PHM-Exch> The WHO Reform and the Need for Democratizing Global Health

[Claudio Schuftan]

*Delhi Statement*

* *

*Time to Untie the Knots: *

*the WHO Reform and the Need for Democratizing Global Health*

* *

*As representatives of organisations working on campaigns for health and
social justice, of academia, governments and multilateral institutions, we
gathered in New Delhi from 2nd to 4th May 2011, from all parts of the world,
to address the need for an effective and accountable global governance for
health. In the wake of the Regional Dialogue on the right to health held in
Johannesburg at the end of March, the purpose of this global consultation
was to achieve a common vision for realizing the human right of everyone “to
the highest attainable standard of physical and mental health “, and
reignite a health for all movement with shared objectives and actions.*

* *

Health is an essential condition for human and social development. That is
why the right to health is enshrined in the Constitution of the World Health
Organization, in the International Covenant on Economic, Social and Cultural
Rights (CESRC) and in over 130 national constitutions worldwide. Yet, it
concerns us that while health is increasingly recognized in both
international and national law to be enforceable, the health of the majority
of world population remains insufficiently protected and promoted. In the
last two decades 20 million people, at least one third of all deaths, have
continued to die every year due to global health inequity.



Even now, when global health and poverty reduction are relatively high on
the international policy agenda, and governments are launching directs
assaults on poverty through various programmes, health inequalities within
and between countries are on the rise. Persistent poverty and growing
inequalities, these intractable foes, are stark reminders that economic
globalization and market liberalization have not created an environment
conducive to sustainable and equitable social development. On the contrary,
new emerging threats to health – the global economic and financial crisis,
climate change, food insecurity, mounting unemployment – can rapidly worsen
an already desperate situation for billions of people, the growing poor and
marginalised.



Health is a common good that demands collective responsibility. Instead,
structural violations of the right to health are produced by the dominant
market dynamics and the uncontrolled influence of profit-driven
transnational corporations, supported by the policies of international
financial and trade institutions – the International Monetary Fund, the
World Bank and the World Trade Organization. Such violations are often
unmonitored, unmeasured, and are too numerous to quantify. As they form part
of a process of systematic violations of other rights - to gender equality,
to water and food, to work and income, to housing and education - any
commitment for the right to health cannot be conceived in isolation from a
broader approach of universal social protection as a key policy to human
development.



As the UN health agency, the WHO remains in today’s globalised world the
“directing and coordinating authority” for the realization of the right to
health and universal coverage. Its role as the sole global legal authority
in health is embedded in its constitution, and needs to be strongly
supported. The last few decades, however, have witnessed the rapid emergence
of new actors who have highlighted health as a priority and largely shaped
the global agenda, but also contributed to much fragmentation in health
governance. Their increasing prominence has produced a shift in
institutional culture, favouring the penetration of market values into areas
where they do not traditionally belong and resulting in a new sphere of
influence in health policies. This trend has progressively stifled the
voices of Member States and weakened the institutional mandate of WHO, with
controversial implications.



The topics of global health governance and the WHO reform agenda were
prominently featured during the WHO Executive Board debate in January 2011,
a development we welcome.  Fire has been lit and WHO, through its Member
States, needs to take responsibility for the policy dialogue opportunity it
has opened up. It is a collective responsibility, too.



Our gathering in New Delhi, just before the 64th World Health Assembly,
bears witness to how seriously the process initiated by the WHO Director
General is taken by organizations engaged in social justice worldwide. We
are convinced that WHO needs to rediscover its fundamental multilateral
identity.  Drawing on its strengths, the organization has to take advantage
of its reform process to rethink and reassert itself as *the* leading actor
in a broader governance for health that is coherent with the need for solid
public policy responses to the neoliberal prescriptions, so that
globalization be shaped around the core values of equality and social
justice.



But governance for health starts at home. Governments, the main stakeholders
of WHO, have clear obligations to the people they represent. Beyond mere
institutional approaches, issues related to public policies in health have
to be democratically debated and tackled at the local, national and regional
level. This entails the continued participation and meaningful contribution
of communities, public opinions, and their direct empowerment through
education and knowledge sharing. Unless and until governments have the
people directly affected around the decision-making tables, their health
policies will remain ineffective. Health democracy, namely participation,
transparency and accountability in health, is a pre-condition for countries
to make an impact in the decision making processes at the global level,
within WHO and in other multilateral fora.



 *We, the participants in the New Delhi consultation

*



1.     Call on Member States to strengthen the enforceability of the right
to health, and the other economic, social and cultural rights. We draw their
attention to the need for an improved legal framework to enhance the limited
national enforcement provisions and absence of enforcement internationally,
despite the binding nature of the right to health. Precise mandatory
arrangements and monitoring mechanisms are required. We support the
exploration of and research into a binding framework convention on global
health, and on universal social protection to this end;



2.     Are convinced that the primary responsibility to enforce the right to
health lies with national governments*.* Any endeavour to fulfil countries’
legal obligation to respect, promote and fulfil this right on a
non-discriminatory and equitable manner must include communities as well as
the engagement of public interest organisations. Without people’s
mobilization, human rights cannot be met. The right to health is no
exception.

 3.     Consider that the implementation of the right to health, beyond its
technical and legal aspects and financial implications, entails political
will and policy coherence across sectors. Therefore, the right to health
must have priority in all national and international negotiations and
agreements that have an impact on health (environment, energy, labour,
trade, agriculture, taxation). Transnational corporations are to be held
accountable in this regard;



4.     Urge governments to tackle the structural downsides associated with
the current global health governance* *- its fragmentation, inadequate
global leadership, institutional weakening of mandated bodies, inadequate
health financing, erosion of poor countries’ ownership of their health and
development agenda, etc. - and overcome the poor accountability of the
ever-growing number of agencies and initiatives, which has led to
unnecessary high transactions costs, wasted resources, and drained
absorptive capacity;



5.     Favourably consider the proposal by WHO for innovative consultation
mechanisms that allow meaningful participation of the multiple actors
involved in global health and require that the WHO consult with public
interest groups to this end.  We encourage WHO to undertake and properly
resource public hearings that must be inclusive, participatory, democratic,
accountable and transparent, including through electronic means, in order to
inform the development of relevant public health policies, rather than
creating new permanent peer structures that do not appear to tackle the
heart of the global governance intricacies. A sustainable long term plans is
needed to re-build a democratic and effective global governance for health;



6.     Strongly challenge the increasingly disproportionate participation of
the corporate private sector in WHO processes without a robust mechanism to
address conflict of interests. WHO needs to develop a comprehensive
framework that would guide interaction with commercial actors as well as
develop and implement measures to avoid and properly manage conflict of
interest situations. These go beyond transparency and include a clear
definition of institutional conflict of interest, clear entry criteria and
sunset clauses;



7.     Demand that WHO clearly defines its stakeholders. Since the reform of
the WHO is aiming at enlarging interaction, and increasing trust, with a
wider range of actors, it is crucial that the reform package be
characterised by a process in which the space for contributions is based on
the voice and needs of people, not the power of money. This requires clear
definition of actors and their roles, goals and interests. Prior to the
convening of any structured public dialogue for global health, all these
issues need to be addressed and clarified.  This process would contribute to
but not replace the formal decision making process at the World Health
Assembly, where countries are represented;



8.     Urge Member States to focus on taxation as one of the key policy
instruments to enhance revenue capacity to advance human welfare*,* and in
particular to finance a home-grown health agenda. Achieving the right to
health and other basic rights is conditional on the availability of
financial resources to fund them. We propose a human right perspective on
tax systems and urge governments to intensify the redistribution of wealth
for promoting social cohesion and fair growth.  The world is awash in money
and time has come to focus on wealth as a way to reconnect redistribution
and social policy with economic and fiscal policymaking. Progressive
taxation is a key process to nurture a healthy relationship between a state
and its citizens, at the national and international level, beyond short-term
donor support and excessive dependence on philanthropic funding. Operational
suggestions in this area should be addressed and enacted through a global
framework focussed on the principle of solidarity.



9.     Recall that international solidarity is essential in many countries
with insufficient financial potential to ensure the necessary human and
material resources to guarantee the right to health. Today’s non binding
provisions need to be turned into mandatory arrangements if we are to make
such support predictable and long term.



10.   Strongly encourage Member States to increase their financial
contributions to WHO and enhance their impact in the organisation. The idea
that WHO should overcome its budgetary pressures by drawing resources from
the private and commercial sector, as suggested in para 76 of the DG report
(WHA 64/4 Future of Financing of WHO,
http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_4-en.pdf),* *is one to be
rejected.



11.   Recognize that, as public interest organizations, we have to make
efforts to strengthen our own transparency and enhance accountability in our
work, to improve democracy on health. We commit to this goal through
participatory mechanisms.



12.   Engage to continuing the process of collective learning and alliance
building to ensure that the right to health is placed at the centre of
national and global policymaking, and to shape an effective and accountable
global governance for health.



 The Delhi meeting was convened by *Prayas, Sochara, PHM, PHFI, *and* Medico
International*

For further information: *gebauer at medico.de* <gebauer at medico.de> &  *
nicolettadentico at libero.it* <nicolettadentico at libero.it>* ***

*Medico International*, Burgstr. 106, D- 60389 Frankfurt, Germany
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