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<P>From: Katz, Alison <BR> <BR>Open Letter to Dr Margaret Chan,
<BR>Director-General, World Health Organization <BR>Geneva, January 2007
<BR><BR>Dear Dr Chan, <BR><BR>You have taken office as Director-General of the
World Health Organization after two discouraging decades in which the
international health authority has been progressively subjected to pressure from
powerful minorities, separated from the people it serves and diverted from its
public health mission. <BR><BR>In short, WHO has fallen victim to neoliberal
globalization - as have most social and economic institutions serving the public
interest. A number of WHO staff, in senior and less senior positions, have
struggled against the worst excesses of this process, but the damage has been
extensive. In addition to the tragedy (and scandal) of continuing, avoidable
disease and death, WHO has lost friends among the people it serves and has
gained rich and powerful "partners" in search of new areas of influence.
<BR><BR>Almost certainly, the world's people will force a return to the goal of
social and economic justice, and in the area of health, to the promise of Alma
Ata - which was itself explicitly predicated upon a new international economic
order. <BR><BR>"Health for All" became WHO's slogan at the end of "Les Trentes
Glorieuses" (1945-1975) - thirty years of genuine progress towards a fairer -
and therefore a healthier - world. This was the era of decolonization, when the
need for redistribution of power and resources, including the rights of peoples
to self determination and control over national resources, was widely recognized
and there was strong commitment to universal, comprehensive public services to
meet basic needs for health. A time of optimism, moral vision and genuine
progress. <BR><BR>Optimism was fully justified because the world had (and still
has) ample resources to ensure peace, security and the wellbeing of all. Health
for All is no utopia. It was and is achievable even if it is far more ambitious
than the Millennium Development Goals which are - quite literally - a set of
half measures defined and delimited by the G8. <BR><BR>If thirty years is the
length of cycles of progress and backlash, with social progress for people
always overtaking, if only by a small margin, the backlash of powerful
minorities to maintain their privileges, we are embarking now on the new 30 year
cycle of progress. <BR><BR>And your five years as Director-General (DG) of WHO
coincides with that new cycle of progress. <BR><BR>Before I leave, I would like
to comment on some of the excellent points you have made in various speeches (1)
since your election, confident that your vision - if you can realize even part
of it unimpeded, will reinforce and accelerate that progress. <BR><BR>1.
Inequality should be the focus rather than poverty and insecurity <BR>You
identify poverty and insecurity as two of the greatest threats to harmony which
as you rightly state is "a word at the core of the WHO constitution"<WBR>. You
state that "health is intrinsically related to both development and security,
and hence to harmony". The social justice perspective would go further by
stating that peace and security cannot be achieved without justice, and health
cannot be achieved without equitable and emancipatory development. <BR><BR>Our
focus today should be on inequality rather than poverty, not because of a
preference for the relative over the absolute, but because unequal power
relations are themselves the root cause of both poverty and insecurity, and
because inequality, over and above any level of material wealth or deprivation,
is bad for health and for cohesive, safe, healthy societies. Current
inequalities - in which the richest 1% of adults alone owned 40% of global
assets in the year 2000 and the richest 10% of adults accounted for 85% of the
world total - are not only grotesque in their divisiveness, they are lethal.
<BR><BR>2. Time to focus attention on the rich but to meet with the poor <BR>It
has become fashionable to focus attention on the poor but to meet - and
establish partnerships with - the rich. In order to address the fundamental
problem of inequality, this pattern must be reversed. It is time to focus
attention on the rich and powerful because they are the experts in the
mechanisms of unequal power relations and the architects of policies and
strategies which produce, reinforce and accelerate inequalities. Those systems
must be closely examined and opened up to public scrutiny and democratic
control. To clarify, this is not a discourse on good and evil; the issue is one
of profoundly antisocial and violent systems not of the use made of those
systems by a handful of rapacious individuals. <BR><BR>Poor people do not attend
G8 summits, board meetings of the latest "Global Fund" or "philanthropic"
foundation, let alone the World Economic Forum - where Chief Executive Officers
of transnational corporations are offered even more privileged access to
political leaders than they already enjoy. But poor people also hold meetings
and they are represented - if imperfectly - at the World Social Forum (and in
national and regional social fora), in trade union, social and political
movements and elsewhere. <BR><BR>As Director-General of WHO, you are committed
to "the people of Africa who bear an enormous and disproportionate burden of ill
health and premature death" and you have made this "the key indicator of the
performance of WHO". Your presence at the next World Social Forum on Health
(Nairobi 21-23 January 2007 unfortunately coincides with your first Executive
Board) and many other such events in the future, would represent real hope and
inspiration for the world's people and an essential counterbalance to high level
meetings with government leaders and their corporate backers/advisers - who are
increasingly one and the same. <BR><BR>3. Public-private partnerships or a
solid, equitable tax base? <BR>You note that "the landscape of public health has
become a complex and crowded arena for action, with a growing number of health
initiatives" and you remind us that WHO is "constitutionally mandated to act as
the directing and coordinating authority on health". As you know, public-private
partnerships have become the policy paradigm for global health work despite the
evident conflict of interest which would have outlawed such arrangements thirty
years ago. Agencies and organizations with public responsibilities are
"partnering" with the private sector for one reason. It (appears to have) become
the only source of funds. This situation has arisen because under neoliberal
economic regimes, public sector budgets have been slashed and tax bases
destroyed. Those developments are themselves the result of the influence of
transnational corporations on governments and the international financial
institutions. <BR><BR>The solution to this problem is not for public bodies to
go begging to the private sector, nor to the foundations of celebrity
"philanthropists" with diverse agendas, from industry. The solution is economic
justice, including an adequate tax base, both nationally and internationally, to
cover all public services, as well as proper funding of public institutions such
as WHO through regular budgets so that they may fulfill their international
responsibilities unimpeded by corporate interests. <BR><BR>You report that "the
amount of money being made available by foundations, funding agencies and donor
governments is unprecedented"<WBR>. This will be entirely positive if you are
able to use these funds to pursue your vision and priorities, as is your right
and your duty. It can be argued that if WHO had operated exclusively on regular
budget, even with a significantly smaller workforce but one that was dedicated
to WHO's constitutional mandate, far more progress towards Health for All would
have been achieved. <BR><BR>As you say "Primary Health Care (PHC) is the corner
stone of building the capacity of health systems. It is also central to health
development and to community health security." PHC will remain health rhetoric
if it is not supported by a solid, equitable tax base and other forms of
redistributive justice (debt cancellation and reparation, fair trade, abolition
of tax havens, democratic control of TNC activities etc). WHO itself needs to
set targets for the level of core funding, starting perhaps at 70% of total
expenditure, and increasing annually until undue influence is removed. The
private sector has no place in public health policy making at global or national
level. This does not of course exclude responsibly designed interactions as in
the past but it does exclude partnerships because partners must share the same
goal. <BR><BR>4. Knowledge for the public good - the world cannot afford
corporate "science" <BR>You cite technical authority as one of WHO's four unique
assets and you state that "we can be absolutely authoritative in our guidance"
and that "WHO must influence the research and development agenda". WHO's role as
the technical health authority is indeed the jewel in its crown. All the more
important then to address the current crisis in science and reclaim knowledge
systems for the public good. <BR><BR>The commercialization of science and the
close relationship between industry and academic institutions (2) should be at
the centre of WHO's concerns. In this regard, the public has every right to
insist that assurances be provided that WHO's recent reports on the health
effects of Chernobyl and on the safety of genetically modified foods were
researched, developed and produced in full consultation with independent
scientists, unimpeded by other interests. <BR><BR>In relation to the corruption
of traditional ideals of science, an editorial in the Lancet reported that
"Academic institutions . . . have become businesses in their own right, seeking
to commercialize for themselves research discoveries rather than preserve their
independent scholarly status". Equally worrying is the new trade-related
intellectual property regime which represents an unprecedented privatization of
knowledge. Knowledge should be in the public domain, accessible to all. It must
above all be truthful and reliable - a reminder which is not superfluous today.
<BR><BR>Given continuing high levels of avoidable disease and death, alarming
resurgence and emergence of old and new infectious disease respectively, and the
devastating effects of environmental degradation and resource depletion on
population health, the world cannot afford corporate "science". As the world's
technical health authority, WHO must take the lead in transforming the way
scientific research is conducted and funded and the way knowledge is acquired
and applied. <BR><BR>5. Ethical values and independence of international civil
servants <BR>You state that "We share the ethical foundations of the health
profession. This is a caring, healing and science-based profession dedicated to
the prevention and relief of human suffering. This gives us our moral authority
and a most noble system of ethical values". <BR><BR>It has not always been easy
for staff to stay close to WHO's mandate nor to maintain respect for ethical
values either as public servants or as colleagues during the neoliberal decades.
The pressure often proved overwhelming while the independence of international
civil servants was increasingly undermined. As you know, staff management
relations reached a low point and resulted in the first industrial action in
WHO's history in November 2005, a massive work stoppage involving 700 staff.
This was despite threats of disciplinary action including dismissal from the
Director-General'<WBR>s Office which reflected not only deep dissatisfaction on
the part of staff but astonishing disregard for international labour standards
on the part of a UN agency. <BR><BR>The work stoppage was not an event to be
deplored, lamented, let alone sanctioned.(<WBR>3) It was a needed signal to
Member States and WHO's wider constituency that radical change was needed.
<BR><BR>Staff who struggled against the tide during these past two decades were
often "guilty" of their attachment to the Declaration of Alma Ata which clearly
identified social and economic root causes of avoidable disease and death,
placed the debate squarely within international power structures and insisted on
a broad public health perspective which addressed non-health sector determinants
of health. They were part of the broad movement led by civil society
organizations promoting a return to the values and principles of Health for All,
which was instrumental in the creation of WHO's Commission on the Social
Determinants of Health. <BR><BR>Some, through the Staff Association, were also
guilty of revealing to member states, as is their duty, (4) corruption,
nepotism, abuse of rules and procedures and an ineffective internal justice
system. In an exemplary response, members states called for a progress report on
staff management relations at the next EB (January 2007) and an audit of all
direct appointments at and under the D1 level. <BR><BR>The response however of
the last administration was dismal. WHO staff are now represented by a "Staff
Committee" which, apparently in collusion with administration, opposed
discussion of the application of international labour standards (human rights in
the workplace) in WHO, at the Annual General Meeting of the HQ Staff
Association. This is an absurd situation, unworthy of a UN agency. Today, there
is an opportunity for civilised and dignified staff management relations in
which staff concerns and perspectives are welcomed with interest and respect.
The first step will be to declare that WHO supports not only a rights-based
approach to health but a rights-based organization which fully respects the ILO
Covenants. Staff morale and motivation will soar as will confidence in their
leadership. <BR><BR>6. Health for All is value laden and explicitly political
<BR>In discussion with colleagues about all the above concerns, I have often
heard that with my views, I should rather work for an NGO, that my perspective
is "political" and that WHO is not an implementing agency. My response to the
first comment is that WHO staff should surely be more committed to the values
and principles of Health for All than staff of any other organization, just as
all UN staff should be at the frontline of the defense of the UN Charter.
<BR><BR>My response to the second comment is that health is political and that
the PHC approach and Health for All was and is an explicitly political project -
as is the neoliberal project for health and health care. Today's international
health establishment denies any political values, intentions or interests and
presents itself as neutral, objective and armed with scientific facts. But
scientific objectivity requires awareness and acknowledgement of underlying
values and principles. The States Parties to the Constitution, in line with the
Charter of the United Nations accepted a set of nine ethical principles when
they established the World Health Organization. This is the source of our "moral
authority" and it is a value laden and highly political document - if one
accepts that politics is about the organization of societal structures and
functions, in particular in relation to the distribution of power and resources,
for the benefit of its members. <BR><BR>My response to the third comment is that
although WHO is not an implementing agency, it has a clear advocacy role in
terms of identifying and promoting policies and strategies - on the basis of
serious science and sound evidence - that will ensure the meeting of basic needs
for health, among other things. <BR><BR>7. Conflicting loyalties <BR>In the
neoliberal decades, WHO staff, and other international civil servants, have
found themselves in an uneasy position with conflicting duties of loyalty on the
one hand to WHO's constitutional mandate and the UN Charter, and on the other
hand - as WHO is an intergovernmental agency - to member states and current
office holders and their interpretation of these mandates. The most obvious
examples are UN sanctions and the invasion of Iraq which have caused public
health catastrophes.<WBR>(5) These actions have been qualified as war crimes and
genocide respectively.<WBR>(6) <BR><BR>Less spectacular examples of conflicting
loyalties relate to certain policies and strategies which do not make the
headlines but which cause illness and death on a daily basis and an even larger
scale. WHO has failed to denounce, in the strongest possible terms, unfair rules
of trade and commerce, odious debt, ruthless liberalization of economies,
privatization of public services and continued exploitation of people's national
resources. This is despite ample evidence that these processes create poverty
and inequality, interfere with people's capacity to provide themselves with
adequate supplies of food and water, and maintain more than half the world's
people in unspeakably miserable living conditions. <BR><BR>At least 10 million
children die every year and the vast majority of those deaths are avoidable.
Life threatening, structural violence requires principled, unambiguous
resistance not cautious admonitions, let alone timid acquiescence. <BR><BR>We
live in exceptional times when leaders of powerful nations, who scarcely
represent their own people let alone all member states, embark on illegal action
leading to death and destruction and when transnational corporations, in
collusion with international financial institutions - with no democratic
legitimacy or accountability - are allowed to impose policies which have been
shown to have devastating effects on population health. Should staff choose
loyalty to current office holders and selected member states rather than loyalty
to the mandate of their organization and the world's people who are often, very
poorly represented by their governments? Should respect for human rights and
confidence in our own moral judgment tip the balance in these conflicting
loyalties ? <BR><BR>8. Perhaps exceptional responses are required in exceptional
times <BR>"The way in which citizens of the rich countries currently live their
lives is, on the whole, morally acceptable". (7) Recognition that "everyone's
favourite prejudice" is profoundly wrong is fundamental to the struggle for
social justice and Health for All. <BR><BR>WHO (and other UN) staff may be
misinformed (by failing to consult alternative sources of information) and
disinformed (by accepting la pensée unique of mainstream and conventional
sources of information)<WBR>. However none of us can claim lack of access to
full information. It is time to consider whether the way in which UN and WHO
staff serve the UN Charter and WHO's constitutional mandate, respectively, is,
on the whole, morally acceptable or whether this belief is "our favourite
prejudice". <BR><BR>Dr Chan, the vision you have articulated is exemplary and an
inspiration to staff. But you will need them to summon up the courage of their
convictions, stand strong in the face of powerful opposition, and keep close to
WHO's constitutional mandate, if they are to assist you in its realization.
<BR><BR>Sincerely, <BR><BR>Alison Katz <BR><BR>Notes <BR><BR>1. Speech to the
World Health Assembly, 9 November 2006 as DG elect and Address to WHO staff, 4
January 2007, as DG. <BR><BR>2. This section is drawn from the Convention on
Knowledge, Institute of Science in Society.
<BR>www.i-sis.org.<WBR>uk/conventiononk<WBR>nowledge.<WBR>php <BR><BR>3. My post
was abolished three weeks after the work stoppage and three weeks before the
normal renewal of my two year contract, after 17 years service. This has been
qualified as retaliation for industrial action (a violation of human rights) by
Swiss unions and staff association lawyers. <BR><BR>4. According to an Executive
Board Resolution EB91/1993/REC/<WBR>1 <BR><BR>5. Just prior to February 2003,
WHO was involved in preparations for post-invasion emergency health measures. In
the interests of contributing to the prevention of violence rather than merely
participating in the "mopping up operation" staff asked administration if they
might circulate a petition in support of the UN Charter (available on request).
They were informed that if they did so they would be asked to present their
resignations. <BR><BR>6. See for example Initial Complaint prepared for the
First Hearing by staff of the International War Crimes Tribunal <A
href="http://deoxy.org/wc/warcrim2.htm"
target=_blank>http://deoxy.<WBR>org/wc/warcrim2.<WBR>htm</A> and report on
effects of UN sanctions <A
href="http://www.geocities.com/iraqinfo/sanctions/holocaust.html"
target=_blank>http://www.geocitie<WBR>s.com/iraqinfo/<WBR>sanctions/<WBR>holocaust.<WBR>html</A>
<BR><BR>7. Thomas W. Pogge, World Poverty and Human Rights, Polity Press 2002
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