[afro-nets] Food for a thought that twists the logic

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

Food for a thought that twists the logic
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Apologies: The last HRR (No.112) sent out in Mid May was actu-
ally a summary of HRR Nos. 91 and 92 already sent out earlier.
Therefore, this is the real Reader No. 112.

Food for a thought that twists the logic

Human Rights Reader 112

The Sachs Macroeconomics and Health Report: Investing in health
for economic development or increasing the size of the crumbs
from the rich man's table?
(Part 1 of 2)

A restricted mandate and a reversal of logic:

1. The relationship between health and poverty is two way, but
the relationship is not symmetric. Poverty is the single most
important determinant of poor health. People suffer from ill-
health and malnutrition because they are poor. But poor health
is very far from being the single most important determinant of
poverty. Poor health exacerbates existing poverty and poverty is
most often a political problem, i.e., people are poor because of
structural, man-made situations.

2. The neoliberal approach to health has turned this reasoning
on its head by asserting that people are poor because they are
ill, because there are too many of them, because they place a
strain on scarce resources and -- to add insult to injury-- be-
cause they behave irresponsibly.

3. But no amount of top-down health interventions delivered to
Haitians or Tanzanians today are going to make them or their
country prosperous tomorrow if the national economy is strangled
by debt, unfair terms of trade and the continued pillage of
natural resources. To this, add the destabilization caused by
uncontrolled financial outflows, widely fluctuating commodity
prices and outside interference in matters of national sover-
eignty.

Is economic growth the ultimate aim?

4. The last 25 years of globalization (1980-2005) have shown
clear declines in progress in development as compared with the
previous two decades, e.g., income inequality has risen in most
countries since the early-mid 1980s and in many cases sharply.
Moreover, the higher the levels of inequality, the less impact
economic growth has in reducing poverty --for any rate of eco-
nomic growth. [Oddly enough, the development community fre-
quently offers poor persons "micro" versions of the advantages
that the rich enjoy, such as, micro-credit --a micro-life per-
haps?]

5. Globalization also gives us 'doublespeak': For example,
'free' trade is far from being free --it is very carefully set
around the interests of private capital and rich nations. It
also fosters the privatization of profits and the nationaliza-
tion of losses and debt. Worse even, economic liberalization is
cynically made synonymous with political democracy, and the
creation of decent livelihoods is made incidental to the making
of money for those who already have far more of it than they
need.

6. The main differences that we have with the Sachs Report are
that the neoliberal approach to health tends to blame the vic-
tims; a social justice/human rights approach to health blames
the 'system'.

7. Some of the main thoughts that are of relevance to the right
to health and to sustainable development in the alternative eco-
nomics we put forward are as follows:

* The current system must be brought under democratic control.
* The economic system and structures should be informed by the
ethical and political values of social justice and human rights.
* There is an urgent need to democratize the debate on economics
and on health to encourage public action on these issues.
* Economic growth must be replaced by a fair distribution and
sustainable use of existing and new resources; economic growth,
when pursued, must not be achieved at the expense of poor people
or the environment.

Health is what you get from health services?

8. Health problems are not solved through technical interven-
tions delivered through health services. Scaling up the access
of the world's poor persons to essential health services, in-
cluding a focus on specific disease-oriented interventions, will
not solve their health problems either.

9. The Establishment further regards acting on the major deter-
minants of health as 'complementary and additional actions'
rather than as the fundamental actions in reaching Health For
All.

10. 'The major interventions required lie outside the health
sector' --people repeat this over and over. But it is hard to
tell if we are dealing with insincere lip service, ignorance or
cynicism here.

11. The bottom line is that the proportion of diseases attribut-
able to factors lying outside the health sector --and which can-
not be addressed through health services-- is overwhelming.

12. It is, therefore, puzzling to find statements in the Sachs
Report urging the international health community to undertake
yet more research or to base policy on 'evidence' --as if in the
past, public health decision makers sifted through policy op-
tions selecting at random or even selecting those for which
there was no evidence!

13. Do we need to say it again? In the context of basic inter-
ventions for health, we do have all the knowledge we need to
eradicate the major burden of disease and its root cause --
poverty.

14 The political will is lacking among those who have the power
to eradicate disease and poverty and who have in no small meas-
ure contributed to the current state of affairs (or is it a de-
liberate choice rather than a lack of will?).

International aid is the only way to finance health?

15. Seriously suggesting that there are no ways of distributing
income and assets between countries other than through interna-
tional aid is, we think, a fallacy.

16. The Human Rights-based approach to health rejects poverty
being 'a fact of life' and focuses attention on impoverishment
as a process which is inherent to capitalist accumulation and
the inevitable and galloping concentration of power and wealth.

17. The factors that allow the North to flourish, the South to
wither and the disparities to widen are at the centre of inequi-
ties in health. It is simply impossible for all nations to bene-
fit from unfair terms of trade.
And international aid is not designed to change the structure
and dynamics of relations between North and South. Aid is more
an instrument to project power beyond national borders. So we
see the globalised economy of today as equivalent and not
greatly different from the colonial economy of the past. More-
over, official aid can be considered to function largely as an
export subsidy for Northern companies.

18. Aid then, inevitably results in undue influence if not out-
right interference in national public policy. The supposed bene-
ficiaries (the people) are very rarely consulted, but then nei-
ther are their elected representatives.

19. Because of this, the Human Rights-based approach to health
rejects the assumption that international aid is the only way to
finance health and proposes an alternative assumption: A fair
and rational international economic order so that sovereign and
solvent states can meet the needs of their people sustainably
and without external interference.
(contd.)

--
Claudio Schuftan
Ho Chi Minh City, Vietnam
mailto:claudio@hcmc.netnam.vn

Extracted and paraphrased from the article by the same name by
Alison Katz.