D Banerji, New Delhi
A critique of the report of the WHO commission on Macroeconomics and Health as highlighted in INHP Bulletin 10 March 2002
The Report on of the WHO initiated Commission on Macroeconomics and Health is a very disappointing document. It is ahistorical, apolitical and atheoretical. It is biased. Its contents are so highly skewed that it glosses over some of the such crucial interdisciplinary dimensions of the disciplines of health economics as epidemiology, choice of technology, cultural anthropology, sociology, political science and political economy and organisation and management (Banerji 1994). One can not also rule out possibilities of market considerations in its advocacy for focussing on select few communiicable diseases – Malaria, Poliomyelitis, AIDS and TB – as `international public good’; such programmes involve massive expansion of markets for vaccines, cold chain equipment, diagnostic kits antiretroviral and antituberculosis drugs, Control/eradication of these communicable diseases also help international business personnel to penetrate the hitherto untapped markets to sell their goods. Use of the eighteenth century economic concept of `Public Good’ seems to have a resonance of the (in)famous exclamation made by Marie Antoinette in the same century!
A very brief mention of three of the classic landmarks in the growth of concepts of public health is being made to underline some of the major infirmities in the Report.
- The Alma Ata Declaration of 1978 (WHO 1978): health as a fundamental human right; people (rather than the technology driven agenda of the rich countries) are the prime movers in the growth and development of their health services; intersectoral action in health; social control over the health services that are meant to serve them; coverage of the entire population; providing services in an integrated form; use of appropriate technology; use of the relevant elements from the traditional systems of medicine; use of only essential drugs, and so on.
- As early as in 1975, in his seminal publication, Medical Nemesis, Ivan Illich (1975) had produced convincing evidence about some very disturbing aspects of practice of Western medicine. He pointed out that market driven practice of medicine has been instrumental in causing various kinds of serious iatrogenic consequences, mystification of medical practice and promotion of unjustified dependence of people on an increasingly powerful medical profession. He had summed up these undesirable aspects by calling it `medicalisation’ of life of people. As the situation deteriorated further in the years that followed, he coined the term `systematisations of medicine’, `corporatisation of medicine’. He calls its present more advanced stage as `conglamoratisation of medicine’ (personal communication, 2000).
- Even earlier, in 1946, as a counterpart of the post-war Beveridge Committee of the UK, the report of the Bhore Committee set up by the then British Indian Government (Government of India 1946) proclaimed that `inability to pay should not be allowed to come in way of seeking health services by all the citizens of the country’.
Apparently, the Commission suffered from such massive blindspots that they could not see the significance of such critical concepts of public health practice in their study of the macroeconomic aspects of health. Even within this narrow vision, which is confined to the economic concept of a public good, there have been great deal of ambivalence in defining the scope of this obviously utopian concept, both globally as well as nationally. This is manifested in their identifying global health good only to a few of the numerous communicable diseases; the enormous task of combating such problems as undernutrition and malnutrition, maternal mortality and morbdity, anaemia and pneumonia seem to have entirely escaped their attention span while they made recommendation for making health as a global public good. Also, considering the very narrow vision of the Commission, it is not unexpected that they overlooked the patently poor performance of the earlier global initiatives in health for which the rich countries have poured in billions of dollars (Banerji 1999). Also, dutifully following its very distorted thinking, The IPHN Bulletin starts by entioning,`The World Health Organization is calling for a massive investment by the rich governments of the world into the health of the world’s poor’. The figure given by the Commission is US$27 billion annually by 2007′, which is `estimated to save 8million lives per year’.
It is interesting that the `eminent’economist and a former Finance Minister of India, Man Mohan Singh has been quoted as observing, `We have an historical opportunity to combine and use resources and know how to ensure better health and economic growth in just a couple of decades. If we want security in our lifetime and the future generations, we can not afford to miss this opportunity’. Milan Kundera has observed that `Man’s struggle against oppression is a struggle between memory and forgetfulness’. Man Mohan Singh conveniently `forgets’ that as the then Union Finance Minister who initiated infamous structural adjustment programme in India in 1992, he presided over the decimation of the health services in the country by inflicting a massive 20 per cent cut in the Union Health Budget (excluding the annual inflation of over 10 per cent). Ironically, Singh’s knife fell particularly severely on the malaria programme – a cut of 40 per cent (World Bank 1992).
Banerji, D (1992): A Simplistic Approach to Health Policy Analysis: World
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Banerji, D (1999): A Fundamental Shift to Approach to International Health by WHO, UNICEF and the World Bank:Instances of Practice of Intellectual Fascism and Totalitarianism in Some Asian Countries, International Journal of Health Services, vol.29, pp.227-225.
Government of India, Health Survey and Development Committee (1946). Reoprt Delhi, Publications Division.
Illich,I (1975) Medical Nemesis, London, Penguin.
World Bank (1992) India:Health sector Financing, Washington D C,
World Health Organization and UNICEF (1978): Primary Health Care: Report of the International Conference on Primary Health Care, Alma Ata, USSR, Geneva, WHO
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