Paul Krugman: America’s Greatest Public Health Champion?

Last week the New York Times reported on a study which documents a reversing trend in life expectancy for the least educated whites in the US. The study shows that since 1990, life expectancy for white Americans without a high school diploma has fallen by five years for women and three years for men. Reading […]

How Not to Think About Social Determinants of Health: A cautionary tale from Canada

In this guest post, Ted Schrecker critically discusses the results of a recently published public health study in Canada. Illustrated are the hazardous implications of de-contextualized conceptualizations of health.

From the Social to the Ultimate Determinants of Health

The notion that health is influenced by society, and the politics governing it, has been around for generations. The contemporary uptake of this idea can be found in the increasingly popular concept of ‘social determinants of health’. But should all social determinants be treated with equal concern? Or are certain determinants more important than others in influencing the health of populations?

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Global Health Watch 4: Critique and Hope for a Healthier World

In this guest post, Ronald Labonté announces the release of Global Health Watch 4. Labonté holds a Canada Research Chair in Globalization and Health Equity at the Institute of Population Health, and is Professor in the Faculty of Medicine, University of Ottawa; and in the Faculty of Health Sciences, Flinders University of South Australia.

globalhealthwatchToday marks the release of the 4th ‘Alternative Health Report’, widely seen as the critical voice for a more health equitable future. This fourth edition joins three previous ones released in 2005, 2008 and 2011; and readers new to the GHW and its family of reports should consider perusing these for their many still contemporary and important insights. All three earlier editions are available for free download from the Global Health Watch website (www.ghwatch.org), as will be the new 4th edition sometime in late February or early March 2015, by arrangement with its publisher, Zed Books.

Global Health Watch 4, like its predecessors, has been a collaborative effort by activists and academics from across the world, coordinated by the People’s Health Movement, Asociacion Latinoamericana de Medicina Social, Health Action International, Third World Network and Medact. All four editions of the reports are intended to provide health activists with the knowledge tools and mobilizing ideas to challenge the pathologies of a persisting neoliberal political economy. Indeed, unpacking that political economy has been a recurrent theme in all four editions, and the first section of the new report is build around a detailed account of the health crises of neoliberal globalization and the health damaging fiscal policies of austerity in Europe. Rather than see the financial crisis of 2008 and its subsequent ‘Great Recession’ as a regrettable ‘one-off’ of contemporary capitalism, these early chapters regard these recent events as extensions of a 40 year uncontrolled global experiment in neoliberal economic orthodoxy, an orthodoxy once described “as a belief that ‘the nastiest of men for the nastiest of motives will somehow work for the benefit of all’” (p. 12). There are signs of hope on offer, by way of evidence-informed policies that, if chosen, could steer the toxic ship of finance capital and rampaging inequalities around through re-regulation of global finance, rejection of austerity, increases in progressive national and global taxation, a clean break with the fossil fuel economy and continuous efforts to reclaim public discourse. There is some movement in all of these areas. Even austerity’s fiscal contractions, by no means restricted only to Europe, are increasingly under attack on both empirical and ethical grounds. But public health activists need to keep the pressure on.

Some of the evidence for alternatives to the dominant global economy can be found in popular struggles in Latin America, and it is not accidental that GHW4 gives considerable space to many of the health systems and broader social innovations taking place in that region of the world. But as GHW4’s second section, drilling down on contemporary debates in health systems reform, not all bodes well. Despite the new emphasis being given to ‘Universal Health Coverage,’ public health systems in many parts of the world continue to be underfunded and under attack by private capital:

The fight for a just and equitable health system has to be part of the broader struggle for comprehensive rights and entitlements. To take this struggle forward, the dominant interpretation of UHC today – weakening public systems and the pursuit of private profit – needs to be understood and questioned (p.2).

From successful primary health care roll-outs in Brazil and promised tax-funded health insurance coverage in South Africa, to ongoing efforts to roll back the heavily privatized markets in countries such as Colombia and India, to the dismal efforts of the World Bank’s International Finance Corporation to incentivize private capital and actors to provide health care to Africa’s poorest, the struggle for equitable access to quality health care that is progressively financed continues to dominate health social movement efforts. As earlier GHWs, and the chapter on the TRIPS agreement in this 4th edition, warn, these activist efforts will continue to be challenged by the expansion of intellectual property and investors’ rights through new generation trade treaties, and ongoing efforts by transnational service industries to hive off more public sector services.

These trends are becoming most apparent in the important ‘beyond healthcare’ domains of public policy that govern social determinants of health:

  • social protection policy: high on the radar of international agencies but lacking the necessary commitments to changes in labour markets and taxation to make pre- and post-market incomes more equitable and social protection more extensive and sustainably funded
  • non-communicable diseases: where public health policies to reduce the commercial vectors of transmission may run afoul of trade and investment treaties
  • and the persisting devastation of extractive industries: with a particular nod to the role Canada has been playing as a safe tax regime for some of the most polluting mining transnationals in the world.

GHW4 Image A1.3 Demonstration in Bali in December 2013: demands to curb corporate power have grown (Benny Kuruvilla)

Unfortunately, as GHW4’s continuation of its ongoing ‘Watch’ on the World Health Organization finds, the world’s voice on global health is still muted on these and other issues by its financial woes and “is under continuing pressure to retreat to a purely technical role and to withdraw from any effective engagement with the political and economic dynamics that characterize the global health crisis” (p.5).

As with previous editions, GHW4 concludes with stories of resistance and struggle. Latin America again is prominent, evidence of the profound social and political changes that have characterized that region as a focal point of neoliberal opposition. But resistance is global. From India’s right to food movement to Australian Aboriginal controlled health services, GHW4’s final section illustrates that popular health struggles continue, community-controlled services work, and globally linked movements represent an ‘optimism of the will’ to counter the too-often experienced ‘pessimism of the intellect’ (with apologies to Gramsci). There is no pretense that these oppositional struggles will succeed. But what GHW4 represents, in its inception, development, writing, editing and production, and in the very content it creates, is a self-conscious effort to overcome the individualization of our social, political and economic lives that has been the thrust of the 40 year neoliberal project, through a deliberately collective endeavour to re-ignite the soul of solidarity.

Health Inequalities

The Scottish Referendum and Health Equity

In this guest post, Beth Thomas discusses what the Scottish Referendum means to her as a medical student and as a citizen of Scotland. Beth is currently a final year medical student at the University of Glasgow who has been working with Medsin UK for the past 5 years. She is currently the Scottish and Northern Irish Coordinator […]

Bangladesh

Global Trade and Health: Rana Plaza, One Year On

Last Thursday marked the one year anniversary of the Rana Plaza tragedy in Bangladesh, which left more than 1100 dead and many more injured. The disaster has been described as one of the worst industrial accidents in modern history. In the year since the accident, we have witnessed a number of initiatives aimed at providing compensation to […]

Canada

Canada and the post-2015 world: Part II

In this post, guest blogger Ronald Labonté concludes a two-part blog series about post-2015 development goals. Discussed are their relationship to health and specific steps Canada could take to encourage a healthy and progressive transition. Labonté holds a Canada Research Chair in Globalization and Health Equity at the Institute of Population Health, and is Professor in the Faculty […]

Canada

Canada and the post-2015 world: Part I

In this post, guest blogger Ronald Labonté introduces a two-part blog series about post-2015 development goals. Discussed are their relationship to health and specific steps Canada could take to encourage a healthy and progressive transition. Labonté holds a Canada Research Chair in Globalization and Health Equity at the Institute of Population Health, and is Professor in […]

Global

Healthcare spending and health: looking beyond the money

This graph was posted on the Atlantic last week and illustrates the striking relationship between healthcare spending and life expectancy.  There are many important and interesting aspects to this relationship, which has been documented for some time, but there is one aspect which is seldom discussed when the topic surfaces in mainstream media outlets. One […]

Canada

Canada’s Austerity Agenda: It’s About the Taxes

Austerity policies pose major threats to the public’s health. In this guest post, Ronald Labonté argues that the austerity agenda in Canada stems not from a crisis in finances, but from a crisis in fair taxation. Labonté holds a Canada Research Chair in Globalization and Health Equity at the Institute of Population Health, and is Professor in the Faculty of Medicine, University of Ottawa; and in the Faculty of Health Sciences, Flinders University of South Australia.

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#StandingwithDNLee

Readers of Healthy Policies will know that inequities in health are very much rooted in inequities of power. Recent posts by Ted Schrecker have outlined how political trajectories shape landscapes of health disparities. A defining feature of these trajectories is that in addition to being determined by unequal distributions of power, they also perpetuate the […]

Canada

Changed priorities ahead? An anti-Thatcherite view of health and equity

As a follow-up to last week’s guest post, this week Ted Schrecker outlines the political trajectories which have not only shaped current landscapes of health disparities, but also continue to obstruct avenues towards achieving greater health equity. He challenges us to consider the prospects for national-level inroads and contemplates whether the future lies in more localized efforts. Ted is a Professor of Global Health Policy at Durham University.

Global

Acting to reduce health inequity: How much evidence is enough?

It is often asserted that more evidence is needed to take action on the social determinants of health. In this guest post Ted Schrecker identifies such claims as a key obstacle to achieving health equity. He argues that to overcome this obstacle, we must recognize that decisions about how much evidence is enough are irrevocably […]

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