PHM-Exch> [PHM NEWS] GHW5 serialized summary (6)

[Claudio Schuftan]

LAST INSTALLMENT.

For 6 weeks, the PHM-exchange has, on a weekly basis, been bring you
summaries of all the chapters of its recently published Global Health Watch
5.   By the time this 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.*
>
>
>
> *D5. INVESTMENT TREATIES: HOLDING GOVERNMENTS TO RANSOM.*
>
> It is evident that the rights given to investors in bilateral investment
> treaties and free trade agreements significantly restrict governments’
> ability to regulate how companies operate within its national borders
> especially when TNCs challenge health, environmental and other laws and
> policies. This has prompted calls for the rejection or the overhaul of the
> global investment treaty framework. Governments should no longer sign any
> trade agreement that includes investor-state dispute mechanisms. They
> should withdraw from or renegotiate existing contracts and instead favor
> domestic investor protection laws.
>
> These treaties further often have a negative interplay with human rights
> treaties --one more powerful reason to be vigilant.
>
> Both bilateral and multilateral investment treaties aggravate the problems
> of extreme poverty, jeopardize foreign debt negotiations and affect the
> rights of indigenous people and other persons living in vulnerable
> situations.
>
> The call is for greater transparency and public consultation in current
> trade and investment agreement negotiations, as well as for human rights
> impact assessments of these treaties so as to ensure full citizens
> protection and enjoyment of human rights.
>
> States need protection from predatory investors and TNCs that do not
> hesitate to engage in frivolous litigations that are extremely expensive
> and have resulted in awards in the billions of dollars and millions in
> legal costs. The time has come to abolish investor-state dispute mechanisms.
>
> Xx
>
> *D6. FRAMING OF HEALTH AS A SECURITY ISSUE.*
>
> Since the 1990s, health issues have increasingly been framed as security
> threats. As such, collective health security is concerned with preventing
> potential threats to *developed* countries. But funds allocated have not
> been spent on reforms to ensure long-term health systems strengthening.
> This is problematic. It constructs a dynamic in which global health actors
> become focused on developing surveillance systems and ‘fighting wars’
> against outbreaks. This means that the underlying causes of epidemics that
> are rooted in the lack of access to healthcare and underlying social,
> economic and political determinants of health are overlooked. It also
> results in the misallocation of scarce resources in a manner that
> undermines efforts to extend universal health coverage to vulnerable
> populations so as to improve the social determinants of health.
>
> What is needed is to demand a more people-centered approach to health
> security taking a more long-term view and building up health systems. For
> all thee reasons, GHW5 recommends the securization of health must be
> treated with skepticism by global health activists and academics.
>
> Xxx
>
> *D7. POLITICS OF DATA, INFORMATION AND KNOWLEDGE.*
>
> The politics of measurement actually fogs-over health policy analysis.
> There are significant costs related to dishonest data and secrecy. It is
> also necessary to appreciate how official information systems are cast
> within, as well as project a particular ideology notwithstanding their
> veneer of objectivity. The quality of research is often subject to the
> gatekeepers’ interpretation of both the social value of the anticipated
> knowledge production and the proposed (or used) methodology. The most
> striking of measure of political bias in research funding is the imbalance
> between funding of basic science/clinical medicine and (the lack of)
> funding for research on the delivery of healthcare and prevention. There is
> an increasing preference for research methodologies that yield quantitative
> estimates amenable to statistical testing over qualitative methods.
> Research performance (and funding) of universities is being measured in
> terms of publication in highly cited journals. Academic collaboration with
> communities, learning from practice and locally relevant knowledge are
> discounted in favor of technological research-oriented material useful for
> the new globalized marketplace.  Worrisome are fraudulent analyses of
> clinical trials data and the failure to publish negative studies. Needed is
> a mandatory registration of all clinical trials. The corrupting influence
> of corporate sponsorship of clinical trials is at the center of this worry.
>
> Program evaluations mostly attempt to assure donors that their funds are
> being productively used.
>
>  GHW5 thinks the hegemonic ideology behind all of this can be challenged.
>
> Xxx
>
> *D8. ACCES AND BENEFIT SHARING FORM VACCINES.*
>
> This chapter is based on the experiences drawn from the pandemic influenza
> preparedness framework.
>
> Technologies and know-how used in vaccines development and production is
> largely based in developed countries and is indeed also protected by
> intellectual property. This creates more obstacles for developing
> countries.
>
> Pandemic preparedness also includes a fair and transparent sharing of
> viruses intended to make access to vaccines made from them accessible to
> poor countries. It is also to be made clear that neither the provider nor
> the recipient should seek to obtain any intellectual property rights on
> these materials.
>
> Also indispensible will be royalty free licenses to vaccine manufacturers
> in developing countries including receiving support in the transfer of
> technology and know-how.
>
> Multilateral access and benefit-sharing  with equity  are at the core of
> these arrangements, with WHO  facilitating all aspects of the pandemic
> preparedness process.
>
> Xxx
>
> *D9. TOTAL SANITATION PROGRAMSAT THE COST OF HUMAN DIGNITY.*
>
> This chapter critically interrogates the ongoing Community-Led Total
> Sanitation (CLTS) Program.
>
> The CLTS model exemplifies a neoliberal approach that individualizes
> problems and their solution, CLTS has been termed ‘Toilet Tyranny’ since it
> shames people who defecate in the open and do not have latrines. This very
> vertical program frees governments from promoting true all-round welfare
> for their citizens. This, because access to latrines and good sanitation is
> an inclusive human right and all those rendered poor stand to benefit the
> most from such access provided as a priority by government programs.
> Blaming those rendered poor for living in unsanitary conditions, as the
> CLTS does, is not the way to address these problems.
>
> Participatory, and not top-down, processes are needed to ensure universal
> access to sanitation facilities. The first big issue to address actually
> concerns the availability of water for the toilets *and* for safe water
> for drinking.
>
> Women currently have to fill and carry water for servicing toilets, in
> addition to arranging water for cooking, drinking and washing. This is thus
> also a human rights concern that must be addressed. Women’s participation
> is key.
>
> Coercive practices, such as those in the CLTS program, lend themselves to
> gross violations of the rights of people. Clearly a course correction in
> the model is overdue.
>
> Xxx
>
> *A.    **RESISTANCE, ACTIONS AND CHANGE.*
>
>
>
> *E1. SOCIAL MOVEMENTS DEFEND PROGRESSIVE HEALTH REFORMS.*
>
> This chapter is based on the experiences in El Salvador.
>
> The role of a pressure groups to influence key political actors, i.e., the
> role of social movements as a political force was proven here to be the
> decisive factor for the needed reforms to have proceeded. Using this
> approach, among many other:
>
> ·      fees for treatment were abolished;
>
> ·      community health teams were rolled out in the country’s poorest
> municipalities and new community clinics were added that had well organized
> referral and reverse referral systems;
>
> ·      quite massive human resources were trained and hired and
> facilities were repaired and expanded; needed equipment was acquired;
>
> ·      pharmaceutical manufacturers were removed from the Medicines
> Regulatory Board that controls purchases and procurement;
>
> ·      a price regulation system and quality control mechanisms were set
> up that reduced the out-of-pocket expenditures of patients;
>
> ·      drug shortages in the public network was reduced by more than half
> in 5 years; the medicines supplier base was broadened and the in-country
> production capacity of medicines was expanded;
>
> ·      it was decided that taxation had to be the base of healthcare
> financing;
>
> ·      tax evasion was curtailed and  laws of progressive taxation were
> introduced;
>
> ·      an increase of minimum wages was instituted;
>
> ·      social auditing of the health system provided information to the
> public so as to change their attitude;
>
> ·      mobilized groups closely interacted with PHC facilities  and
> hospital administration in their areas;
>
> ·      information was also disseminated through workshops and seminars,
> as well as through press conferences.
>
> GHW5 emphasizes that all these changes were possible because social
> movements played a key role in pressing for these progressive measures.
> Street mobilizations showed how the balance of power can indeed be shifted.
>
> Countries such as El Salvador just cannot conduct a lone battle, and
> progressive initiatives will flounder in the absence of international
> solidarity.
>
> Xx
>
> *E2. CONTESTATIONS CONCERNING THE MANAGEMENT OF SEVERE ACUTE MALNUTRITION.*
>
> Experiences here come from India.
>
> Malnutrition is the outcome of socioeconomic and political inequalities.
> It thus has to be managed with a strong focus on its root causes.
>
> Unfortunately, the approach followed has been informed by a biomedical
> rather than a public health perspective where malnutrition is often treated
> without considering its broader social determinants. This approach includes
> using manufactured commercial products for the treatment and prevention of
> undernutrition which is of great concern since there is a lack of evidence
> for its long term health impacts. These products, generically known as
> Ready to Use Therapeutic Foods (RUTFs) do not, by any means, replace
> nutritional best practices and consumption of normal household foods. Too
> often locally sourced ingredients are not used in their manufacture.
>
> The entry of the private sector has resulted in commercial interests
> coming into conflict with the local public health challenges behind
> malnutrition. The increase in producers of RUTFs has resulted in their
> development for the consumption by populations that are not suffering from
> severe acute malnutrition which is what RUTFs should be used for.
>
> These product-based solutions being offered to combat malnutrition fail to
> address issues regarding the prevention of malnutrition, important
> continuity of care and sustainability issues, as well as having a negative
> impact on local food systems and economies or even on efficacy.
>
> This all medicalizes the management of malnutrition and unacceptably
> minimizes community participation and ownership. A comprehensive
> participatory approach will clearly provide better access, sustainability
> and continuity of care at lower costs with fair outcomes.
>
> The use of commercial RUTFs only has an impact equivalent of that of
> augmented home foods so that their use goes against the available evidence.
> Compelling evidence points to the efficacy and greater sustainability of
> comprehensive community-based nutrition programs that incorporate the use
> of locally devised solutions.
>
> xxx
>
> *E3.  PEOPLE LIVING WITH HIV: THE STRUGLE FOR ACCESS.*
>
> The experiences here also come from India.
>
> ·      Massive campaigns for the access to antiretroviral therapy took
> years of long struggle and advocacy to organize, but the government finally
> announced its plan to provide these drugs to the affected population in
> December of 2003.  Much of the struggle was related to allowing free
> competition in the manufacture of generics;
>
> ·      patents on these medicines were abolished with costs dropping to
> 1/10 to 1/5 of prices in the global market;
>
> ·      ceilings on royalties to multinational corporations were
> introduced;
>
> ·      manouvers by Big Pharma to  extend their exclusive patent rights
> were successfully opposed and the law allowed challenging new patent
> applications; the threat of patent rejection lead companies to withdraw
> their applications;
>
> ·      public interest groups were critical sources of technical
> information and analysis, as well as of social mobilization;
>
> ·      the right to protect public health was made paramount in promoting
> access to medicines for all;
>
> ·      several victories  in courts ensured that generic versions of ARVs
> continued to be available;
>
> ·      also, different health groups undertook protests, and organized
> press conferences to maintain the public focus on the case.
>
> The end result was a string of victories for people living with HIV who
> could now continue to rely on access to affordable treatment.
>
> Several Indian companies have now been acquired by TNCs or have tie-ups
> with them so they are now less likely to challenge patents.
>
> The successful use of patent opposition has inspired similar work in other
> countries. These successes have not come easily and many countries are now
> facing a persistent onslaught from several TNCs. Developed countries are
> not only using FTA negotiations, but are also using bilateral pressure to
> defend the patents of the corps they house. GHW5 calls for continued
> vigilance.
>
> Experiences so far show the benefits of using the legal system to achieve
> gains for people’s rights. Most importantly, they show that community
> groups are at the heart of the successful use of litigation.
>
> Xxx
>
> *E4. COMMUNITY ENGAGEMENT IN THE STRUGGLE FOR HEALTH.*
>
> Experiences here come from two movements in Italy.
>
> The food sovereign movement here showed that the access to healthy food in
> the country was not possible without fighting against the prevailing
> exploitation, land grabbing and environmental devastation, as well as
> without practicing alternative forms of governance rooted in local and
> autonomous communities.  The work of the group supporting a community
> struggle against the effects of asbestos became an example and an
> inspiration internationally for the struggle against environmental
> pollution and violence in many communities.
>
> Xxx
>
> Claudio
>
>
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