Food for a thought falling on deaf ears (2)
-------------------------------------------
Human Rights Reader 128
YESTERDAY'S FUTURE HAS ARRIVED: THE POST-WASHINGTON CONSENSUS
ONLY HAS A PITIFUL VAGUE ORIENTATION TOWARDS THE ERADICATION OF
POVERTY AND ILL-HEALTH AS HUMAN RIGHTS PRIORITIES (Part 2 of 2)
12. In the more specific case of health, there is a conflict be-
tween WB policies under the poverty reduction strategies (PRS)
process and the Right to Health (RTH). Bank policies do under-
mine progress in respecting, protecting and fulfilling the RTH
by, among other, restricting health care budgets. A higher level
of funding of health services is a necessary-but-not-sufficient
condition for realizing the RTH of individuals and populations.
There is a minimum level of health expenditure below which the
system simply cannot function. Current funding and expenditure
levels practically guarantee that the RTH cannot be realized. On
average, public health expenditures fell 20% during WB-promoted
structural adjustment programs (SAPs), and stagnated thereafter.
[To justify this, the Bank argues that without wealth creation
it would be impossible to see human rights (HR) being realized.
'Grow now and realize HR later' the Bank obliquely suggests].
Result: A retrogression in the achievement of the RTH. SAPs vio-
late(d) the critical concept of progressive-realization-of-the-
RTH in resource-poor countries.
13. All health development programs/projects carry immediate ob-
ligations! And these core obligations are: universal access to
equitably distributed health facilities with quality services
and essential drugs, access to minimum essential food, access to
basic shelter, water and sanitation, and a focus that addresses
the major local health concerns. To these can be added: ensuring
reproductive, maternal, neonatal, infant and child care, the
provision of immunizations, the control of epidemic and endemic
diseases, health and nutrition education, and the training of
sufficient and qualified health personnel. As the key benefici-
aries, poor persons need to be empowered to monitor and sanction
health service providers making sure that policy makers (not-
only-hear, but also) respond to the demands of these marginal-
ized groups as regards the above-mentioned core obligations.
14. From a HR perspective, not even the threat of macroeconomic
distortions voiced by neoliberal economists can justify public
health expenditures below the level necessary to comply with
these core obligations. As past evidence shows, WB policies have
played an important role in the inability of countries to comply
with their core obligations. Moreover, the PRS process continues
to result in underfunding of health (primarily in Africa).
15. So, it is, in good part, up to socially conscious health
professionals worldwide to assert their public health authority
to limit the negative consequences government and corporate ac-
tions are having on health, and to ensure proper regulatory
frameworks that protect the universal right to health care are
put in place. In short, they have to see social medicine as po-
litical.
16. But, to begin with, health professionals are not looking at
the more political indicators of social medicine that can show
us some retrogression, stagnation or progress in the achievement
of the RTH. Examples of such indicators we are not looking at
are: Percentage of the population whose RTH care is still vio-
lated (importantly, but not only, access); the percentage of
households with decreased, stagnant or increased expenditure on
food; the income distribution by quintile; the percentage in-
crease (or not) of income of the lowest quintile compared to
other quintiles; the percentage of reduction (or not) in infant
and child mortality or the percentage of increased survival of
the same children in the lowest quintile. This is what I mean by
seeing social medicine as a vehicle for ending the violations of
the RTH.
Claudio Schuftan
Ho Chi Minh City, Vietnam
mailto:claudio@hcmc.netnam.vn
--
Mostly adapted from Global Health Watch, MEDACT/PHM, Nov 2005,
and D+C 32:8/9, Aug/Sep 2005.