<div dir="ltr">For the next 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. <br>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. <br>We encourage you to read, use and share this material since it provides crucial advocacy contents.<br><div><b><span> </span></b>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b><span style="font-size:8pt">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. <span></span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b><span style="font-size:8pt">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.<span></span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b><span style="font-size:8pt">GHW5 presents to you a decisive global health critique
and outlook not easily found elsewhere.<span></span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b><span> </span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b>INTRODUCTION<span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">GHW5 presents the case for the need for a new global economic
and social political platform given that the SDGs do not offer help for such a platform.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The SDGs instead propose growth strategies that seek to
perpetuate the current neoliberal model that de-facto perpetuates poverty and
destroys the planet.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">GHW5 realizes that real change can only result from clashing
with opposing forces; nothing less will be able to complete the task of
dismantling the power of the neoliberal regime. An ideological counteroffensive
is underway and PHM is part of it; the poor healthcare those rendered poor is
just the port of entry PHM uses. Resistance is growing also from other people’s
and worker’s organizations. Now, the progressive forces must find a way to
globalize their struggles and demands.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">*Globalization and neoliberal economic policies are fueling
migration --and migrants are unacceptably victimized by denying them
healthcare.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">UHC is the <i>slogan du
jour</i> in global health policies, but this approach is highly contested. Instead,
PHM joins those advocating for the need to advance tax-based funding of health
services, for single payer systems, for capped program funding and for
participatory clinical governance. Furthermore, a more prominent role for community
health workers and community involvement is needed. Conversely, currently, UHC advocates
are arguing for care that is purchased from a range of private and public
providers. This has legitimized the dismantling of public health services. Therefore,
greater community power is needed to control healthcare so as to increase the
community’s control over their own health. Neoliberal reforms in restructuring
healthcare services have simply been flawed and have represented a transfer of
public resources to the private sector. Therefore, since marketplace solutions
have been a failure, only involving citizens in the management of health services
will makes them strong advocates for non-commercialized healthcare. Civil
society activism is to bring about change from below.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Donor funding through private and non-governmental
recipients have resulted in cuts in public spending by the state especially under
ongoing austerity regimes. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Remuneration of health workers has been decreasing over the
years, so they are organizing themselves to improve their conditions of work. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Women’s sexual and reproductive rights are being
ignored.<span> </span><span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Risks that FTAs pose to the health of workers are also being
ignored, as is the impact of the extractive sector on the health of workers.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">For long, WHO has been in a deep funding crisis that has led
to a serious erosion of the principles of democratic governance of the organization.
The growing influence of philanthropic founds is part of such an erosion. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The rights-based approach to health is being worrisomely undermined
with WHO framing health interventions as technical exercises that downgrade the
role of community voices.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">PHM sees PPPs like GAVI a GFTAM as a threat to the hitherto
nation-state driven system of global governance. Botha are under increasing
private sector influence.<span> </span>The mechanisms
that are embedded in trade and investment treatises place an onerous burden on
countries. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The securization of health has, so far, mostly encouraged
feelings of fear. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">PHM has much to say about the politics of data; the sharing
of biological materials; ongoing sanitation programs that thrive on coercive
practices. (see below)<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">GHW5 advocates for a greater political mobilization that opt
for a model that is truly fair in healthcare delivery. The same needs to be
adequately funded. GHW5 warns us that private interests and local elites can
take democratic institutions hostage and can sabotage reforms that benefit the
majority. People’s movements have a key role to play in this. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Countries find it extremely difficult to create the fiscal
space for meaningful reforms of the health services. International mobilization
must be designed to break the power of the international financial institutions,
the international trade regime and of TNCs. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">As regards the approach used to address malnutrition, the
one followed has been biomedical rather than using a public health perspective,
and this without considering its broader social determination.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The struggle conducted by people living with HIV using the
legal system to make full use of the flexibilities under TRIPS been remarkable.
This has been an inspiration. The struggle for health must thus be conceived
and constructed as a very broad struggle that upholds a vision that is critical
of the ills of neoliberal globalization.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">PHM believes that change is necessary and urgent.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span> </span></p>
<p class="gmail-MsoListParagraphCxSpFirst" style="margin:0in 0in 0.0001pt 0.5in;font-size:12pt;font-family:Cambria"><b><span><span>A.<span style="font:normal normal normal normal 7pt "Times New Roman"">
</span></span></span></b><b>THE GLOBAL
POLITICAL AND ECONOMIC ARCHITECTURE<span></span></b></p>
<p class="gmail-MsoListParagraphCxSpLast" style="margin:0in 0in 0.0001pt 0.5in;font-size:12pt;font-family:Cambria"><b><span> </span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b>A1. THE SUSTAINABLE
DEVELOPMENT GOALS IN THE AGE OF NEOLIBERALISM.<span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">To PHM, The SDGs are a case of: <i><span> </span>Plus ca change, plus ca reste la
meme chose.</i> <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">GHW5 starts warning readers that the SDG targets actually give
nations too much latitude in defining their own ‘level of ambition’ therefore
allowing them to choose their own particular targets so that the targets rather
become <span> </span>‘aspirational’ with each country able
to ‘cherry pick’ on them --and this is a problem.<span> </span>(Note that the SDGs do not emphasize their
indivisibility allowing this cherry picking of their favorite goals). With
little attention given in the SDGs to income distribution needs, GHW5 points
out that it would take 200 years to eliminate poverty at the $5/day/cap income
level. <span> </span>Add to this that the SDGs do neither
consider binding enforcement measures, nor measures to demand progressive
taxation regimes nor measures to counter tax evasion (especially by TNCs and
wealth y individuals). Notable also is the embedded contradictions in the SDGs
between equitable, sustainable development and the insatiable economic growth
model of global capitalism. It is not about promoting sustainable consumption,
but about consuming sustainably particularly by reducing aggregate demand in
high income countries. (Is there sustainable economic growth that is
environmentally sustainable?)<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">With all these caveats, the SDGs risk becoming everyone’s
business, but no-one’s major responsibility. It thus falls on public interest civil
society to hold both state and market to account for actions responsible for economic
and environmental sustainability, as well as for the health equality targets of
the SDGs. Urgent activist priority is going to be zeroing-in on the health and
environmental SDGs including those on water, energy, climate, biodiversity and
other.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The main critique is that the SDGs care more for instituting
‘policies by numbers than policies that address true neglect’. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">There is further no measure proposed for reducing between-country
inequalities, nor measures addressing affordability of health insurance schemes
or unaffordable out-of-pocket health expenditures. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Also not found are meaningful measures on<span></span></p>
<p class="gmail-MsoListParagraphCxSpFirst" style="margin:0in 0in 0.0001pt 0.25in;font-size:12pt;font-family:Cambria"><span style="font-family:Symbol"><span>·<span style="font:normal normal normal normal 7pt "Times New Roman"">
</span></span></span>metrics for social protection systems; <span></span></p>
<p class="gmail-MsoListParagraphCxSpMiddle" style="margin:0in 0in 0.0001pt 0.25in;font-size:12pt;font-family:Cambria"><span style="font-family:Symbol"><span>·<span style="font:normal normal normal normal 7pt "Times New Roman"">
</span></span></span>assistance to small food producers; <span></span></p>
<p class="gmail-MsoListParagraphCxSpMiddle" style="margin:0in 0in 0.0001pt 0.25in;font-size:12pt;font-family:Cambria"><span style="font-family:Symbol"><span>·<span style="font:normal normal normal normal 7pt "Times New Roman"">
</span></span></span>doing something substantive about trade-distorting
food export subsidies; <span></span></p>
<p class="gmail-MsoListParagraphCxSpMiddle" style="margin:0in 0in 0.0001pt 0.25in;font-size:12pt;font-family:Cambria"><span style="font-family:Symbol"><span>·<span style="font:normal normal normal normal 7pt "Times New Roman"">
</span></span></span>the availability of affordable essential meds
and vaccines for all;<span></span></p>
<p class="gmail-MsoListParagraphCxSpMiddle" style="margin:0in 0in 0.0001pt 0.25in;font-size:12pt;font-family:Cambria"><span style="font-family:Symbol"><span>·<span style="font:normal normal normal normal 7pt "Times New Roman"">
</span></span></span>the availability of <span> </span>universal access to sexual and reproductive
health care services for women;<span></span></p>
<p class="gmail-MsoListParagraphCxSpMiddle" style="margin:0in 0in 0.0001pt 0.25in;font-size:12pt;font-family:Cambria"><span style="font-family:Symbol"><span>·<span style="font:normal normal normal normal 7pt "Times New Roman"">
</span></span></span>actions to promote sustainable lifestyles in the
North; and<span></span></p>
<p class="gmail-MsoListParagraphCxSpLast" style="margin:0in 0in 0.0001pt 0.25in;font-size:12pt;font-family:Cambria"><span style="font-family:Symbol"><span>·<span style="font:normal normal normal normal 7pt "Times New Roman"">
</span></span></span>human rights, gender equality and global
citizenship.<span> </span><span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The SDGs are simply plagued by too many woulds and shoulds
rather than forceful statements of will and shall.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">GHW5 concludes that the SDGs provide us with an imperfect
roadmap. This, since there are no non-radical options left before us. It is one
thing to campaign for the priority SDGs and another to envision the type of political
system and organization that may see to the fruition of these goals to the year
2030. In no goal is the inequality intrinsic to a capitalist economy really questioned
as a causal agent. This is why activists need to also critique the economics
that underpins the current stagnation in meaningful development progress.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The situation being what it is, the UN system has regrettably
been under a neoliberal assault for decades and is facing its own test of
contemporary relevance. A struggle to change the effects this has on the UN’s governance
is of high priority. Public interest CSOs are to articulate and to agitate
confronting this power at the national and the global level.<span> </span>Only a new more transparent governance will resolve
the fundamental contradictions inherent to capitalism’s distortions that remain
implicit in the SDGs. Disparity reduction to reduce inequalities is the true
goal to pursue to 2030.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Bottom line, building a stronger activist base remains
essential to move governments forward on the SDGs seen from the perspective of
their weaknesses as per above. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Xx<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b>A2. ARE THE SDGs THE
WAY FORWARD?<span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Do not be fooled: The SDGs omissions are not due to an
oversight; they are intentional; the goals set do not necessarily rank as
priorities for most UN member states. At best, GHW5 thinks the SDGs tinker with
the global economic system to make it all seem a bit less violent. But this is
not a time for tinkering. And all this is not about willingness; the driving
force is profit making. Wealth simply piles up faster than growth --and so does
power. <span> </span>In our world, profit comes before
people, before climate, before planet. The resources of countries rendered poor
are exploited not for the benefit of local populations, but to satiate the
consumer needs of wealthy nations.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">This being the case, vested interests will have to be
countered and radical new choices will have to be made. These must involve
social organizations to champion the struggle to change the fundamental flaws
in the current economic and political architecture of the globe. The SDGs
cannot simply propose growth strategies that seek to perpetuate the current
neoliberal model --ever increasing levels of extraction, production and consumption.
The SDGs fail to acknowledge that mass impoverishment is the product of extreme
wealth accumulation and overconsumption by a few; they simply avoid addressing
these deeper causes; they actually do the opposite by calling for more trade
liberalization and more power to the WTO. No word is uttered about debt
servicing and about debt cancellation. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Proceeding with the SDGs roadmap, the risk is transforming
the UN into a big PPP where democratic represent is weakened in favor of private
commercial interests as progressively seen in the multi-stakeholderization of
global governance. Can the SDGs truly encourage corporations to be reasonable?
Or unreasonably pursue GDP growth when poverty is the primary cause of the
underdevelopment it tries to conquer?<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Only societal counter-power through working class organization
can force the needed redistribution mechanisms (i., e., what is needed is
building broad domestic counter-power). <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">A renewed attention to the importance of the social determinants
is the only way forward. It is clear that change will not occur by itself. It
will be the result of the clash of opposing forces. PHM thinks we have to
position ourselves on the side of the wellbeing for all and of a healthy planet
and against profit for a few. We need to mobilize.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Xx<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b>A3. ADVANCES AND
SETBACKS TOWARDS A SINGLE PUBLIC HEALTH SYSTEM.<span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">A key lesson from Latin America here is that we need to rid
ourselves of the illusion that it is possible to redistribute wealth and to
expand democracy without confronting the power of capital. Under neoliberal
globalization, health is now an area where capital tries to wrest from the
state a new space for capitalist accumulation. Therefore, as GHW5 points out, health
is an area of struggle in the process to transform the state itself. In this
struggle, trade unions have unfortunately not assumed the role of advocates of
collective and social rights, but have negotiated private health insurance and
better remuneration for their members and have opposed the creation of a single
unified public health system. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Where is their ethics of public service?<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Physicians tend to consider themselves as the center of the
health system even though the widespread commecialization and growth of
corporate power in the health sector have displaced them from this central
role. They claim for themselves better working and economic conditions rather
than for the rest of the health work force and are reluctant to lose their
privileges.<span> </span>Where is their ethics of
public service?<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">A variety of regressive transfers of resources from the public
to the private sector are also under way the world over. Public resources are used
to finance and support health care delivery by the private sector. There
clearly is a need to regulate this, as well as the explosive use of new technologies
in the private sector due to its unjustified costs. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">GHW5 warns us that the widespread use of the terms ‘insurance’
and ‘coverage’ seeks to indicate that the provision of healthcare services is a
contractual relationship, not a human right.<span></span></p>
<span style="font-size:12pt;font-family:Cambria">Progressive left-wing forces must therefore find
a way to globalize their struggles and demands starting by developing a strategy
for globalizing their struggles against the ongoing neoliberal assault.<br></span> <br></div></div>