PHM-Exch> A new, pernicious epidemic is stalking the health care systems of the world

[Claudio Schuftan]

A new, pernicious epidemic is stalking the health care systems of the
world. It is striking rich countries and poor alike, with understandably
most devastating impact on the poorest. It saps vital resources, dislocated
and fragments systems, prevents systems responding to health needs, and
obstructs the development of planning.


The epidemic is not a medical problem, but is a man-made disaster for the
development of equitable health care systems: it is the rampant spread of
neoliberal, pro-market “reforms,” devised and promoted by a narrow
policy-making academic and political elite in the wealthiest countries.It
can only be eradicated by the spread of information, political campaigning
and critical thinking, with regular injections of evidence and social
solidarity.


The so called “reforms” are driven not by evidence, but by ideology – and
behind the ideology is a massive material factor: the insatiable pressure
from the private sector to recapture a much larger share of the massive $5
trillion-plus global health care industry, much of which only exists
because of public funding.

Everywhere the role of the private sector and the size of its potential
market is always constrained by an “inverse care law”: most health care is
required by those least in a position to pay the market price for it –
whether this be the old, the very young, the poor or those with chronic
sickness and disabilities.


Since 1980 global agencies like the World Bank, new powerful players like
the Gates Foundation, and even at times the World Health Organisation have
played a role in promoting these changes, along with a burgeoning industry
of right wing “think tanks” and an elite coterie of academics drawn to the
chance of lavish funding. Their loyalty appears to be to the giver of the
research grant rather than to the evidence.

One has to distinguish between cost-cutting “market-driven” reforms, which
reduce the size, scope and scale of services but leave systems largely
unchanged, and “market-style” reforms, which aim first and foremost to open
up a growing share of health spending for private providers and ultimately
private insurers.

Market-style reforms are remarkable in that they consistently serve neither
to cut costs nor to improve efficiency: in fact the systems most dependent
on private, competing providers have the highest overhead costs and waste
billions while excluding millions from proper access to health care.


As for the international spread of “Public Private Partnerships,” despite
their many costly flaws, failures, and false starts, more PPPs are now
under way in many OECD countries, but also in Latin America, Asia, South
Africa and even Lesotho – where a $120m hospital is set to soak up a
disproportionate share of the health budget, but generate a healthy profit
stream for its South African “partner” the health care multinational
Netcare.


And then, there are the “Missing Millennium Development Goals” – the
massive public health issues which call for reform and for large-scale
action, but which are completely ignored by current health “reforms”. The
biggest unresolved issues are the development of adequate health care for
the growing world-wide population of more dependent older people (summed up
as “customers the private sector doesn’t want”); the millions suffering
mental illness, and the “hidden giant” of the millions facing physical
disability.


Market-style reforms don’t start from the evident problems facing health
care systems, and don’t solve any of them. Market-style reforms result in
systems more unequal, more costly, more fragmented and less accountable –
but which offer more profits to the private sector. That’s why the question
really is whether we want to see global health – or private profit. Most
people are clear which they would prefer to prevail. All those working for
political and popular action must challenge the status quo, and the flimsy
arguments and assertions the reforms are based on.


But it doesn’t have to be this way: the policies are not inevitable
products or a response to the current situation, but choices that have been
deliberately made by politicians working to a neoliberal agenda, and which
can be rejected and defeated by mass political action. There are
alternatives. The question is to develop a political leadership with the
courage to embrace them and fight for them.


We are many, with the facts on our side: the neoliberals are few. But as I
say in the preface, good ideas must be turned into political action to
change the world.


Let’s ensure we win!


John Lister

*Health Policy Reform:* *Global Health versus Private Profit, *by John
Lister (£25) is available from www.libripublishing.co.uk or from good
booksellers!
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