[TLDR (too long didn’t read): If you are reading this, chances are you care about HR. This Reader is about the elements of the Alma Ata Declaration that have been left out. For a quick overview, just read the bolded text]. Traducir/traduire los/les Readers; usar/utiliser deepl.com.
1. WHO’s Health For All Campaign, was predicated on a New International Economic Order (NIEO) as proposed by the Group of 77 and, as such, it was deeply threatening to the geopolitical order as seen by the Group of 7 (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States; additionally, the European Union is a ‘non-enumerated member’).
Within two years, Alma Ata (19878) was reduced to four priority interventions unencumbered by larger issues of economic justice.
2. It is indeed tragic that this magnificent comprehensive primary health care (PHC) project of WHO was effectively aborted and silenced within a matter of a few years. Of course, luckily it is not forgotten by social and human rights(HR) activists working in health. But often, its truly revolutionary nature (in the best possible sense of social and economic justice internationally) is not understood even in quite radical groups.
3. The essential points about the values and principles of Alma Ata and the ‘betrayal’ of these were not alleviated by WHO’s 2008 Report on PHC that scarcely presented a sort of ‘revival of PHC’ that incredibly omitted all its central pillars. In referring to the NIEO, it is important even today to make clear that this was a project of the Non-aligned Group of 77. The Non-aligned Movement is still an extremely important and active entity.*
*: Contrast this with the following: The mass media refers constantly to what it calls the ‘international community’ that, in fact, is quite simply the USA, with the UK as its little follower and increasingly the EU as a block. The Non-aligned Movement is actually the largest group of states at the UN (and represents a far larger population). This group of states continues, even today, to make, by far, the most important contribution to the fight against neocolonialism and imperialism (that is actually the subject of the NIEO). (Alison Katz)
4. So, do not forget: Health for All (or even the very limited upcoming idea of Universal Health Coverage (UHC), is not to be financed by international aid or private insurance companies, but by a solid, redistributive tax base (nationally and internationally) and a single-payer-system (a health care system in which one entity –a single payer– collects all health care fees and pays for all health care costs), as well as, of course, by all the other measures to halt and reverse the shameless and unregulated ongoing South to North transfer of resources. (A. Katz)
The World Bank’s “nothing should be publicly financed if it can be commercially financed in a sustainable way” is a sham
-Today, the global health system is more fragmented than it was when WHO was established in 1948.
5. WHO has suffered a tremendous relative reduction of member states’ assessed contributions, and has seen a growing of influence of international health agencies, philanthropies and corporations to which WHO has been compelled to cede operational space. Such marginalization of WHO is in the interest of the dominant actors in global health and leads to the neglect of health as a key development issue. Rich donor countries and corporations indirectly dominate the decision-making through multistakeholder governance structures they are imposing in health partnerships. These, marginalize most of the WHO member states in the ultimate decision-making –notably, the ones from the Global South.
6. A consequence of this fragmentation in global health governance is that the space in the only multilateral organization where developing countries have an equal presence in terms of participation and decision-making as sovereign states –namely,WHO– has been overtaken by spurious forces. As a result, the development dimension of health is also overtaken so that development assistance only gets attention and funding for vertical programs and the agencies involved only address limited biomedical health needs without effectively addressing the basic need of strengthening health systems.
7. Therefore, for developing countries, it is imperative that WHO is effectively retooled to act as the leading and coordinating authority on global health with adequate legal powers, as well as institutional and financial capacities and to do so without undue influence from donor countries and entities that have interests in their respective private sector. Only this will enable WHO to ensure that the interests of all countries are fairly addressed in its normative and operational activities. Such a transformation of WHO will require action both within and outside the organization.** (Nirmalya Syam, South Center)
**: Consider, for example: It is important to distinguish between the social determinants (as factors that are shown to influence population health) and the social determination of health (that focuses on the forces of the dynamics that reproduce those factors). [The-causes-of-the-causes principle at stake here is that health and disease are determined, not caused, through a ‘process of becoming’; social determination thus is about an investigation of power, space, and history].
Furthermore, also when called-for, consider the need for turning from public health to collective health in order to avoid over-stating the role of the state in shaping population health and to highlight the ways in which the health of populations is shaped by the forces, engagements and dynamics of communities and civil society more broadly. (PHM)
Claudio Schuftan, Ho Chi Minh City
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Postscript/Marginalia
–While we give politicians the RTK (Right To Kill), the right to health and other rights have never been respected and fulfilled by governments. On the contrary, wars create ill-health –physical and emotional. The RTK is responsible for life-long trauma in millions of children. It is responsible for violations of almost all HR. The RTK is a vicious circle, precisely because: hunger, ill-health, unemployment… gives politicians the right to embark on wars so that injustice ultimately fuels wars. The most ironic is that the slaves of the politicians –the military– never lack housing, medical care or food. (Alberto Portugheis) Ah, and stop talking about defense enterprises when we truly refer to a bunch of merchants of war.