[TLDR (too long didn’t read): If you are reading this, chances are it behooves you. This HR Reader addresses important health sector changes underway with only some being in the direction of the right to health; it questions an epidemiology that is obsolete and biased. For a quick overview, just read the bolded text]. Traducir/traduire los/les Readers; usar/utiliser deepl.com
Death is a social disease
1. Kids are the best barometer to gage the economic and social conditions anywhere.* They are the first to die, the first to be neglected, the first to recover if things improve. (A. Kielmann) Jim Grant (of UNICEF history) famously said that our task is to do the most we can to ensure that death does not follow birth too closely and that life lived long is lived well.
* So is the number of water taps/1000 population. It is a better indicator of a country’s health status than the number of hospital beds. (Halfdan Mahler of WHO history) This is as valid today as it was then.
2. But it is not only death. The health-disease relationship must also be understood in a social and political context, i.e., diseases are socially determined. Ultimately, it is the political structure what allows us to understand the logic of how disease occurs; social class is thus a very important determinant of health.
3. Therefore, continuing to merely cataloguing individual risk factors from an amorphous web of causation is no longer adequate or sufficient. If our goal is to alter the web rather than merely break its strands, it is time to look for the spider. (Nancy Krieger)].
Communities can hardly give priority to health if other survival needs are not covered (David Werner)
4. Need proof? Those rendered poor often already posess the basic knowledge being spread by many a health program, but living in absolute poverty makes it impossible for the neediest to implement many of the recommendations they are given. Once incomes are increased, it makes sense to them too to follow basic health messages.
I am afraid WHO softens the ugliness of globalization; it will remain irrelevant if it continues to talk of health interventions alone (Prem John)
5. The current WHO model to make universal health care (UHC) a reality is increasingly governed by elite technocracies –global consultancy firms, philanthropic funders and remote policy platforms– rather than by the people most affected. Ergo, health has been converted into a state of aggregated illnesses. The sidelining of civil society and community health workers in health policy decision-making mirrors an erosion of democratic governance in global health. It is also fundamentally at odds with WHO’s own resolution on UHC and participation.
6. The ‘selective’ logic of UHC leads to care gaps and care foregone, especially for rural, racialized and marginalized populations. Current UHC indicators fail to capture unmet needs, quality of care, or the lived realities of inequality. By focusing on narrow service indicators, these metrics obscure the very inequalities they are meant to expose.
7. The failures of UHC are not accidental. They reflect decades of neoliberal policy choices, embedded in colonial structures and driven by private interests. But the tide can turn. To truly achieve health-for-all, claim holders must confront the corporate capture of healthcare systems and resist the expansion of financially driven models of care.** The next phase of global health must be built not on multistakeholderism, but on people’s rights and public leadership. Where multistakeholderism divides and derails health goals, it must be exposed –not celebrated. Let this be the moment where health care must be reclaimed from the logic of the market and returned to the public. (David Franco, Indrachapa Ruberu)
**: In that context, the struggle for social and collective health actually means for claim holders to struggle for universal access to public health systems based on an integral and comprehensive primary health care. (PHM)
Going back to Orbinski above, it has become a cliché to speak of health crises as also being opportunities
8. Global health is truly at a crossroads (crisis), but one that provides an opportunity to construct a new vision that seeks, not just to reduce disease and illness, but also to dismantle ecologically destructive and unjust political and economic systems, as well as reasserting universal rights and freedoms. But for this to happen we must work with claim holders*** to organize and to commit to principles of a fair global health governance and thus be willing to combine our professional duties with our civic and political responsibilities to uphold democratic and public-interest institutions –and to strengthen the voice and efforts of communities and public interest civil society organizations on the ground. (David McCoy)
***: Note that health care workers are both claim holders and protectors of the
rights of health seekers. These workers protect, not only their patients’ rights to health, but also other rights. What this tells us is that the practice of medicine is a tool for the promotion of human rights. Health care workers are actually key to a human rights-based healthcare system that ensures universal access to health facilities, goods and services without discrimination. (Tlaleng Mofokeng)
Bottom line
Social determination or colonial racial determination of health and of life in the Global South? Or both?
9. Much of this argument revolves around an epidemiology that is still captive to the racialization and dehumanization that comes from colonial thinking. Western biomedical science is a constituent part of the oppressive system of colonialism with its classist, sexist, and racist features that are reproduced daily in the capitalist system. (Frantz Fanon)
10. More dehumanization, more social exclusion in health, and more accelerated ecological destruction are characteristics of extractive Capitalism. Faced with a global system that reproduces power politics, we must understand that there is an international determination of health. We believe we know the determinants (mostly biological) of health and, therefore, we look at epidemiology, yes, from the South, but using lenses from the North.
11. Working with claim holders, and to act strategically, we need to begin using a new language that breaks with the old ethics and political action in health. To do this, we must reinvent public health education, leaving aside the models inherited from the North. We must promote truly sovereign centers of health at multiple local levels. Claim holders must set aside vertical obedience in health systems, inviting all of community to take center stage and thus recover the voices of the people. In addition, they must criticize oppressive government health policies and the many micro-reforms that change nothing. They must promote the vision of buen vivir and other time-proven knowledge emanating from the South.
12. In short, we seek to revive a vision of health with a historical, relational, territorialized, and collective approach, as well as to criticize the current fragmentation of many of the social determinants in order to integrate class, race, gender and our relationship with nature into our epidemiology. (Gonzalo Basile)
Claudio Schuftan, Ho Chi Minh City
Your comments are welcome at schuftan@gmail.com