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Global Health Watch 4

Global Health Watch 4


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Global Health Watch, now in its fourth edition, is widely perceived as the definitive voice for an alternative discourse on health and healthcare. It covers a range of issues that currently impact on health, including the present political and economic architecture in a fast-changing and globalized world; a political assessment of the drive towards Universal Health Coverage; broader determinants of health, such as gender-based violence and access to water; stories of struggles, actions and change; and a scrutiny of a range of global institutions and processes. It integrates rigorous analysis, alternative proposals and stories of struggle and change to present a compelling case for a radical transformation of the way we approach actions and policies on health.
The Global Health Watch is a broad collaboration of public health experts, non-governmental organizations, civil society activists, community groups, health workers and academics. It was initiated by the People’s Health Movement, Global Equity Gauge Alliance and Medact as a platform of resistance to the neoliberal dominance in health.
'Global Health Watch 4 challenges us to look at health and health care from a critical perspective, providing a bridge between big, global questions and independent local issues. It not only 'watches' what is unfolding before our eyes but also offers inspiration and strategies for changing what we do not like. Essential reading for the movers and shakers in health policy the world over.' Gill Walt, professor emeritus at the London School of Hygiene and Tropical Medicine 'I highly recommend this fourth edition for anyone concerned about the future of equitable global health. It adds value to its predecessor editions through penetrating critiques of current issues such as the debate on universal health coverage. The analyses of various crises are also balanced by encouraging stories, including the 'living well' movement in Bolivia.' Vic Neufeld, Special Advisor, Canadian Coalition for Global Health Research 'We live in an era of stark contrasts in the prospects for health and development for much of the World's population. Although great advances in our knowledge of effective prevention and treatment have been achieved in recent decades, the fruits of this knowledge have been shared inequitably. Global Health Watch provides an invaluable independent analysis of these challenges and suggests constructive ways to address them. It should be required reading for students of global health and their teachers.' Professor Sir Andy Haines, London School of Hygiene and Tropical Medecine

Table of Contents

Section Title Page Action Price
Front Cover Front cover
Praise for Previous Editions i
Title iii
Copyright iv
Contents v
Boxes, Tables and Figures vii
Images x
Acknowledgements xiii
Introduction 1
The Global Political and Economic Architecture 1
Health Systems: Current Issues and Debates 2
Beyond Healthcare 4
Watching 5
Resistance, Actions and Change 6
Towards a Shared Narrative for Change 7
Section A: The Global Political and Economic Architecture 9
A1: The Health Crises of Neoliberal Globalization 11
Introduction 11
From Neoliberalism 1.0 to Neoliberalism 3.0: An Abbreviated History 12
Modelling Health Costs 24
Towards a Progressive Public Health Agenda 26
Where Should Health Activists Start? 37
Note 38
References 38
A2: Fiscal Policies in Europe in the Wake of the Economic Crisis: Implications for Health 43
Genesis of the Economic Crisis in Europe 43
Influence of Policies in Germany 44
Crisis in the US and Its Aftermath 45
Greece and Spain: Acute Manifestations of the Crisis 46
Social Consequences 48
Greece: The Face of the Health Crisis in Europe 49
Manifestations of the Crisis on Healthcare in Different Parts of Europe 52
Solidarity in the Midst of a Crisis 54
Notes 55
References 55
A3: Social Struggle, Progressive Governments, and Health in Latin America 59
Social Changes and the Health Sector 60
Advances Towards Universal Public Health Systems 62
Countries Where Neoliberal Reforms Dominate 64
Conclusions 66
References 67
A4: After the Arab Spring 68
Neoliberal Policies and the Decline of the Welfare State 68
Praise from the IMF 70
Change and Continuity 71
Rebuilding the Neoliberal Agenda 72
Conclusions 73
Note 74
References 74
Section B: Health Systems: Current Issues and Debates 75
B1: The Current Discourse On Universal Health Coverage (UHC) 77
The Ideological Foundations of UHC 79
The Ambiguities of UHC\r 82
Where is the Evidence? 83
Public Systems Efficiencies 85
UHC in Advanced Capitalist Countries 86
UHC in Low- and Middle-Income Countries 88
Conclusions 92
Notes 92
References 93
B2: The National Health Service (NHS): Prey to Neoliberal Lust for Markets 95
The NHS as It Was Conceived\r 95
Thatcher and the Attack on the NHS\r 96
The Health and Social Care Act (HSCA) and the New ‘National Healthcare Market’ \r 102
The Failure of Democracy to Save the NHS 102
The Moral of the Story of the NHS 105
The Challenge for Health Professionals 106
References 107
B3: Reform of the Mexican Healthcare System: The Untold Story\r 108
The Mexican Health System 108
Reforms to Promote a Clear Agenda 109
Health Insurance: The Fashionable ‘Success Story’ 110
An Uncertain Future 112
Notes 112
References 112
B4: Brazil: The Rocky Road to a Universal Healthcare System\r 114
The Health System in Brazil 114
Challenges and Limitations of SUS 117
Looking Ahead 118
References 118
B5: South Africa: Building or Destroying Health Systems?\r 120
Proposed Reforms 120
Obstacles Posed by Treasury Policy 122
Private Sector Challenges 122
Strategic ‘Purchasing’ of Care? 123
Notes 125
References 126
B6: The Right to Health in Tunisia\r 127
Social Security in the Pre-Independence Period 127
Provision of Free Healthcare After Independence 128
Authoritarian Rule and Crisis 129
Structural Adjustment Programmes and the Erosion of the Right to Health 130
Neoliberal Policies and Healthcare for Those Who Can Afford It 131
The Right to Health in the Aftermath of the ‘Freedom and Dignity Revolution’\r 132
Conclusion 133
Notes 133
References 133
B7: The Revival of Community Health Workers in National Health Systems\r 134
Introduction 134
Programa de Agentes Comunitários de Saúde in Brazil 137
South Africa: Still Seeking a Clear Role for CHWs 138
India’s ‘ASHA’ Programme 139
Behvarz in Iran: Linchpin of Primary Healthcare 141
Conclusion 142
Notes 144
References 144
B8: The Crisis of Maternal and Reproductive Health\r 147
Global Progress in Reducing Maternal Mortality Rates, 1990–2010 147
Why Pregnancy Kills Women in Africa 148
Interventions That Could Make a Difference 154
Conclusion 155
References 156
B9: The Global Health Workforce Crisis\r 158
The ‘Big Picture’ Challenges for Human Resources for Health\r 158
Flawed Analysis and Proposals 159
WHO’s Global Code of Practice: Fatally Deficient\r 161
Who Is a Health Worker? 161
Steps Forward in Mitigating the Crisis 162
Scaling Up Transformative Education 163
Conclusion 165
References 166
B10: The Politics and Landscape of Medical Devices in a Global Market\r 167
Medical Device Innovation, Safety and Regulation 169
Access and Organization 171
The Politics of Medical Technology and Global Health 173
Conclusion 175
References 175
Section C: Beyond Healthcare\r 177
C1: Social Protection: Reimagining Development\r 179
History of the Debate on ‘Development’ 179
Poverty Reduction and Social Development 182
Universal Social Protection 183
Conclusion 185
References 186
C2: Non-Communicable Diseases: Is Big Business Hijacking the Debate?\r 188
Evidence as a Marketing Tool 188
A Fresh Look at Mortality and ‘Burden of Disease’ Data\r 189
What Does the GBD Data Show? 192
A Critical Look at the GBD 194
Promoting NCDs as a Profit-Making Arena 195
Conclusions 196
Notes 197
References 197
C3: Nutrition and Food Sovereignty\r 198
Erosion of Food Sovereignty and Impact on Nutritional Status in India 199
Factors Responsible for the Erosion of Food Sovereignty 201
Food Support Schemes 204
Challenges to Food Sovereignty and the Risks to Human Health in the Pacific Islands 205
Effect on Farmers of Changing Patterns of Production 205
Food Prices, Food Accessibility and Food Culture 206
Erosion of Policy Space 208
Conclusion 209
Acknowledgements 209
Notes 209
References 210
C4: Breaking Free from Gender-Based Violence\r 213
Recognition of Gender-Based Violence as a Human Rights and Public Health Issue 213
Gender-Based Violence: How Prevalent Is It?\r 215
Consequences for Human Rights and Health 216
Health System Response to Gender-Based Violence 216
The Way Ahead 218
Note 218
C5: Talking Shit: Is Community Led Total Sanitation Empowering or Divisive?\r 220
Distinctive Features of CLTS 221
How Sustainable Is CLTS? 222
A Rights-Based Analysis of CLTS 224
Who Takes Responsibility? 225
Power Dynamics of CLTS 225
Conclusion 227
References 227
C6: Extractive Industries and Health\r 229
Impact of Extractive Industries on Health 230
Social Environment and Health 233
Economic Benefits: Questioning Claims 234
Canada: A ‘Safe Haven’ for Mining Companies 236
Conclusions: Mining Justice and Better Health are Possible 241
Note 242
References 242
Section D: Watching 245
D1: WHO Reform: For What Purpose? 247
Background to Reforms in WHO 248
Evaluation of the Reforms 249
Global Health Governance: A Sub-Domain of Global Economic Governance\r 250
The Features and Capabilities of the ‘WHO We Need’ 255
Scorecard for the Current Reform Programme 263
An Advocacy Programme for Civil Society: ‘Save WHO!’ 264
Notes 265
References 265
D2: A New ‘Business Model’ for NGOs? 267
Introduction 267
Conceptual and Definitional Ambiguity 269
Numbers and Scope 269
Implications for Governance and Health Systems 272
Two Vignettes of NGO-Led ‘Interventions’ 273
Risk of Co-Option 275
In Lieu of a Conclusion 276
Notes 277
References 277
D3: Private Sector Influence on Public Health Policy 279
The Gates Foundation 279
The Global Fund 281
The GAVI Alliance 282
The Role of Mckinsey and Co. in the Privatization of the NHS 284
The Tax Avoidance Industry 285
Conclusion 285
Notes 286
References 286
D4 : The TRIPS Agreement: Two Decades of Failed Promises 288
TRIPS Flexibilities: Do They Work? 288
Free Trade Agreements: Going Beyond TRIPS 292
Using the Bogey of ‘Counterfeit’ to Criminalize Generic Drugs 295
Voluntary Licences and Differential Pricing 296
International Investment Agreements 296
The Way Forward 297
Notes 298
References 298
D5: Cholera Epidemic in Haiti\r 300
Haiti: A History of Occupation 300
Structural Adjustment Programmes and UN Presence 301
The Earthquake and Its Aftermath 303
Two Tales and an Epidemic 305
The Response from the International Community 305
Conclusion 306
References 307
D6: The International Finance Corporation’s ‘Health in Africa’ Initiative\r 309
IFC’s Track Record in Health 310
Poor Progress on Health in Africa Investments 311
High-Cost, Low-Impact Investments 313
Turning a Blind Eye to Measuring Impact 313
Unaccountable and Opaque: Use of Financial Intermediaries 315
The World Bank’s Response to Health in Africa’s Mid-Term Evaluation 315
Conclusion 316
Notes 316
References 316
D7: The Ethical Cost of Offshoring Clinical Trials 319
Offshoring: At What Price? 319
Lack of Transparency and Accountability 322
Case Studies: Deficient Regulatory Environments 323
Conclusion 328
Notes 328
References 328
Section E: Resistance, Actions and Change\r 331
E1: Reframing Health in Bolivia Around the Concept of ‘Living Well’ 333
Background 333
Living Well 335
Structural Changes in the Health Sector: ‘Mobilized for the Right to Health and Life’ for Living Well 338
Conclusion 339
Notes 340
References 340
E2: Social Change in El Salvador and the Health Sector 341
Historical Backdrop\r 341
The Struggle Against Military Dictatorship\r 341
The Health System in El Salvador\r 342
The New Government and Health Reform 343
The Reform Process 345
Evidence of Success 346
Obstacles and Constraints 347
Notes 347
References 348
E3: Venezuela: The Impact on Health of Social Change 349
New Vision of Health in the 1999 Constitution 349
Transforming Health: Mission Barrio Adentro 349
Developing a Health Workforce and Social Participation 352
The Results are Evident 352
The Struggle Ahead 354
References 354
E4: Colombia: Social Struggles against the Commodification of Health 356
Law 100 and Its Impact on the Right to Health 356
Collective Social Action for the Right to Health 358
Looking Forward 360
Note 360
References 360
E5: Peru: Social Movement against Neoliberal Reforms 361
Introduction 361
Key Numbers and the Failure of Universal Health Insurance 361
Resistance against the Reforms 362
Forging an Inclusive Social Movement 364
Notes 366
References 366
E6: Struggles for Health in Europe\r 368
National Mobilisations in Different Countries 368
Transnational Solidarity and Mobilization 377
The Movement against ‘Unnecessary Imposed Mega Projects’ 377
Struggles against Extractive Industries 378
The Struggle against the Transatlantic Trade and Investment Partnership (TTIP) 378
Note 380
References 380
E7: The Struggle against a Destructive Mining Project in Greece 382
Background 382
Impacts 382
Genesis of a Popular Struggle 383
Notes 387
References 387
E8: The Right to Food Campaign in India\r 388
Judicial Pressure and Popular Mobilization 388
National Legislation on Food Security 390
A Minimalist Approach to Food Security 391
Building Solidarity across Different Movements 392
Notes 394
References 394
E9: Aboriginal Community-Controlled Health Services in Australia\r 395
Development of Aboriginal Community-Controlled Health Services (ACCHS) 395
Flag-Bearer of Comprehensive Primary Health Care\r 396
The Struggle to Be Part of the ‘Mainstream’ Health System 397
Welfare Colonialism 398
Improvements in Health Outcomes 399
New Challenges 401
References 401
Contributors 403
Index 405
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