Global economic system is bad medicine

by Ranjit Devraj

Savar (Bangladesh), 11 Dec 2000 (IPS) -- Diagnosing what ails public health delivery was the easy part for the international People’s Health Assembly (PHA), which ended Friday in this remote area of one of the world’s poorest countries.

“The question now is how to tackle the virus of the global trading system which thrives on human greed,” said Gauripada Dutta, a doctor and veteran legislator from India’s West Bengal state which borders Bangladesh.

Not one of the 900-odd delegates from 92 countries here had an iota of doubt on what was responsible for the deterioration in health service delivery around the world or for creating socioeconomic conditions that deprive the vast majority of people a healthy existence.

They adopted with unanimity the People’s Health Charter - 2000, the main product of the five-day assembly, which demanded the cancellation of Third World debts and the transformation of the World Bank and the International Monetary Fund (IMF) in favour of public health.

“The consensus is the thing - we have to learn to help each other,” said Huma Rashid, coordinator for the Punjab Lok Sujag, a non-government group that works for consumer protection and community awareness in Pakistan.

Part of the credit for that consensus goes to the battery of savvy experts who were brought in by the PHA and explained to the delegates the dangers lurking in the thousands of pages of documents like the World Trade Organisation (WTO) trade rules.

“These documents are drafted by the best business and legal brains that money can hire and the fact that they are all written in English adds to the handicap of negotiators from the Third World,” said Mira Shiva from the Voluntary Health Association of India (VHAI), an NGO campaigning for the rational use of drugs.

Moreover, the developing world has to contend with corrupt administrations at home which are only too happy to do business with transnational corporations (TNCs) and the global financial institutions that back them such as the Bank, IMF and WTO.

“Influential sectors in many Third World countries have given up ideas of national self-sufficiency and now intend to reap benefits as junior partners to foreign capital in search of quick profits or purchasing public assets at a low price through privatisation,” said Mohan Rao, a PHA coordinator who helped draft the charter.

The result has been quick capitulation by developing countries, whose bargaining power has been weakened by mounting debts to the interests of TNCs articulated through the Bretton Woods institutions, set up after World War II and which jealously guard the economic dominance of the North.

Halfdan Mahler, who was director-general of the World Health Organisation (WHO) for 15 years, blamed the situation on the “unipolar” world which emerged at the end of the Cold War.

“One terror for the people was replaced by another,” said Mahler, who as WHO chief oversaw the Alma Ata Declaration of 1978 which envisaged health for all by 2000 through the now-abandoned primary health care approach. Mahler said that by 1993, the World Bank had decided to give itself a ‘human mask’ by getting itself into the health sector. Before long, he added, through sheer financial clout, it had a budget for health larger than that of the WHO.

Under the new world trading order which emerged with the completion of the Uruguay Round of talks in Marrakesh, the role of the Bretton Woods institutions and governments was redefined in a way that hurt those which state-managed economies.

At another level, patent regimes brought in under the WTO’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement caused the prices of essential drugs to soar out of the reach of the poor, already grappling with the commercialisation of health services.

The structural adjustment programmes (SAPs) prescribed by the World Bank to help countries repay debts only led to retrenchment and steady withdrawal of funds from social sectors and sounded the death knell for primary health care.

The articles of the new, post-Cold War WTO even envisaged that many aspects of SAPs would become legally enforceable, but the idea floundered through stiff resistance it met at Seattle last year.

Making sense of the legalese for ordinary people was one of the tasks of the PHA, said Kattrin Lempp of the Brussels-based Medecins Sans Frontieres. “This is the first time we have had an opportunity to meet and share perspectives.”

“People from vastly different countries have similar problems arising out of globalisation,” she said, referring to the personal testimonies that were a daily feature of the PHA.

“Don’t let them close down the garment factory,” pleaded Farida Akhtar in one such testimony, referring to the sweatshop she labours in for a pittance. She says she worries all the time for her small children who have to be left at home.

>From the other side of the globe, Kevin Lafferty, a tough-looking Scotsman sporting a tartan kilt, broke down when he spoke of chronic unemployment which has “driven the once-proud working man of Glasgow to poke about in the ashes of his dreams.”

Richard Lee Skolnik, a World Bank representative who attended one of the assembly’s sessions, was treated to a giant montage on which destitute women had embroidered headlines dealing with the consequences of structural adjustment in Zimbabwe.

Skolnik denied that the World Bank ever asked for a stoppage of funds for the social sector in Zimbabwe or anywhere else. He said the Bank only asked for better governance in countries where “governments have no concern for their people.”

But Antonio Tujan from the Philippines explained how in his country only 3% of a $1.8 billion programme actually goes into health, and most of that into projects on women’s reproduction. “I believe that the World Bank must be dismantled. It must be replaced with an international development financing agency that truly recognises the objective of equity and genuine development for our peoples and countries,” Tujan said.

Indeed, some found the people’s charter too weak to make a difference.

“The charter should have nailed the Bank and the WTO down to a timeframe of, say, two years, in which the Bank demonstrates that it is moving in the desired direction at least,” said Robin Storr, who chairs the UK-based MEDACT. But the World Bank, with its 55% domination by larger shareholders in the North, “will not disappear,” said Sholnik

Little wonder, then, that suggestions for the “way forward” that came from hundreds of delegates after the health charter was adopted Friday were in favour of increased Seattle-style agitation.