The future is now
22. Scenario One: Doctors love high tech gadgets and treatments; nothing wrong about this love affair. But high tech treatments drain resources away from the kinds of public health and medical measures that can improve the health of a much larger number of people. Therefore, high tech treatments act as a distraction from more immediate, lower-cost alternatives that more directly address the right to health of every individual.
23. Yes, a poor person may have a chronic genetic disorder, but being poor was probably the first disorder that he or she had to deal with. In addition, in the high tech conundrum, particularly women may find themselves at the crossroads of science, society, industry and policy, with their lives being affected, their bodies being claimed by several sectors, and their voices being heard by none.
24. Despite the fact that hard commercial realities do not sit comfortably with researchers’ belief that their work will have genuine medical benefits and reduce human suffering, the symbiotic relationship between speculative capital, industry, university and governments has blurred the distinction between ‘public’ and ‘private’. Companies generously fund university departments and chairs, sponsor professional and patient organizations and support extensive continuing medical education. They approach supposedly independent academics, clinicians, and others who are paid handsomely to give product presentations and, otherwise, to make representations on behalf of the companies. Suffice it to say, medical publications that come out of these partnerships are, in fact, ‘information laundering operations’.
25. Technology without democratic social control, and in the hands of global capital, is a very uncertain bet. The uncertainties regarding the directions and implications of technological development underline the importance of health and human rights (HR) activists maintaining a close watchdog engagement in this field.
26. Scenario two: Transnational corporations, under the guise of corporate social responsibility very hardly try to harness the power of the market in order to achieve what they consider desirable social outcomes. In reality, they are trying to make corporate philanthropy pay off, i.e., be cost effective to them. Philanthro-capitalism presents itself as operating outside of formal political channels, while actually wielding considerable influence over these channels. Companies purchase not only political support and favors, but also the services of ‘key opinion leaders’.
What are the main strategies which health and human rights activists can deploy to drive social change?
27. There is no simple way of representing the structures of global governance that we need to triumph over. For instance, global health governance encompasses the social determinants of health and health system development. It is necessary to look at governance from a range of different, but overlapping perspectives (nation-states, intergovernmental institutions, the corporate sector, the marketplace, civil society and social movements) and do this based on knowledge, good information and the appropriate ideology.
28. To complicate things further, 21st century global public-private partnerships (GPPPs) have taken up the role of shoring up the legitimacy of the regime of global governance which, as we know, reproduces inequality, exclusion and marginalization –all HR issues. GPPPs picture the widening inequality we live under as ‘unfortunate-but-necessary’. The question is: Necessary for what?
29. So, do we have a social movement shaping our collective destiny? I think you would agree that this is not the case. A social movement is a collectivity that shares a common set of concerns, understandings and claims and a sense of shared identity (Pakulski 1991). It is bigger than, but includes formal organizations.
30. The emergence of a global middle class with a shared interest in consumer goods and the good life, as well as with limited loyalties to poorer people in their own and other countries has detracted from social movement building. Sad.
31. The challenge for social movements active in the health and HR front is to find a balance between continuing to struggle for local and national change while also building links with global movements that confront the overall flawed dynamics of Globalization. Health and HR activism thus needs to be informed by an understanding of the structures, forces and dynamics that shore up the prevailing system and its regimes still so firmly in command.
32. The rise of neoliberalism and the related ideologies of individualism and consumerism have been powerful negative influences on HR and on health over the last half-century. Neoliberalism has ‘normalized’ inequity and inequalities and, with its faith in markets and its distrust of government, has discounted a collective, participative control of our future. In that sense, the People’s Health Movement (PHM) has little doubts that the negativity of neoliberalism has contributed to the rise of various religious fundamentalisms. Unfortunately, the promise of personal salvation through apocalyptic religious fundamentalism is critically weakening our movement towards a more deliberate control over our collective destiny.
33. A more optimistic scenario provides us with a clearer vision of the kinds of directions that progressive social movements need to work towards. Activists, including HR activists, will have to mediate the process of change. The changes needed go beyond behavioral change, which ‘objectifies’ the people whose behavior will be changed (while rendering invisible the agents who will ‘intervene’ to achieve this). The change needed is collective, as well as individual and is political, as well as personal. It involves actively reworking our values and culture, as well as combating mis-information and myths.* Only practicing differently can we change the world.
*: An example of a myth here is: Violent conflict in Africa is much more connected to resource abundance (rich oil and mineral reserves, valuable timber, diamonds, etc.) than to resource scarcity.
34. So, one of the take-home messages here is that, despite the global pressures to further fragment health systems that are widening inequalities day-in-day-out, it is possible to confront these pressures directly at the sub-national, national and global levels. It is our strategic opponents, the merchants of neoliberal ideology, who maintain the expectations and the narratives that keep the unsustainable and inequitable governance regime afloat. …and they are by no means permanently entrenched. These merchants, as PHM probably does not need to remind you, include, among many others, the owners of the media, the bankers and insurance executives, the executives of transnational corporations, the elite universities and the private ‘axe-to-grind’ think tanks and philanthropies.
35. Their delegitimation is a first-stage central strategy for social movements (leadered by health and HR activists in our case) –being wary though of the speed with which the ‘regime governors’ can respond and react in terms of shoring up their challenged legitimacy. Never forget that the delegitimation of the structural adjustment plans (SAPs) left the World Bank little chance but to scrap SAPs and replace them by poverty reduction strategy papers (PRSPs) that gave the appearance that countries were designing their own SAPs. This gained the Bank some time …until the PRSPs were rightfully deligitimized by activists.
36. Delegitimation is a powerful strategy for health and HR activists, but must be accompanied by positive, prospective policies and actions towards institutional reforms which will lock-in any gains that can be achieved from such delegitimation. Otherwise, the ‘dance of delegitimation’ will proceed one step forward but (almost) two steps backwards.**
**: Remember the social unrest in Cancun and Vancouver during crucial WTO meetings. Did it lead to a sustained movement? Not really. Street protests can only be a start.
37. Agreed, anger at injustice is a negative although powerful motivator. PHM thinks we also need to project alternative and inspiring visions, partly to assist people to move from passivity into movement activism.
Strategies and models are indeed inspiring when their underlying logic makes sense, when they offer practical entry points and when they are seen as powerful in effecting change.
38. In this optic, the human rights framework is inspiring. The inspiration that many people derive from the affirmation that their burdens constitute a denial of recognized rights provides the drive to put in place these necessary institutional mechanisms.
39. Hope and determination are necessary, but not sufficient. We also need strategy, solidarity, mobilization and activism. Strategy requires an understanding of the dynamics of historical change and the ways in which intentional action does foster change. Mobilization requires that we have a clear analysis of why the world is the way it is plus a plausible vision of how it can be changed. Activism requires hard work (does PHM not know this…!).
40. The struggle against environmental destruction and against the abuse of workers rights is just another illustration of the breadth of the struggle for health and for HR that PHM has embarked in. This struggle is not solely the province of people who identify themselves as ‘health activists’. There are many such parallel movements which are considered as part of a global People’s Health Movement.
41. So in summary:
What is our nemesis?: The resilience of transnational capitalism that resists the call for a new international economic order.
What is our roadmap to be?: Policy critique and placing and following up on active demands are central strategies of the social movements for change.
Claudio Schuftan, Ho Ch Minh City
cschuftan@phmovement.org