GHW Content: 27 chapters
Development
Global health governance
•
•
The global health landscape
•
The World Health Organization
Health Sector
•
The Gates Foundation
•
Health systems advocacy
•
•
Mental health: culture, language and power
The Global Fund to Fight AIDS, TB
and Malaria
•
Health care for migrants and asylum-seekers
•
The World Bank
•
Prisoners
•
Medicine
An alternative paradigm for development
Government aid
•
US foreign assistance and health
Beyond health care
•
Canadian and Australian health aid
•
Carbon trading and climate change
•
Security and health
•
Terror, war and health
•
Globalisation, trade, food and health
Transnational corporations
•
Urbanisation
•
Protecting breastfeeding
•
The sanitation and water crisis
•
•
Oil extraction and health in the Niger delta
Tobacco control: moving
governments from inaction to action
•
Humanitarian aid
•
Education
Postscript: Resistance
Key features ….
1.
Social and structural determinants emphasised
Commission on the Social
Determinants of Health
Power and Politics
Poor health and health inequalities within and between countries
“are caused by the unequal distribution of power, income, goods,
and services, globally and nationally ..”
The unequal distribution of health-damaging experiences is the
result of: “a toxic combination of poor social policies and
programmes, unfair economic arrangements, and bad politics”
“….. social injustice is killing people on a grand scale”
Commission on Social Determinants in Health, 2008.
Key Features …
1.
Social and structural determinants emphasised
2.
Clear and explicit set of positions
–
Counterbalance to neoliberalism
–
Equity-focussed, not just pro-poor
Income Poverty (millions)
Income Poverty line
1981
2004
$1
1,470
970
Change
-500
- 34.0%
Income Poverty (millions)
Income Poverty line
1981
2004
Change
1,470
970
-500
- 34.0%
836
841
+5
+ 0.1
$1
(excl China)
Income Poverty (millions)
Income Poverty line
1981
2004
Change
1,470
970
-500
- 34.0%
836
841
+5
+ 0.1
2,450
2,550
+ 100
+ 4.1%
1,576
2,096
+ 520
+ 33%
$1
(excl China)
$2
(excl China)
“The developing world is poorer than we
thought, but no less successful in the fight
against poverty”
Shaohua Chen and Martin Ravallion
Development Research Group, World Bank
http://wwwwds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2008/08/26/000158
349_20080826113239/Rendered/PDF/WPS4703.pdf
World Wealth Report (Merrill-Lynch)
• 10 million people have investable, liquid funds worth US$ 40 trillion
• Richest 2% of adults owned 51% of global assets in 2000
• Bottom half owned barely 1%
Davies, Sandström, Shorrocks and Wolff, 2006. World Distribution
of Household Wealth.
World Institute for Development Economics Research (WIDER)
Tax - a neglected public health instrument
• The CSDH refers to a number of ‘fiscal termites’ that affect
governments in rich and poor countries alike
– Hyper-mobility of financial capital and of high-income individuals
• Offshore financial centres for tax avoidance costs developing countries US$
50 billion per year
– Transfer pricing through intra-firm trade
• Transfer ‘mispricing’ accounted for financial outflows of over US$ 31 billion
from Africa to the United States between 1996 and 2005.
• Global financial deregulation requires the establishment of a globallevel agency to collect public revenue
Key features …..
1.
Social and structural determinants emphasised
2.
Clear and explicit set of positions
3.
Multi-sectoral, development and ecological perspective
–
Emphasis on health, poverty and climate change
–
Sectors beyond health care system
We need to cut carbon emissions
Global CO2 Emmissions from Fossil Fuel Use (Target)
120
1990 = 100
100
80
60
40
20
0
1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
But they are out of control…
Global CO2 Emissions from Fossil Fuel Use (Actual)
140
120
1990 = 100
100
80
60
40
20
0
1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
• We’re failing on poverty and climate change
• We need more growth to reduce poverty faster
• But we need to grow less to limit carbon emissions and
control climate change
• How can we do both?!!!
We need an alternative development
paradigm
• GHW2 describes three fundamental flaws with the
current model of development:
–
Economic growth the primary objective – not social objectives
–
Predominant reliance on increasing exports as a source of
economic growth, and the requirement for global consumption to
grow in order to absorb these extra exports
–
Competition between countries
From economic growth to social growth
• Orthodox:
– fixation with global economic growth
– assumption that benefits will “trickle down” to the poor
• Problem:
– the benefits don’t trickle down
– carbon constraints limit global growth
• Alternative:
– focus on social and environmental goals
From Top-Down to Bottom-Up
• Orthodox:
– Policies imposed globally by IMF/WB/WTO, based on economic
theory/neoliberal ideology
• Problem:
– Policies aren’t working
• Alternative:
– Design policies locally and pragmatically to meet social and
environmental goals
– Design national policies/system around them
– Design global policies/systems to foster and support
From Sticking Plasters to a Systemic Approach
• Orthodox:
– ‘Add-on’ policies to off-set negative impacts
• Problem:
– Limited benefits
– Only needed because main policies don’t work
• Alternative:
– Systemic approach with social/environmental goals at the centre
From Globalisation to Localisation
• Orthodox:
– Reliance on export markets and foreign investment
• Problems:
– Export markets are limited
– Foreign investment creates fewer jobs
– Profits taken out
• Alternative:
– Develop local markets and encourage local investment
From Supply-Side to Supply-and-Demand
• Orthodox:
– Promote export production
• Problem:
– Export markets are limited (adding-up problem)
• Alternative:
– Increase demand and supply in parallel
– Go beyond aggregates: consider whose supply and demand is
increased
– Promote production of goods which will be consumed locally as
poverty is reduced
From Competition to Collaboration
• Orthodox:
– Competition between countries “to promote efficiency”
• Problem:
– Who benefits?
– False logic….
• Alternative:
– Foster a collaborative approach at the global level
– A new global governance system
Local Policies
• Targeted income generation – e.g. microcredit, agricultural extension
• Labour-intensive public works
• Local procurement from small producers
• Citizens’ income?
• Free/universal health services and education
• Promote ecological sustainability
• Micro-renewable energy for rural development
National Policies
• Promote / fund local policies
• Strengthen / support local institutions
• Provide public goods (health, education, infrastructure,
etc)
• Strengthen tax-base, and stop taxing the poor
• Pro-poor trade and procurement policies
• Redistribution between areas
Global Policies (I)
• Cancel unsustainable and odious debts
• Increased aid as stop-gap
• Global taxes to fund automatic North-South transfers
and international institutions
• Control tax competition
• Harness financial markets for sustainable human
development
Global Policies (II)
• Ensure pro-poor/sustainable trade policies in North
• Enforceable global commodity agreements
• Collective bargaining on extractive rights
• Global mechanisms to ensure contraction and convergence of carbon
emissions
• Global fund to finance micro-renewable energy technologies in rural
areas
• Democratise global governance
Section C: Beyond health care
C2
Terror, war and health
C3
Globalisation, trade, food and health
C4
Urbanisation
C5
The sanitation and water crisis
C8
Education
C6 Oil extraction and health in the Niger Delta
Key features ….
1.
Social and structural determinants emphasised
2.
Clear and explicit set of positions
3.
Multi-sectoral, development and ecological
perspective
4.
No chapters on diseases
Section B: The health care sector
B1
Health systems advocacy
B2
Mental health: culture, language and power
B3
Health care for migrants and asylum-seekers
B5
Medicines
B4
Prisoners
Photo of a remand cell in Malawi (Credit: Joao Silva)
Key features ….
1.
Social and structural determinants emphasised
2.
Clear and explicit set of positions
3.
Multi-sectoral, development and ecological
perspective
4.
No chapters on diseases
5.
An accountability instrument
Section D: Holding to account
D1 Global health governance
D1.1 The global health landscape
D1.2 The World Health Organization
D1.3 The Gates Foundation
D1.4 The Global Fund to Fight AIDS, Tuberculosis and Malaria
D1.5 The World Bank
D2 Government aid
D2.1 US foreign assistance and health
D2.2 Canadian and Australian health aid
D2.3 Security and health
Letter from Bill and
Melinda Gates
More than a decade ago, the two of us read an article about
the millions of children who were dying every year in poor
countries from diseases that were long ago eliminated in this
country. One disease we had never even heard of—rotavirus—
was killing literally half a million kids each year. We thought:
That's got to be a typo. If a single disease were killing that
many kids, we would have heard about it, because it would
have been front-page news. But it wasn’t a typo.
We couldn't escape the brutal conclusion that—in our world
today—some lives are seen as worth saving and others are
not. We said to ourselves: "This can’t be true. But if it is true, it
deserves to be the priority of our giving."
We sent the article to Bill's father, Bill Gates Sr., with a note
attached that said, "Dad, maybe we can do something about
this." And he helped us get started.
Source:
http://www.gatesfoundation.org/about/Pa
ges/bill-melinda-gates-letter.aspx
We created the Gates Foundation in 2000 ……
WHO: Under-funded and donor-driven
•
Extra-budgetary funds: now about three-quarters of WHO’s expenditure (previously
one-fifth)
•
Greater reliance on EBFs reflects growing donor control over the WHO and the
period of financial austerity imposed upon the UN.
•
Policy of zero real growth in 1980 of assessed contributions to all UN organisations.
Then in 1993, a policy of zero nominal growth was introduced.
•
Problems associated with a heavy reliance on EBFs include unhealthy competition
amongst departments within WHO and with NGOs and other organisations chasing
donor funding, and limitations to WHO’s ability to plan, budget and implement its
strategic aims coherently.
WHO: Putting health first
•
Margaret Chan says that WHO will “speak the truth to power”
•
WHO has resisted pressure from powerful interests in the past
– Framework Convention on Tobacco Control
– International Code on the marketing of Breastmilk Substitutes
– Global Strategy on Diet
– Essential Medicines
•
But not enough?
•
On other occasions it has buckled under pressure
Section D: Holding to account
D1 Global health governance
D1.1 The global health landscape
D1.2 The World Health Organization
D1.3 The Gates Foundation
D1.4 The Global Fund to Fight AIDS, Tuberculosis and Malaria
D1.5 The World Bank
D2 Government aid
D2.1 US foreign assistance and health
D2.2 Canadian and Australian health aid
D2.3 Security and health
Jeremy Bentham
•
A pugnacious critic of established
political doctrines and a passionate
democrat.
•
He had much to say about prison
reform, religion, poor relief,
international law and animal welfare.
•
Having trained as a lawyer, he soon
became disillusioned with its practice,
and instead, decided to write about the
law, suggesting ways for its
improvement and advocating for
reform.
Key features …
1.
Social and structural determinants emphasised
2.
Clear and explicit set of positions
3.
Health, poverty and climate change
4.
Multi-sectoral
5.
No chapters on diseases
6.
An accountability instrument
7.
Linked to existing advocacy, social action and
active resistance
Commission on Social
Determinants in Health
“Any serious effort to reduce
health inequities will involve
changing the distribution of
power within society and
global regions …..”
“The Commission seeks to
foster a global movement for
change”.
The Peoples Health
Movement
“The struggle for health in the
South needs to take place in the
corridors of power within
Washington, Geneva and
London …..
but it is also already taking
place across the world through
many acts of resistance and
direct action”
The struggle of indigenous
peoples’ to hang on to their
lands and cultures …
The successful struggle against water privatisation in
Cochabamba (Bolivia) followed days of street protests
and police retaliation
Other ‘launches’
Belgium
Zimbabwe
Netherlands
Canada
USA
Egypt
South Africa
Switzerland
Australia
Lebanon
Ecuador
Germany
Italy
Iran
Bangladesh
France
Sri Lanka
India
Philippines
Nicaragua
Brazil
Thailand
Morocco
Pakistan
Kenya
What next?
• Watching at the country and regional level
• A campaign agenda for civil society and the progressive
international public health community
• GHW 3
Thank you