Last week I attended the launch of the Global Health Watch 5 in Brussels. The launch (on 29 March) was a joint event organised by the working group “Determinants of International Health”, a group that has regular meetings, organizes events, writes contributions for international events, and publishes documents. Organisations involved this time were: Be-Cause Health, Action platform Health and Solidarity, G3W-M3M, FOS, Memisa, Christelijke Mutualiteiten, African European Faith and Justice Network, Geneeskunde voor het Volk, Socialistische Mutualiteiten, People’s Health Movement, Wereldsolidariteit, Solidar, CNCD-11.11.11, TAM-TAM and Solidarité Socialiste. The aim of the event was to address the key challenges facing governments and health practitioners today, within the context of rapid shifts in global and national governance mechanisms and the UN’s Sustainable Development Goals (SDGs). The Global Health Watch aims to challenge the mainstream global health discourse, and this fifth version is no exception.
I can say without any fear of contradiction that the Global Health Watch launch was quite interesting and beneficial to me. Global targets are frequently set but rarely met, which motivates the need to look at both global concerns and local particularities. The economic consequences of poor health in many countries have been the centre of attention for many years, and the same is certainly true for me. I learnt a lot during the launch, and I found that I still have much to learn, even though most of the issues were not new to me. Below I will try to give some key message delivered by David McCoy, well known in global health circles and certainly among readers of this newsletter, in a keynote speech at the event. I will also give some of my own reflections in this regard.
First of all, it is important to understand why David McCoy said what he said at the launch. We are involved in a struggle for health (everyone ‘s health worldwide), he emphasized, and if we want to win this struggle we need to understand the issues and engage with them, in order to liberate ourselves.
McCoy started the discussion by providing a general history of the GHW-5 Report. The Report – the fifth edition already of the Global Health Watch report – is divided into five sections: Political Economy; Health Sector; Beyond the Health Sector; Watching; Alternatives, Actions and Change. It focuses on what is happening in the field, on the ground, and at the global level.
McCoy made a very powerful statement about global inequality and emphasised the need to mobilize people’s health “movements” as problems of inequality within countries cannot be addressed without observing and taking into account global issues.
According to McCoy, a political economy of health highlights two fundamental matters, which he thus considers as the key challenges for global health in the 21st century: 1) the state of global inequality and 2) ecological collapse. Inequality is a central issue that we need to address as a global health community because it lies at the heart of all the issues we face. It is often a question of inequality in terms of power and political influence, where power is concentrated in the hands of the few and so it causes moral, cultural, social and economic crises. Regarding ecological collapse, McCoy’s argument was that environmental degradation is already causing a number of vicious cycles. He also discussed food problems that we face over weather conditions and greenhouse emissions that we have failed to avoid, even after decades of scientific warnings.
McCoy devoted a great deal of attention to neoliberalism, which is one of the root causes of global health issues and challenges. If we are to understand the struggle we’re in, we need to understand also what we’re up against, and thus have a firm grasp of neoliberalism, he emphasized. Neoliberalism is not a science nor the natural human condition, rather it’s the belief that free markets are best for allocation of resources. McCoy also pointed out the ideas in neoliberalism that there is no limit, and that “greed is good” for the economy, presumably because wanting ever more stimulates economic growth. He made reference to two books, one of which was “A short history of neoliberalism by Susan George” (1999). In this book, George describes neoliberalism as a doctrine that sees competition as the best way to improve society.
McCoy also mentioned the importance of getting involved in democratic politics because according to him for global health to be improved, we need to redistribute wealth and power, and we need to constrain the destructive power of multinational corporations (MNCs) and private capital. The only way to do this is through politics, he emphasized. There is now so much power concentrated in few hands and we can see evidence everywhere of democracy having been undermined. As an alternative, he said people can change things through protest, boycotts, blockades, strikes, etc. This is how the suffragettes and civil rights movement kickstarted real change. And it is not inappropriate to draw parallels between apartheid South Africa and the current global political economy.
McCoy also argued for “Public-Public-Partnerships” which he defined as cooperative working arrangements between separate organisations that work in the public sphere or in the public interest. They can include government departments, publicly funded universities, public-interest NGOs and charities, a publicly funded press like the BBC, ombudsman bodies, etc. As you might have guessed, the term is designed to provide a counter-posing view to that of public-private partnerships (‘PPPs’). In his opinion, it’s vital to set up broad(er) alliances with organisations outside the health sector also, and try to change things on various global platforms and political venues (WTO, WHO, WB, IMF, G20, …). That’s where (part of) the real battle happens, rather than in ministries of health.
We shouldn’t be too romantic about government, he acknowledged, as most of the global inequalities that we see are in fact caused by governments. Also, public–public partnership does not mean that there shouldn’t be any partnerships with the private sector. But he stressed the focus should be more about shaping the way in which we think about politics. Human beings are susceptible to propaganda. This is how millions of dollars are being used. Therefore, education is very important; we have to be careful about media and the information we receive. It is important to engage citizens in political discussions. I concur with him; we need good people in politics and in parliament, and citizens really have to become ‘citizens’ again, not just consumers.
We must also think of the global community, he argued. He gave the example of Facebook, which has created a lot of global dis-community, and is creating divisions and groups. I don’t know whether Facebook’s creation of dis-community is deliberate or not, but McCoy did emphasize that we must form a positive global community for effective global governance. As for how exactly to do that, he was a bit less clear.
David McCoy ended his keynote by stating that we need “public humanitarianism”, beyond medical humanitarianism. We have humanity and our common humanity must thus be used to strengthen our humanitarian public health. For this endeavour to be successful, we need to engage with political powers and also use education as a political action.
In conclusion, a few criticisms perhaps. It is very important to mention that we keep having similar conferences and seminars analysing the same issues as addressed by McCoy and other panellists at this event, but no substantial action ever seems to be taken afterwards. I admit that these movements, like the People’s Health Movement, are very critical and sharp in their analysis. However, they’re a bit weaker when it comes to solutions and ways forward. A lot of what they say is very true, for example when it comes to the need to go back to our roots and rethink politics. Too often we consider politics as a ‘dirty game’. Yes, it is, I think, a ‘dirty ‘ game because bad people are in politics, and so we need (more) good people in politics to make a beneficial contribution to the struggles we face. In such a light, it is somewhat doubtful whether the People’s Health Movement is indeed a movement and not merely trying to be a movement.
I hope that real change is possible. I am hoping for change and I am hoping that we can create that global community for effective global governance. And let me end on this note: I strongly admire David McCoy’s continued fight for change, even if he admitted being a pessimist himself. Somehow this pessimism didn’t lead to cynicism, and that’s a lesson for all of us.