PHM-Exch> More on the Oslo/Lancet report on global health governance

[Claudio Schuftan]

From: Alison Katz <katz.alison at gmail.com>


The  critique of David Mc Coy in the Medact website is welcome.  I hope it
will convince everyone that analysis is no longer required (and hasn’t been
for a decade or more). I have two points, one on explicit political
language and the other on what I see as a fatal flaw in the Oslo Lancet
report.

I am making a plea to *make use of political wisdom acquired over more than
a century. And a start would be to use honest political language* for
really existing political processes and phenomena.   Not once yet, in this
discussion has the word capitalism been mentioned and that is a feat in
itself. Neoliberal dogma has made useful political terms into dirty words.
Capitalism is not a dirty word. It is a dirty system.   I sincerely believe
that if we want Health for All, we have got to *use honest political
language in order to explain political processes and systems and then take
effective political action.*

No wonder we cannot mobilize “the people”.  These discussions are
unintelligible to most people but they don’t have to be. Curiously, when
politics is explained truthfully, it is perfectly understandable for most
of the population.

Example, Ireland, lost 9 million of 10 million in famine (1846, 47, 48)
while ships full to the brim with wheat and oats sat in Cork harbor before
setting off for England.  Today in the Horn of Africa, people starve and
ships full to the brim sit in the harbours  . . . . . with food on its way
to Europe.

Nothing has changed  . . . . not yet.  And in many ways it is worse. *Ireland
had to fight. What  was it fighting? Capitalism and colonialism.*

Real socialist parties in Geneva are leading a campaign to outlaw the
murderous speculative trade that today is concentrated in our city.
(Cargill and others). We can all do more in our own town or city to ensure
food sovereignty (and thereby contribute significantly to Health for All)
and to stop the diabolical exploitation of human and material resources in
poorer countries than we can by contributing to Commissions whose political
analyses are somewhat weaker than those presented a century ago. And make
no mistake, speculation in cereals is capitalism. It is not some kind of
spontaneously occurring phenomena, appearing independently of a political
system.

 *1.      **Global health governance and global governance for health
cannot be separated. Doing so (as Oslo Lancet commission does) removes the
central question from the debate*

 *Global health governance (GHG*) refers to governance of the global health
system – defined as “the actors and institutions with the primary purpose
of health”. *Global governance for health* (GGH), refers to “all governance
areas that can affect health” (definitions used by the Lancet-University of
Oslo Commission on Global Governance for Health.

 The Commission’s report “does not focus on improving the governance of
global health actors but rather looks at how global governance processes
outside the health arena can work better for health and for the continued
success of the global health actors”

 GHG and GGH must be considered together for the following reasons. Not
only is the relationship between these two kinds of global governance
two-way but a discussion which separates the two, removes one of the
central controversies from the debate, namely the scope of the leadership
role of public health institutions and authorities in general, and of
course the World Health Organization.

This particular global health actor is - until further notice - the
peoples’ international health authority. As such, and as a knowledge and
advocacy organization, *the WHO itself is responsible for defining the
scope of governance in relation to health, i.e., for identifying all the
areas outside the health sector which affect health and for providing
advice to Member States on how policy in these areas can promote and
protect health.*  This is the rationale of the WHO’s Commission on Social
Determinants of Health which published its findings in 2008. Root causes of
poor health - miserable living conditions resulting from poverty - had been
progressively sidelined and then ignored in the thirty years since Alma
Ata, in favour of the neoliberal approach exemplified by the Sachs Report
in which health is conceived as an input to productivity, and illness as -
by and large - the result of  irresponsible individual behavior.

 It is because global governance processes outside the health arena have
not taken into account the health impact of their activities, that this
debate is taking place. The private sector has strenuously resisted
measures for health, environmental and human rights protection in
non-health sectors, because these would inevitably restrict their
activities and profits. It is the reason for the right wing backlash which
aborted the social justice project “Health for All” only two years after
the declaration of Alma Ata. Social justice and human rights groups, on the
other hand, have called for enforceable protection measures in non-health
sectors for decades now. Furthermore, they support prioritization of
health, the environment and human rights over trade and any other aspect of
economic activity and as a logical consequence, they advocate for* health
governance institutions to exercise directing and coordinating authority in
matters of health, over non-health sectors*.

According to its constitution, WHO is the directing and coordinating
authority in all health matters. That means health matters arising out of
activities in non-health sectors. If anyone wants to change that, they must
propose changing the constitution. We should be very clear on that.
 Because very few of these “thinkers” promoting different versions of yet
more global health fora are honest enough to say that that would imply
changing WHO’s constitution. And they would likely encounter far more
resistance if they did so. $
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