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Global Health Watch 5

Global Health Watch 5

(2017)

Abstract

For over a decade, Global Health Watch has been the definitive source for alternative analysis on health.

This new edition addresses the key challenges facing governments and health practitioners today, within the context of rapid shifts in global governance mechanisms and the UN’s Sustainable Development Goals. Like its predecessors, it challenges conventional wisdom while pioneering innovative new approaches to the field.

Collaboratively written by academics and activists drawn from a variety of movements, research institutions and civil society groups, it covers some of the most pressing issues in world health, from the resurgence of epidemic diseases such as Ebola to the crisis in the WHO, climate change and the ‘war on drugs’. Combining rigorous analysis with practical policy suggestions, Global Health Watch 5 offers an accessible and compelling case for a radical new approach to health and healthcare across the world.


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 neoliberal dominance in health.

‘Offers a courageous and serious assessment, making it compulsory health policy reading.’
Michael Moore, President, World Federation of Public Health Associations

‘Addresses the increasingly complex problems affecting the health of populations. It draws attention to the destructive impact of corporate power and to the abuse of technological and scientific developments.’
Nila Heredia Miranda, former Minister of Health for Bolivia, and Executive Director of the Andean Health Organisation

‘This encyclopaedic work offers a thorough discussion of the state of human health worldwide, a deep analysis of the social causes of persistent health deficits, and constructive ideas for reform. An indispensable second opinion to government propaganda.’
Thomas Pogge, Yale University

‘A consistent source of critical information and analysis of health around the world. Terrific for researchers, teachers, students and health activists. The current edition will help the fight for better social, economic and environmental conditions.’
Paulo Buss, Director, FIOCRUZ Center for Global Health

‘Brings together vision, critique, solidarity, and the promise of a collective path towards health equity for the world’s peoples. GHW5 makes vivid the connections between social justice and public health.’
Nancy Krieger, Harvard T.H. Chan School of Public Health

Global Health Watch again meets our expectations for a critical analysis of the two great challenges of our time: the ecological crisis, and continuing economic disparities. It holds us accountable, and moves us toward an alternate vision.’
Vic Neufeld, Special Advisor, Canadian Coalition for Global Health Research

'A highly informative book – an extremely useful contribution offering an indeed alternative understanding of current global responses to probably the world’s greatest challenge.'
Medicine, Conflict and Survival

'An invaluable alternative health report to the mainstream consensus that privatized health insurance (known as Universal Health Coverage) is the answer to the world’s health problems.'
Social Medicine Portal

Praise for the Global Health Watch series:

‘Provides us with compelling evidence about all that is wrong with the governance of health care systems across the world. At the same time it also provides us with hope, in the many stories about what can be done and what is being done.’
Halfdan Mahler, former director general of the World Health Organization

‘An incisive socio-political critique of contemporary global health issues’
K. Srinath Reddy, president, Public Health Foundation of India

‘Reading Global Health Watch is a necessary step in understanding how challenging and urgent change is, but that it is increasingly necessary for the survival of our planet Earth.’
Eduardo Espinoza, vice-minister for health of El Salvador

Global Health Watch confirms the failure of the UN, capitalism and liberal democracy. It also convinces us that we shall need a radically new manner of thinking if mankind is to survive.’
Suwit Wibulpolprasert, former senior adviser on disease control, Ministry of Public Health, Thailand

'Challenges us to look at health and health care from a critical perspective. Essential reading for the movers and shakers in health policy the world over.'
Gill Walt, London School of Hygiene and Tropical Medicine


Table of Contents

Section Title Page Action Price
Cover Cover
Title Page iii
Copyright iv
Contents v
List of Abbreviations vii
List of Tables and Figures xi
Acknowledgements xiii
Introduction 1
Section A: The Global Political and Economic Architecture 11
A1: Sustainable Development Goals in the Age of Neoliberalism 13
Introduction 13
The SDGs: Plus ça Change, Plus C’est La Même Chose? 15
The Myth of Poverty Reduction 17
The Contradictory Hearts of the SDGs 19
The Indivisibility of the SDGs 25
The Long List of SDG Priorities 26
The (Very) Short List of Priority SDGs 32
Governance for the SDGs 33
A2: ‘Leave No One Behind’ – Are SDGs the Way Forward? 39
Fundamental Flaws and Contradictions in the Pledge That No One Will Be Left Behind 40
What Is Sustainable? The Elephant in the Room 44
The Search for a Comprehensive Approach 45
The Future Starts Today 47
A3: Advances and Setbacks Towards a Single Public Health System in Latin America 49
The Neoliberal Response 50
Challenges in Transformation of the Health System 51
The New Neoliberal Governments and Setbacks to the Right to Health 56
A4: Structural Roots of Migration 60
The Dimensions of Global Migration 60
Globalization and Migration 62
The Discourse on Migration: Omissions, Double Standards and Exclusions 64
Conclusions 68
Section B: Health Systems: Current Issues and Debates 71
B1: Universal Health Coverage: Only About Financial Protection? 73
‘Universal Health Coverage’ – Slogan de Jour 74
The Emergence of UHC 75
The Economistic Mindset 86
The Macroeconomic Imperative 87
The Pragmatics of Global Health Governance 91
How Health Systems Develop 92
B2: Revitalizing Community Control in Primary Healthcare 96
Evidence for the Benefits of Community Control in ACCHOs 98
Evidence for the Benefits of Community Control in Community Health Centres 101
Conclusion 102
B3: Healthcare in the USA: Understanding the Medical–Industrial Complex 106
Introduction 106
The Medical–Industrial Complex 106
Meet the MIC: Major Players 108
Conclusions 115
B4: Contextualizing the Struggle of Health Workers in South Africa 118
Public Health in South Africa in the 1930s and 1940s 118
Health Civil Society during Apartheid and in the 1990s 119
The Current South African Health Crisis 120
The HIV Epidemic and Developments in Health Civil Society 121
The National Health Insurance Project 124
A Critical Perspective on South Africa’s Health Reforms 126
B5: The ‘New’ Karolinska Hospital: How PPPs Undermine Public Services 129
Vision of a New Karolinska 129
Hidden Costs and Secrecy 130
B6: Access to Healthcare of Migrants in the EU 136
Introduction 136
Migrants’ Health in Times of Crisis 140
Barriers and Challenges for Migrants Seeking Healthcare 145
Conclusion 148
B7: Informalization of Employment in Public Health Services in South Asia 151
Introduction: Global Context of ‘Informal’ Employment in the Health Sector 151
Informalization of Hospital Workers in South Asia: Case Studies 153
Community Health Workers 157
Conclusion 164
Section C: Beyond Healthcare 169
C1: Climate Change, Environmental Degradation and Health: Confronting the Realities 171
Introduction 171
Underlying Forces (and Consequences) of Environmental Degradation 172
Leading Environmental and Health Problems 174
Spaces and Places of Inequity and Injustice 178
What Is to Be Done? 179
Conclusion 184
C2: Gendered Approach to Reproductive and Sexual Health and Rights 188
Queering the Right to Health and Healthcare 189
Sex Workers’ Health: An Agenda for Public Health 191
Whither the Right to Safe Abortion? 193
Towards a Conclusion 195
C3: Health Reforms in Chile: Lack of Progress in Women’s Sexual and Reproductive Health and Rights 199
Introduction 199
The Marginalization of SRHR in Health Reform Debates 202
The Role of the Catholic Church and Other Conservative Vested Interest Groups 203
The Role of Medical Professionals 204
Conclusion 205
C4: Trade Agreements and Health of Workers 207
From WTO to Free Trade Agreements 207
Trade Impacts Health in Several Ways 209
The Rise of Precarious Employment and Its Impact on Health 210
Labour Provisions in Free Trade Agreements: A Solution? 213
The Future for Trade Agreements 217
C5: Public Health in the Extractive Sector in East and Southern Africa 219
Equity and Development in East and Southern Africa 219
Health in a Region of Increasing Extractive Activities 220
International Norms to Promote Fair Benefit from EI Activities 223
Variable Application of International Standards 224
The Demand for More Direct Social Voice and Accountability 228
Steps to Advance Health Equity in Relation to Extractive Industries 229
C6: The War on Drugs: From Law Enforcement to Public Health 233
Drug Policies – Public Health Impacts 234
A Turning Tide 238
What Next? 240
Section D: Watching 243
D1: Money Talks at the World Health Organization 245
Who Finances WHO 246
Embracing Philanthropic Foundations and Corporate Engagement 250
Partners or Competitors for Health? 252
Impact of Voluntary Contributions on Programme Budget Allocations 253
Consequences Beyond Global Public Health 257
Shift in Governance: Member State-Driven to Multi-Stakeholder 258
Concluding Observations 260
D2: Private Philanthropic Foundations: What Do They Mean for Global Health? 263
An Alternative Notion of Welfare 264
Risks and Side-Effects 266
Lack of Political Will to Limit Influence of Philanthropic Foundations 273
Need for Clear Rules and Criteria for Cooperation with Private Foundations 274
D3: Management Consulting Firms in Global Health 278
How Management Consulting Firms Became Ubiquitous in Global Health 278
Applying a Management Consulting Frame to the Health Field 283
Governance Issues That Ought to Be Explored 287
Revolving Doors and Conflicts of Interest 291
Conclusion 293
D4: GAVI and Global Fund: Private Governance Structures Trump Public Oversight in Public Private Partnerships 298
GAVI: Publicly Funded with a Private Vision 298
Global Fund’s Demand for Immunities and Privileges 307
Conclusion 311
D5: Investment Treaties: Holding Governments to Ransom 316
Introduction 316
Understanding Investment Treaties and ISDS 316
Philipp Morris Sues Uruguay and Australia 318
Pharmaceutical Companies in the Fray 319
Energy and Environment Sector 320
Limited Victories 321
IP Safeguard Proposals 322
Not Just Intellectual Property Rights 322
Reform, Reject, Repeal 323
D6: Framing of Health as a Security Issue 327
Introduction 327
What Is Securitization? 327
Securitizing Health 328
Problems with the Securitization of Health 331
Conclusions 333
D7: Politics of Data, Information and Knowledge 335
Introduction 335
Creating, Storing and Accessing Data 335
Processing Data, Generating and Accessing Information 336
Knowledge: Generation, Authorization, Communication and Management 343
Conclusion 344
D8: Access and Benefit Sharing: The Pandemic Influenza Preparedness Framework 346
PIP Framework: The Origins 346
Achievements and Challenges of the PIP Framework 348
An Access and Benefit-Sharing Model for Other Pathogens 354
D9: Total Sanitation Programs at the Cost of Human Dignity 357
Toilet Tyranny: Case Studies from Chhattisgarh in India 357
‘Victim Blaming’ Is a Constant Feature of CLTS Programs 363
Section E: Resistance, Actions and Change 367
E1: Social Movements Defend Progressive Health Reforms in El Salvador 369
Introduction 369
Health Reforms: Key Interventions 369
Advances in Health Reform 370
Challenges to the Health Reforms 373
Economic Landscape and Government Revenues 375
Popular Mobilization in Defence of Progressive Reforms 378
Conclusion 381
E2: Contestations Concerning Management of Severe Acute Malnutrition in India 385
Introduction 385
Tackling Malnutrition: The Indian Experience 386
RUTFs and Conflicting Commercial Interests 387
Addressing Malnutrition in the Indian Context 389
Conclusion 392
E3: People Living with HIV in India: The Struggle for Access 394
Changes in India’s Patent Law 395
‘Patent Oppositions’ by Phliv Groups 397
The Novartis Case 399
The Free Trade Agreements 400
The Voluntary Licences 402
Future Struggles 403
E4: Community Engagement in the Struggle for Health in Italy 407
Genuino Clandestino: Struggle for Food and Land Sovereignty 407
Supporting Community Struggle Against Effects of Asbestos 411
List of Contributors 415
Index 417