PHM-Exch> Food for a thought to watch (2)

[Claudio Schuftan]

Human Rights Reader 292



*WHAT CAN WE DO TO INTENTIONALLY SHAPE OUR COLLECTIVE DESTINY? *(part 2 of
2)

* *

[This and the previous Reader are a summarization of the key messages found
in Global Health Watch 3, PHM’s alternative flagship publication that
analyzes the current world health situation].





*The future is now*

22.* **Scenario One*: Doctors love high tech gadgets and treatments;
nothing wrong about this love affair. But high tech treatments drain
resources away from the kinds of public health and medical measures that
can improve the health of a much larger number of people. Therefore, high
tech treatments act as a distraction from more immediate, lower-cost
alternatives that more directly address the right to health of every
individual.



23. Yes, a poor person may have a chronic genetic disorder, but being poor
was probably the first disorder that he or she had to deal with. In
addition, in the high tech conundrum, particularly women may find
themselves at the crossroads of science, society, industry and policy, with
their lives being affected, their bodies being claimed by several sectors,
and their voices being heard by none.



24. Despite the fact that hard commercial realities do not sit comfortably
with researchers’ belief that their work will have genuine medical benefits
and reduce human suffering, the symbiotic relationship between speculative
capital, industry, university and governments has blurred the distinction
between ‘public’ and ‘private’. Companies generously fund university
departments and chairs, sponsor professional and patient organizations and
support extensive continuing medical education. They approach supposedly
independent academics, clinicians, and others who are paid handsomely to
give product presentations and, otherwise, to make representations on
behalf of the companies. Suffice it to say, medical publications that come
out of these partnerships are, in fact, ‘information laundering operations’.



25. Technology without democratic social control, and in the hands of
global capital, is a very uncertain bet. The uncertainties regarding the
directions and implications of technological development underline the
importance of health and human rights (HR) activists maintaining a close
watchdog engagement in this field.



26. *Scenario two*: Transnational corporations, under the guise of
corporate social responsibility very hardly try to harness the power of the
market in order to achieve what *they *consider desirable social outcomes.
In reality, they are trying to make corporate philanthropy pay off, i.e.,
be cost effective to them. Philanthro-capitalism presents itself as
operating outside of formal political channels, while actually wielding
considerable influence over these channels. Companies purchase not only
political support and favors, but also the services of ‘key opinion
leaders’.



*What are the main strategies which health and human rights activists can
deploy to drive social change?*

27. There is no simple way of representing the structures of global
governance that we need to triumph over. For instance, global health
governance encompasses the social determinants of health and health system
development. It is necessary to look at governance from a range of
different, but overlapping perspectives (nation-states, intergovernmental
institutions, the corporate sector, the marketplace, civil society and
social movements) and do this based on knowledge, good information
*and*the appropriate ideology.



28. To complicate things further, 21st century global public-private
partnerships (GPPPs) have taken up the role of shoring up the legitimacy of
the regime of global governance which, as we know, reproduces inequality,
exclusion and marginalization --all HR issues. GPPPs picture the widening
inequality we live under as ‘unfortunate-but-necessary’. The question is:
Necessary for what?



29. So, do we have a social movement shaping our collective destiny? I
think you would agree that this is not the case. A social movement is a
collectivity that shares a common set of concerns, understandings and
claims and a sense of shared identity (Pakulski 1991). It is bigger than,
but includes formal organizations.



30. The emergence of a global middle class with a shared interest in
consumer goods and the good life, as well as with limited loyalties to
poorer people in their own and other countries has detracted from social
movement building. Sad.



31. The challenge for social movements active in the health and HR front is
to find a balance between continuing to struggle for local and national
change while also building links with global movements that confront the
overall flawed dynamics of Globalization. Health and HR activism thus needs
to be informed by an understanding of the structures, forces and dynamics
that shore up the prevailing system and its regimes still so firmly in
command.



32. The rise of neoliberalism and the related ideologies of individualism
and consumerism have been powerful negative influences on HR and on health
over the last half-century. Neoliberalism has ‘normalized’ inequity and
inequalities and, with its faith in markets and its distrust of government,
has discounted a collective, participative control of our future. In that
sense, the People’s Health Movement (PHM) has little doubts that the
negativity of neoliberalism has contributed to the rise of various
religious fundamentalisms. Unfortunately, the promise of personal salvation
through apocalyptic religious fundamentalism is critically weakening our
movement towards a more deliberate control over our collective destiny.



33. A more optimistic scenario provides us with a clearer vision of the
kinds of directions that progressive social movements need to work towards.
Activists, including HR activists, will have to mediate the process of
change. The changes needed go beyond behavioral change, which ‘objectifies’
the people whose behavior will be changed (while rendering invisible the
agents who will ‘intervene’ to achieve this). The change needed is
collective, as well as individual and is political, as well as personal. It
involves actively reworking our values and culture, as well as combating
mis-information and *myths.* Only practicing differently can we change the
world*.

*: An example of a myth here is: Violent conflict in Africa is much more
connected to resource *abundance *(rich oil and mineral reserves, valuable
timber, diamonds, etc.) than to resource *scarcity*.



34. So, one of the take-home messages here is that, despite the global
pressures to further fragment health systems that are widening inequalities
day-in-day-out, it *is* possible to confront these pressures directly at
the sub-national, national and global levels. It is our strategic
opponents, the merchants of neoliberal ideology, who maintain the
expectations and the narratives that keep the unsustainable and inequitable
governance regime afloat. …and they are by no means permanently entrenched.
These merchants, as PHM probably does not need to remind you, include,
among many others, the owners of the media, the bankers and insurance
executives, the executives of transnational corporations, the elite
universities and the private ‘axe-to-grind’ think tanks and philanthropies.



35. Their delegitimation is a first-stage central strategy for social
movements (leadered by health and HR activists in our case) --being wary
though of the speed with which the ‘regime governors’ can respond and react
in terms of shoring up their challenged legitimacy. Never forget that the
delegitimation of the structural adjustment plans (SAPs) left the World
Bank little chance but to scrap SAPs and replace them by poverty reduction
strategy papers (PRSPs) that gave the appearance that countries were
designing their own SAPs. This gained the Bank some time …until the PRSPs
were rightfully deligitimized by activists.



36. Delegitimation is a powerful strategy for health and HR activists, but
must be accompanied by positive, prospective policies and actions towards
institutional reforms which will lock-in any gains that can be achieved
from such delegitimation. Otherwise, the ‘dance of delegitimation’ will
proceed *one step forward but (almost) two steps backwards*.**

**: Remember the social unrest in Cancun and Vancouver during crucial WTO
meetings. Did it lead to a sustained movement? Not really. Street protests
can only be a start.



37. Agreed, anger at injustice is a negative although powerful motivator.
PHM thinks we also need to project alternative and inspiring visions,
partly to assist people to move from passivity into movement activism.

Strategies and models are indeed inspiring when their underlying logic
makes sense, when they offer practical entry points and when they are seen
as powerful in effecting change.



38. In this optic, the human rights framework is inspiring. The inspiration
that many people derive from the affirmation that their burdens constitute
a denial of recognized rights provides the drive to put in place these
necessary institutional mechanisms.



39. Hope and determination are necessary, but not sufficient. We also need
strategy, solidarity, mobilization and activism. Strategy requires an
understanding of the dynamics of historical change and the ways in which
intentional action does foster change. Mobilization requires that we have a
clear analysis of why the world is the way it is plus a plausible vision of
how it can be changed. Activism requires hard work (does PHM not know
this…!).



40. The struggle against environmental destruction and against the abuse of
workers rights is just another illustration of the breadth of the struggle
for health and for HR that PHM has embarked in. This struggle is not solely
the province of people who identify themselves as ‘health activists’. There
are many such parallel movements which are considered as part of a global
People’s Health Movement.

* *

41. So in summary:

*What is our nemesis?*: The resilience of transnational capitalism that
resists the call for a new international economic order.

*What is our roadmap to be?*: Policy critique and placing and following up
on active demands are central strategies of the social movements for change.

* *

Claudio Schuftan, Ho Ch Minh City

*cschuftan at phmovement.org*

*____________________*

Summarized and adapted from Global Health Watch 3, An Alternative World
Health Report. People’s Health Movement, Zed Books, London and New York,
October 2011.  www.ghwatch.org/ghw3



<http://www.ghwatch.org/ghw3>**
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