GLOBAL HEALTH WATCH AN ALTERNATIVE WORLD HEALTH REPORT Global Health Watch Zed Books | Global Health Watch 3: An Alternative World Health Report was first published in by Zed Books Ltd, Cynthia Street, London , and Room , Fifth Avenue, New York, , www.zedbooks.co.uk Copyright © People’s Health Movement, Medact, Health Action International, Medicos International and Third World Network, The right of People’s Health Movement, Medact, Health Action International, Medicos International and Third World Network to be identified as authors of this Work has been asserted by them in accordance with sections and of the Copyright, Designs and Patents Act Set Monotype Plantin and FontFont Kievit by Ewan Smith, London Index: … Cover designed by Jason Anscombe, Rawshock Design Printed and bound in Great Britain by … Distributed in the exclusively by Palgrave Macmillan, a division of StMartin’s Press, , Fifth Avenue, New York, , All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying or otherwise, without the prior permission of Zed Books Ltd. A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data available hb pb CONTENTS Boxes, tables, charts | vii Photographs | ix Acronyms | ii Acknowledgements | ii Introduction . . . . . . . . . . . . . . . . . . . . . . The global political and economic architecture A Economic crisis and systemic failure: why we need to rethink the global economy . . . . . . . . . . . . . . . . . . . . Health systems: current issues and debates B Primary health care: a review and critical appraisal of its ‘ revitalisation’ . . . . . . . . . . . . . . . . . . . . . B Financing health care: aiming for long-term solutions. . . . . . B Health financing models that make health systems work: case studies from Costa Rica, Sri Lanka and Thailand . . . . . . . B Dysfunctional health systems: case studies from China, India and the US . . . . . . . . . . . . . . . . . . . . . . B Achieving a shared goal: free universal health care in Ghana . . . B Maternal mortality: need for a broad framework of intervention. . B Research for health . . . . . . . . . . . . . . . . . . . B Pandemic influenza preparedness: in search of a global health ethos . . . . . . . . . . . . . . . . . . . . . . . . B Mental health and inequality . . . . . . . . . . . . . . . Beyond health care C The global food crisis . . . . . . . . . . . . . . . . . . C Health information, conflict, and the right to health . . . . . . C Trade and health. . . . . . . . . . . . . . . . . . . . C The future is now: genetic promises and speculative finance . . . C Climate crisis . . . . . . . . . . . . . . . . . . . . . C Challenging the population: climate connection . . . . . . . . Watching D World health organisation: captive to conflicting interests . . . . D UNICEF and the ‘medicalisation’ of malnutrition in children . . D Conflicts of interest within philanthrocapitalism . . . . . . . . D The pharmaceutical industry and pharmaceutical endeavour . . . D Health and global security: reasons for concern . . . . . . . . D The international health partnership+: glass half full or half empty?. . . . . . . . . . . . . . . . . . . . . . . . D New reproductive technologies . . . . . . . . . . . . . . Resistance, actions, and change E The movement for change . . . . . . . . . . . . . . . . E The right to health: from concept to action. . . . . . . . . . E Cuba’s international cooperation in health . . . . . . . . . . Contributors | Index | BOXES, TABLES, CHARTS Boxes PHC and the Aboriginal community in australia . . . . . . . . . The politics of aid . . . . . . . . . . . . . . . . . . . . . Overview of the health system in ghana. . . . . . . . . . . . . . Human rights and maternal mortality . . . . . . . . . . . . . . Institutional deliveries – not a panacea . . . . . . . . . . . . . . Alternative indicators of social progress. . . . . . . . . . . . . . Cooperative research centre for Aboriginal health . . . . . . . . . What is a futures market? . . . . . . . . . . . . . . . . . . Death and injury in conflict: who, when, and where . . . . . . . . . ‘TRIPS plus’ measures in FTAs . . . . . . . . . . . . . . . FTAs – the devil lies in the details. . . . . . . . . . . . . . . . Plumpy’nut and patents . . . . . . . . . . . . . . . . . . . From Ann Veneman to Anthony Lake . . . . . . . . . . . . . . The great vitamin A fiasco. . . . . . . . . . . . . . . . . . Medicines in search of a disease . . . . . . . . . . . . . . . Signatories of IHP+ . . . . . . . . . . . . . . . . . . . . . The international people’s health university . . . . . . . . . . . . Changing from within . . . . . . . . . . . . . . . . . . . . Campaign on patients’ rights. . . . . . . . . . . . . . . . . . RTH campaign in Guatemala . . . . . . . . . . . . . . . . . Fighting for the human right to health care in the United States . . . Tables . Costa Rica: expenditure on health: comparison with some Latin American countries . . . . . . . . . . . . . . . . . . . . . Comparison of development indicators (by the late s): Sri Lanka with other regions . . . . . . . . . . . . . . . . . . . . . . Sri Lanka – key health indicators . Sri Lanka – share of health expenditure by function and source in . . . . . . . . . . . . . . . . . . . . . . . . . . . Thailand: progress in health insurance coverage . . . . . . . . . . Catastrophic expenditure by households, – . . . . . . . . . Share of households’ OOP and drug spending in India, / . . . . India: out-of-pocket expenditure on health care: / and / . . . . . . . . . . . . . . . . . . . . . . . . . viii | , , Charts . World real GDP and trade growth, – . . . . . . . . . . . World fuel prices, –. . . . . . . . . . . . . . . . . . World cereal prices, – . . . . . . . . . . . . . . . . . Linkages between crises and root causes . . . . . . . . . . . . . Growth of global fossil fuel CO emissions . . . . . . . . . . . . Net private financial flows (excluding direct investment), developing countries, –. . . . . . . . . . . . . . . . . . . . . Tertiary enrolment ratios and tertiary migration (rates by income level, ) . . . . . . . . . . . . . . . . . . . . . . . . Sources of health care financing, selected low and middle income countries, . . . . . . . . . . . . . . . . . . . . . . . The rapid removal of health user fees in Africa since . . . . . . Average tax revenues by country income levels, . . . . . . . . Costa Rica: total expenditure and general government expenditure on health as a percentage of GDP . . . . . . . . . . . . . . . . Sri Lanka: public expenditure on health as a percentage of GDP, – . . . . . . . . . . . . . . . . . . . . . . . . . Share of government and private health expenditure in Thailand, – . . . . . . . . . . . . . . . . . . . . . . . . . Health expenditure in India, / . . . . . . . . . . . . . . Public expenditure on health in India (as percentage of GDP) . . . . . Health insurance coverage in India, . . . . . . . . . . . . . Regional distribution of maternal deaths . . . . . . . . . . . . . Number of undernourished people worldwide . . . . . . . . . . . Price volatility of food grains . . . . . . . . . . . . . . . . . . Changes in wheat price . . . . . . . . . . . . . . . . . . . . Primary commodity prices and OTC futures contracts . . . . . . . . Fair and actual share of carbon budget available . . . . . . . . . . Control over the carbon budget by delaying deep cuts in emissions . . . Sources of voluntary contributions to WHO’s budget . . . . . . . . Breakdown of contributions by member states to WHO’s budget – –. . . . . . . . . . . . . . . . . . . . . . . . . Six domains of global governance . . . . . . . . . . . . . . . . ‘Good’ ratings for village-level health services across villages in Maharashtra over three phases of CBM . . . . . . . . . . . . Improvement in immunisation services over three phases of CBM . . PHOTOGRAPHS Construction boom in China (Chongging) . . . . . . . . . . . Sign on a building in the US, November . . . . . . . . . Anti-WTO protests in Hong Kong . . . . . . . . . . . . . . Police stop ant-G protestors in Rome, May . . . . . . . . Rag-pickers in Nairobi, Kenya: social and economic development are key components of PHC . . . . . . . . . . . . . . . . Woman in a shanty in Cape Town, South Africa: persisting social and economic inequity in LMICs . . . . . . . . . . . . . . Demise of primary health care. . . . . . . . . . . . . . . . Rally for equity in health at Peoples Health Assembly, Cuenca, Ecuador, . . . . . . . . . . . . . . . . . . . . . . Medical college in Tianjin . . . . . . . . . . . . . . . . . Demonstration for free health care in India . . . . . . . . . . . Separation of health financing and provisioning can mean public financing of the private sector . . . . . . . . . . . . . . . . Memorial to Rudolph Virchow in Berlin . . . . . . . . . . . . Demonstration for health care reform in the US, October . . . Women’s health problems are often seen only in relation to child- bearing . . . . . . . . . . . . . . . . . . . . . . . . Women patients at a hospital in Madhya Pradesh, India where several deaths took place over a short period . . . . . . . . . . . . . Research on broader determinants of health is neglected . . . . . Health research is not prioritised. . . . . . . . . . . . . . . Flaws in the peer review system . . . . . . . . . . . . . . . Man with a mask to protect against influenza in a subway in Buenos Aires, June, . . . . . . . . . . . . . . . . . . . . . Contrary to claims the food crisis was not brought about by increased demand in India and China. . . . . . . . . . . . . . . . . Biofuels have taken over agricultural land . . . . . . . . . . . Ethanol bio fuel refinery . . . . . . . . . . . . . . . . . . Paddy field in Hechuan, China. . . . . . . . . . . . . . . . Activists demanding equitable access to food: US Social Forum, Atlanta, . . . . . . . . . . . . . . . . . . . . . . Tamil protestors in Geneva demonstrating against military operations in Sri Lanka, February . . . . . . . . . . . . . . . . Demonstration by HIV+ve groups against Indo-EU FTA, New Delhi [...]... the Global Health Watch – is the ‘Watching’ section, which scrutinises global processes and institutions that are crucially important for health and 2 | introduction health care throughout the world The final section proposes alternatives and highlights stories of success and resistance that are exemplars of actual actions that have contributed to better health and health care Global political and... 20 03 as a collaborative effort by activists and academics from across the world It is designed to question present policies on health and to propose alternatives The previous two editions of the Global Health Watch, published in 2005 and 2008, were widely acclaimed as important contributions to efforts to redesign the way we approach issues related to health and health care Global Health Watch 3 has... organisations – the People’s Health Movement, Medact, Health Action International, Medicos International and Third World Network Global Health Watch 3, building on the two previous editions, is designed to accomplish a number of objectives It provides analysis of contemporary issues that impact on health and health care It analyses policies, technical debates and global processes, not just in the health. .. production of the Watch Specifically, we would like to thank Tamsine O’Riordan, Jakob Horstmann, Ewan Smith and Margaret Ling for their patience, understanding and support Finally we would like to acknowledge Indranil Mukhopadhyaya and Shilpa Modi Pandav for the valuable research support provided by them Amit Sengupta (on behalf of Global Health Watch, editorial group) introduction The Global Health Watch was... global scale that prevents the flowering of human potential, manifest also at local and regional levels, is deeply embedded in human practice, and needs to be interrogated, challenged and changed In the final analysis, Global Health Watch 3 is an effort to give voice to the voiceless Many of the ideas that are explored in this book are being explored in greater detail on the website of the Global Health. .. trying to change their situation in diverse settings across the world Global Health Watch 3 comprises five broad sections The first section, entitled ‘The global political and economic architecture’, provides an analysis to locate the decisions and choices that impact on health The second section, Health systems – current issues and debates’, provides a view of current issues and debates on health systems... chracterised as just a technical agency 3 6 WHO’s role as an independent organisation is at risk 3 7 Two malnourished Nigerian children during the Nigerian-Biafran 3 civil war, 1968: not enough has changed in many parts of the world in the last 3 decades 8 Homeless woman with child in New Delhi, 2007 3 3 9 Child in Senossa, Mali ... Community-based Health Planning and Services (in Ghana) Community Health Worker Cooperative Medical Scheme (in China) Conference of Parties comprehensive primary health care Cooperative Research Centre for Aboriginal Health (Australia) Commission on Social Determinants of Health Centre for International and Intercultural Health Civil Servant Medical Benefit Scheme (in Thailand) De-worming and Enhanced Vitamin... Organisation Free Trade Agreement xii | ACRONYMS GAIN GATS GATT GAVI GDP GFATM GHG GHI GHP GHW GISN GNP GOBI Global Alliance for Improved Nutrition General Agreement on Trade in Services General Agreement on Tariffs and Trade Global Alliance for Vaccines and Immunisation gross domestic product Global Fund for AIDS, TB and Malaria greenhouse gas; global health governance Global Health Initiatives Global. .. • • global economic inequality; the dominant role of the financial sector; unequal global economic integration; and ineffective and undemocratic global governance Global economic inequality The twin ‘slow-burn’ crises of development and climate change epitomise global economic inequality On the one hand, we have a crisis of climate change, which is a classic crisis of over-consumption Climate change . GLOBAL HEALTH WATCH AN ALTERNATIVE WORLD HEALTH REPORT Global Health Watch Zed Books | Global Health Watch 3: An Alternative World Health. product GFATM Global Fund for AIDS, TB and Malaria GHG greenhouse gas; global health governance GHI Global Health Initiatives GHP Global Health Programmes GHW Global