PHM-Exch> [PHM NEWS] GHW5 serialized summary (4)

[Claudio Schuftan]

For 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.*



*C3. LACK OF PROGRESS IN WOMEN’S SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS.*

Experiences here come from Chile.

Gender inequalities are partially manifested in the treatment of women’s
sexual and reproductive health and rights (SRHR) where there has been a
significant lack of progress towards securing better health outcomes. The
role of power in policy making on these issues is too often overlooked.
They are, for sure, overlooked in health reform debates. The
marginalization of women within central decision making arenas is pathetic.
This raises significant questions about the likelihood of SRHR issues being
taken up as political matters of serious concern.  Moreover, attempts to
introduce a more redistributive focus on the health system are, quite
predictably blocked by private insurance companies. The influence of the
Catholic Church in health policy making in this area cannot be denied
--certainly impacting women’s health outcomes. Despite there being low
popular adherence to the Church, the Church has successfully maintained a
conservative agenda on issues of reproductive rights. Add to this the
Church’s alliance with conservative business and right wing elites and you
get the full picture. This chokehold also has an influence on sex education
in schools, as well as on access to emergency contraception and to
abortion.

The medical profession has further failed to prioritize women’s own
definitions of their health. Health and medical workers still exert power
and control over women seeking health care services, a sit that has
arguably been reinforced in the context of privatization of these services.

If governments are serious about their commitment to overcoming
inequalities and meeting development goals, it is essential that SRHR
issues are forcefully and fully addressed. PHM is active in this struggle.

Xxx

*C4. TRADE AGREEMENTS AND HEALTH WORKERS *

Trade agreements have substantial effects on the well-being and livelihoods
of people, including on their health. Think, for example, on the issue of
access to essential medicines. Additional reasons of concern are: a lack of
transparency in the negotiation of these FTAs, the heavy involvement of
private lobby groups, the facts that developing countries are usually in a
week bargaining position and that developed countries attempt to remove any
flexibilities favoring developing countries. The existing power imbalances
are reflected in the rules established in these agreements (they tend to
deepen inequalities in multiple ways).

FTAs promote corporate interests at the expense of public health
priorities. They cause a loss of government revenue by the abolition or
lowering of tariffs on cross-border trade. In a significant proportion of
government revenues in the poorest countries this loss limits the capacity
of these countries to implement social policies and to make investments in
vital sectors such as health and education.

Note that health care in developing countries can be very profitable, so
commercial interests do get involved. (The health sector is one of the
fastest growing sectors in the world economy). FTAs encourage the
commercialization and the privatization of health services. Insurance
companies are always in search for new markets!

Trade agreements lock countries into a situation where privatization of
health services becomes irreversible. They are loaded in favor of Big
Pharma and often promote monopolistic situations. They often lead to
changes in diets and the nutrition status of the population. Food imports,
especially of ultra-processed foods have more than doubled since 2000. This
is accompanied by rising rates of obesity and chronic diseases. Poor
households are most sensitive to these changes since it is them that
consume cheaper ultra-processed foods. Consumption of alcohol is also
driven up.

Trade further indirectly affects working conditions of the working class
with increased powerlessness of them to exercise their workplace rights.
More severe adverse effects on healt can be expected in countries with
limited social protection. Note that availability of social protection is
usually restricted to standard, formal employment relationships and not to
different forms of precarious employment.

Basically, maintaining competitive prices has been achieved at the expense
of workers’ rights. When employment and working conditions worsen under
pressure of FTAs, women are the first to be affected. Informal workers (the
majority of whom are women) do not receive any social protection.

Trade liberalization has negative effects on the unionization of workers
and their bargaining power as employees. The disempowerment of workers and
their unions has gone hand in hand with the increasing power of large TNCs
and their influence on policies on labor. If workers try to organize to
change their situation, they may be blacklisted or threatened.
Consequently, they are afraid to stand up for their rights.

The TPP (now approved with modifications) is unlikely to increase the power
of workers --actually the contrary is more likely. Signatory countries  of
the TPP find an inadequate range of domestic options to meet minimum labor
standards to be eligible for FTAs.

Many provisions in FTAs pertaining to labor are largely ornamental and
offer little concrete improvements especially since labor provisions often
lack binding rules for workers to claim. Plus there is a lack of sanction
mechanisms in the case of failure of compliance.

Claims that increased trade leads to econ growth and well-being are
contradicted by facts. The negative effects on health occur through various
pathways.

There is an urgent need to think beyond a framework that is bound by the
neoliberal recipes. We have to go beyond.

Developing countries must be compensated for revenue losses arising from
lower tariffs demanded by developed countries that demand lowering or
removal of tariff barriers.

Xxx

*C5. PUBLIC HEALTH IN THE EXTRACTIVE SECTOR. *

Experiences here come from East and Southern Africa.

What is missing for public health aspects to be respected by extractive
industries are a transparent, democratic and accountable government-led
governance system that addresses these issues, with greater voice and
influence from public interest CSOs, as well as affected communities so as
to face industry on an equal footing.

International standards relating to health in instances of extractive
industries are actually not covered completely by any country. None of them
requires explicit health sector approval for their operations. There are
basically weak specific provisions for health and social protection, as
well as for relocating affected communities due to poor representation of
the directly affected in related decision making and in grievances
redressal. Few countries include health care or medical surveillance for
affected workers since this is regarded as a matter of voluntary corporate
social responsibility.

Let us face it: The ‘polluter pays’ remedy reluctantly offered leaves
public health harms unresolved. Corrective actions triggered by claims
against corporations are seldom carried out.

The most serious problem here is the gap between what the law or policy
says should happen and what in reality does happen. Countries are simply
ill-prepared to manage the social issues in the rapidly growing extractive
industry sector.

Government too often agree to investor-friendly clauses so as to attract
foreign investment. But states face capacity deficits on the regulation
front with fines imposed ending up being too low to have a deterrent effect.

Poorly negotiated contracts, tax concessions cost countries significant
revenues. Voluntary measures do not address the health determinants that
arise from extractive industry activities. This reflects the corporate
public relations and lobbying power. Voluntary corporate social
responsibility has never had a commitment to involve affected communities.

As regards accountability, public interest CSOs need to carry out the
independent oversight function needed through comities with clear
disclosure obligations. Workers and unions must exercise joint pressure and
not only focus on wage demands. A demand for a meaningful voice is
called-for as are transparent environmental *and* health impact assessment
studies. Local communities are to further receive an appropriate small
share of the economic and social benefits of extractive operations.

Power asymmetries between global corporate actors, the states and
communities are at the base of the problems addressed here. Public-public
partnerships between affected communities, CSOs and state institutions are
needed.  CSOs are to collect the evidence needed to regulate the commercial
interests that are harmful to health --even if this means confront the
economic powers involved. There is an urgent need to move from just
demanding medical services for the affected to advocate and demand what
rights and obligations must be secured.

Xxx

*C6. THE WAR ON DRUGS: FROM LAW ENFORCEMENT TO PUBLIC HEALTH.*

The war on drugs is not working. It has also undermined health and has
failed some of the poorest groups worldwide. The ‘war’ must move towards
adopting a public health approach. Strict prohibition has meant: there are
no controls on drugs strength and purity; injections are most frequently
done with unsafe equipment; aerial drug crops spraying has not worked and
has ended up endangering the health of exposed local residents.

Moreover, the use of needed essential medicines for pain management has
been highly restricted due to the ‘war’. The availability of needed
essential opioid analgesics has been severely curbed.

The criminalization of people who use drugs has acted and acts as a strong
barrier to accessing medical care. Harm reduction services giving access to
sterile injecting equipment through needle and syringe programs remain
essential in reducing HIV transmission and prevalence.

It is almost always the poorest and most marginalized that bears the brunt
of the war on drugs. Taking the public health approach to drug policy will
mean that people who use drugs will no longer be targeted --a human rights
abuse; they will be able to access the health and support services they
need. Money spent on enforcing failing drug laws *can* be freed and spent
on public services, e.g., emphasizing harm reduction services, legalizing
cannabis for recreational use.

Decriminalization with strict regulation is possible, GHW5 argues.

Bottom line, drug use is a public health problem requiring public health
solutions. No one-size-fits-all approach will do. Active participation of
those who are most affected is a must.
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20180530/f5d5c07f/attachment-0002.html>