Time to put UN system back on track, health activists say

by Ranjit Devraj

Savar, Bangladesh, 5 Dec 2000 (IPS) -- The United Nations system has stumbled off the track of equitable development and now needs to be put back on that path, activists at an international health meeting here said Tuesday.

Indeed, this was the uppermost concern of some 600 delegates at the second day of the People’s Health Assembly (PHA) held in this remote town, 40 km outside of Bangladesh’s capital, Dhaka.

Economic policies around the world are now being shaped not by the United Nations, but by international financial institutions like the International Monetary Fund (IMF) and the World Bank (WB), said professor Mohan Rao from India’s Jawaharlal Nehru University.

These, in turn, are having adverse effects on health and health services, he adds.

Rao said that the situation was created by countries like the United States, staving off falling profit rates and unemployment at home by using its clout with the IMF and the Bank to open up markets in developing countries.

These pressures prod countries to liberalise economic policies to a more “efficient” one. In the process, they change a system of state control designed to ensure equitable distribution of income—with disastrous consequences for poor people.

However, Rao says, this same situation is leading to movements for change at many levels, local, national and international, including the present People’s Health Assembly from 4-8 December.

“Powerlessness is being addressed through a range of movements that organise in a representative and accountable manner giving a voice to the voiceless,” he added.

Goran Sterky, who successfully led the international campaign to promote breast-feeding, against the interests of baby food manufacturers, says that the UN system is often in cahoots with power elites in many developing countries.

Thus, he says, activists could act by “blowing the whistle” on deals that were inimical to the people.

Sterky said Sweden’s Dag Hammarskjold Foundation, for which he now works, is already using its access, as well as the academic freedom it enjoys in its home country, to draw attention to profit-hungry policies detrimental to the interests of the people.

“We are not against the UN system but it happens that decisions on serious issues, including those that concern the health of the people, are not taking place within a world body that is now operating under a unipolar system,” he said.

Sterky says he and his foundation were not against free trade and liberalisation, but “we only want to minimise its side-effects.”

He suggested as a remedy, a restructured “tricameral” United Nations— one in which government and business, which now dominate the present system, become answerable to a third house, that of the people.

According to Nadine Gasman, one of the organisers of the PHA, the world is now struggling with a gross miscalculation on the part of the advocates of liberalisation who believe that long-term economic gain would offset short-term social cost.

“What they did not foresee was that the social impact could itself frustrate the desired economic effect,” she added. “Globalisation expands the opportunities for unprecedented human advance for some, but shrinks those opportunities for others and erodes human security,” Gasman said.

David Werner, founder of the International People’s Health Council (IPHC), said the World Bank’s takeover of health planning and its recommendation of privatisation and cost-recovery schemes had clearly pushed health out of the reach of the poor.

Oral testimonies given at the PHA conference here show how the liberalisation of economic policies at the international and national level hurt health at the local level.

For instance, Mwajuma Saiddy of Tanzania told of a case where the pressure on health care centres to show profit meant the denial of services to the needy, and where awareness of health rights could have made a difference.

When a pregnant woman in Naikesi village in Sonega district went to a primary healthcare centre, the health worker, who said he was ‘not allowed to treat her for free’, turned her away.

The woman went home, where she and her unborn child later died. There was in fact a provision for payment to be waived for pregnant women and children, but neither the health centre nor the woman knew of it.

The case of India also shows how, despite the praises it earns for “economic reforms”, it has actually been cutting down on its health budget since embarking on liberalisation and structural adjustment in 1991.

This has had disastrous consequences for health delivery in the country and crippled the work of primary health centres, which are left without medicines or doctors, says Isher Judge Ahluwalia, an economist and commentator on economic policy.

American economist Jeffrey Sachs previously said that the 2% of GDP India now spends on health is grossly inadequate and should be at least 5%.

Werner’s prescription is to get people to understand how the Bank and IMF put the squeeze on poor countries to keep paying huge interest on foreign debts and how structural adjustment has forced cutbacks on public services—making poor families pay for health care and schooling.

“People need to understand who is responsible for the decisions that allocate vast amounts of money for weapons, pet food, tobacco, golf courses and trips to the moon, when millions of children do not get enough to eat,” argued Werner. He says the present situation is the direct result of the World Bank taking over the World Health Organisation’s role as the world leader in health policy planning.

“The takeover was powered by money and the World Bank’s health budget is now triple that of WHO’s total budget,” he added. The result, Werner says, is that health care is no longer a human right. “You pay for what you get. If you are too poor, sick and hungry to pay, forget it.”

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