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Subject: "Let Us Live and Let Them Die" WHO's approach to HIV, poverty and economix
ISIS Press Release 12/04/07
"Let Us Live and Let Them Die"
A WHO staff member's parting salvo to the international health agency and
its neoliberal approach to health
Sam Burcher
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Social scientist, Alison Katz has left the World Health Organisation (WHO) after 17 years of devoted
service, condemning its "Let us live and let them die" attitude, which
sums up the neglect of millions of people over the past three decades,
suffering and dying from diseases of poverty, including notably HIV/AIDS
[1]. She is the second AIDS researcher to leave within the past 12 months
(see On Quitting HIV [2] this series).
"For over twenty years now, the international AIDS community has persisted
in a reductionist obsession with individual behaviour and an implicit
acceptance of a deeply flawed and essentially racist theory." Katz writes.
She believes that the narrow and totalitarian approach to AIDS by the WHO
not only has had negligible effect, but also has betrayed public health
principles and perversely forbidden exploration of any alternative
perspectives. Like many others, Katz questions the exclusion of a plethora
of co-factors known to increase biological susceptibility to infection by
all disease agents, including HIV, among which are under-nutrition,
poverty, powerlessness, and the basic necessities for a healthy and
dignified life.
She believes that the WHO has fallen victim to neoliberal globalisation,
and by default, to the economic interests of powerful nations and the
transnational corporations. In an open letter dated January 2007 [3]
addressed to Dr. Margaret Chan, the incoming Director-General of WHO, Katz set out seven key points to
steer her focus back to serving the public, including the critical
importance of addressing the commercialisation of science, and the close
relationship between industry and academia as highlighted in ISIS'
Discussion Paper Towards a Convention on Knowledge [4].
The neoliberal approach to health
There is a strong tendency in the neoliberal approach to health ? and
particularly in relation to HIV/AIDS, to blame victims, Katz says [5], for
their faulty or irresponsible behaviour. Demeaning stereotypes, coupled
with flawed analysis, and ineffectual policies do not appear to have
contributed to any significant decrease in infection rates in the worst
affected regions such as the continent of Africa. Furthermore, the world's
first global sex survey published in The Lancet in 2006 found that multiple sex partners were more common in
industrialized countries where disease incidence is relatively low [6].
According to Katz, the dominant neoliberal perspective reinforces the
structures of hegemony that create poverty and powerlessness which are
themselves the root causes of avoidable disease and death. (Poverty
eradication must be central to change and the narrow focus to the problem
is being challenged by women in Africa (see Women Confront Aids in Africa SIS 34 [7]).
Eileen Stillwaggon, an associate Professor of Economics at Gettysburg College USA, says that
[8] the ecology of poverty must be understood, as populations that lack
access to medical care and are already coping with parasitic and multiple
other infections, are more vulnerable to other diseases, regardless of how they are transmitted. In this respect, HIV/AIDS is no exception. The public health principle,
neatly summarized by Pasteur as "the bacteria is nothing; the terrain is
all", applies to all the diseases of poverty. The focus on individual
sexual behaviour is itself highly stigmatising - in addition to being
unscientific. On an optimistic note, Stillwaggon observes that solutions
to the problems caused by almost all the co-factors exist, and
institutions, like the WHO are well placed to advocate for them among
vulnerable populations. ISIS has proposed many affordable and patent-free
alternative treatments to the disease and its' co-factors in Unraveling AIDS [9]).
In order to neutralise the entrenched neoliberal bias within international
agencies Katz believes that the WHO must return to its founding principles
and advocate for attention to root causes ? the social and economic
determinants of health and disease. In today's world, this implies
denouncing unfair rules of trade and commerce, the exploitation of
national resources, and ruthless liberalization foisted on developing
countries, all of which have been shown to have devastating effects on the
health of populations. Furthermore, the WHO must take the lead in
providing scientific research with independent scientists free of vested
interests. To achieve its mandate of "Health For All", the WHO must
support serious science based on sound evidence. Millions of people's
lives are at stake.
Political prejudice within the WHO
Katz worked for 12 years in the division of WHO dealing with family,
community, sexual and reproductive health, and 8 years in the HIV/AIDS
department. In 1999 she responded to an Internet discussion posting from
the perspective of biological vulnerability to HIV infection and racist
assumptions underlying current policies and strategies. Her supervisor, on
instructions from the executive director, immediately censored her by
sending an email instructing that she must not debate this issue. At the
same time she received a request from the editor of the African Journal of Aids Research to write up her ideas in an article [1]. Shortly after that, she was
isolated from all technical work within her department for 18 months.
Following her isolation, Katz's contract was not renewed, so she submitted
an internal legal appeal against the WHO for reinstatement and for a
proper contract after serving 11 years on 37 temporary contracts. She won
the appeal on condition that she leave the HIV/AIDS department. As a
working mum supporting three children, she had no choice but to accept the
Director General's offer.
Efforts on Katz's part to discuss alternative approaches with the WHO
HIV/AIDS programme director and the UNAIDS executive director have
consistently been declined, even after the publication of the Lancet series, mentioned above, which supports the perspective she is
advocating.
Independence of international civil servants to fulfil WHO's mandate
Katz's concerns expanded to the question of independence of international
civil servants, which is seriously undermined by neoliberal influence
exerted through powerful member states, private sources and
extra-budgetary funding. Pressures at this level have resulted in a
repressive, authoritarian and hierarchical management style, which
discourages free debate. Katz joined the staff association to fight for
proper contracts for all long term "temporary staff" - some 55 percent of
the workforce. The success of this action was limited. A very small
proportion of "false temps" were regularized into proper contracts and
then through a major, costly "restructuring" exercise, many of these long
serving staff then lost their jobs, often to inappropriately qualified
appointees with better connections.
These struggles took place against what she describes as a background of
nepotism, cronyism, corruption, harassment, financial mismanagement and
chaotic, highly discretionary, human resources management [5]. Furthermore
there is an under representation of Africans, Asians, Latin Americans, or
Eastern Europeans within staff departments. The predominant influence of
the UK, USA and Canada, as well as Australia, and New Zealand; whose representatives are
invariably white, male, Anglo-Saxon Protestants linked by powerful
networks prevails.
WHO's first strike and out
Together with a small group in the staff association, Katz organized a one
hour work stoppage, the first industrial action in WHO's history, in which
700 staff participated. Her post was abolished three weeks after the work
stoppage and three weeks before the normal renewal of her 2-year contract.
Swiss unions and staff association lawyers qualify this as interference in
the right of association; the WHO administration qualifies it as a
"coincidence".
Katz believes that the WHO must respect international labour standards,
including negotiation status for the staff association, in line with ILO
(International Labour Organisation) covenants; to provide workers with
formal power, adequate funding, and strong links to a bona fide UN umbrella union. WHO staff should be held accountable to WHO's 1978
constitutional mandate, to the Alma Ata principles underlying Health for
All, and to the UN Charter and should fully understand the duties and
responsibilities of public service.
WHO's challenge to achieve Health for All
Katz calls for a return to a basic needs and rights-based approach to
health [1] in order to provide a sustainable and meaningful response to
AIDS that is simultaneously a response to all the diseases of poverty. An
alternative political strategy for AIDS and its co-factors would embrace
macroeconomic reforms for a fair, rational and sustainable international
economic order so that democratically elected governments may reasonably
meet people's basic needs, including health, without external
interference.
In her open letter [3], Katz urges WHO's newly elected Director General,
Dr Chan, to address the following major issues in order to fulfil her
vision. A focus on inequality rather than poverty; holding meetings and
consulting with the poor rather th[a]n the rich; a solid, equitable tax
base, nationally and internationally, rather than public-private
partnerships; knowledge for the public good rather than corporate
"science"; respect for ethical values and an appropriate balance between
loyalty to WHO's constitutional mandate and loyalty to current governments
of powerful member states and current office holders.
Other ISIS articles about HIV and AIDS
http://www.i-sis.org.uk/LULALTD.php
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