PHM-Exch> [PHM NEWS] GHW5 serialized summary (1)

[Claudio Schuftan]

For the next 6 weeks, the PHM-exchange will, on a weekly basis, bring you
summaries of all the chapters of its recently published Global Health Watch
5.
By the time the last installment is sent out, PHM expects to be able to
post the full text of GHW5 electronically for your reading and perusal.
We encourage you to read, use and share this material since it provides
crucial advocacy contents.


*As in the case of all previous Global Health Watches, GHW5 does nothing
but build on PHM’s People’s Charter for Health launched in the year 2000. *

*All Watches tell activists worldwide what issues worry PHM and its
partners, why we denounce them, what consequences loom in the future if
nothing is done about them, what (if anything) is being done about them and
what actions PHM calls for and supports.*

*GHW5 presents to you a decisive global health critique and outlook not
easily found elsewhere.*



*INTRODUCTION*

GHW5 presents the case for the need for a new global economic and social
political platform given that the SDGs do not offer help for such a
platform.

The SDGs instead propose growth strategies that seek to perpetuate the
current neoliberal model that de-facto perpetuates poverty and destroys the
planet.

GHW5 realizes that real change can only result from clashing with opposing
forces; nothing less will be able to complete the task of dismantling the
power of the neoliberal regime. An ideological counteroffensive is underway
and PHM is part of it; the poor healthcare those rendered poor is just the
port of entry PHM uses. Resistance is growing also from other people’s and
worker’s organizations. Now, the progressive forces must find a way to
globalize their struggles and demands.

*Globalization and neoliberal economic policies are fueling migration --and
migrants are unacceptably victimized by denying them healthcare.

UHC is the *slogan du jour* in global health policies, but this approach is
highly contested. Instead, PHM joins those advocating for the need to
advance tax-based funding of health services, for single payer systems, for
capped program funding and for participatory clinical governance.
Furthermore, a more prominent role for community health workers and
community involvement is needed. Conversely, currently, UHC advocates are
arguing for care that is purchased from a range of private and public
providers. This has legitimized the dismantling of public health services.
Therefore, greater community power is needed to control healthcare so as to
increase the community’s control over their own health. Neoliberal reforms
in restructuring healthcare services have simply been flawed and have
represented a transfer of public resources to the private sector.
Therefore, since marketplace solutions have been a failure, only involving
citizens in the management of health services will makes them strong
advocates for non-commercialized healthcare. Civil society activism is to
bring about change from below.

Donor funding through private and non-governmental recipients have resulted
in cuts in public spending by the state especially under ongoing austerity
regimes.

Remuneration of health workers has been decreasing over the years, so they
are organizing themselves to improve their conditions of work.

Women’s sexual and reproductive rights are being ignored.

Risks that FTAs pose to the health of workers are also being ignored, as is
the impact of the extractive sector on the health of workers.

For long, WHO has been in a deep funding crisis that has led to a serious
erosion of the principles of democratic governance of the organization. The
growing influence of philanthropic founds is part of such an erosion.

The rights-based approach to health is being worrisomely undermined with
WHO framing health interventions as technical exercises that downgrade the
role of community voices.

PHM sees PPPs like GAVI a GFTAM as a threat to the hitherto nation-state
driven system of global governance. Botha are under increasing private
sector influence.  The mechanisms that are embedded in trade and investment
treatises place an onerous burden on countries.

The securization of health has, so far, mostly encouraged feelings of fear.

PHM has much to say about the politics of data; the sharing of biological
materials; ongoing sanitation programs that thrive on coercive practices.
(see below)

GHW5 advocates for a greater political mobilization that opt for a model
that is truly fair in healthcare delivery. The same needs to be adequately
funded. GHW5 warns us that private interests and local elites can take
democratic institutions hostage and can sabotage reforms that benefit the
majority. People’s movements have a key role to play in this.

Countries find it extremely difficult to create the fiscal space for
meaningful reforms of the health services. International mobilization must
be designed to break the power of the international financial institutions,
the international trade regime and of TNCs.

As regards the approach used to address malnutrition, the one followed has
been biomedical rather than using a public health perspective, and this
without considering its broader social determination.

The struggle conducted by people living with HIV using the legal system to
make full use of the flexibilities under TRIPS been remarkable. This has
been an inspiration. The struggle for health must thus be conceived and
constructed as a very broad struggle that upholds a vision that is critical
of the ills of neoliberal globalization.

PHM believes that change is necessary and urgent.



*A.    **THE GLOBAL POLITICAL AND ECONOMIC ARCHITECTURE*



*A1. THE SUSTAINABLE DEVELOPMENT GOALS IN THE AGE OF NEOLIBERALISM.*

To PHM, The SDGs are a case of: * Plus ca change, plus ca reste la meme
chose.*

GHW5 starts warning readers that the SDG targets actually give nations too
much latitude in defining their own ‘level of ambition’ therefore allowing
them to choose their own particular targets so that the targets rather
become  ‘aspirational’ with each country able to ‘cherry pick’ on them
--and this is a problem.  (Note that the SDGs do not emphasize their
indivisibility allowing this cherry picking of their favorite goals). With
little attention given in the SDGs to income distribution needs, GHW5
points out that it would take 200 years to eliminate poverty at the
$5/day/cap income level.  Add to this that the SDGs do neither consider
binding enforcement measures, nor measures to demand progressive taxation
regimes nor measures to counter tax evasion (especially by TNCs and wealth
y individuals). Notable also is the embedded contradictions in the SDGs
between equitable, sustainable development and the insatiable economic
growth model of global capitalism. It is not about promoting sustainable
consumption, but about consuming sustainably particularly by reducing
aggregate demand in high income countries. (Is there sustainable economic
growth that is environmentally sustainable?)

With all these caveats, the SDGs risk becoming everyone’s business, but
no-one’s major responsibility. It thus falls on public interest civil
society to hold both state and market to account for actions responsible
for economic and environmental sustainability, as well as for the health
equality targets of the SDGs. Urgent activist priority is going to be
zeroing-in on the health and environmental SDGs including those on water,
energy, climate, biodiversity and other.

The main critique is that the SDGs care more for instituting ‘policies by
numbers than policies that address true neglect’.

There is further no measure proposed for reducing between-country
inequalities, nor measures addressing affordability of health insurance
schemes or unaffordable out-of-pocket health expenditures.

Also not found are meaningful measures on

·      metrics for social protection systems;

·      assistance to small food producers;

·      doing something substantive about trade-distorting food export
subsidies;

·      the availability of affordable essential meds and vaccines for all;

·      the availability of  universal access to sexual and reproductive
health care services for women;

·      actions to promote sustainable lifestyles in the North; and

·      human rights, gender equality and global citizenship.

The SDGs are simply plagued by too many woulds and shoulds rather than
forceful statements of will and shall.

GHW5 concludes that the SDGs provide us with an imperfect roadmap. This,
since there are no non-radical options left before us. It is one thing to
campaign for the priority SDGs and another to envision the type of
political system and organization that may see to the fruition of these
goals to the year 2030. In no goal is the inequality intrinsic to a
capitalist economy really questioned as a causal agent. This is why
activists need to also critique the economics that underpins the current
stagnation in meaningful development progress.

The situation being what it is, the UN system has regrettably been under a
neoliberal assault for decades and is facing its own test of contemporary
relevance. A struggle to change the effects this has on the UN’s governance
is of high priority. Public interest CSOs are to articulate and to agitate
confronting this power at the national and the global level.  Only a new
more transparent governance will resolve the fundamental contradictions
inherent to capitalism’s distortions that remain implicit in the SDGs.
Disparity reduction to reduce inequalities is the true goal to pursue to
2030.

Bottom line, building a stronger activist base remains essential to move
governments forward on the SDGs seen from the perspective of their
weaknesses as per above.

Xx

*A2. ARE THE SDGs THE WAY FORWARD?*

Do not be fooled: The SDGs omissions are not due to an oversight; they are
intentional; the goals set do not necessarily rank as priorities for most
UN member states. At best, GHW5 thinks the SDGs tinker with the global
economic system to make it all seem a bit less violent. But this is not a
time for tinkering. And all this is not about willingness; the driving
force is profit making. Wealth simply piles up faster than growth --and so
does power.  In our world, profit comes before people, before climate,
before planet. The resources of countries rendered poor are exploited not
for the benefit of local populations, but to satiate the consumer needs of
wealthy nations.

This being the case, vested interests will have to be countered and radical
new choices will have to be made. These must involve social organizations
to champion the struggle to change the fundamental flaws in the current
economic and political architecture of the globe. The SDGs cannot simply
propose growth strategies that seek to perpetuate the current neoliberal
model --ever increasing levels of extraction, production and consumption.
The SDGs fail to acknowledge that mass impoverishment is the product of
extreme wealth accumulation and overconsumption by a few; they simply avoid
addressing these deeper causes; they actually do the opposite by calling
for more trade liberalization and more power to the WTO. No word is uttered
about debt servicing and about debt cancellation.

Proceeding with the SDGs roadmap, the risk is transforming the UN into a
big PPP where democratic represent is weakened in favor of private
commercial interests as progressively seen in the multi-stakeholderization
of global governance. Can the SDGs truly encourage corporations to be
reasonable? Or unreasonably pursue GDP growth when poverty is the primary
cause of the underdevelopment it tries to conquer?

Only societal counter-power through working class organization can force
the needed redistribution mechanisms (i., e., what is needed is building
broad domestic counter-power).

A renewed attention to the importance of the social determinants is the
only way forward. It is clear that change will not occur by itself. It will
be the result of the clash of opposing forces. PHM thinks we have to
position ourselves on the side of the wellbeing for all and of a healthy
planet and against profit for a few. We need to mobilize.

Xx

*A3. ADVANCES AND SETBACKS TOWARDS A SINGLE PUBLIC HEALTH SYSTEM.*

A key lesson from Latin America here is that we need to rid ourselves of
the illusion that it is possible to redistribute wealth and to expand
democracy without confronting the power of capital. Under neoliberal
globalization, health is now an area where capital tries to wrest from the
state a new space for capitalist accumulation. Therefore, as GHW5 points
out, health is an area of struggle in the process to transform the state
itself. In this struggle, trade unions have unfortunately not assumed the
role of advocates of collective and social rights, but have negotiated
private health insurance and better remuneration for their members and have
opposed the creation of a single unified public health system.

Where is their ethics of public service?

Physicians tend to consider themselves as the center of the health system
even though the widespread commecialization and growth of corporate power
in the health sector have displaced them from this central role. They claim
for themselves better working and economic conditions rather than for the
rest of the health work force and are reluctant to lose their
privileges.  Where
is their ethics of public service?

A variety of regressive transfers of resources from the public to the
private sector are also under way the world over. Public resources are used
to finance and support health care delivery by the private sector. There
clearly is a need to regulate this, as well as the explosive use of new
technologies in the private sector due to its unjustified costs.

GHW5 warns us that the widespread use of the terms ‘insurance’ and
‘coverage’ seeks to indicate that the provision of healthcare services is a
contractual relationship, not a human right.
Progressive left-wing forces must therefore find a way to globalize their
struggles and demands starting by developing a strategy for globalizing
their struggles against the ongoing neoliberal assault.
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