no accidents
in the world of Naomi Klein.”

How is ‘Health for All’ affected by the Construction of a Neo-Liberal
Hegemony? At the time when Alma Ata was convened, the majority of liberal
thinkers still believed that the Chilean coup d’état of 1973 was a political
‘accident’ or - at best - ‘manufactured’ exclusively by external political
forces, while the ‘economic shock therapy’ in this country was the work of
Milton Friedman’s ‘students’ from Chicago, who had written a ‘recipe book’
for Pinochet’s economic policies, after having occupied the front seats in
economic academia in Chile, albeit with the assistance of the US government.
With historical distance, however, it becomes clear that “seductive
possessive individualism” (historian David Harvey, Oxford) did its
‘infectious’ job during the second half of the twentieth century in the
lower income strata not only in Chile but world-wide,” forg(ing) consent
through the cultivation of a middle class that liked the joys of home
ownership, private property, individualism and the liberation of
entrepreneurial opportunities....”. The construction of mass consent has
been, and remains, the main avenue to neo-liberal hegemony, as we see it
today. The “Magic of the Market” has invaded the mind of modern man. This
happened at a time when global GDP dropped from 4.9 per cent in the
post-Bretton Woods era to 3 per cent between 1973 and 1989 - a drop of 40
per cent!

The second ‘temptation’ of modern players produced by surplus production was
“financialization”, or channelling investment towards financial speculation,
where much greater returns are expected than in productive investment.
Still, neo-liberal policies, globalization and financialization have finally
not been effective in world capital accumulation, except on the top layer of
global income strata. Aggregated growth rates were 1.4 per cent in the
eighties and 1.1 per cent in the nineties, compared to 2.4 per cent in the
seventies, the decade of Primary Health Care inauguration - and we all know
what the Structural. Adjustment Process (SAP) did to ‘Health for All’ (HFA).
Accumulation by dispossession has now been achieved on a large scale, and is
the latest desperate effort of the ‘global market’ to surmount the deepening
crisis of global overproduction. Accumulation by dispossession involves the
privatization and commodification of common goods, including land, water,
energy and knowledge. Millions of peasants and indigenous people are
expropriated in the name of this neo-liberal process - often with support of
the World Bank and the IMF, and often the silent consensus of the
“International Community”. Seeds and genetic potentials are systematically
privatized through international arrangements such as the Trade Related
Property Rights (TRIPS) - which has dampened technological development in
the South, mainly due to fear of infringing the rights of global
corporations. Critical views like Indonesia’s in the recent avian influenza
debate on the agreement of ‘virus sharing’ (for public health research) can
therefore easily be denounced in the “common good” debate by all partners of
the “international community”, invoking private profiteering, and
highlighting the “hollow shell” theory of nation states’ role in the current
political economy. The most significant development, however, is in this
context the privatization of public assets - and that is what disaster
capitalism is all about. The key factor is dividing up core social functions
such as security, defence, shelter, health and disaster preparedness and
response between private economic players. Through the ‘War on Terror’ the
US achieved: “…the creation of the disaster capitalism complex – a
fully-fledged new economy in homeland security, privatized war and disaster
reconstruction, tasked with nothing less than building and running a
privatized Security State, both at home and abroad... Just as the internet
launched the dot.com bubble, 9/11 launched the disaster capitalism bubble...
For decades, the market had been feeding off the appendages of the State;
now it would devour the core...”. (N. Klein, The Shock Doctrine, 2007).
Disaster, either of the natural kind like Katrina or the politically created
like Iraq, is seen as economic opportunity. It creates demand for a
commodity by taking advantage of natural or man-made disasters. It provides
an opportunity to alter the physical landscape and “add value” (also social
value through humanitarian reconstruction) toit, by sweeping away
value-deprived communities (like in post-Tsunami Sri Lanka) or converting
the land to upscale real estate like in New Orleans. In Iraq, war becomes
the tool to erase the “hollow shell” interventionist State and create from
scratch the “functional” and “ideal” neo-liberal government, which will give
core functions to private contractors or ‘for-profit NGOs’. The White House
motto of President Bush: “…If a task can be performed by a private entity,
it must be…” governs currently all aspects of economic forces involvement.
The problem is, of course, that disaster capitalism is anti-people. Dressed
up in the rhetoric of freedom, entrepreneurism and efficiency, it cannot
‘win over’ people in the way that market-cum-social strategies were
successful in the era prior to Thatcher and Reagan. Frightening activities,
like Paul Bremer III’s decrees in Iraq, making all of Iraqi youth a “surplus
population” (N. Klein), in a society where the State functions primarily to
enrich foreign contractors, will necessarily enhance the insurgence in such
country.

Empowerment of Individuals in Health Matters? One hidden motive of technical
vulgarization/democratization was possibly the insight to permit the
‘incompetent’ individual to manoeuvre in the ocean of technical health
science. For this purpose clear sets of health management handbooks were
composed and ritualized, not unlike instruction manuals for electronic
equipment (i.e. how to use the “user interface” and how to “maintain” the
machine). This ritualistic adoption constituted the democratization of
“world health” in the post-WWII era. Disease control and eradication,
together with improving life expectancies in the second half of the
twentieth century, were system produced and very much the result of
cutting-edge technologies; very little of it is attributable to mass
solidarity increments on a global scale.

Positioning of Mass-based PHC in the Post-modern era. The landmark of the
beginning third millennium is rather the vulgarization  and  pathetic
manipulation of new technologies, often presented as creativity, whereas
inessence it is only a new form of design. It remains the kinetic
centrepiece of “progress”. Modernity is therefore an end in itself, and
health development remains a part of the future to come. For this reason,
PHC re-framing after 30 years must include a profound analysis of
contemporary anthropological concepts and sociopolitical reality.

*J**ournal of Humanitarian Medicine - vol. IX - n. 1 - January/March 2009*
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