[afro-nets] A didactic exchange of e-mails

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

A didactic exchange of e-mails
------------------------------

Hello,

I am living in Paris. I'm actually ending my medical studies and
working on the subject of my Ph-D. I'm particularly interested
in the impact on health of the policies of the IMF and of the
World Bank, as well as the impact on health of the trade agree-
ments conceived by the WTO. More precisely, I do not want to
study the impact of those policies and agreements on health care
systems, as I think that the debates often concentrate on those
issues, whereas the health determinants are mostly affected by
the social and economics changes. I am searching for informa-
tion.

I discovered and read with great enthusiasm the report of Eve-
lyne Hong written for the People Health Assembly (PHA), "global-
isation and the impact on health, a third world view". Through
the PHA exchange list, I also came to know about the assessment
of the impact on health of the PRSP process. So my questions
are:
* do you have more information about the ongoing evaluation of
the impact on social issues of the HIPC initiative?
* can you advice me some specific books about the impact on
health (and others social issues) of the SAPs (except the SAPRIN
report that I have already)? Moreover, I would be really inter-
ested to discuss with professionals interested by those prob-
lems.

I thank you in advance,
Julie


Dear Julie,

It is good to hear from young people wanting to do research on
the impact on health policies of the IMF, WB and WTO. Good to
know that you are focusing on the impact of these policies on
health determinants.

In this context, you may wish to consider the right to health as
a fundamental human right. And you can quote Kofi Annan, UN Sec-
retary General "It is my aspiration that health will finally be
seen not as a blessing to be wished for but as a human right to
be fought for". In this context article 12 of the International
Covenant on Economic, Social and Cultural Rights (ICESCR) is
relevant. This article interprets the right to health as an in-
clusive right extending not only to timely and appropriate
healthcare but also to the underlying determinants of health
such as access to safe and potable water and adequate sanita-
tion, an adequate supply of safe food, nutrition and housing,
healthy occupational and environmental condition and access to
health related information.


The policies of WB, IMF and WTO have an adverse impact on all
these determinants of health.

Why is it that the Human Right to Health still remains so far
from being realized? Why should you fight for it as the UN Sec-
retary General has said? Your thesis should give an answer why &
how.

The reason in my opinion is that the WB, the newest and strong-
est player in international health, has convinced health policy
planners' that the key obstacles to achieving Health for All are
economic. In this process the WB has put into reverse gear the
global debate on HFA by focusing on a very market oriented con-
cept of Human Health. The World Development Report, 1993, "In-
vesting in Health" described a Master Plan for making health
cost effective. To support its thesis the Bank created and eco-
nomic jargon "DALYS" or Disability Adjusted Life Years". Very
few health planners understand this but all including WHO, have
accepted it.

I suggest you go through the document, "The Disability - Ad-
justed Life Year" (DALY) Definition, Measurement and Potential
Use". The abstract may mislead you. The conclusion on pages 11 &
12 are revealing and you can download it at:
http://www.worldbank.org/html/extdr/hnp/hddflash/workp/wp_00068.html

Another market oriented approach was the Commission on Macro-
Economics and Health. Dr Gro Harlem Bruntland a former Director-
General of WHO, requested Prof Jeffrey Sachs & a team of Econo-
mist to assess the place of health in global economic develop-
ment.

They produced a report. This was one more nail on the coffin on
the Alma Ata Declaration on HFA. MedAct has prepared a response
you will find useful.

The WB & IMF introduced Structural Adjustment Programme (SAPs)
in the 1980s and forced it on to indebted developing countries.
Which developing country is not indebted and unable to keep up
the scheduled repayment? Well one condition for WB/IMF loan was
implementing SAPs. In about five year, the SAPs reversed all the
gains in health achieved by developing countries particularly
those in sub-Saharan, Africa over the previous 15-20 years. It
took WB/IMF a very long time to accept the failure of SAPs. The
Economists in WB & IMF invented a more civilized term - PRSPs.
These were to be prepared by the countries themselves. What is
not published is that these are remote controlled in Washington.
A report you will find useful is "Pushing the boundaries: health
and the next round of PRSPs" published by WEMOS and MedAct June
2004.

The report attempts to assess whether health has benefited from
PRSP process launched 5 years ago. One particular focus in this
paper is very relevant to your proposed thesis. The authors ar-
gue that Health cannot be secured by health sector above. Health
advocates should look beyond the boundaries of the health sector
and join others calling for polices that reduce social and eco-
nomic inequities. Contact Wemos for this publication. This may
be the reference you found through PHA exchange. These are my
rambling thoughts in response to your request.

Best wishes,
Dr Bala

[From the Moderator: You can download the WEMOS and MedAct re-
port as Adobe PDF file (50 pp. 647 kB) at:
http://www.medact.org/content/Wemos%20and%20Medact%20-%20Pushing%20the%20boundaries.pdf 
]