<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">---------- Forwarded message ---------<br>From: <b class="gmail_sendername" dir="auto">David</b> <span dir="auto"><<a href="mailto:dlegge@phmovement.org">dlegge@phmovement.org</a>></span><br></div><br><div class="msg-5835032386272204581"><u></u>
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<h1 style="text-align:center;display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:26px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal">Council on Economics and Health pushes WHO for action on the economic determinants of population health </h1>
<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020">The Council on the Economics of Health For All was established on 13 November 2020 by the WHO Director-General “to rethink how value in health and wellbeing is measured, produced, and distributed across the economy.”<br>
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The Council sought “to reframe health for all as a public policy objective, and ensure that national and global economies and finance are structured in such a way to deliver on this ambitious goal.” <br>
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The <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7d81fec1ff&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">final report</a> was launched in May 2023. In its forthcoming meeting, the Executive Board of WHO will review the Council’s recommendations and consider their implications for WHO’s program of work.</p>
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Thirteen excellent recommendations</h2>
The Secretariat report introducing this item (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=9e26bb39b8&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB154/26</a>) describes the context of the Council’s work as characterised by the “interlinked crises of health, inequality and climate, which [...] disrupt solidarity and stability”. The need for change is illustrated by extensive references to the Covid pandemic.<br>
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There is a clear articulation in the Council report for the need for an alternative economics that changes the way value is conceived and the financing of health services operates. Such an alternate valuation is described as including the role of health workers and health care as an investment not a cost but there is no further examination of how this could be achieved.<br>
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The Council’s report recognises that health system development (access, quality, efficiency, etc) and the conditions which shape population health are complexly determined by economic activities and trends and by the pressures of economic actors.<br>
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The Council report critiques the subordination of health expenditure to debt repayments. To address this, it recommends the exclusion of health investment from sovereign fiscal deficit. The report also calls for a suspension of debt repayments by lower income countries during health pandemics and other disasters.<br>
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At the country level, the Council report critiques austerity policies and favours generating public funding including taxes on wealth and on multinational entities. It also promotes regulation of private sector actors for the common good. <br>
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The <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fae7c5778f&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">13 recommendations are all excellent ideas</a>; a package of directions which if achieved would make a big difference. The recommendations all take the imperative mood - commanding that something happen - but the agents who will drive the required change and their whys and hows are not identified. <br>
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The recommendations of the Council articulate high level desiderata which are flouted, in many respects, in the ways national economies and the global economy operate. The Council does not analyse the barriers to the implementation of its recommendations, nor does it explain how these barriers might be overcome.
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Analysis of causation</h2>
There is no explicit analysis of the forces and dynamics which have led to the interlinked crises of health inequality and climate, and there is no explicit theory of change articulated in the Council’s report. Without a credible theory of change and implementable actions which arise from that theory, this could be just another report on the shelf. However, there are aspects of the Council’s recommendations which suggest an implicit theory of change.<br>
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The creation of the Council itself was strategic in the sense that putting new ideas into public discourse and giving them the imprimatur of WHO might in some degree change the discourse around policy formation at national and global levels and contribute to change in that way. The calls for reform of the intellectual property regulation in the Council’s report illustrate the importance of authoritative statements as contributing to change.<br>
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However, new ideas need to find the constituencies whose action and advocacy can change political realities on the ground. There is little in this report which might link high level pronouncements about intellectual property policy reform to successful domestic pressure in a sufficient number of WTO member countries to effect change. <br>
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The proposal for a ‘Dashboard for a healthy economy’ may reflect the view that new information can contribute to social and economic change. However, as a theory of change, new information must change the distribution of political forces; strengthen the agency of constituencies seeking to achieve social and economic change. There is no indication in the Council’s report of such consideration. <br>
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There are hints of an implicit theory of change in the discussion offered in EB154/26 about how WHO could advance the Council’s agenda:
<ol>
<li>WHO should expand its work in macroeconomics and health and ensure additional resources to enable comprehensive contributions by WHO in this area;</li>
<li>WHO’s efforts to address the social and commercial determinants of health should be further strengthened and could include advocating for the transition to clean energy, more sustainable food systems and cleaner transportation systems;</li>
<li>WHO could promote capacity-strengthening [..] in order to better equip country offices and health ministries to engage in dialogues with economic and finance sectors and to enhance overall public capacity to shape economic and fiscal policies and drive public-private collaborations;</li>
</ol>
The report suggests that deploying WHO’s technical expertise in providing normative guidance and rigorous analysis on the economics of health for all could also contribute to the achievement of the Council’s agenda.
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Barriers to change</h2>
There is no discussion (in the Council’s report or that of the Secretariat) of the obstacles which have limited WHO’s capacity to move in these directions, including the repeated (and bullying) denials by the USA of the mandate or competence of WHO in these fields and the deliberate policies of most of the high income countries to keep the Secretariat on a tight leash through restricting the growth of assessed contributions and insisting on tightly specifying voluntary contributions.<br>
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<b>PHM urges members of the Board to request further work by the Secretariat, directed to:</b>
<ol>
<li>analysing in more depth the genesis of the interlinked crises, in particular the crisis of inequality and alienation;</li>
<li>identifying and exploring the barriers to the implementation of the 13 recommendations; </li>
<li>building the required consensus to operationalize international debt relief to sustain health finances and ensure health services in developing countries during periods of crisis;</li>
<li>reorienting economics towards prioritizing health as a public good and therefore to build international alliances around exchanging knowledge and technology not driven by corporate profit requirements; and </li>
<li>developing further recommendations to inform WHO action towards an economy for health for all.</li>
</ol>
<b>PHM urges the Board to:</b>
<ol>
<li>request the Secretariat to design and undertake a survey of WHO member states directed to identifying and analysing the barriers to the implementation of the Council’s recommendations and identifying initiatives which have successfully overcome such barriers;</li>
<li>request further work by the Secretariat directed to exploring the role of health systems such as healthcare facilities, public health units, and healthcare personnel in building political pressure for intersectoral action towards an economy for health for all; </li>
<li>to request further work by the Secretariat to explore the scope for ‘meaningful public engagement’ and ‘community health partnerships’ working towards intersectoral action towards health for all.</li>
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<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020">The full <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=3cf3a1d867&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM commentary on this item</a> provides more detail and references. </p>
<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020"><span style="font-size:12px">The WHO Tracker and PHM item commentaries are produced as part of <b>WHO Watch</b> which is a project of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=86e8fa537d&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">People's Health Movement</a> in association with <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=52648877f6&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Medicus Mundi International</a>, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=739ee4cd43&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Third World Network</a> and a number of other civil society networks. WHO Watch contributes to democratising global health governance, through new alliances, new information flows and by broadening the policy discourse.</span></p>
<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020">See the WHO Tracker page for this EB154 session (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a83a8230c9&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>). See PHM’s <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d47728b693&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">integrated commentary</a> on the full agenda of EB154 (or read the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=aa4b7fc4dc&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">flipbook version</a>). To ensure that you receive Update Alerts <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=5103485477&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">subscribe</a> to the Updater. <br>
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