FROM "pha-exchange" <[log in to unmask]>
Some very thoughtful comments. - dr
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Some more comments received on the Bangkok Charter.
I would recommend PHM not endorsing this charter. Among dozens of points I
will just highlight three: those who are familiar with the arguments will
only need to read the titles in bold. Sorry to be so lengthy but I think it
is important.
1. The repeated references to the private sector as "critical to the
achievement of health" or as a vital "partner" in health promotion.
The reality is that the private sector means TNCs, which have been clearly
identified as major obstacles to Health for All. It is time to state that
explicitly and stop repeating these mindless mantras about the importance
of involving the private sector. What is important is drastically
curtailing the illegitimate influence and control in ALL policy making and
removing the private sector as partners (as they do not share the same
goals!!!) .
We have to clarify once and for all some fundamental democratic principles.
In this text (as in all othe "lite" "humane" neoliberal texts) society
consists of government, civil society and the private sector. Why ? Why not
for example the public sector? Why not associations of health workers? Why
not the unions or peasant's federations?
All citizens are involved and concerned in health matters as individuals
but for reasons of conflict of interest, various groups are explicitly
excluded as partners in public policy making. Note that TNC employees or
their CEOs enjoy the same rights as any other citizens but not as
representatives of the financial interests of their company.
Interactions with the private sector are important of course but they take
place only under the authority of the sovereign (the people) through their
elected representatives (leaving aside imperfections of our "democracies")
and this would include consultation to obtain needed information, certain
expertise or to discuss provision of services or goods to be delivered etc
etc. Never in the formulation of policy.
The private sector has a legal obligation to make a profit for
shareholders. This is certainly a critical subject for law reform and
perhaps we need to return to the idea of companies having to show that they
play a socially useful role and fulfil a public need in order to have the
right to operate. However, meanwhile, the private sector is subject to laws
and regulations which need urgently to be properly enforced. Legally
binding restrictions apply to them as do human rights obligations. Much new
legislation is required of course but even today, enforcing what exists
would enormously improve the situation of the poor. I would we need to
solidly reject the whole concept of social responsibility as a sort of
voluntary mechanism and "a plea to industy to be good and nice" and insist
on legally binding measures to societal actors who are emphatically NOT
partners in public policy making.
2. The reversal of public health logic and history (again and again this
nonsense)
"Health determines socioeconomic and political development". It simply does
not! And this position is promoted in order to avoid addressing structural
poverty, inequality and violence which are the direct causes of suffering
on earth.
The relationship between health and poverty is two way but it is not
symmetric. Poverty is the single most important determinant of poor health.
But poor health is very far from being the single most important
determinant of poverty. Poor health exacerbates existing poverty. Both the
vicious cycle and the 'virtuous' cycle of health and poverty are misleading
images, as they imply equal weight of the two poles of health and economic
development.
No amount of excellent medical interventions delivered to Haitians or
Tanzanians today are going to make them or their country prosperous
tomorrow if the national economy is strangled by debt, unfair terms of
trade and the continued pillage of natural resources and destabilized by
uncontrolled financial outflows, wildly fluctuating commodity prices and
outside interference in matters of national sovereignty.
Haitians and Tanzanians receiving medical treatment today may survive where
others die - in very precarious conditions, allowing them to contribute
valiantly for a couple more months to gross national product (GNP) - until
the next bout of illness. Unless of course, while the medical technology is
being delivered, attention is being paid to the underlying causes of the
population's poor health status, such as miserable living conditions.
3. Completely absent from the analysis (if it can be termed as such) are
actors, causes and clashes of interests: this text, like all the others
emanating from establishment circles is "apolitical" (but supporting the
status quo so in fact highly political - just not acknowledgeing it),
ahistorical and amoral. The time has come for honest political brokering in
which we state our moral values and principles upfront and the political
action required to work towards that moral vision. (It used to be called
socialism and it needs to be reappropriated from the Blairs and Schroders
of this world).
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