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The Health of Nations

The Health of Nations

Gavin Mooney


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Why, despite vast resources being expended on health and health care, is there still so much ill health and premature death? Why do massive inequalities in health, both within and between countries, remain? In this devastating critique, internationally renowned health economist Gavin Mooney places the responsibility for these problems firmly at the door of neoliberalism. Mooney analyses how power is exercised both in health-care systems and in society more generally. In doing so, it reveals how too many vested interests hinder efficient and equitable policies to promote healthy populations, while too little is done to address the social determinants of health. Instead, Mooney argues, health services and health policy more generally should be returned to the communities they serve. Taking in a broad range of international case studies - from the UK to the US, South Africa to Cuba - this provocative book places issues of power and politics in health care systems centre stage, making a compelling case for the need to re-evaluate how we approach health care globally.
'The reader will be absorbed from the first to the last page. ... This book is not only immediately relevant, it will become a classic' Vicente Navarro, in the Preface 'Inequality, whether of wealth or power, undermines our best efforts to provide effective support to communities in their quest for better health. Mooney challenges neoliberal assumptions and through elegant case studies demonstrates how we can improve what we do through real community involvement in making decisions about health according to the values that matter.' Stephen Leeder, Director, The Menzies Centre for Health Policy, Director, Research Network, Western Sydney LHD, The University of Sydney 'In this most original and highly readable book, Gavin Mooney makes a compelling case that we can do far more to improve people's health in both developed and developing countries. Rather than just posing the problem, he comes up with thought-provoking solutions, showing, for example, that local citizenry are fully capable of coming up with sophisticated organizational and distributional policy aimed at improving the health of the community. This book aims high and achieves.' Thomas Rice, UCLA School of Public Health 'A biting and insightful book on what is wrong with the political economy of the world today that so much goes wrong with our health systems. Sharply written and informative in the best Zed tradition!' Gita Sen, Centre for Public Policy, Indian Institute of Management 'This is Mooney at his "no-holds-barred" best, laying bare the power relationships affecting health. Unless health economists start paying attention to the political economy of health, progress in solving the health challenges facing us will be painfully slow. This book is setting us on that path.' Di McIntyre, Health Economics Unit, University of Cape Town 'Many social scientists and activists have long felt extremely frustrated by a paradigm which links health care closely to the market - a market that is supposed to be free of corporate power. Mooney's book shows what can be achieved even under the power of big corporations that dominate the pharmaceutical industry worldwide, as well as under the neoliberal ideology adopted by many governments, some of which profess to be leftist. While exposing the misdeeds of big corporations and their clientelistic governments, Mooney's book indicates how much can be achieved by, first, promoting communitarianism in a principled and rational way and, second, listening to the concerns of the people being served by health care, not just hospital managers or those in the medical profession.' Amiya Bagchi, Institute of Development Studies Kolkata 'Gavin Mooney is that rare breed, a health economist "as if people mattered". Reading this book, it is abundantly clear how much he cares about suffering, poverty and inequality: most health economists analyse and pronounce on these issues, but leave the expression of values to other professions. Mooney's clear and accessible documentation of the economics and power dynamics of social and environmental injustice in health is a must-read for anyone studying, searching or struggling for a healthier world.' Alex Scott-Samuel, Director, International Health Impact Assessment Consortium, University of Liverpool
Gavin Mooney worked as a health economist for 40 years and held academic positions in Scotland, Scandinavia, South Africa and Australia. In 2009 he was given an honorary doctorate by the University of Cape Town as 'one of the founding fathers of health economics'. He died in 2012.

Table of Contents

Section Title Page Action Price
About the author i
More praise for The Health of Nations ii
Acknowledgements vii
Preface ix
PART I / Introduction 1
Introduction: neoliberalism kills 3
Map of the book 9
PART II / Why are things so bad? 13
1 Why has the economics of health-care policy gone wrong? 15
In health care, who decides – about what? 15
Current political economy of health care 17
More observations on current health-care economics 21
Conclusion 23
2 Why have broader policies affecting health been inadequate? 25
Shifting power 25
The WHO’s Commission on Social Determinants of Health 26
The state and the market 28
Conclusion 33
3 The malaise of neoliberalism in health, health care and health economics 34
Neoliberalism 34
Neoliberalism and health care 40
4 Neoliberalism, the global institutions and health 44
Introduction 44
The World Health Organization 44
The World Trade Organization 45
The World Bank 49
The IMF 52
Conclusion 55
PART III / Case studies 57
5 The US: the fear of ‘socialised’ health care 59
Public intellectuals discuss the reforms 59
The reforms 61
Ethics and values 63
Conclusion 66
6 The UK National Health Service and the market 67
The formation of the NHS 67
Market reform 68
Experience elsewhere 71
The public sector ethos 72
A final word 73
7 South Africa, neoliberalism and HIV/AIDS 75
HIV/AIDS and the pharmaceutical industry 75
South African health care 78
South African health 81
Some parallels with the UK 83
Conclusion 84
8 Australia and victim blaming 86
The Preventative Health Taskforce 86
The corporatisation of government? 88
So what might be done? 91
Conclusion 93
9 Local community versus corporation 94
Health policy and the corporatisation of government 94
Yarloop, Alcoa and the corporatisation of the West Australian government 95
University capture 98
Conclusion 101
10 The pharmaceutical industry 103
What to do? 104
Reacting to Big Pharma 105
Conclusion 109
11 Neoliberalism and global warming 111
Map: Estimated deaths attributed to climate change in the year 2000, by subregion 112
Global warming, health and political economy 113
How did it happen? 114
South Africa, the World Bank and coal 117
So what is the answer? 119
PART IV / Solutions 121
12 The solutions in theory: communitarian claims 123
Communitarianism 123
Levels of preferences 127
Communitarian claims 128
Claims in practice 130
Conclusion 131
13 The solutions in health care 132
How to build on communitarian claims in health care 132
A political economy of health care 132
A constitution for health care 134
Citizens’ juries 139
Conclusion 141
14 The solutions in society more generally 143
The end of neoliberalism? 143
Some principles 143
Power and values 146
Social institutions and compassion 148
PART V / How things might get better 153
15 Kerala: community participation 155
Kerala’s health 155
Why so good? 156
Some vignettes in Kerala 158
Coca-Cola and Kerala 161
Conclusion 163
16 Cuban health care and social determinants of health: just too good for the US? 164
Cuban health and health care 164
Cuban health and the US 168
Conclusion 171
17 Venezuela: power to the community 173
The revolution in Venezuelan health care 174
Does it work? 176
Transferable elsewhere? 177
Conclusion 179
PART VI / Conclusion 181
Conclusion: can we change? 183
Why do we fail? 183
Can we change? 186
References 191
Index 205