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Global Health Watch


Power and Politics. Commission on Social Determinants in Health, 2008. Key Features ... pushed and pulled by the tidal forces of international politics. ... – PowerPoint PPT presentation

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Title: Global Health Watch

(No Transcript)
Global Health Watch
  • Background to the development of GHW2
  • The book itself
  • The way forward

Over 130 people from 6 continents, plus reviewer
and editors
GHW 2 production
(No Transcript)
  • UK
  • Belgium
  • Zimbabwe
  • Netherlands
  • Canada
  • USA
  • Egypt
  • South Africa
  • Switzerland
  • Australia
  • Lebanon
  • Ecuador
  • Germany
  • Italy
  • Iran
  • Bangladesh
  • France
  • Sri Lanka

India Philippines Nicaragua Brazil Thailand Moroc
co Pakistan Kenya Denmark
Policy Context WHO reports, 2008
  • World Health Report, 2008
  • Primary Health Care. Now More Than Ever
  • Reasserts the primary health care agenda post
    Alma Ata
  • Closing the gap in a generation
  • Health equity through action on the social
    determinants of health
  • Addresses the causes of the causes

The three reports are highly complementary
The book itself..
GHW Content 27 chapters
  • A Development
  • An alternative paradigm for development
  • B Health Sector
  • Health systems advocacy
  • Mental health culture, language and power
  • Health care for migrants and asylum-seekers
  • Prisoners
  • Medicine
  • C Beyond health care
  • Carbon trading and climate change
  • Terror, war and health
  • Globalisation, trade, food and health
  • Urbanisation
  • The sanitation and water crisis
  • Oil extraction and health in the Niger delta
  • Humanitarian aid
  • Education
  • D Holding to account
  • D1 Global health governance
  • The global health landscape
  • The World Health Organization
  • The Gates Foundation
  • The Global Fund to Fight AIDS, TB and Malaria
  • The World Bank
  • D2 Government aid
  • US foreign assistance and health
  • Canadian and Australian health aid
  • Security and health
  • D3 Transnational corporations
  • Protecting breastfeeding
  • Tobacco control moving governments from inaction
    to action
  • E Postscript Resistance

Key features .
  • Social and structural determinants emphasised

Commission on the Social Determinants of Health
  • GHW 2 echoes many of the analyses of the report
    of the Commission on Social Determinants of
    Health, highlighting for example, the fundamental
    issues of power and politics

Poor health and health inequalities within and
between countries are caused by the unequal
distribution of power, income, goods, and
services, globally and nationally .. The
unequal distribution of health-damaging
experiences is the result of a toxic
combination of poor social policies and
programmes, unfair economic arrangements, and bad
politics .. social injustice is killing
people on a grand scale
Power and Politics
  • Commission on Social Determinants in Health,

Key Features
  • Social and structural determinants emphasised
  • Clear and explicit set of positions
  • Counterbalance to neoliberalism
  • Equity-focussed, not just pro-poor

An alternative paradigm
  • GHW 2 provides an alternative perspective on the
    state of global health in the 21st century.
  • It places major health concerns in their
    political and economic context, highlighting the
    disparities in health between the rich and the
    poor and between the powerful and the
  • It emphasises the need to tackle the underlying
    determinants of ill-health and health

  • Three key challenges for the 21st century
  • Eradicating poverty and reducing inequities
  • Fulfilling the right of all people to good health
  • Bringing climate change under control
  • GHW 2 pg 9

(No Transcript)
. in many cases, there is a net financial
outflow from poorer to richer countries an
alarming state of affairs.
So while we talk about poverty, we mustnt forget
to talk about wealth. While we produce world
health reports, Meryll Lynch produces a world
wealth report 10 million people have investible
liquid funds worth 40 trillion US
Income Poverty (millions)
International comparison of health indicators
Source World Bank 2005
Climate change as a potentially catastrophic
threat to global health
But they are out of control
  • When we bring the twin challenges of poverty
    reduction and climate change together, we end up
    with a major dilemma
  • Were failing on poverty and climate change
  • We need more growth to reduce poverty faster
  • But we need to grow less to limit carbon
    emissions and control climate change
  • How can we do both?!!!

  • The need for an alternative development paradigm
  • GHW2 describes three fundamental flaws with the
    current model of development
  • Economic growth the primary objective not
    social objectives
  • Predominant reliance on increasing exports as a
    source of economic growth, and the
    requirement for global consumption to grow in
    order to absorb these extra exports
  • Competition between countries

  • Whether we are concerned with HIV, malaria,
    health systems, access to medicines, avian flu,
    maternal mortality, malnutrition, diarrhoeal
    disease . we in the international health
    community have to mobilise around a broader
    political, economic and ecological agenda -
    working much more closely with economists,
    geographers, engineers and social scientists
  • There is no simple solution and even the
    proposals set forth in GHW2 merely offer some
    broad ideas that would need further development.

From economic growth to social growth
  • Orthodox
  • fixation with global economic growth
  • assumption that benefits will trickle down to
    the poor
  • Problem
  • the benefits dont trickle down
  • carbon constraints limit global growth
  • Alternative
  • focus on social and environmental goals

From Top-Down to Bottom-Up
  • Orthodox
  • Policies imposed globally by IMF/WB/WTO, based on
    economic theory/neoliberal ideology
  • Problem
  • Policies arent working
  • Alternative
  • Design policies locally and pragmatically to meet
    social and environmental goals
  • Design national policies/system around them
  • Design global policies/systems to foster and

From Sticking Plasters to a Systemic Approach
  • Orthodox
  • Add-on policies to off-set negative impacts
  • Problem
  • Limited benefits
  • Only needed because main policies dont work
  • Alternative
  • Systemic approach with social/environmental goals
    at the centre

From Globalisation to Localisation
  • Orthodox
  • Reliance on export markets and foreign investment
  • Problems
  • Export markets are limited
  • Foreign investment creates fewer jobs
  • Profits taken out
  • Alternative
  • Develop local markets and encourage local

From Competition to Collaboration
  • Orthodox
  • Competition between countries to promote
  • Problem
  • Who benefits?
  • False logic.
  • Alternative
  • Foster a collaborative approach at the global
  • A new global governance system

Policy agenda
Targeted income generation eg microcredit Free
universal health care Micro-renewable energy
Cancel debts Global taxes to fund north-south
transfers Pro poor sustainable trade policies in
Promote/fund local policies Strengthen local
institutions Redistribution
Key features .
  • Social and structural determinants emphasised
  • Clear and explicit set of positions
  • No chapters on diseases

  • Section B The health care sector
  • B1 Health systems advocacy
  • B2 Mental health culture, language and power
  • B3 Health care for migrants and asylum-seekers
  • B5 Medicines

GHW 2 illustrates.
  • Despite growth in development assistance for
    health hundreds of millions of people still lack
    access to essential health care and the basic
    prerequisites for health.
  • inadequate public finance and user fees lead to
    barriers to care or they result in poverty
  • poor coordination of health care due to multiple
  • biomedical, vertically organised selective health
    care programmes lead to duplication and draining
    skilled staff away from the public sector.

A nine point plan..
  • Comprehensive human resources plan
  • Adequate public financing
  • Harmonised health sector coordination and
  • Unhindered access to health care
  • Effective health sector management
  • Vertical and horizontal alignment
  • Public accountability and community involvement
  • District health system
  • private sector harnessed to the public good

An impact on vulnerable people
  • Mental health problems associated with social
    determinants are treated with Western biomedical
    and individualistic approach
  • Pharmaceutical industry priority for high revenue
  • 9m people and over 1m children in the
    worlds prisons. Higher rates of TB, HIV and
    mental illness

Photo of a remand cell in Malawi (Credit Joao
Migrants and asylum seekers
  • by the end of 2006 there
  • were approximately
  • 9.9 million refugees
  • worldwide, an increase
  • of 14 from the
  • late 2005 (UNHCR 2007)
  • Of these, only 30 are in the developed world

Access to health care in Europe for asylum
seekers and undocumented migrants
  • In five countries, pregnant asylum seekers were
    allowed only emergency care
  • Of 78 with some right to access to health care,
    only 24 had any real access to care.
  • In seven countries, entitlements of children were
  • In some countries, health administrators are
    required to report the presence of undocumented
    migrants to immigration officials.
  • Norredam et al, 2006
  • In some countries, health administrators are
    required to report the presence of undocumented
    migrants to immigration officials.

Key features
  • Social and structural determinants emphasised
  • Clear and explicit set of positions
  • No chapters on diseases
  • Multi-sectoral action beyond health care.

  • Section C Beyond health care
  • C1 Carbon trading and climate change
  • C2 Terror, war and health
  • C3 Globalisation, trade, food and health
  • C4 Urbanisation
  • C5 The sanitation and water crisis
  • C6 Oil extraction and health in the Niger
  • C7 Humanitarian Aid
  • C8 Education

Health impacts of climate change
  • Direct impact of heat and cold
  • Indirect impact of
  • Drought affecting food production
  • Migration due to environmental
  • damage, eg drought, flooding
  • Increase in infectious diseases

  • GHW argues that according to current trends, an
    increase of 2 degrees centigrade could result in
  • 220 million more people at risk from malaria
  • 12 million more at risk from hunger due to crop
  • 2,240 million more people at risk from water
    shortages, particularly in developing countries.

Trade and food
  • liberalisation and increased privatisation have
    influenced the volume and pattern of food trade.
  • Food import bills more than doubled between 1974
    and 2004
  • Exports have increased, eg fruit and flowers
  • there were an estimated
  • 854 million undernourished
  • people worldwide in 2001-3
  • and it is predicted that
  • 700 million people will be
  • obese by 2015

Urbanisation, water and sanitation
  • Half the worlds population now lives in urban
    areas. Reasons include natural growth and forced
    displacement from rural areas
  • Urban areas struggle to provide basic services
  • 4,500 children die every day
  • because of poor hygiene and
  • sanitation.
  • Slum-dwellers in
  • Lagos pay 40 times as much
  • for water as residents in
  • downtown New York

Oil industry
  • The oil extraction industry in the Niger Delta
    has lead to violence, oppression, poverty and
  • Despite the billions of dollars of revenue
    generated from the sale of oil, only a small
    fraction has trickled down to local communities -
    insufficient even for them to set up a
    rudimentary health service

Key features .
  • Social and structural determinants emphasised
  • Clear and explicit set of positions
  • No chapters on diseases
  • Multi-sectoral, development and ecological
  • An accountability instrument

  • Section D Holding to account
  • D1 Global health governance
  • D1.1 The global health landscape
  • D1.2 The World Health Organization
  • D1.3 The Gates Foundation
  • D1.4 The Global Fund to Fight AIDS,
    Tuberculosis and Malaria
  • D1.5 The World Bank
  • D2 Government aid
  • D2.1 US foreign assistance and health
  • D2.2 Canadian and Australian health aid
  • D2.3 Security and health

  • Development assistance for health has increased
    from US2.5 billion to almost US14 billion
    between 1990 and 2005 (WB).
  • There are now 40 bilateral donors, 26 UN
    agencies, 20 global and regional funds and over
    90 global health initiatives.
  • While this is welcome, there are concerns about
    poor coordination, duplication and fragmentation,
    with many developing countries having to spent
    time and finances on dealing with multiple

Gates Foundation
  • is now the third equal biggest funder of the
  • funds the GF and GAVI to the tune of billions of
  • sits on the board of every single major global
    health partnership
  • funds a great number of NGOs and universities
    which in turn use Gates funding to influence the
    global health agenda and the way in which
    international health policy is formulated.

Concerns about Gates.
  • The lack of accountability and transparency no
    board or Trustees etc
  • Process of soliciting and reviewing proposals
  • Controlling and domineering approach
  • Focus on vertical programmes, which fragment
    health systems and divert funds from the public

World Health Organisation
  • Focus of GHW 2 is on the challenges faced by the
    WHO, and the Commission on Social Determinants of
  • The WHO is still pushed and pulled by the tidal
    forces of international politics

World Health Organisation
  • Under funded and donor driven..
  • Funding divided between Regular Budget Funds
    (RBFs from member states) and Extra-budgetary
    funds (EBFs member states, donors, private
    sector, charities)
  • (EBFs) now about three-quarters of WHOs
    expenditure (previously one-fifth)
  • Greater reliance on EBFs reflects growing donor
    control over the WHO.
  • Problems associated with a heavy reliance on EBFs
    include unhealthy competition amongst WHO
    departments and other organisations, and
    limitations to WHOs ability to plan, budget and
    implement its strategic aims coherently.

WHO Putting health first
  • WHO has resisted pressure from powerful interests
    in the past
  • It helped to establish the Framework Convention
    on Tobacco Control and the International Code on
    the marketing of Breastmilk Substitutes
  • But not enough?
  • On other occasions it has buckled under pressure.
  • The WHO recommendations to lower the consumption
    of sugars and sugar sweetened drinks were opposed
    by the Sugar Industry, supported by the US
  • support for the pharmaceutical industry in
    Thailand, where a generic drug industry was being

Key features .
  • Social and structural determinants emphasised
  • Clear and explicit set of positions
  • No chapters on diseases
  • Multi-sectoral, development and ecological
  • An accountability instrument
  • Linked to existing advocacy, social action and
    active resistance

  • The final focus of GHW 2 is its support for
    existing advocacy, social action and active
  • The role of civil society is highlighted
    throughout GHW 2, as part of the strategies for
    change. The role of civil society is also
    developed in the final chapter on Resistance.
  • This call is supported by the CSDH and PHM

  • Global Right to Health and Health Care Campaign
    local South African campaign

Public hearing at a Health Centre in India by
peoples organisation involved in monitoring
  • Treatment Action Campaign in South Africa that
    took the Government to court over its failure to
    provide antiretrovirals

  • Joint report on health care in Iraq by Medact
    and Doctors for Iraq and follow up surveys,
    lobbys of parliament, etc. in the UK

  • Campaigns for access to health care for asylum
    seekers in the UK, Germany and other countries.

  • Training International Peoples Health
    University courses (PHM) being organised in
    several countries, including the UK, Greece,

  • Medical student action Medsin in the UK has
    organised conferences on Globalisation and health
    and seminars on GHW

Medsin is part of International Federation of
Medical Students Associations
In conclusion a role for GHW 2
  • GHW is a resource more then a book that can be
    used as
  • A peer reviewed evidence base for use by
    academics, politicians, policy makers
  • Information at different levels macro to micro
  • Support advocacy and campaigning
  • A mobilising tool for local action

Our role in the North?
  • Locally significant levels of poverty and
    inequities within our countries
  • Our role as lobbyists of our governments and the
  • The struggle for health in the South needs to
    take place in the corridors of power within
    Washington, Geneva and London ..
  • (PHM)

What next?
  • Watching at the country and regional level
  • A campaign agenda for civil society and the
    progressive international public health community
  • GHW 3 secretariat will be in India, supported
    by the Indian PHM

GHW 2 overview
Languages English, Spanish and Dutch Coming
soon Arabic, Farsi, Portuguese, French and German
  • GHW 2 and the overview are available online on
    the GHW and PHM websites. The book can be
    downloaded as a whole document, or as individual
  • See
  • and
  • Hard copies of GHW2 are available from Zed Books
    at http//

Thank you!!