Food for thought... - reactions
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[excerpts]
It is my conviction that health activism must have solid scientific
foundations. I thank you, Claudio, for taking initiative in raising
some important issues in your 'food for thought' pieces. I hope other
concerned readers will also respond to the ideas put forward by you.
I am contributing some additional 'food':
1. You have defined and discussed the 'four E': equality, equity,
ethics and efficiency. You are perhaps aware that there are different
views on these definitions. These terms have gained currency during
the past decade or so, apparently to cover-up the retreat from the
commitments made in the Alma Ata Declaration. This becomes apparent
when one relates these lofty principles to the actual ground situa-
tion prevailing among the poor of the world. Preoccupying oneself
with such refined discourses amounts to a cruel joke on the helpless-
ness of hundreds of millions of the world's poor who do not get
critically needed health care, potable water, sanitation and housing.
To what extent have all the learned debates on equality, equity and
ethics contributed to improve the health status of these people? The
learned debates become not only futile, but also downright counter-
productive. It is therefore very apt that the concerned health work-
ers meeting at the Asian Social Forum at Hyderabad considered imple-
menting the Alma Ata Declaration and Health For All Now! as the theme
for action in 2003.
2. We know that in the Global Village that is being set up by the
rich countries, the rich are going to have the dominant position.
They use their muscle power to dictate the economic, political and
cultural lives of the poor; they will manipulate information to en-
sure that the well reasoned arguments presented by honest intellectu-
als are banished from the memory screens and that those put forward
by servile 'researchers' are projected as 'the' pearls of wisdom. How
do principles of equality, equity and ethics fit in such a global
'order'?
3. We have to constantly keep in mind that despite assertions of con-
sidering health as a fundamental right of all the people of the
world, the neoliberal system has relentlessly put pressure on the
poor countries to cut down government expenditure on health and have
encouraged further growth the private health sector by offering them
subsidies of various kinds. To exhort the poor to pay for their
health needs (no free lunch for you!) is infamous. Health activists
have to avoid this trap when they discuss financing health services
in poor countries.
4. You have tried to draw a line between `cost sharing' and `cost re-
covery. There could be different interpretations of these terms. It
is, at best, an academic exercise. We ought to keep on haranguing the
governments of the poor countries to take steps to ensure that health
becomes a fundamental human right of all the people.
When making the poor pay for their health services, to my knowledge,
there are few, if any, instances of success of such ill-fated ven-
tures; then why resurrect the old ghost?
I will warmly welcome comments and criticism from you and other read-
ers.
With regards.
Sincerely yours,
D Banerji
Emeritus Professor JNU
New Delhi, India
mailto:nhpp@bol.net.in
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