- In the more specific case of health, there is a conflict between WB policies under the poverty reduction strategies (PRS) process and the Right to Health (RTH). Bank policies do undermine 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 that 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 violate(d) the critical concept of progressive-realization-of-the-RTH in resource-poor countries.
- All health development programs/projects carry immediate obligations! 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 beneficiaries, 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 marginalized groups as regards the above-mentioned core obligations.
- 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).
- 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 actions 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 political.
- 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 violated (importantly, but not only, access); the percentage of households with decreased, stagnant or increased expenditure on food; the income distribution by quintile; the percentage increase (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