PHM-Exch> WHA_opening day report

[Claudio Schuftan]

From: chiarezza <chiarabodini at hotmail.com>  PHM WHA Watch



*Dr. Margaret Chan opens 64**th** World Health Assembly... (to the private
sector!)*



 The 64th World Health Assembly started yesterday, Monday 16th May 2011, in
Geneva. The opening speech made by the Ministry of Health of El Salvador,
Maria Isabel Rodriguez, strongly called for a return to the values and
principles of the Alma Ata Declaration. She blamed the structural adjustment
plans, forced on many low and middle income countries by the World Bank and
the International Monetary Fund, for their devastating impact on the health
of the people. She advocated for social justice as the basic principle that
should guide the struggle for health for all. She also specifically
addressed and thanked former WHO Director Dr. Halfdan Mahler, who was
present in the room.

The following opening speech by WHO Director General (DG), Dr. Margaret
Chan, extensively covered the successes achieved by the Organisation in the
field of communicable diseases (including neglected tropical disease), with
emphasis put on the development of new vaccines (for meningitis and
pneumonia) as well as new technologies to diagnose TB. Significantly, the
collaboration with the Bill and Melinda Gates Foundation was mentioned
twice, and more generally multistakeholder action was praised as the way to
go in order to mobilise private funds for the people's good. The work of the
Commission on the Social Determinants of Health was quickly mentioned once,
and no referral was made to the growing health inequalities within and
between countries. Dr. Chan then moved to the current global financial
crisis, stating that WHO has been advised to “prepare for an era of enduring
economic austerity” and therefore justifying the need to “introduce
cost-saving measures” and “cut back on traditional areas of work, with deep
regret”. She foreshadowed what she called “the most extensive
administrative, managerial and financial reform” in the history of WHO,
aimed at giving “a bigger voice to the many partners that work in health”.
The “new” WHO will pursue excellence, as well as effectiveness, efficiency,
responsiveness, objectivity, transparency and accountability. Finally, Dr.
Chan invited Member States to join her on “this journey to reaffirmation,
remembrance, reform and revitalisation”. “Remember the people” is how she
opened and closed her speech, however it's not clear how the foreshadowed
reform will help WHO to accomplish this task.

In the afternoon, the plenary session continued with the statements from the
national delegates, who were asked to focus particularly on non-communicable
diseases (NCDs). Nearly all contributions addressed mainly lifestyles and
behaviours, mentioning in particular alcohol and tobacco use. With the
exception of Brazil, France and Iran, nobody mentioned the unequal
exposition to risk factors, such as unhealthy nutrition or poor life and
working conditions, which explains the differential burden that NCDs have
among the rich and the poor, at both the national and the global level.
Similarly, little or no mention was made on the broader and structural
determinants which underlie NCDs epidemiology and the need to address them.
Strikingly out of context, the statement from the US delegate addressed
almost entirely the issue of smallpox virus. The need to keep viral strains
within US-based laboratories, in order to continue the research on vaccines
as well as on diagnostic and therapeutic tools, was emphasised. The delegate
strongly opposed the WHA resolution, which will be discussed in the coming
days and which proposes a destruction of all viral strains.

Simultaneously with the discussion on NCDs that was happening in the main
plenary room, the first session of Committee A (which will be discussing
technical and health matters during the Assembly) started addressing the
Health System Strengthening agenda point (see *
http://www.ghwatch.org/node/223* for background resolutions, reports and the
PHM comment). In general, the challenge of universal coverage was the main
issue addressed. However, as many delegates made their statements from the
floor, nothing new came up: words of support to the WHO reports as well as
quotes from these, mentions to the challenge of universal coverage, health
system financing, health workforce policies, health information systems, and
so on. The principles of the Paris Declaration on Aid Effectiveness were
brought up by many member states: alignment, harmonisation and
accountability. Chile underlined the need for disaster and emergency
situation preparedness. In brief, amongst so many repetitive statements,
Thailand was the only country making a more critical intervention: the
delegate expressed great concern to see that health has not been treated by
WHO in the sense of well being, rather it has been addressed in the context
of a limited view aligned with the biomedical perspective only; WHO is
seeing health systems mainly as health CARE systems, not as a systems to
achieve well being; in addition, WHO is clearly being influenced by
biomedical researchers funded by pharmaceutical industries and by the
corporate sector. In summary, regarding Health System Strengthening, we saw
a very repetitive session with many commandments to WHO for its reports and
for its 2010 World Health Report, with only Thailand speaking up about some
crucial concerns.

Among the relevant evening events, a joint seminar from the WHO and the
Brazilian government announced the upcoming world Conference on the Social
Determinants of Health, which will take place in Rio de Janeiro from the 19
th to the 21st of October 2011. Dr. Margaret Chan, Dr. Mirta Roses (PAHO
Director), Dr. Alexandre Padilha (Brazilian Minister of Health) and Paulo
Buss (Brazilian delegate from Fundação Oswaldo Cruz, taking the lead on the
organization of the Conference) were on the panel. Dr. Nila Heredia (Health
Minister of Bolivia) and Dr. Eduardo Espinoza (Health vice-minister of El
Salvador), as well as numerous PHM members, were present in the audience.
The Conference has the ambition to put into practice the recommendations
stated in the final report of the WHO Commission on Social Determinants of
Health (CSDH), although it has to be noticed that the proposed subthemes in
the agenda are not at present strongly linked to the Commission’s
recommendations. The expected output of the Conference is a strong political
document, which asks for governments' commitment to address SDH through
long-term multisectoral plans. The need for civil society participation has
been stressed several times, however it is not yet clear by which mechanisms
civil society will be invited and allowed to participate in the works. The
effort to guarantee a participatory, transparent and open process is
currently relying on an online consultation on the Conference platform, open
to public comments until June 3rd (see *http://www.who.int/sdhconference/en/
*). Several PHM members were able to raise critical voices at the end of the
presentations, highlighting in particular the need to address the structural
macroeconomic determinants of the SDH, related to the global economic order.
Serious concern was raised on the role of “civil society”, which might well
include philanthropic foundations and the private sector, representing the
interests of their founders or share-holders and not the broader public
interest.

Simultaneously, a side event on non-communicable diseases (NCDs) took place,
organised by The Lancet in collaboration with a partnership of scientific
societies and NGOs and financed by the Rockefeller Foundation and the main
pharmaceutical companies. Public-private-partnerships (PPPs) have once again
been mentioned as “the way to go” in order to address prevention and
treatment of NCDs. Critical questions from the audience, including PHM
members, were not addressed by the speakers.
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