PHM-Exch> "The breathing catastrophe"/depoliticization

[Claudio Schuftan]

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


Below are some comments, as brief as I can, on Nicoletta Dentico's article
in Development, July 2021.

http://link.springer.com/article/10.1057/s41301-021-00296-y


*Preamble*: Obviously I agree with most of the points. The question of
depoliticization strikes me as most important, for social justice activists
(and for academics) in the area of global health. .

*Depoliticization*
Nicolette correctly observes that "Covid 19 has ignited the recognition
that global health legitimizes the hegemony of neoliberal values and
contributes to the depoliticization of causes of ill health."

(By "global health", I assume Nicoletta is referring to current global
health *governance *by the "small set of actors" she refers to, not global
health itself.)

Like many other articles on this subject, the words capitalism and
socialism are never used in Nicoletta's article.

But neoliberal is an *adjective *describing a form of capitalism. I think
it is a *euphemism* that is used for purposes of *respectability and even
credibility.* People fear they will be seen as "extreme" if they use terms
such as capitalism or socialism. In the climate of the past 30-40 years,
this was often true, so they were terms to be avoided if you wanted to be
published or to have a voice at all. But capitalism and socialism are the
elephants in the room, for social justice activists or even academics.

I believe that not using precise terms to accurately identify political
concepts (such as capitalism) has serious implications in terms of
depoliticization, in analysis AND in action/mobilization.

(I have been saying this for at least 20 years, so apologies to oldies in
PHM for repeating myself.)

PHM may well have needed this strategy in order to *gain respectability and
entry into WHO.* It was a tremendous achievement. But I think that era has
passed (some time ago) and that this particular depoliticization is an
obstacle to us contributing to achieving HfA/ health as an HR and
democratic GH Governance.

Just two examples of how this is an obstacle:

1. We trip ourselves up with this strategy because by using the euphemism
neoliberalism instead of (neoliberal) capitalism, *we support the idea that
there is a nice, "humane" form of capitalism that is compatible with social
justice*. I will not elaborate on this, it would take too long, but we have
seen only too clearly that the Blairs, Mittérands and even Obamas of the
world, continued to deepen inequalities/to wage dreadful illegal wars/to
privatize global commons etc.

2. We make it *impossible to ally ourselves with those people's movements/
associations /political parties/ trade unions who have the courage and
clear sighted analysis to call themselves socialist and therefore
anticapitalist.* Incidentally, part of what is so irritating about the term
"civil society" is that it never refers to the groups just mentioned - the
very groups of people who are achieving various goals on the road to social
justice. We should be explicitly allied with these groups.

*An example of lost time and lost opportunities.
Anticapitalist groups/movements/parties have been denouncing the role of
the WEForum and PPPs for at least 20 years. We should have been with them
all this time - on the street whenever possible which is the only place
where change happens. *

*Comments on a selection of points *
*1. Covid 19 as common destiny*. Poor communities face multiple and more or
less permanent health catastrophes. In terms of "shocking imbalances" (to
quote Tedros and hundreds of others), Covid 19 is not nearly as striking as
infant mortality/maternal mortality etc. Covid 19 is experienced as a major
catastrophe in rich countries because we are not used to such things.We
have clean water, sanitation, adequate food, shelter and relative physical
safety. "The worst human and economic crisis of our lifetimes"  ? This can
scarcely ring true for the peoples of Iraq, Mali, Afghanistan, Haiti,
Sierra Leone, Palestine, Vietnam, Bolivia - or even the State of
Mississippi (if they were consulted). I think PHM and G2H2 and any such
groups should really be pointing this out.

*2. Alma Ata(1978) was predicated on the NIEO (1974), it was not the other
way round.* Health was not "conceived as the building block upon which
economic development could be designed". This is Sach's neoliberal reversal
of public health lessons: He promoted health as an investment for economic
productivity/development. This formulation is incompatible with health as a
human right (it is not profitable or productive to save old or handicapped
people, nor even premature babies).

The NIEOrder does not just precede HfAll historically but logically. The
NIEO was to be the foundation for meeting all basic needs, each relating to
a human right (food, health, housing, public services, education etc).

*3. China is among the countries that succeeded*. As far as I know, deaths
are still under 5000. (And their figures are not contested in the
scientific literature. Anyone interested, I can send some links and look at
Richard Horton on Western arrogance.) China succeeded in halting the spread
of Covid 19 *in the absence of a treatment or a vaccine, i.e. non
pharmaceutical measures*. 85% of all deaths were in Wuhan and 97% in Hubei
province. By any standards, this is an extraordinary feat. A rapid and
radical response meant a short confinement and lives saved. Beware of
absurd and unfair anti-China reports (hospitals as concentration camps
etc). The subject is performance of health systems (not pro or anti China),
and China massively invested in health systems over the past 20 years.

*4. "No nation can handle the outbreak in isolation". I think that needs
qualifying. Several countries more or less did this: Vietnam, China, New
Zealand. *It has never been true that we are all in this together, except
of course that variants are going to spread. But country responses have
been very, very different. Note also that the Intl Health regulations
(IHR) deal
only with problems that can pass across borders. So that problems confined
to one country, within one country or within several countries (most health
problems) are not covered by IHR. Quite a limitation.

*5.References*: Hickel is referenced a few times. His book is a wonderful
compilation and he credits authors correctly. The figures on "207 years to
eliminate poverty" etc are from calculations presented in an article by
David Woodward (PHM member).  Given the central role that PPPs in health
have played in diverting WHO from HfA, it would be useful to readers to
have references to that particular research (many articles by Buse and
Waxman or Judith Richter). Gleckman's articles are great but he has not
researched the particular case of the WHO and GHGovernance (as far as I
know). And that is at the centre of our concerns.


*Note on the way forward*
I suspect that using the term anticapitalist will alienate some readers.
Suffice to say that today, it is desperately important to spell out what
that means -* even approximately*. One example: meeting basic needs that
correspond to human rights must be controlled, directed and supervised,
democratically, within the public sphere. These are not spheres for profit
making (be reassured, there will still be plumbers and electricians, just
not TNCs running the show!). That is an anticapitalist position that many
would find reasonable. Refusing the privatization of water is an
anticapitalist position.  A wedge has been driven between "respectable left
leaning academics" and anti capitalist activists who are actually achieving
change and forcing improvements. That wedge is massive disinformation
driven by the powerful 1% of the capitalist dominated world. Perhaps these
two groups have enough in common to fight together. We can't afford to be
divided by powerful entities.
.
Nicoletta urges us to go "beyond classical models". WhIch models? Why must
we go beyond them? Socialism for example has not yet been properly tried.
But its efforts so far show considerable potential, do they not? (!)
Extensive, well funded public services, "work", if the aim is social
justice. That is a classical model, is it not?

In solidarity
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