[TLDR (too long didn’t read): This Reader explores why Health for All with its interdependent implications for human rights has never been achieved. For a quick overview, just read the bolded text].
1. Forty+ years on from Alma Ata, all kinds of ‘revivals’ of PHC have been attempted. None have been genuine revivals, because among the several pillars supporting Health for All, never has the New International Economic Order (NIEO) called-for in Alma Ata been revived, i.e., to address between-country- and within-country-inequalities.*
*: Take the Global Fund (GFTAM): The critical question is what would have been achieved if the massive effort of this Fund had been devoted to halting the transfer of resources from South to North and to encouraging emancipatory development (which had got off to a good start before the neoliberal backlash); in short, to allow peoples of the world to achieve their right to health (i.e., true Health for All) on the foundations of a fair and rational international economic order. All that was required from those rendered rich and powerful was to stop interfering. Of course, for the elites, that would have meant sacrificing their major source of wealth and power. (A. Katz)
2. Neither democracy nor human rights (HR) nor national health systems can be imposed or ‘donated’ from above or outside (whether by governments, the UN, foundations, NGOs or academics). These systems must be home-grown organically or they will wither on the stem! Health for All will never be achieved through CSO’s advocating for the right to health. It will only ever be achieved through social and economic justice, between and within countries. This is and always was a political struggle. Again, forgive the much-repeated observation that Health for All cannot be achieved in a vacuum. International social and economic justice/peoples’ struggles for equality are the air that has been sucked out of the vacuum-packed global health box. (A. Katz)
3. Health inequalities persist, because their political context is often ignored in public health, in the medical field, and in academia. I short, politics, i.e., ‘the relationships between class, gender, race and the given national correlation of forces and how they play out through the apparatus and ideology of the state through deliberate policy’, is shunned in the public health discourse. (Vicente Navarro)
Health is the most sensitive indicator of the right to human dignity (Gianni Tognoni, Alejandro Macchia)
-Health is the terrain that best documents the level of inequalities-iniquities generated when priority is given to goods and services over humans.
4. For example, in alliance (collusion?) with WHO, the World Bank has drawn a new map of health priorities where investments-away-from-its-social- determinants are at the center.** The health goal is placed within a generic framework to fit the profile of an insurance scheme for which somebody should pay. (Is not this what the acclaimed ‘official’ Universal Health Coverage approach ultimately aims for…?).
**: The silence of the scientific and institutional literature on WHO’s Social Determinants of Health and on the right to health is indeed very telling. Barely any space is left for a terminology reminiscent of the ‘human’ in the global reporting anymore. (G. Tognoni, A. Macchia)
5. Therefore, in the dialogue between public interest civil society organizations (PICSOs) and the WHO leadership, we need not repeat the stories already told by civil society representatives from various countries in innumerable earlier WHO sessions and World Health Assemblies. We must indeed take these repeated stories as an agreed starting point for the dialogue and now push for what cannot wait to be done next. (G2H2)
And then there is COVID
–COVID-19 has shone a spotlight on the pre-existing condition at the heart of our economies: scarcity, precarity and injustice for the many; and unimaginable plenty for the few. (Kate Donald et al, A Rights-Based Economy: Putting People and Planet First, CESR, 2020)
6. The deeper, flawed structural foundations of health governance that drive global health outcomes these days are clearly being obscured during the pandemic.*** (Susan Sell and O.D. Williams) The COVID-19 outbreak has, for instance, magnified the HR, the racial and the colonial hierarchies that lie underneath the social, economic and political determinants of health vulnerability. (Jonathan Cohen) We are simply made to falsely feel safe in the biomedical domain of a vertical economic management of health. The huge risk is wasting unprecedented amounts of taxpayers’ money to chase dead ends ultimately protecting the profits of the few. (Nicoletta Dentico)
***: One would imagine that with the new coronavirus still on the loose, research agendas that are focused on the structural challenges and interconnections of the health-(in)security and health-(in)equality linkages would have gained new meaning. But have these research agendas done so…? (N. Dentico) This is precisely the research narrative rupture and gap that our HR community must push to bridge.
7. Crises have many positive attributes. Most significantly, they make people forget the frivolous**** and bond together for greater good. But has the current crisis really done this…? (David Baldacci, The Whole Truth)
****: Quarantine: all days are the same in the lockdown: get up, take a shower, eat, walk, sit down, get the cell phone, go to the computer, to the TV, work, get back home, watch the news, how many dead?, eat supper. The day is over, go to bed, sleep, wake up, shower, have a coffee and start all over again; and life goes on. (Minutes are only important to make hard-boiled eggs). (Luis Weinstein)
A reset to more just and equitable social and economic outcomes will not happen by itself
8. Continuous mobilization and education on the right to health will have to be based on ‘a co-creation’ together with claim holders. Holistic choices are needed that demand a more direct protagonism of claim holders that can inject new energy into this conversation, and mobilization to demand needed changes. In this sense, always keep in mind that health is as good as or better than any viable pathway in the journey towards freedom, democracy and the progressive realization of HR. It is an entry point for renewed policy options that sternly address the pathological consequences/outcomes of globalization. (N. Dentico)
Claudio Schuftan, Ho Chi Minh City
Your comments are welcome at schuftan@gmail.com
All Readers are available at www.claudioschuftan.com
Postscript/Marginalia
-How good and generous politicians are! For every 10 persons their actions help cure of a disease, they (only) kill 3 with bombs and rockets… The you-know-who politicians always count with the ignorance and stupidity of a humanity that does not realize that to transport 100 sick patients you need 100 ambulances; instead, to kill 100 people it just takes one tank. (Alberto Portugueis)