PHM-Exch> SOME REFLECTIONS ON THE STATE AND HEALTH

[Claudio Schuftan]

SOME REFLECTIONS ON THE STATE AND HEALTH. (Pedro Luis Castellanos).


What are we talking about here?

  -Of health, of a healthy living, of a life lived in wellness.

  -Of the state:

     -Of power.

     -Of the legitimized use of force; of domination; of exploitation.

     -Of the hegemony of one social group that has given itself legitimacy,
i.e., of the

      legitimization of the rules of the economic and the political game.

     -Of a situation of conflict and of a consensus with multiple
contradictions around the

      decisions of what is public, i.e.:

         -re public and private; private vs social ownership; public goods
and private goods.

         -re general interests and particular interests.

         -re what are national and what are international interests.

         -re class conflicts.

Some points upfront:

  - Do we live in an era of change or are we witnessing the change of an
era?

  - An era of grave simultaneous crises: economic, financial, social,
political,

    environmental, climate, food, cultural, techno-scientific…

Capitalism in its neoliberal phase:

  - Dominance of the financial capital over productive capital;

    speculation in the area of production.

  - Subordination of corporations to banks and speculation on stock and
commodity

    markets.

  - Exacerbation of the worse traits of capitalism.

  - Weakening of the status of nations; globalization.

  - Nature at its limits.

  - Humanity in danger of extinction.

  - Greater uncertainty; the future is a crystal ball.

The Washington Consensus:

  - The state is the problem. Deregulate. Liberalize. Open markets.

  - Free markets are the solution and are ‘rational’.

  - Minimalist, focused and temporary social policies.

  - Dominance of the financial system.

Consequences of it are economic, social, political, ecological and an
expansion in the numbers of the excluded groups in society.

Towards a new discourse:

  - Again, do we live in an era of change or are we witnessing the change of
an era?

  - Returning to common sense; returning to the same basic questions, but to
arrive at

    new responses.

  - A new way of understanding the world and humanity is needed.

The transition:

  - New historical anti-neoliberal blocks are joining in and coalescing.

     -What Unites us: a confrontation with neoliberalism, decolonization, a
new culture of

      equity and solidarity together with a re-insertion in nature, defense
of the national

      productive apparatus, direct democracy and participation as
protagonism.

Three major tasks facing us:

  - Disengage countries from the neoliberal locomotive.

  - Address the historically accumulated social debt.

  - Advance towards a greener and better future.

Transition towards what? Need to clarify this.

How does health fit in this scenario and in the transition?

  -We have to make our discourse succeed and become the lead paradigm.

Struggles for health during the transition:

  - Recognize the complexity of the task ahead; recognize the consequences
for theory

    and for practice.

 - Dealing with very different and heterogeneous groups.

 - Contesting neoliberalism is fighting against capitalism.

 - Contesting neoliberalism is actually much more, i.e., defending the
national state,

   defending the public sector (the common interest as opposed to the
private interest),

   regulation of the agents of the market through public economic, social
and institutional

   policies, through democratization, through fostering the free
determination of

   people, through having politics taking an interest in the every day life
of common

   people.

 Setting the stage to advance towards a new form of state and a new society:

  - confront neoliberalism in its financial complex version as applied to
health.

  - Pay back the historically accumulated social debt.

  - Foster and coach new social actors to be mobilized as protagonists of
change.

 - Democratize, decentralize and strengthen local government; move towards
direct

    democracy.

Some common objectives of health policies:

   -Health as a human right, universal coverage, inclusion, equity….

   -Comprehensive social policies pointing towards quality of life, towards
social

    solidarity and full citizenship rights.

Escape from the trap of single-track thinking:

 -Creativity and diversity; the new paradigm is not arrived at through
bureaucratic

  decisions.

An open future:

  -Uncertainty, need for legitimization and for the resolution of
contradictions in the

   neoliberal system and also within our anti-neoliberal groups. The latter
can only be

   resolved when we set it as a priority to resolve our internal conflicts;
otherwise we

   play into the hands of capitalism.

  -Empowerment of social actors. Participatory management style.
Participation and

   mass mobilization. Foster the creative energies and a creative anger of
the people as

   political actors towards a truly new historical wo/man.

xxx
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