PHM-Exch> [PHM NEWS] SDGs shortfalls point to core contradictions

[Claudio Schuftan]

PHM CommentSDG shortfalls point to core contradictionNotes for discussion
at WHA72, WHO, end May 2019
(The links refer to documents in the WHO website)

Your feedback welcome; to be sent to David Legge <dlegge at phmovement.org>

Part I of A72/11
<http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_11-en.pdf> is a burning
indictment of the health consequences of the prevailing global governance
regime. Likewise the more detailed figures provided in WHS18
<https://www.who.int/gho/publications/world_health_statistics/2018/en/> and
the actual 2030 targets here.

Part I of A72/11
<http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_11-en.pdf>needs to be
read far more widely than just within WHO.  Health science students and
practitioners should read this and ask why. Journalists should read and ask
why. Parliamentarians should read and ask why.

Unfortunately A72/11
<http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_11-en.pdf> does not seek
to explain the looming shortfalls in the SDG targets.

Various reports including the SDG Index and Dashboard <http://sdgindex.org/>
report show that no country is on track to achieve the SDGs by 2030. In
fact the number of people living in poverty in Africa is increasing;
likewise the number of children who are stunted. Global maternal mortality
(now 216 per 100,000 live births) is unlikely to reach the target of 70 by
2030 if the rate in Africa remains high (currently 542).

Part II lists a range of WHO programs, projects and engagements and seeks
to demonstrate how, through these activities, WHO is contributing to the
achievement of the SDGs. Many of these are admirable initiatives and WHO
staff are to be congratulated for their commitment and achievement.

Unfortunately, despite these valiant efforts, in many areas the shortfalls
with respect to achieving the health related targets are growing. A72/11
<http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_11-en.pdf> does not seek
to explain these widening shortfalls.  Simply listing all of the activities
which WHO is contributing to is not enough.

The key to understanding the widening shortfalls in achievement is the
contradiction between the humanistic aspirations of the SDGs and the
dynamics of liberalised transnational capitalism.

Simply measuring poverty distracts attention from the distribution of
global wealth and global income and the dynamics which maintain extreme
inequalities of wealth and income;

Simply measuring stunting distracts attention from the world food system
including protection and price supports in the rich world; the capture of
arable land, water, and energy to over-feed the rich; the global structures
which drive small farmers off their land.

Simply measuring health care impoverishment distracts attention from the
global forces, political and economic, which extract the wealth of resource
rich countries leaving governments without the fiscal capacity to
underwrite health care costs; which enforce high prices of medicines in
order to maintain pharma profits and export earnings.

Simply noting the impact of global warming on food production and
environmental disaster distracts attention from the corporate and political
forces seeking to prevent and defer action on greenhouse gas emissions.

The SDGs provide an inspiring vision of ‘the world we want’. However, they
also serve to distract attention from the economic and political forces
which are preventing the realisation of this vision. In effect they are
helping to maintain an appearance of good faith and commitment on the part
of those who are in effect working to prevent the achievement of the goals.
This is the legitimation function of the SDGs.

PHM urges member state delegates to speak truth to power at the Health
Assembly.

PHM urges health activists around the world to raise public awareness and
lobby their governments around the disaster that is looming behind the
language of ‘sustainable development’.  Key talking points in such advocacy
include:

   -

   insist on naming liberalised transnational capitalism as a failed
   economic system (driving widening inequality, deepening the imbalances
   between productive capacity and consumption, increasing financial fragility
   and deepening our peonage to the banks through increasing debt);
   -

   insist on naming neoliberalism as a policy package (austerity, small
   government, privatisation, tax competition and corporate privilege) being
   implemented in order to protect the transnational corporations and preserve
   the privileges of the transnational capitalist elite;
   -

   recognise the contradictions between the neoliberal program on the one
   hand and the goals of reducing poverty, promoting Health for All, and
   mitigating climate change on the other;
   -

   reject the bizarre assumption that the SDGs can be paid for through
   increased economic growth (as measured by GDP) without attention to the
   harms or benefits of the market transactions so measured;
   -

   insist on the need for a New International Economic Order as called for
   in the 1978 Alma-Ata Declaration
   <https://www.who.int/publications/almaata_declaration_en.pdf> (and
   completely ignored in the October 2018 Astana Declaration
   <https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf>
   );
   -

   insist on naming the xenophobic backlash, and the populist demagoguery
   which is stoking it, as barriers to effective action on the SDGs; and
   -

   continue to denounce the restrictions imposed on WHO’s capacity and its
   voice by the donor chokehold and the ACs freeze.

These issues are all strikingly absent from A72/11
<http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_11-en.pdf>.
Internal contradictions

In previous commentaries we have focused on the contradictions within and
across the SDGs themselves.  These remain important.

See PHM comment on Item 31.2 at WHA69
<https://docs.google.com/document/d/1Hy64u7j2T6f0flFdxglfh_-UKwLJd7vu7_0vktnWftk/edit?usp=sharing>
which highlighted:

   -

   Goal 12 which promises sustainable consumption and production but lacks
   any drivers to achieve this;
   -

   Goal 8 which promises high rates of economic growth but ignores the
   contradictions between economic growth and ecological sustainability; and
   -

   the contradictions between the SDGs and the real effects of ‘free trade’;

See also PHM comment on Item 16.1 at WHA70
<https://docs.google.com/document/d/1710S9ZzSn5W_g1Y6H5sdQ-PHjcaByPqn4Ant8K9rCeA/edit?usp=sharing>
which highlighted:

   -

   the need for a real world ‘theory of change’ regarding how the SDGs
   could be achieved;
   -

   the dangers of the drive towards ‘multi-stakeholder partnerships’, as in
   SDG17.16 and 17.17, which projects universal beneficence and completely
   ignores the Trojan horse functions of many such ‘partnerships’;
   -

   the importance of following the health implications of all of the SDGs.

Two of the chapters in the current Global Health Watch also carry powerful
criticisms of the SDGs:

   -

   A1: Sustainable Development Goals in the age of Neoliberalism
   <https://phmovement.org/wp-content/uploads/2018/07/A1.pdf>
   -

   A2: ‘Leave No One Behind’ — are SDGs the way forward?
   <https://phmovement.org/wp-content/uploads/2018/07/A2.pdf>

SDG8 proposes that the cost of meeting the rest of the goals will be met
through ‘sustained per capita economic growth’.  GHW comments that the
assumed metric, GDP, is a measure of market transactions regardless of
their contribution to ecological sustainability or human development (or
health). Manufacturing and deploying weapons of mass destruction makes a
powerful contribution to GDP.

SDG8 calls for full employment (Target 8.5) and for ‘higher levels of
economic productivity’ (‘increase in real GDP per employed person’). This
combination of targets ignores the role of productivity increases (as
measured) in creating unemployment!  Conventional economic theory assumes
that the labour displaced by increased productivity will simply be
re-employed in new forms of better-paying work. What such theory disregards
is the massive displacement of agricultural labour from ‘increased
productivity’ in agriculture and the huge mobilisation of Third World
workers (displaced from agriculture) in global manufacturing: “too many
workers competing for too few jobs to produce too many goods or services
for too few consumers with too little income to afford them without
increasing their already high levels of personal debt”.

GHW5 also comments on the continuing call for increased ‘development
assistance’ as a key pathway to funding the SDGs. This strategy has failed
to impact on sustainable development over several decades even while
fragmenting health systems and placing huge administrative burdens of
governments.  Meanwhile no action is proposed on tax evasion through
transfer pricing and tax havens nor on the pressures of tax competition and
corporate tax extortion which have held back tax revenues and public
spending.

GHW5 also comments on principle of reciprocity (non-discrimination) in the
current regime of trade agreements; a principle which treats poor countries
the same as rich countries despite massive differences in economic and
political power. The New International Economic Order, which features in
the Alma-Ata Declaration (and is notably missing from the 2018 Astana
Declaration), envisaged discrimination in favour of developing countries to
be structured into a rules based trading regime. Not only are modern trade
agreements non-discriminatory (in the sense of including few or no
provisions for ‘special and differential treatment’) but they discriminate
blatantly in favour of the rich countries through extreme IP provisions,
regulatory harmonisation and investor protection.

GHW5 also addresses the difficult topic of population control. It is
established that family sizes fall with economic development and the
provision of social protection. However as population levels level or fall
in the rich countries the call is increasingly heard for encouragement for
population growth through fertility and (selective) immigration. GHW5
labels this as a Ponzi population policy:

Its argument is that, with population aging, immigration and/or incentives
for larger families should be encouraged to re-swell a comparatively
shrinking working age cohort (those between 15 and 64 years).The economic
rationale is that the taxes collected from the productivity of the working
age population is needed to pay for the services and pensions of a
proportionately greater and increasing number of elderly.That makes sense,
perhaps, for the short-term. But fast forward 40 or 50 years, and the
re-swelled working age cohort has itself become elderly (and far more
numerous), requiring an ever larger expansion in the base of the working
age population.And so on, and on, and on.
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