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The end of public health as we know it

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'There is no single time: all of our times are alive, all of our pasts are present. ... will have to move their advocacy forcefully into the political arena ... – PowerPoint PPT presentation

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Title: The end of public health as we know it


1
The end of public health as we know it
  • Ilona Kickbusch
  • Leavell lecture
  • WFPHA Brighton, 2004

2
  • There is no single time all of our times are
    alive, all of our pasts are present.
  • Carlos Fuentes

3
The past is alive
Streetchildren 1890
4
The past is present
Salgado
5
A turning point
6
New global social contract on health
7
The new Europe
Koolhas
8
The external Objectives of the European Union
upholding and promoting the EU Values and
Interests
Sustainable development of the earth
Security
Respect for the principles of the UN
Charter
Peace
Respect for international law
Solidarity
Global health strategy
Protection of the rights of the child
Mutual respect between peoples
Free and fair trade
Eradication of poverty
Protection of human rights
TF-AU/3
European Commission
9
Health Societies
  • Post modern societies are health societies and
    are defined by five major characteristics
  •  
  • a high life expectancy,
  • an expansive health and medical care system,
  • a rapidly growing private health market,
  • health as a dominant theme in social and
    political discourse and
  • as a major personal goal in life.

10
The wealth gap
  • 1.2 billion people live on less than 1 a day
  • Thirty years ago the gap between the richest 5th
    and the poorest 5th stood at 301
  • Now it is 741 (UNDP 1999)
  • Gender No country treats its women as well as
    its men.

11
Poorest countries.
  • A falling life expectancy in many African
    countries
  • A  lack of access to even the most basic services
  • An excess of personal expenditures for health of
    the poorest
  • Health as a neglected arena of national and
    development politics
  • Health as a matter of survival

12
MDG 4 Reduce child mortality
  • Infant mortality rate
  • IMR 5.1 (Canada), 62.0 (Bolivia) and 97.1 (Haiti)
  • Under five mortality rate
  • 500,000 deaths annually
  • Mortality 16.5 times greater in Haiti than in
    Canada

13
MDG 5 - Improve Maternal Health
  • 23,000 maternal deaths annually in LAC (1,000 in
    adolescents)
  • RR of maternal death 35 times higher in LAC than
    in North America
  • Life time risk of death 1 in 7,700 deliveries in
    Canada - 1 in 17 in Haiti

14
New global mindset
  • Implicit in the idea of globalization rather
    then internationalization is the idea that we
    are moving beyond the era of growing ties between
    nations and are beginning to contemplate
    something beyond the existing conception of the
    nation state
  • Concept One World
  • Peter Singer 2002

15
Millennium Development Compact
Collective Intentionality to reduce poverty
through building on mutual responsibilities The
Millennium Development Goals are the first
global development vision that combines global
political endorsement with a clear focus on, and
means to engage directly with, the worlds poor
people.
16
The Millennium Development Goals
  • The Millennium Development Goals are time-bound
    and measurable goals and targets to be achieved
    between 1990 and 2015, they include
  • halving extreme poverty and hunger
  • achieving universal primary education
  • promoting gender equality
  • reducing under-five mortality by two-thirds
  • reducing maternal mortality by three-quarters
  • reversing the spread of HIV/AIDS, malaria and TB
  • ensuring environmental sustainability
  • developing a global partnership for development,
    with targets for aid, trade and debt relief

17
Goal 8 Partnership for development
  • The last goal-global partnership for
    development-is about the means to achieve the
    first seven. Many of the poorest countries will
    need additional assistance and must look to the
    rich countries to provide it. Countries that are
    poor and heavily indebted will need further help
    in reducing their debt burdens. And all countries
    will benefit if trade barriers are lowered,
    allowing a freer exchange of goods and services.

18
Commitment to Development Index
19
Caskets galore
Richard Morin Washington Post
20
The health wars..
  • In modernity the sharpest discourse on difference
    always takes its starting point from the body
  • Michel Foucault

21
The health wars.different concepts
Risk
Threat
justice

22
No excuses
  • There are no excuses left, no rationalizations to
    hide behind, no murky slanders to justify
    indifference there will only be the mass
  • graves of the
  • betrayed.
  • Stephen Lewis

           
           
Photovault.com
23
The problem..
  • the pervasiveness of todays crises suggests
    that they might all suffer from a common cause,
    such as a common flaw in policy making, rather
    than from issue specific problems. If so, issue
    specific responses, typical to date, would be
    insufficient allowing global crisis to persist
    and even multiply
  • (Kaul et al 1999 Global Public Goods)  

24
WHO
Gates Foundation
25
NEW POLITICAL ECOSYSTEM for health



MSF
CLINTON
BONO
150 PPPH
26
In the 21st century Health is.
  • Foreign policy
  • Security policy
  • Economic policy/Trade policy
  • Demographic development
  • Geopolitics

27
Dimension 1
  • The growth of epidemics
  • AIDS, SARS etc
  • Global obesity/tobacco epidemics
  • Increasing Global risk factors
  • Unhealthy consumption
  • The threat of bio terrorism

28
Dimension 2
  • The lack of sustainable health systems
  • Lack of health care coverage of the poor
  • Insufficient national capacities for public
    health in rich and poor countries
  • The dramatic fall of investment in universal
    health systems.
  • Lack of human resources //export and brain drain

29
Dimension 3
  • The socio-economic-political context
  • Unstable world
  • New emerging poverty
  • People movement 1 bill on the move
  • Negative impacts of globalization

30
Dimension 4
  • The values
  • Lack of value attached to human lives in the
    south
  • Lack of support for strong public systems
  • Lack of support for new global financing
    mechanisms

31
Dimension 5
  • The international actors
  • An ever denser network of actors with lack of
    transparency
  • Increasing lack of accountability
  • Balkanization of global public health and
    unintended consequences

32
Dimension 6
  • Systems default
  • Focus on disease
  • A world of vertical programs and quick fix
    solutions
  • A tendency to invest in technologies and drugs
    and not in social protection, health systems and
    people

33
Expansions
  • the expansion of the territory of health into an
    increasing array of personal, social and
    political spaces
  • the expansion of risk and a changing nature of
    risk
  • the expansion of the do-ability of health.

34
Global solidarity/human rights
35
Health is an individual right
36
Nation state global governance
  • Security
  • Rule of law
  • Social welfare
  • Identity and participation
  • Human Security and Human Rights
  • International rule of law/global ethics
  • Fairness in Global Distribution
  • Common Identity as global citizens and a global
    voice and channels of participation

37
Signing the IFCT
Codes, treaties, conventions
38
ACCESS No more business as usual
WTO/TRIPS/pricing
Global social movements
39
Political advocacy
  • Governance and policy questions will begin to
    move to the center of the global health debate
  • Public health advocates and associations will
    have to move their advocacy forcefully into the
    political arena
  • New financing mechanism for global public goods

40
5 Global Health action areas
  • health as a global public good
  • health as a key component of global security
  • health a key factor of global governance of
    interdependence
  • health as responsible business practice and
    social responsibility
  • health as global citizenship.

41
International law
  • Pooling sovereignty and right to intervene on
    behalf of the global community
  • Revised International Health Regulations

42
Transparency and Accountability
Accountability to own constituency and global
community
43
Global Ethics From charity to entitlements
  • the very values of an enlightened and civilized
    society demand that privilege be replaced by
    generalized entitlements if not ultimately by
    world citizenship then by citizens rights for all
    human beings of the world
  • Ralf Dahrendorf

44
5 Global Health action areas
  • health as a global public good
  • health as a key component of global security
  • health a key factor of global governance of
    interdependence
  • health as responsible business practice and
    social responsibility
  • health as global citizenship.

45
Phases of Collective Intentionality
  • 1. Fight disease
  • Small pox eradication
  • 2. Create Health
  • Primary Health Care 1978 HFA 2000
  • Ottawa Charter 1986
  • 3. Invest in Health
  • World Bank Report 1993
  • Macroeconomic Report 2001
  • 4. Health as a global public good

Health is a collective Community effort
46
Political determinants
  • The key challenge in this new phase of
    globalization will be political because it
    addresses distribution of wealth
  • Governance and policy questions will begin to
    move to the center of the globalization debate
  • Public health advocates and associations will
    have to move their advocacy forcefully into the
    political arena political will matters

47
The third public health revolution
  • to act that you treat humanity whether in your
    own person or any other person never merely as a
    means but as an end in itself. (1785)

Immanuel Kant
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