Abstract
Timing is everything in comedy and in scholarship. One cannot imagine a better timing for this book’s publication.
Conceived in 2003 as a collaborative effort by activists and academics from across the world, the Global Health Watch questions present policies on health care and propose alternatives. The first and second editions of the Global Health Watch, published in 2005 and 2008, were hailed for their groundbreaking analysis and mobilising call to action. Global Health Watch 3 (GHW3) has been coordinated by the five civil society organisations. With an incisive and even militant tone, the book proceeds at a brisk pace with many original insights.
GHW3 provides an overview of the multiple crises facing the globe—the financial, food and fuel crisis (the ‘three Fs’)—as well as two ‘slow burn’ crises— the climate crisis and the crisis of development. It argues that these are not transient crises, but point to a deep ‘systems failure’ that plagues capitalism as informed by neoliberal theory and practice. The report traces the links between the global food crisis and the process of replacement of food crops with biofuels, and the huge increase in speculative trading of food grain commodities. The report advocates the urgent need to redesign the global economic and political architecture as a necessary condition to address widespread health care inequity and the rapid deterioration of conditions of living that adversely impact health and the access to health care.
The report characterises many of the features of the present articulation of primary health care as clearly departing from the more radical vision of the 1978 Alma Ata Declaration. It makes a strong case for the promotion of public financing of health care predicated on a tax-based financing system. Evidence from three of the largest countries in the world—China, India and the US—suggests the link between the application of neoliberal economic theory and the collapse of health care systems. Positive experiences from Costa Rica, Thailand and Sri Lanka, on the other hand, highlight the possibility of building health care systems that advance equity in health care much better through intervention by governments in both the financing and the running of health care systems.
GHW3 uses the lens of equity and of human rights to examine several issues that impact on health care. It emphasises the importance of a much larger scrutiny of the upstream causes of poor health care and inequity—within countries, as well as across countries. The report argues for an approach that locates the problems associated with high maternal mortality and morbidity in a framework that is sensitive to women’s concerns and vulnerabilities. It discusses how technologies targeting women lend themselves to commercial appropriation and the victimisation of women, especially women in poor and socially disadvantaged communities. GHW3 appropriately draws attention to mental health problems that are often rooted in structural problems of inequity, rising consumerism and the marginalisation of communities. GHW3 also calls attention to the deep and persisting inequality in access to the available tools that can control the spread of diseases. These are further perpetuated by the existing global trade regime, the way the pharmaceutical industry operates and the manner in which research is heavily skewed in favour of biomedical interventions.
GHW3 reminds us about the enormous challenges faced by health care workers in conflict situations while attempting to collect and disseminate information on access to health care and health care inequalities. It traces the deep links between the biotech industry and speculative finance, both premised on a ‘future’ that is illusory and often false. The report advocates for an approach on the climate crisis, based on ‘carbon budgeting’ that could balance the requirements for decreasing greenhouse gas emissions, on one hand, and servicing the development needs of developing countries, on the other. At the same time the report raises concerns about the renewed focus on ‘population control’ in many developed countries, a focus that seeks to fundamentally link the climate crisis with population increases in developing countries.
GHW3’s scrutiny of global institutions (actually its ‘watching’ chapters) identifies the fundamental problems in the existing global health care governance. There are serious concerns, today, that the influence of large corporations and of a few developed countries is leading to a shift in WHO’s constitutional mandate. Similar concerns exist as regards UNICEF’s role in promoting narrow biomedical approaches to the problem of malnutrition and its association with platforms of agribusiness corporations and private corporations. While UN bodies face a crisis of legitimacy, alternate centres of power influence global policies—prominent among these being private philanthropies. GHW3 examines the functioning and priorities of one of them, the Bill and Melinda Gates Foundation, and furthermore looks at the alignment of corporate interests and philanthropic investments.
Why should you want to read GHW3? Because on the action side, the GHW3 proposes a framework for civil society movements to intervene and challenge the existing order, and provides examples of how this is already happening in many parts of the world (a timely section given the recent Wall Street-type mobilisations around the world).
GHW3 does not claim to have made all the connections necessary to change global health care. But it does aspire to be a prime agent of change, a change that it clearly considers both possible and urgent.
In this book you will find much useful intellectual ammunition. With its measured optimism, this book is a timely wake-up call and is thus welcome.