[TLDR (too long didn’t read): If you are reading this, chances are it behooves you. This Reader is about the crises global health and ‘One Health’ are experiencing. For a quick overview, just read the bolded text]. Traducir/traduire los/les Readers; usar/utiliser deepl.com
The crisis is exacerbated by increasing privatisation, a massive decline in public funding for development aid, and the growing influence of powerful private actors (Global Policy Forum Europe, Bread for the World and Misereor)
–It has to be noted that private and for-profit health care importantly produces profits from sickness. (Francine Mestrum)
–Developed countries now spend more money on health care than the poorest half of the world spends on major budgetary items. (William Chandler)
1. The withdrawal of the responsibility of so many states on financing their health systems has increased their dependence on corporations and foundations to fill the gap thereby weakening their democratic control and weakening their resolve to consider and to treat health as a common good. Instead of long-term strengthening of their public health systems low- and middle-income countries have importantly been using technocratic and market-oriented approaches. These approaches are often narrowly focused on diseases and ignore the structural causes of the same as inserted in situations of glaring inequality (as somebody said, this is like skating on the icy surface of the causes thus distracting us from the big picture).
2. Countering this trend, pursuing a more just and fair global health order, among other, requires the political determination of governments (i.e., WHO member states) to strengthen WHO as a central multilateral institution with the responsibility to secure transparency and accountability, as well as to, again, more forcefully fence-off the privileges and influence of private actors in the health domain.
3. Only through public funding, human rights-based policies, democratic oversight and genuine participation of claim holders and their civil society organizations can the right to health be realized. Global health must, therefore, once again be understood as a public good –not as a market, and for that it simply must:
- Ensure equitable global access to medicines and research findings. This, since the compatibility between access to medicines and intellectual property is caught between human rights (HR) and economic interests. (The existing pharmaceutical system hinders equitable access to essential medicines, including vaccines and technologies such as diagnostics, particularly in the countries rendered poor and during global health crises such as pandemics).
- Limit the power and influence of private actors in global health policy. Private actors, companies and their interest groups are increasingly shaping global health policy; their influence jeopardizes democratic decision-making processes and weakens WHO. (Take multi-stakeholder initiatives and PPPs: they exacerbate imbalances, fragment and unilaterally bias international health governance).
- Curb the dominance of philanthropic foundations. (The growing dominance of philanthropic foundations in global health policy jeopardizes the independence of WHO and distorts priorities in the global health agenda).
- Safeguard public healthcare, stop its financialization and privatization. (The increasing financialization and privatization of the healthcare sector are restricting universal access to high-quality healthcare services, particularly for the poorest sections of the population, this clearly violating the right to health).
- Engage in a paradigm shift away from the biomedical model towards a holistic, equitable and HR-based health model. (The increasing focus on health security, the medicalization and verticalization of global health policy jeopardizes the right to health, because it tackles symptoms rather than causes).
- Prioritize the strengthening of public interest civil society and local communities. (Without the active involvement of public interest civil society organizations and social movements, particularly from the countries rendered poor, the existing power imbalances in the health sector between private and public actors cannot, as is indispensable, be tackled).*
*: Professor Dzulkifli Abdul Razak from Malaysia proposes an alternative stepwise approach anchored on three key transformations:
- From silos to systems
- From knowledge to lived experience
- From technology-driven to human-centered care.
This, for him, means embedding empathy, compassion, and ethical responsibility (plus the social determination of health and nutrition, I would add) into healthcare systems since values (and the political economy of health) are so often overlooked yet essential for long-term sustainability.
And then there is One Health…
One Health? Maybe. There is a main ambivalence here
4. The One Health approach now en-vogue is interpreted as a means, as a way of managing actions using intersectoral and interdisciplinary lenses, but it projects no strategic outlook or political compass. With this outlook missing, One Health is being utilized as a frame in ongoing health security initiatives like the Pandemic Accord (https://www.who.int/news-room/questions-and-answers/item/pandemic-prevention–preparedness-and-response-accord): and this is a problem.
5. The One Health approach gets hooked on risk adaptation and mitigation when it comes to dealing with existing and future pathogens that emerge in the interactions between humans, animals and the environment. But the One Health cooperation being called-for too often takes a narrow approach to improve global health security, as it was originally meant 25 years ago.
6. Dominated by a heavily Eurocentric biomedical scientific discourse, One Health, only to a limited extent, includes environmental and earth-system disciplines with the exclusion of social and political science expertise. It is mostly countries rendered rich that set the agendas and directions —often expressed via public-private partnerships. This leads to rather targeted, specific interventions. The benefits and profits emanating from these interventions risk being influenced by private commercial interests that do not care about the deepening inequality this causes.
7. Human rights-based approaches, health equity and the social determinants of health are seldom prominently invoked as arguments in One Health actions and cooperation agreements. Particularly missed is a mention of deeper structural determinants. This leads to a need to interrogate and counter the neglected ‘deep core’ neoliberal policy templates that drive contemporary One Health policies …if behind the scene.
The overall One Health approach remains anthropocentric and utilitarian
8. It primarily aims to mitigate and adapt to the health risks for humans coming from the animal and the natural environments, but much less addressing the myriad underlying societal issues. One Health policies still put humankind as a separate entity from the rest of the living world, rather than integrating it as a vital part of the metabolism of the ecosystem Earth.
9. Moreover, One Health continues to neglect putting into question the (capitalist) structures that sustain the artificial rift between humans and the rest of the living and natural world. One Health policies largely ignore the need for addressing the enormous global inequities and inequalities, the deprivation of so many and the requirement to at least regulate and even de-grow the uncontrolled industrial food and bio-industry, including its land investments and the speculative oligopolies behind this industry.
10. The key questions here are: What kind of security risks are actually addressed by One Health security measures? And risks for whom? It is said that “the One Health approach challenges the prevailing corporate systems that drives inequitable, unsustainable and unhealthy production and consumption trends”. But how does that fit with a WHO that envisions health as a fundamental HR. This is a far cry from the biosecurity and economic approach that (quite aggressively) drives the One Health approach in the contemporary diplomatic agenda. (Remco Van de Pas et al)
Claudio Schuftan, Ho Chi Minh City
Your comments are welcome at schuftan@gmail.com
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