AFRO-NETS> Report of WHO Commission on Macroeconomics and Health

[Claudio Schuftan <aviva@netnam.vn>]

Report of WHO Commission on Macroeconomics and Health
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Possibility of a Collaborative Analysis
Globalisation on trial
World health warning issued

A high level WHO commission has warned the rich world that unless 
there is a dramatic increase in development assistance for health the 
legitimacy and stability of the current regime of global economic 
governance may be seriously threatened. 

The report of the WHO Commission on Macroeconomics and Health (CMH) 
is now available an an Adobe PDF file at:
http://www.cmhealth.org/docs/activity_report.pdf

This report will have a big impact on policies and programs in the 
field of health development. It is a major intervention in discus-
sions about official development assistance including the role of the 
World Bank (and PRSPs). 

Opportunity

The debate around the report will also provide an important opportu-
nity to challenge neoliberal orthodoxy in development policy and to 
further undermine the legitimacy of the prevailing regime of global 
economic governance. 

The purpose of this posting is to invite health activists, NGOs and 
academics, who see in this regime of global economic governance the 
major causes of health stagnation in the developing world, to a col-
laboration in developing a strong response to the CMH: building upon 
its sombre warning to the captains of capital while challenging many 
of its assumptions and conclusions.

Background

The WHO Commission on Macroeconomics and Health (CMH) was established 
by the Director-General of WHO in January 2000. The Commission was 
chaired by Professor Jeffrey Sachs of Harvard. It members and helpers 
included former ministers of finance, people from the World Bank, the 
International Monetary Fund, the World Trade Organisation, the United 
Nations Development Program, the Economic Commission on Africa and 
the Organisation for Economic Cooperation and Development. The Com-
mission was financially supported by the Bill and Melinda Gates Foun-
dation, the Rockefeller Foundation and the UN Foundation and by the 
governments of the UK, Luxembourg, Ireland, Norway and Sweden. The 
CMH presented its final report to Dr Brundtland in December 2001. 
The Commission set up six working groups, on:
* health, economic growth, and poverty reduction; 
* international public goods for health; 
* mobilisation of domestic resources for health; 
* health and the international economy; 
* improving health outcomes of the poor; 
* development assistance and health. 

The reports of the working groups are indexed at: 
http://www.cmhealth.org/wg1.htm
http://www.cmhealth.org/wg2.htm
http://www.cmhealth.org/wg3.htm
http://www.cmhealth.org/wg4.htm
http://www.cmhealth.org/wg5.htm
http://www.cmhealth.org/wg6.htm

WHO Director-General Dr Gro Harlem Brundtland welcomed the report of 
the WHO Commission on Macroeconomics and Health on December 20th 
2001: "This report is a turning point," she said. "It will influence 
how development assistance is prioritized and coordinated in the 
years to come."

A provisional assessment

It is a difficult report to analyse. The argument is tortuous and 
quite selective in its use of evidence. In places it stretches fact, 
logic and credulity to the point of combustion. It is difficult to 
read the strategic purpose of the DG in commissioning the report and 
that of the members of the Commission in framing their presentation. 
It is clear that the report is meant to be read at several different 
levels. 

The core of the report is this: globalisation is on trial: unless 
there is a dramatic increase in development assistance for health 
care in low income countries the legitimacy and stability of the cur-
rent regime of global economic governance will be seriously threat-
ened. It is a warning to the G8, the Paris Club and the Bretton Woods 
institutions to slow down on globalisation and redirect significant 
resources to health care in the poorer countries.

This is quite a finding, given the members of the Commission - which 
is partly why it is such an important opportunity for engagement.
However it is a big report and is accompanied by dozens of working 
group reports. There is a lot of material to absorb and consider. 
This raises questions about how Third World governments, health ac-
tivists, NGOs and academics who had already come to this central con-
clusion might respond to the report. 

A global collaboration in analysing and responding to the CMH report?

I have read the report and most of its working group reports and I 
have prepared a preliminary analysis which I have posted at:
http://users.bigpond.net.au/sanguileggi/PrelimAnalCMHReport.html

I hope this preliminary review will encourage people to read and 
think about the CMH report. I hope that the perspectives that I have 
presented may be useful to others in the task of interpreting, ana-
lysing and critiquing the report.

However, the work involved in considering thoroughly the report and 
that of the working groups is not trivial. The Commission had the re-
sources of Bill Gates and the World Bank at its disposal. The net-
works of activists, NGOs and academics who might wish to take the op-
portunity to challenge the logic and legitimacy of the current regime 
of global governance do not have such resources. But we have our own 
experts and we are in touch with the current lived circumstances of 
different settings and different countries. 

So I am proposing a global collaboration around the task of analysing 
and responding to the CMH report. 

A global analysis would need a coordinating function; a systematic 
approach to analysis and critique; a coordinated approach to generat-
ing alternative strategies and policy principles; a process and ave-
nues for dissemination and follow up. I really don't know how these 
should be organised. 


Process and outcomes

As I envisage it the material outcomes of this collaboration would be 
a collection of articles published in a very wide range of websites 
and journals. They might or might not be identified as arising from 
this collaboration (which might or might not be blessed with an for-
mal name).

I am expecting that through this collaboration people in different 
parts of the world might collaborate in producing different critiques 
or commentaries for different purposes and different audiences. As a 
starter I have produced the preliminary analysis addressed above. I 
would like to publish this commentary but I am not sure where and I 
would greatly appreciate feedback and commentary on the current draft 
before I do. 

Perhaps the commentary might serve as a useful framework for claiming 
and allocating the work which is yet to be done. Another framework 
would be the set of working papers referenced above. 

A global collaborative critique?

Please read the report and my preliminary analysis and answer the 
following questions:
* Do you agree that the report of the CMH justifies a strong and 
  critical response? 
* Do you agree that we could organise and collaborate in a globalised 
  analysis and response through the medium of this and related lists?
* How does a loosely knit global community of health activists under-
  take such a project? 
* What can you and your organisation contribute to such a process?
* Are there particular aspects of the report that you would like to 
  focus upon?

David Legge
School of Public Health
La Trobe University, Australia
mailto:d.legge@latrobe.edu.au
http://www.latrobe.edu.au/publichealth/references/profiles/dgl4sph.htm

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