The Alma Ata Declaration (1978), the outcome of a joint initiative by the WHO and the UNICEF, proclaimed that “the main social target of governments, international organisations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life.”
Now, three decades and more after the solemn declaration and ten years after the target date, the world is nowhere near the goal of “Health for All.” The Infant Mortality Rate in Saharan Africa is well above the 100 mark. Even in countries like India, the growing strength of the economy is not reflected in the health care indices. It is time to visit the way health care is delivered in various countries and their impact on the population. The imperative is all the more because there is a consistent effort to privatise health care delivery systems globally.
State-sponsored health care system in Western Europe and the United Kingdom is passing, slowly but systematically, into private hands. In the United States, President Obama triumphed by promising a better health care delivery system that would not impoverish the uninsured.
In this book, renowned public health activists provide a critical analysis of the impact of neoliberal globalisation on health care. Neoliberal globalisation and privatisation of health care delivery systems across the world rests on two popular assumptions: cost-containment and improved efficiency.
Colin Leys, in his essay “Health, health care and capitalism”, demolishes both these myths by citing several research papers to establish that privatised health care is neither cost effective nor more efficient than a state-sponsored one.
Hans-Ulrich Deppe makes a very valid point about competition in medicare. In a competition, there are winners as well as losers. In the realm of medicare, the losers are the chronically ill and the seriously ill. And these are the ones who need medical care and social support more than the others, and most urgently too. The impact of privatisation of medical research on medical ethics is remarkable.
Deppe cites a U.S. study that finds “every third researcher had committed a punishable crime in their own research during the last 3 years... due to pressure of the financial sponsors.” He asserts that “health is not a commodity.”
In his essay on “Inequality and Health”, David Coburn blames the skewed economic growth for the wide disparities in health indices between countries. If one is to understand why a child born in Swaziland is 30 times more likely to die before the age of five than a child born in Sweden, it is necessary to have some knowledge of the political economy of health care delivery systems. This is acknowledged by the WHO when it declares that “social injustice is killing people on a grand scale.”
Kalman Applbaum speaks of what he calls “medicalisation” and ‘pharmaceuticalisation” of the health care delivery system. Pharmaceutical sales, in recent years, have increased at a compounded annual rate of 10 per cent. This trend is attributable to the vigorous promotional campaign and sales drive the pharmaceutical majors launch to push their products.
He cites an instance where the money spent by a reputed company on promoting the sales of a certain drug in 2002 was 100 times that of the health budget of Haiti in that year.
The core message of the book is that mindless privatisation of the health care delivery system in various countries, which is the result of neoliberal globalisation, is counter-productive to achieving a reasonable level of health. The contributors seek to establish this by critically examining the reforms in the U.S., Western Europe, and Canada. They also mention specific diseases like HIV and malaria to prove their thesis. Mohan Rao, who takes a hard look at the Indian scenario, argues against the ‘new political economy', which is threatening the marginalised and the poorer sections of the people.
On the positive side, how in the face of continued trade embargo by the U.S., Cuba has been able to achieve admirable improvement in health indices is documented. The reforms that are under way in China are also discussed in detail.
What emerges from this work is that there is no alternative to state-sponsored health care globally, if the goal of health-for-all is to be achieved, even if that should take some decades.