<div dir="ltr"><p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b>A4. STRUCTURAL ROOTS
OF MIGRATION. </b><font size="2">(From previous week)</font></p><font size="2">
</font><p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><font size="2">I</font>n many ways, the <span> </span>‘age
of globalization’ and the ‘age of migration’ coincide.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Much of the progress in wealth (and in health) has been achieved
at the price of environmental destruction and climate change; and the health of
people cannot be seen as separate from the health of the planet as a whole. The
major crises we are facing are of our own making –-and the consequences are
well known, not only in Europe.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"></p><br><div class="gmail_quote"><br><div dir="ltr">For 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. 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>
<b><span></span></b><br><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></b></p><p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><br></p><p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">
</p><p class="m_-2621584705724866456gmail-MsoListParagraph" style="margin:0in 0in 0.0001pt 0.5in;font-size:12pt;font-family:Cambria"><b><span><span><span style="font:normal normal normal normal 7pt "Times New Roman""></span></span></span></b><b>B. HEALTH
SYSTEMS: CURRENT ISSUES AND DEBATES.<span></span></b></p>
<br><b><span style="font-size:8pt"><span></span></span></b><p></p>
<b><span></span></b>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b>B1. UNIVERSAL HEALTH
COVERAGE: ONLY ABOUT FINANCIAL PROTECTION?<span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">No, not only about financial protection, but much beyond:
UHC also is about quality of care, equality, efficiency and prevention, plus
about tax-based funding and single payer systems.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span> </span>PHM is of the opinion
that popular movements can and should drive healthcare reform, and here is why.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">While there is some overlap, differences in emphasis between
PHC and UHC approaches are significant. PHC works with communities on the social
and environmental determinants of health, as well as in healthcare development.
This implies a dominant role for public sector providers, simply because private
providers are demonstrably unable to comply with the broader principles of PHC
in their practice. Since 2010, WHO advocates for abolishing user charges at the
point of service. Later, the World Bank complied. But the warm collaboration
between the WB and WHO obscures some very significant differences in approach.
It is basically an unholy alliance. The differing mandates of the two bodies
only align occasionally as is in the case with their respective approaches to
UHC. Add to this the dependence of WHO and its donors particularly the bullying
by the US demanding WHO and its experts continue acting in a primarily
technical advice role.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">In terms of equity, PHC and UHC are not comparable either:
Competitive health insurance markets called by interested UHC proponents provide
different products to different income strata and different benefit packages
according to ability to pay. Certainly, they do not provide for equitable redistribution
of resources through pooling across income levels. Plans for high income
earners end up with looser utilization controls and more generous benefit
packages.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Allocative efficiency is also an import policy goal of UHC,
i.e., incorporating the distribution of resources across geographic areas, across
workforce segments and institutions with appropriate services and programs.
Resource flows should thus be directed to those regions, workforce and other categories
where there is greater need --and this is not done often enough.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">A marketplace in which providers compete to deliver
specified services at specified prices is simply a weak mechanism for promoting
efficient quality healthcare. Health insurance schemes involve a surrogate
purchaser, be it the health insurance plan or another purchasing agency. Be
clear: The neoliberal solution relies on a competitive market based on the mirage
of providing choices. Such an economistic mindset is nowhere more evident than
in policy discussions involving priority-setting that commonly revolve purely on
technological assessments and options. But not all resource allocation choices
can be reduced to a benefit package design. A much broader range of conditions
need to b e considered in determining priorities, GHW5 tells us.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The MDGs were as much about relegitimizing economic globalization
as they were about fostering true ‘development’. Yes, more resources were
found. But just having more money for health will not ensure universal coverage!
The ascendancy of UHC was actually partly a response to the failure of narrow
vertical disease-focused global health initiatives. UHC really took off following
the global financial crisis of 2008. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">UHC actually can be accused of trying to open new markets
for private investment (including healthcare and health insurance markets). The
proponents of this approach try to force governments to make space for privatization.
This renders inequality acceptable by providing safety nets for those rendered
poor (rather than tackling inequality by adopting policies that reverse this widening
trend).<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">UHC also provides us a window to look at the dynamics of
global governance in the present era. This is of practical importance for
activists who are struggling to achieve UHC within the right to health
framework.<span> </span><span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">TNCs power is blatantly being used to extort tax concessions
and to pressure countries to liberalize trade in services including medical
tourism.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">In short, the UHC discourse being pushed is mechanistic and top-down.
The approach now permeates the technical literature.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">It is crucial to internalize the different political
realities at play with which advocates for reform will have to deal. Windows of
opportunity open now and then and have to be seized. The focus must be on the progressive
realization of the right to health and for this, PHM seeks a political
consensus. Using a ‘whole system vision’, localized political pragmatism must
prevail for a bottom-up swell of reform to open new spaces.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">When the opportunities arise, appropriate policy ideas must
be circulated to the various constituencies for all to be ready to go for changes
encompassing a broadly shared vision. Activists’ strategies for healthcare
reform need to drive challenges in all these areas and levels.<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>B2. REVITALIZING
COMMUNITY CONTROL IN PHC<span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">In the spirit of Alma Ata, a community consisting of community
members can and should form locally elected boards of management to govern and
control PHC services. Citizens’ involvement in all aspects of healthcare is considered
fundamental by PHM.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">PHM’s People’s Charter for Health (2000) rejects tokenistic
efforts in this area. For us, the community has to amass real power over
decisions pertaining to their own health, as well as to improve the responsiveness
of the health services to their local needs. This goal continues to be blocked
and must be unblocked through hard work especially given the current trend towards
privatization. Efforts in this area are more relevant than ever since existing
mainstream health services do nothing more than reproduce the unfair power relations
and thus fail to address the existing inequalities. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The elected boards are also expected to engage in community
development, advocacy and health promotion with its members setting the scope
and nature of their own participation. For this, a fair amount of community
health education is needed to better respond to local needs by building
community capacity for health.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">In essence, community control allows for a more comprehensive
PHC vision to be applied, in line with <span> </span>the
Alma Ata Declaration. Self-determination is at the core of PHC.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">With a focus on the local living conditions, the boards can decide
which issues the health services should address.<span> </span>These boards are more likely to undertake
work that addresses the social determinants of health and health equality
issues. The view is to democratize health services, as well as addressing
housing, homelessness, poverty, income insecurity, refugee health services
issues. This makes services more culturally respectful. It is the ability to
enact community control that has the potential to democratize health services. Adding
the community perspectives is seen as complementing and strengthening professional
views of health. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Ultimately, we have to make these boards strong advocates
for non-commercialized healthcare by providing a counter-voice to the powerful
corporate voices at play.<span> </span><span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">PHC continues to be challenged in the era of neoliberalism,
austerity and the privileging of biomedical and commercialized models of health.
Activism here is also a must.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Xxx<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b>B3. UNDERSTANDING THE
MEDICAL-INDUSTRIAL COMPLEX<span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">This is about the medical-industrial complex the USA’s health
system.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The US has an over-regulated market that actually totally escapes
market discipline. Because regulatory capture advances concerns of special
interest groups in America, any true reform would have to dismantle this unsustainable
model. Not all healthcare decisions in it are actually made by doctors, and if
they are, their decisions usually involve flagrant conflicts of interest. It is
easy to identify the big players here by following the money, i.e., that of
insurance companies, Big Pharma and of for-profit long-term service providers
(run by medical elites).<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Market-based health systems in America are characterized by
their lack of transparency. No surprise, then, that healthcare outcomes are
largely dependent on patients social and economic conditions. You know that
furthermore insurance companies cherry pick the healthiest persons to sell them
insurance...<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The insurance market is ever consolidating via mega-mergers.
Much of what Obamacare did was to subsidize the private insurance system.
Rather than competing, companies found/find it safer to merge with competitors.
The end result is a few very big companies that have no interest in a price
war. This is just the opposite of the supposed benefits of the market.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Is the pharmaceutical industry involved in legal extortion? Well,
look at the facts: The price for patented drugs are estimated to have increased
18% each year since 2010. The market has become a vehicle for using old and
newly acquired monopoly advantages. Note that the US Medicare Program is
specifically prohibited from negotiating prices with drug companies! This
reflects the lobbying power of Big Pharma. Big Pharma has one of the largest
lobbies in Washington. Unfortunately, under current congressional rules, this
is entirely legal.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">It should be clear from this that private entities involvement
does not favor the public’s health.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Any positive role by unions: Only nurses’ unions in the US have
been in the forefront of progressive activism; they should be supported.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">In short, the US loses enormous sums of money due to its
failed private programs and to the grossly inflated overhead costs of private
insurers.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Eliminating the private insurance system would free up
resources now spent on administrative costs and would allow for healthcare to
be provided to all Americans without increasing taxes or fees (!).<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">As a worrisome development, US insurance companies have made
important inroads into overseas markets; there are now international hospital
chains and this development of privatization overseas does not make things
better; it just parasitizes the public system. Simply put, the profit motive
corrupts the health care system.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Xxx<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><b>B4.<span> </span>THE STRUGGLE OF HEALTH WORKERS.<span></span></b></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Experiences here come from South Africa.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">After the fall of Apartheid, many key activists moved from
civil society into government. The optimism of this proved to be short-lived.
The country is in the midst of a major health crisis. Average numbers in health
statistics hide great inequality --a major cause of poor health. As there is a
climate of cuts in public spending by the state under austerity, compounding
the problems, donor funding has changed its nature under neoliberalism
directing substantial funding through private non-governmental organizations. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">An important number of community care workers posts have been
created. These agents receive standardized training and work in vulnerable communities.
They have temporary annual contracts, so have no associated benefits. They also
have little support from local health facilities. They perform a wide range of
essential functions in the community management of important prevalent diseases
like HIV and TB. They can also recognize and start early treatment of life-threatening
conditions like pneumonia, diarrhea, acute malnutrition and malaria. They can further
promote maternal, neonatal and child health. Additionally, they perform simple
curative care and personal prevention, home care of the sick and the bed-ridden.
It is important to point out the scheme has created employment opportunities
for women. <span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The possibility that South Africa will soon achieve health for
all and UHC appears bleak since the state is unable to make rapid progress tow
reducing inequality, address the social causes of ill-health and establish an
equitable healthcare delivery syst. Private healthcare scouts are using this
weaknesses to lobby for health PPPs.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">Add to this, rampant corruption and state capture by rich
and powerful health conglomerates overwhelmingly interested in urban
populations.<span></span></p>
<p class="MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria">The above situation calls for massive mobilization for
health, one that turns into a broad social movement in public interest civil
society that will campaign for the right to health for all South Africans. Citizens
action <u>can</u> bring about change from below.<span></span></p>
<br></div></div></div></div>