[afro-nets] Food for a thought that twists the logic (3)

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

Food for a thought that twists the logic (3)
--------------------------------------------

Human Right 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 3 of 3)

Justifying the reversal of logic:

35. We consider it a reversal of logic that attention in the Re-
port is directed primarily to a few highly prevalent diseases of
poverty hoping that conquering them will revert the sorry situa-
tion we are in now and that that will ultimately create prosper-
ity for all; this is perhaps the central thesis of the Report.
It somehow would have us believe that the recommended health in-
terventions will 'jump start' the economies of poor persons in
poor countries.

36. But we counter-argue:
* Poverty is very likely to make poor persons ill repeatedly of
a host of many diseases --and the chances are quite high that
one of these, together with malnutrition, will kill them prema-
turely.
* When poor people are in good health, and live in miserable
conditions, this is usually only a temporary state.
* Neither health nor illness make countries rich or poor; it is
way more complex than that.
* Mainly targeting the main killer diseased is not a sustainable
solution to the poor countries' health problems. It will take
more than "each time a person falls ill, they will get the ap-
propriate medicines".
* In short, health may rhyme with wealth, but unfortunately it
is not wealth. Good health does not automatically lead to
wealth.

37. The problems that really need to be addressed are mediated
through mostly macroeconomic measures that the Report was sup-
posed to address more frontally, but doesn't: international
transfers (e.g., debt, unfair terms of trade and Northern pro-
tectionism, tax havens and capital flight, free trade zones);
SAPs and PRSPs; direct foreign investment; intellectual property
rights and TRIPS; the brain drain; and finally, as aid earlier,
aid itself. It is important to add here that there is a striking
disproportion between the sums which could reasonably be raised
through international aid --usually not exceeding millions-- and
the sums which would be released through simple macroeconomic
measures --that is billions.

38. The losses incurred through unfair terms of trade have been
devastating, for example. The rewards of liberalizing world
trade are immensely skewed towards the rich and we want to con-
centrate on killer diseases?

39. Need another example? Take ATTAC (Action pour une Taxe Tobin
pour Assister les Citoyens); it fittingly reminds us that the
major bankruptcies of the capitalist world have been absorbed by
the state --in other words have been paid for by the people.

40. Not being facetious, debt provides the North with the po-
litical and economic leverage that makes it far too valuable for
cancellation. For every dollar received in aid, three go back to
rich countries to service the debt. This is how debt itself --
which can be seen as bonded labour at the level of nations-- be-
comes a major impediment to development. So, debt is actually an
obstacle to development that the North continues to impose on
the South. As Groucho Marx would have said, the North tells the
South: "These are my principles. If you don't like them, I have
others".

41. Ethically, we are for asocial justice approach to health.
For us, ends are only justified through the use of certain
means. A characteristic of an ethical principle is that it is
absolute. It can neither be diminished, modified, nor disproved
with formulae, models or diagrams, all these so cherished by
mainstream economists. Economic reality cannot be fitted into
diagrams or econometric models (perhaps in an attempt to make
principles more attractive to investors?).

42. But in the Report, growth, market economies, competition,
decentralization, cost containment, foreign investment --even
public private partnerships-- are all presented unquestioningly
as desirable. But all of these are means to an end, one that is
never made explicit.

43. The Report's dubious incursions into the field of ethics re-
veal at best a shallow grasp on international affairs, but at
worst, an inexcusable ignorance or simply arrogance.

Asking the ultimate question: Why this Report?

44. This question only brings on some more questions; a response
evades us.

45. Is a discussion of the structural determinants of poverty
and inequity and, in turn, of ill-health and preventable mortal-
ity threatening to the Report's authors? Or, does it threaten
the existing order?

46. Did the Report start out just to provide modest relief to
the poor so as to defuse a potentially more dangerous situation?
Misery is destabilizing, we know that much. If the proposals set
forth dampen that spark, will they have served the status-quo?
They certainly would not serve the cause of global social jus-
tice and human rights.

47. We are worried; worried that the espousal and promotion of a
bad set of solutions can inflict great suffering on a large num-
ber of our fellow human beings. Was blind faith or blind self
interest the driving force behind this Report? Whatever the an-
swer, it is our duty to reject its key prescriptions and embrace
the alternative thinking and strategy here sketched.

Playing god?

48. Clearly, the era of hidden agendas is over. If today the
purportedly apolitical and a historical discipline of macroeco-
nomics explicitly promotes and legitimize corporate-led capital-
ist globalization --including its application to the health sec-
tor-- it behoves us to speak up forcefully. This is what these
three Readers have attempted.

49. Today, the struggle for health as a right is a struggle
against the mechanisms, structures and processes of impoverish-
ment and deepening inequity.

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

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