IPHN MEETING BACKGROUND PAPERS
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RF_COM_H_84_SUDHA
W( Id Health Assembly Spec il
No. 4
21 May 1999
J p H ru
The Nevmtte^
Unified call to fight pove
I?
Good health is a question of
priorities, not income - Dr Sen
nr- inancial conservatism
J™ should be the nightI marc or the militarist,
not the doctor, or the school
teacher, or the hospital nurse,”
Nobel Laureate Amartya Sen told
the World Health Assembly
Tuesday.
Professor Sen, a scholar from
India whose work produced a
new understanding of the catas
trophes that plague society's
Dr Sen speaking to delegates
Tuesday
poorest people, won the Nobel
Economics Prize last year Tor his
contributions to welfare econom
ics, which help explain the eco
nomic mechanisms underlying
famines and poverty. Sen "re
stored an ethical dimension to the
discussion of vital economic
problems," the 1998 Nobel cita
tion said.
The 65 year-old economist,
Master of Britain’s Trinity Col
lege in Cambridge (UK) and
former Lamoni University Pro
fessor Emeritus al Harvard Uni
versity, said that fast economic
growth has helped improve
health in some countries where
the growth is wide-based and in
come is used to expand health
care education and social securi
ty. However, other countries have
used "support-led processes that
work through a programme of
skilful social support of health
care, education and other relevant
social arrangements" to enhance
living conditions and reduce mor
tality rates, even without much
economic growth", he noted.
Because of this support-led
process, he said, "Despite their
very low levels of income, the
people of Kerala (India), or Chi
na, or Sri Lanka enjoy enormous
ly higher levels of life expectan
cy than do the much richer popu
lations of Brazil, South Africa and
Namibia, not to mention Gabon.”
"And yet, when it comes to
health and survival, perhaps
nothing is as immediately impor
tant in many poor countries in the
world today as the lack of medi
cal services and provisions of
health care,” Professor Sen said.
Citing a recent study called "In
fections and Inequalities: The
modern plagues," by Paul Fann
er, he said “a major difference can
be brought about by a public de
termination to do something
about" pervasive deprivation of
biomedical services, both for eas
ily treatable diseases like cholera
and malaria and more challeng
ing ailment like AIDS and drug
resistant Tuberculosis.
The issues of social alloca
tion of economic resources “can
not be separated from the role of
participatory politics and the
reach of informed public discus
sion," he said.
"The public has to sec itself
not merely as a patient, but also
as an agent of change. The pen
alty of inaction and apathy can
be illness and deaUi," Professor
Sen concluded.
Closer cooperation the way to
better health - Dr Brundtland
he World 1 leallh Organiza
tion will work closely with
Member States and other
UN organizations to substantial
ly.improve the health conditions
of the world's poorest.
"We arc not aiming at mod
est gains," WHO Director-Gener
al Gro Harlem Brundtland told
delegates al the52nd World Health
Assembly - die Organization's
annual “shareholders’ meeting".
"In East Asia, life expectancy in
creased by over 18 years in the
two decades that preceded (he
most dramatic economic take-off
in history. Repeat these gains and we could be launching a new
leap forward for human progress
and development."
In addition to the formal res
olutions adopted al every Assem
bly, this one will also contain
round-table discussions on key
health questions, a lecture by
Nobel Laureate Amartya Sen on
health’s role in development, and
a large number of associated ac
tivities - ranging from a World
Bank report on the economics of
tobacco to briefings on WHO’s
role in relief work in the Balkans.
In her speech to the Assem
bly, Dr Brundtland spelt out the
role WHO will play in the years
to come to ensure that the one
billion who have so far been ex
cluded from the health “revolu
tion" of the second half of the
twentieth century will sec dras
tic improvements in lheir health
in the coming decade. Having re
structured Headquarters and
brought about a realignment to
ensure that regional offices and
Headquarters share priorities and
work effectively, WHO is now
ready to focus on the challenges
ahead. Dr Brundtland said.
She said WHO is working
T
"Health is a fundamental human right," Dr Brundtland said.
“We need public voices to speak out for all those who are
denied dteir human rights to health. “You can count WHO as
one (of these voices)."
South African anti-smoking laws to stay
outh Africa’s health minis
ter, Dr Nkozasana Zuma,
has reiterated her country’s
determination not to bow to pres
sure from the powerful South Af
rican tobacco lobby smarting un
der the country's tough new anti
smoking laws.
The legislation, recently
signed by President Nelson Man
dela, bans the advertising of to
bacco products. It also bans
sports and arts sponsorship by
tobacco interests, the use of to
bacco trade marks on other prod
ucts, and smoking in public plac
es, including the workplace.
"They (the tobacco industry)
are putting a lot of pressure on
S
us through die media, sometimes
attacking me personally and try
ing to mobilize the trade unions
against us ...but our position is
that everybody must comply
(with lhe anti-smoking laws),"
Dr Zuma told reporters.
Addressing charges by lhe
tobacco lobby that the new laws
violate the constitutional princi
ple of freedom of expression, she
replied: “ Freedom of speech is
not an unlimited right; there are
limitations to every right and we
strongly feel that this is an area
where the limitation has to be ap
plied."
The Minister said govern
ment would work with players in
the tobacco industry to help them
diversify intoothcrequally prof
itable ventures. Tobacco is a
multi-billion Rand industry in
South Africa, employing some
200,000 people. "We did a study
on lhe economic implications of
doing something or doing nodting about tobacco use in our
country, nnd came to Ute con
clusion that the economic conse
quences of doing nothing are
much more dire," she said.
With the introduction of to
bacco advertising bans, South
Africa joins more than 22 others
with complete or near-complete
advertising bans, in line with a
May 1990 WHO resolution.
South African Health Minister Dr Nkozasana Zuma Monday
was honoured by the World Health Organization for her efforts
to rein in the tobacco industry and control the tobacco epidemic
in South Africa.
more closely with Member
States, both through increased
day-to-day cooperation with the
missions in Geneva, by establish
ing a closer and more strategic
work with WHO's Executive
Board, and through clearer polit
ical leadership of the World
Health Assembly.
“It is my hope that discussions
and decisions during the coming
days will send a clear health mes-
Dr Brundtland addressing the
Assembly Tuesday
sage to the world," she said.
She added that the dialogue
initialed with the World Bank anti
the International Monetary Fund
over lhe past months had been
fruitful and would be intensified.
A key factor in Wl lO's new
priority-setting is to emphasize the
economic benefits from improved
health and the need for cost-effec
tive, equitable health systems.
"A five year difference in life
expectancy may yield an extra
annual growth of 0.5 percent. Il
is a powerful boost to economic
growth,” Dr Brundtland said, re
affirming conclusions of the
World Health Report, which she
presented to Assembly.
Editorial
2
Smallpox eradication
2
Mental health problems
on the rise in Mongolia
2
New information products
for “one WHO"
2
Amartya Sen on
development and health
3
World Bank launches
report on the economics
of tobacco control
4
Twenty-two nations
discuss ways to put health
at the core of
development Work
4
By Adrca Mach
In her address to the World Health
Assembly, Dr Brundtland landed
keynote speaker Professor Am
artya Sen, 1998 Nobel Laureate
in economics, as "having placed
poverty and development at the
cote ofeconomic theory and, link
ing the social and economic di
mensions of human develop
ment". The interview below is a
TO OUR HEALTH exclusive in
terview with Professor Sen.
Development economics fo
cuses on “the world’s most
enduring problem", persistent,
widespread poverty. Where
docs health fit into the pover
ty picture?
If one thinks of poverty only
as low income, then tile health link
is indirect: it is easier to earn a liv
ing and alleviate poverty when
one is in good healtli. On the oth
er hand, if we tliink of poverty as
basic deprivation of die quality of
life and of elementary freedoms,
then ill health is an asfiect of pov
erty. Bad health is constitutive of
poverty. Premature mortality, es
capable morbidity, undernourish
ment are all manifestations of pov
erty. I believe that health depri
vation is really the most central
aspect ofpoverty.
You are keen to reduce poverty,
especially through better edu
cation and improved health
coverage, so that entire socie
ties may benefit. But if we do a
tcnllly check, what nbout coun
tries like India! Is univetsal
health coverage really feasible
over the short to medium term!
Or is this an idealistic illusion!
Indeed, it would be quite dif
ficult to provide sophisticated
medicine for every person in In
dia. But basic medical carecan be
guaranteed to every human being,
even in a poorcountiy like India.
Some areas of India arc much
better provided in tenns of health
care than others. For example,
Kerala has very wide health care.
Now Kerala is not any richer than
the rest of India; it's in fact slight
ly poorer on average. If Kerala can
do it, the rest of India also can. In
fact, in tenns of survival to ma
ture ages, the African American
population in the United States,
though many times richer than the
population of Kerala, actually has
a lower chance of survival to ma
ture ages. Low per capita income
is not really such a barrier. Tliat’s
the first thing.
Secondly, basic medical care
is very labour-intensive. In a low
wage economy, the state has less
money to spend on health care,
but it also needs less money to
spend on (he same amount of
health care because the cost of
medical services is lower. That
is a very important economic
consideration. So if you do a re
ality check, you should consider
how much the stale must spend
but also what the expenses arc
and by how much good econom
age is no Utopian illusion at all,
even for very poor economies.
What is the relative impor
tance of public vs. private sec
tor funding, especially for re
ally impoverished countries!
Tire importance of the public
sector in fields like health care is
very well established. There is no
way the private sector can do as
much. Those who think privately
financed medicine could do it all
are mistaken. Private insurers
don’t have the incentive to cover
the most vulnerable people be
cause it's always against the in
terests of an insurance company
to cover someone who is more
likely to become ill.
However, I quite agree that
we have to consider how to im
prove the quality of public sector
healtli ciue delivery. The market
gets its incentives from tire profit
motive, but it is radier neglectful
in the field of healtli care. When
it conics to the public sector, you
have to provide die same incen
tive in oilier ways. That requires
active public discussion on health
care provision; it requires constant
vigilance about die quality of hos
pital, medical, nursing services,
etc. This incentive has to be pro
vided through the medium of pub
lic discussion and criticism.
to place the issue of health care
right at the centre of Ole devel
opment agenda.
Secondly, there are enor
mous interdependencies between
different kinds of deprivations.
For example, the deprivation of
health is bad even for the econo
my because people's productivi
ty depends on their level of nu
trition and health. The function
ing of the economy suffers from
illness-related absenteeism.
One of the Director General’s
priorities is Roll Back Malaria. As
someone who did suffer from
malaria very early in my life, I can
tell you that it's extremely debili
tating. Il is important to sec die
interconnection and die impact of
healtli and healdi development,
not just on die lives diat human
beings directly lead, but also what
they can do as productive agents
in die economy and as agents of
social and political change. These
arc all part of die development
agenda.
Health should be seen as an
Today’s world is characterized
by increasing privatization of
medical care. For example,
consider the US model where
costs arc going up, quality is
going down and more and
more people are being left out.
Today 16% of America's GDP
is consumed by healtli related
expenditures and even this
doesn’t do the job - there arc
still 44 million Americans
without health insurance. If
this type of model spreads,
where will it lead in terms of
the goal of Healtli for All!
integral part of the development
agenda. There is, first of all, the
basic recognition that deprivation
of health is an aspect of under
development. Just as for the in
dividual, not having medical
treatment for curable ailments
constitutes poverty, similarly, for
a country, not having adequate
health arrangements is a part of
underdevelopment. So you have
That aspect of American
medical arrangements is not one
of glory. There arc others which
arc quite glorious: the statistics
of survival after die diagnosis of
cancer, for example, show almost
twice as many years in America
ns in, say, Britain. That is some
thing that Americans do right.
That is a characteristic of the ef
ficiency of the system for those
In the past, healtli has often
been both Isolated and Isola
tionist. How can health now
be mainstreamed into the
broader development agenda!
In some Indian states, good public health care has ensured health indicators that arc on
par with those of much richer countries
who can afford it.
But (he glaring defect of the
American system is that it ne
glects lots of people who simply
cannot afford it, like diose who
don't have medical insurance.
You mentioned the number 44
million without medical insur
ance - diat figure seems to be go
ing up relentlessly. Il is not just
specialized medicine; people
may be deprived of even the most
elementary health care.
One has to recognize that die
nature of the market economy
makes it very efficient for certain
types of production, like stand
ard types of industries. But it’s
not very good for other kinds of
economic activity, particularly
medicine.
There are two reasons: one
is that many of the results of med
ical care have the feature of be
ing what economists call public
good which affects not only the
well-being of that person but also
ic organization can reduce them,
building on the low wages that
make health care Hurt much The legacy of apartheid has left South African health services far behind other countries at a
cheaper. Universal health cover- similar economic level
of others, for example with infec Freedoms are of different kinds
tious diseases which arc conta -social opportunities(which ingious to others. In dealing with chide health cure). nimkcl mid
public goods, markets arc notori economic opjx)r( unities, and po
ously defective.
litical freedom in the form of par
Second, the pattern of risk in ticipation in society and dccisionmedicine makes the market less making. in different ways.
efficient because, as I discussed freedoms affect our lives, from
before, it’s always in the interest different ends. But as it happens,
of private insurance to try to gel they arc highly complementary.
out of covering those who nrc
For example, you do not have
most likely to need medical care. famines in a democratic country
But these are people for whom because the government could not
medical care is most important.
face the polls or the criticism of
It’s a question of trying to tain opposition parties if it had a fam
the efficiencies that American ine. There arc other complemen
medical systems have - one tarities like social opportunities in
should not deny those; they arc the form of health care and edu
radically important. If you have cation which make it easier for
a serious illness, you have a very people to participate in a market
good reason to go to America for economy, especially in a rapidly
treatment - if you can afford it. globalizing world. Freedoms of
And yet it’s not very benign in different kinds feed each other,
tenns of its coverage of the poor support each other, consolidate
est. So we have lessons to learn. each other.
The way you put it, in tenns of
I would like to argue that
the limits of (he market economy, freedom is very central to devel
is a very good way of understand opment. both as ends and as
ing it. We must pay adequate at means. It’s the complementarity
tention to the role of public poli of different kinds of freedom
cy in dealing with medical care.
which makes the analysis of “de
velopment as freedom" a partic
You have emphasized “the
ularly fruitful thing to pursue.
abiding role of values as central
Consolidating freedom of one
to growth and development,"
kind helps consolidate freedom
saying that “development is a
of other kinds. This is a very cen
measure of human freedom”
tral issue in facing the challeng
and that "health is crucial to
es of the 21 M century. The differ
freedom”.
ent aspects of freedom must in
Yes, I have a book coming fluence the agenda of the com
out in September which is called ing century.
Development as Freedom. It's an
attempt to see development as en
hancement o[ human freedom. I
argue that freedom is the prima Professor Amartya Sen is Mas
ry end of development. Develop ter ofTrinity College. Cambridge
ment isn’t about raising GNP. No and isfonlttirPresident ofthe In
one wants money for its own ternational Economic Associa
sake. One wants money for some tion, the American Economic
thing else, including good health. Association, the Indian Econom
To be free to lead a good life, not ic Association, and the Econo
to be cut off prematurely, not to metric Society. The Royal Swed
have to sulTcr escapable ailments. ish Academy awarded him the
Freedom of different kinds is con Nubel Prize td economies in /99.S*
stitutive of development.
by citing hiS work in welfare eco
Freedom is not only the pri nomics and, in particular, on so
mary end of development, it cial choice theory, poverty and
is also its principal means. inequality.
Wfld Health Assembly Spe<*il
No. 4
21 May 1999
The Newsletter of the World Health Organization
Unified call to fight pove
Good health is a question of
priorities, not income - Dr Sen
/Jr- inancial conservatism
fr" should be the nightI mare of the militarist,
not the doctor, or the school
teacher, or the hospital nurse,”
Nobel Laureate Amartya Sen told
the World Health Assembly
Tuesday.
Professor Sen, a scholar from
India whose work produced a
new understanding of the catas
trophes that plague society’s
Dr Sen speaking to delegates
Tuesday
poorest people, won the Nobel
Economics Prize last year for his
contributions to welfare econom
ics, which help explain the eco
nomic mechanisms underlying
famines and poverty. Sen “re
stored an ethical dimension to the
discussion of vital economic
problems,” the 1998 Nobel cita
tion said.
The 65 year-old economist,
Master of Britain’s Trinity Col
lege in Cambridge (UK) and
former Lamont University Pro
fessor Emeritus at Harvard Uni
versity, said that fast economic
growth has helped improve
health in some countries where
the growth is wide-based and in
come is used to expand health
care education and social securi
ty. However, oilier countries have
used "support-led processes that
work through a programme of
skilful social support of health
care, education and other relevant
social arrangements” to enhance
living conditions and reduce mor
tality rates, even without much
economic growth”, he noted.
Because of this support-led
process, he said, "Despite their
very low levels of income, the
people of Kerala (India), or Chi
na, or Sri Lanka enjoy enormous
ly higher levels of life expectan
cy than do the much richer popu
lations of Brazil, South Africa and
Namibia, not to mention Gabon.”
"And yet, when it comes to
health and survival, perhaps
nothing is as immediately impor
tant in many poor countries in the
world today as the lack of medi
cal services and provisions of
health care,” Professor Sen said.
Citing a recent study called “In
fections and Inequalities: The
modem plagues,” by Paul Farm
er, he said "a major difference can
be brought about by a public de
termination to do something
about” pervasive deprivation of
biomedical services, both for eas
ily treatable diseases like cholera
and malaria and more challeng
ing ailment like AIDS and drugresistant Tuberculosis.
The issues of social alloca
tion of economic resources “can
not be separated from the role of
participatory politics and the
reach of informed public discus
sion,” he said.
‘The public has to see itself
not merely as a patient, but also
as an agent of change. The pen
alty of inaction and apathy can
be illness and death,” Professor
Sen concluded.
Closer cooperation the way to
better health - Dr Brundtland
he World Health Organiza
tion will work closely with
Member Slates and other
UN organizations to substantial
ly improve the health conditions
of the world’s poorest.
“Wc are not aiming al mod
est gains,” WHO Director-Gener
al Gro Harlem Brundtland told
delegates at the 52nd World Health
Assembly - the Organization’s
annual “shareholders’ meeting”.
“In East Asia, life expectancy in
creased by over 18 years in the
two decades that preceded the
most dramatic economic take-off
in history. Repeat these gains and we could be launching a new
leap forward for human progress
and development.”
In addition to the formal res
olutions adopted at every Assem
bly, this one will also contain
round-table discussions on key
health questions, a lecture by
Nobel Laureate Amartya Sen on
health’s role in development, and
a large number of associated ac
tivities - ranging from a World
Bank report on the economics of
tobacco to briefings on WHO’s
role in relief work in the Balkans.
In her speech to the Assem
bly, Dr Brundtland spelt out the
role WHO will play in the years
to come to ensure that the one
billion who have so far been ex
cluded from the health “revolu
tion” of the second half of the
twentieth century will see dras
tic improvements in their health
in the coming decade. Having re
structured Headquarters and
brought about a realignment to
ensure that regional offices and
Headquarters share priorities and
work effectively, WHO is now
ready to focus on the challenges
ahead. Dr Brundtland said.
She said WHO is working
T
“Health is a fundamental human right,” Dr Brundtland said.
“We need public voices to speak out for all those who are
denied their human rights to health. “You can count WHO as
one (of these voices).”
South African anti-smoking laws to stay
outh Africa's health minis
ter, Dr Nkozasana Zuma,
has reiterated her country’s
determination not to bow to pres
sure from die powerful South Af
rican tobacco lobby smarting un
der the country’s tough new anti
smoking laws.
The legislation, recently
signed by President Nelson Man
dela, bans the advertising of to
bacco products. It also bans
sports and arts sponsorship by
tobacco interests, the use of to
bacco trade marks on other prod
ucts, and smoking in public plac
es, including the workplace.
“They (the tobacco industry)
are putting a lot of pressure on
S
us through the media, sometimes
attacking me personally and try
ing to mobilize the trade unions
against us ...but our position is
that everybody must comply
(with the anti-smoking laws),”
Dr Zuma told reporters.
Addressing charges by the
tobacco lobby that the new laws
violate the constitutional princi
ple of freedom of expression, she
replied: “ Freedom of speech is
not an unlimited right; there are
limitations to every right and we
strongly feel that this is an area
where the limitation has to be ap
plied.”
The Minister said govern
ment would work with players in
die tobacco industry to help them
diversify into other equally prof
itable ventures. Tobacco is a
multi-billion Rand industry in
South Africa, employing some
200,000 people. “We did a study
on the economic implications of
doing something or doing noth
ing about tobacco use in our
country, and came to die con
clusion that the economic conse
quences of doing nothing are
much more dire," she said.
Widi the introduction of to
bacco advertising bans, South
Africa joins more than 22 others
with complete or near-complete
advertising bans, in line with a
May 1990 WHO resolution.
South African Health Minister Dr Nkozasana Zuma Monday
was honoured by the World Health Organization for her efforts
to rein in the tobacco industry and control the tobacco epidemic
in South Africa.
more closely with Member
Stales, both through increased
day-to-day cooperation with the
missions in Geneva, by establish
ing a closer and more strategic
work with WHO’s Executive
Board, and through clearer polit
ical leadership of the World
Health Assembly.
“Il is my hope (hat discussions
and decisions during the coining
days will send a clear health mes-
Dr Brundtland addressing the
Assembly Tuesday
sage to the world.” she said.
She added that the dialogue
initialed with the World Bank and
the International Monetary Fund
over the past months had been
fruitful and would be intensified.
A key factor in WHO's new
priority-selling is lo emphasize the
economic benefits from improved
health and the need for cost-effec
tive, equitable health systems.
“A five year difference in life
expectancy may yield an extra
annual growth of 0.5 per cent. Il
is a powerful boost lo economic
growth,” Dr Brundtland said, re
affirming conclusions of the
World Health Report, which she
presented lo Assembly.
INSIDE
Editorial
2
Smallpox eradication
2
Mental health problems
on the rise in Mongolia
2
New information products
for "one WHO”
2
Amartya Sen on
development and health
3
World Bank launches
report on the economics
of tobacco control
4
Twenty-two nations
discuss ways to put health
at the core of
development work
4
To Our Health - 21 May 1999
______________ 3
Interview
r'
•
Amartya Sen on
development and health
By Adrea Mach
In her address to the World Health
Assembly, Dr Bmndtland lauded
keynote speaker Professor Am
artya Sen, 1998 Nobel Laureate
in economics, as "having placed
poverty and development at the
core ofeconomic theory and, link
ing the social and economic di
mensions of human develop
ment”. The interview below is a
TO OUR HEALTH exclusive in
terview with Professor Sen.
Development economics fo
cuses on “the world’s most
enduring problem”, persistent,
widespread poverty. Where
does health fit into the pover
ty picture?
age is no Utopian illusion at all,
even for very poor economies.
What is the relative impor
tance of public vs. private sec
tor funding, especially for re
ally impoverished countries?
The importance of the public
sector in fields like health care is
very well established. There is no
way die private sector can do-as
much. Those who think privately
financed medicine could do it all
are mistaken. Private insurers
don’t have the incentive to cover
the most vulnerable people be
cause it’s always against the in
terests of an insurance company
to cover someone who is more
likely to become ill.
However, I quite agree that
we have to consider how to im
prove the quality of public sector
health care delivery. The market
gets its incentives from the profit
motive, but it is rather neglectful
in the field of health care. When
it comes to the public sector, you
have to provide the same incen
tive in other ways. That requires
active public discussion on health
care provision; it requires constant
vigilance about the quality of hos
pital, medical, nursing services,
etc. This incentive has to be pro
vided through the medium of pub
lic discussion and criticism.
If one thinks of poverty only
as low income, then the health link
is indirect: it is easier to earn a liv
ing and alleviate poverty when
one is in good health. On the oth
er hand, if we think of poverty as
basic deprivation of tine quality of
life and of elementary freedoms,
then ill health is an aspect of pov
erty. Bad health is constitutive of
poverty. Premature mortality, es
capable morbidity, undernourish
ment are all manifestations of pov
erty. 1 believe that health depri
vation is really the most central
aspect ofpoverty.
You are keen to reduce poverty,
especially through better edu
cation and improved health
coverage, so that entire socie
In the past, health has often
ties may benefit. But if we do a
been both isolated and isola
reality check, what about coun
tionist. How can health now
tries like India? Is universal
be mainstreamed into the
health coverage really feasible
broader development agenda?
over the short to medium term?
Heallh should be seen as an
Or is this an idealistic illusion?
integral part of the development
Indeed, it would be quite dif
agenda. There is, first of all, the
ficult to provide sophisticated
basic recognition th at deprivation
medicine for every person in In
of health is an aspect of under
dia. But basic medical care can be
development. Just as for the in
guaranteed to every human being,
dividual, not having medical
even in a poor country like India.
treatment for curable ailments
Some areas of India are much
constitutes poverty, similarly, for
belter provided in terms of health
a country, not having adequate
care than others. For example,
health arrangements is a part of
Kerala has very wide health care.
underdevelopment. So you have
Now Kerala is not any richer than
the rest of India; it’s in fact slight
ly poorer on average. If Kerala can
do it, the rest of India also can. In
fact, in terms of survival to ma
ture ages, the African American
population in the United Slates,
though many times richer than the
population of Kerala, actually has
a lower chance of survival to ma
ture ages. Low per capita income
is not really such a barrier. That’s
the first thing.
Secondly, basic medical care
is very labour-intensive. In a low
wage economy, the slate has less
money to spend on heallh care,
but it also needs less money to
spend on the same amount of
health care because the cost of
medical services is lower. That
is a very important economic
consideration. So if you do a re
ality check, you should consider
how much the state must spend
but also what the expenses are
and by how much good econom
ic organization can reduce them,
building on the low wages that
make heallh care that much
cheaper. Universal heallh cover
to place the issue of health care
right at the centre of the devel
opment agenda.
Secondly, there are enor
mous interdependencies between
different kinds of deprivations.
For example, the deprivation of
health is bad even for the econo
my because people’s productivi
ty depends on their level of nu
trition and health. The function
ing of the economy suffers from
illness-related absenteeism.
One of the Director General’s
priorities is Roll Back Malaria. As
someone who did suffer from
malaria very early in my life, I can
tell you that it’s extremely debili
tating. Il is important to see the
interconnection and the impact of
health and health development,
not just on the lives that human
beings directly lead, but also what
they can do as productive agents
in the economy and as agents of
social and political change. These
are all part of the development
agenda.
in some Indian states, good public health care has ensured health indicators that arc on
par with those of much richer countries
Today’s world is characterized
by increasing privatization of
medical care. For example,
consider the US model where
costs are going up, quality is
going down and more and
more people are being left out.
Today 16% of America’s GDP
is consumed by health related
expenditures and even this
doesn’t do the job - there are
still 44 million Americans
without health insurance. If
this type of model spreads,
where will it lead in terms of
the goal of Health for All?
That aspect of American
medical arrangements is not one
of glory. There are others which
are quite glorious: the statistics
of survival after the diagnosis of
cancer, for example, show almost
twice as many years in America
as in, say, Britain. That is some
thing that Americans do right.
That is a characteristic of the ef
ficiency of the system for those
who can afford it.
But the glaring defect of die
American system is tliat it ne
glects lots of people who simply
cannot afford it, like those who
don’t have medical insurance.
You mentioned the number 44
million without medical insur
ance - ill at figure seems to be go
ing up relentlessly. It is not just
specialized medicine; people
may be deprived of even the most
elementary heallh care.
One has to recognize that die
nature of the market economy
makes it very efficient for certain
types of production, like stand
ard types of industries. But it’s
not very good for other kinds of
economic activity, particularly
medicine.
There are two reasons: one
is that many of the results of med
ical care have die feature of be
ing what economists call public
good which affects not only the
well-being of that person but also
of others, for example with infec Freedoms are of different kinds
tious diseases which are conta — social opportunities (which in
gious to others. In dealing with clude health care), market and
public goods, markets arc notori economic opportunities, and po
ously defective.
litical freedom in the form of par
Second, the pattern of risk in I ticipation in society and decision
medicine makes the market less I making. In different ways,
efficient because, as I discussed I freedoms affect our lives, from
before, it’s always in the interest different ends. But as it happens,
of private insurance to try to get they are highly complementary.
out of covering those who are
For example, you do not have
most likely to need medical care. famines in a democratic country
But these are people for whom because the government could not
medical care is most important.
face the polls or the criticism of
It’s a question of trying to tain opposition parties if it had a fam
the efficiencies that American ine. There arc other complemen
medical systems have - one tarities like social opportunities in
should not deny those; they arc the form of health care and edu
radically important. If you have cation which make it easier for
a serious illness, you have a very people to participate in a market
good reason to go to America for economy, especially in a rapidly
treatment - if you can afford it. globalizing world. Freedoms of
And yet it’s not very benign in different kinds feed each other,
terms of its coverage of the poor support each other, consolidate
est. So we have lessons to learn. each other.
The way you put it, in terms of
I would like to argue that
the limits of the market economy, freedom is very central to devel
is a very good way of understand opment. both as ends and as
ing it. We must pay adequate at means. It’s the complementarity
tention to the role of public poli of different kinds of freedom
cy in dealing with medical care.
which makes the analysis of “de
velopment as freedom” a partic
You have emphasized “the
ularly fruitful thing to pursue.
abiding role of values as central Consolidating freedom of one
to growth and development,”
kind helps consolidate freedom
saying that “development is a
of other kinds. This is a very cen
measure of human freedom”
tral issue in facing the challeng
and that “health is crucial to
es of the 21 '* century. The differ
freedom”.
ent aspects of freedom must in
Yes, I have a book coming fluence the agenda of the com
out in September which is called ing century.
Development as Freedom. It’s an
attempt to see development as en
hancement of human freedom. I
argue that freedom is the prima Professor Amartya Sen is Mas
ry end of development. Develop ter ofTrinity College, Cambridge
ment isn’t about raising GNP. No and isformerPresident ofthe In
one wants money for its own ternational Economic Associa
sake. One wants money for some tion, the American Economic
thing else, including good health. Association, the Indian Econom
To be free to lead a good life, not ic Association, and the Econo
to be cut off prematurely, not to metric Society. The Royal Swed
have to suffer escapable ailments. ish Academy awarded him the
Freedom of different kinds is con Nobel Prize, in economics in 1998
stitutive of development.
by citing his work in welfare eco
Freedom is not only the pri nomics and, in particular, on so
mary end of development, it cial choice theory, poverty and
is also its principal means. inequality.
Telegr.: (JNISANTE GENEVA
Tel.: (41 22) 791 21 11 Telex: 415416
FACSIMILE: (41 22) 791 07 46
Direct Facsimile;
WORLD HEALTH ORGANIZATION
CM - 1211 GENEVA 27 - SWITZERLAND
466'18
FACSIMILE
Message No.
From: J. Jameson, ICO
Fax No : (91 80) 55 333 58 Date'
P9/370/22
pages
To: Dr R. Narayan, Coordinator. Society for Community Health
and Awareness, Bangalore, India
Your ref:
Our ref:
Page 1 of 5
Subject:
9 December 1997
EACROkdtW T?J MEETING in'
17
DECEMBER 1997
Dear Dr Narayan,
Please find attached copies of the Baltimore Charter and the London Declaration, which John Martin
aksed me to fax to you
With best wishes.
Yours sincerely,
uha
eson
Divisjdn of Intensified Cooperation
(th Countries (ICO)
ia?3 ’ch
'ri’cCiot. ci '
YAaiiSS CHM
£S:?4
£661 '^0 '£
ACTION IN INTERNATIONAL MEDICINE
CONFERENCE ON HEALTH AND POVERTY
Co-sponsored by the Division of Intensified Cooperation with Countries
and Peoples in Greatest Need (ICO) of the World Health Organization
3-4 November 1995
77ie Conference on Health and Poverty held in London, 3-4 November J995, was sponsored and
organized by Action in International Medicine (AIM) and the Division of intensified Cooperation
with Countries and peoples in Greatest Need (ICO) of the World Health Organization. It was
attended by 85 eminent members of major health and development professions, representing some
50 Institutions ad Associations in 209 countries, in official membership with AIM, as well as
invited guests.
THE LONDON DECLARATION
The Conference on Health and Poverty meeting in London on this fourth day of November, nineteen
hundred and ninety-five, expressing the need for urgent action by all relevant international organizations
governments health, social and educational nongovernmental organizations, and all health and
development workers to address the issue of gross and increasing inequities between countries and the
widening gap between rich and poor within countries, hereby makes the following Declaration:
The Conference believes that the effects of political insecurity and the huge debt burden of many countries
are seriously undermining the global heal th achievements of the past three decades. WHO has declared
that worldwide action is required if a health catastrophe is to be prevented Although there has been some
improvement in health statistics in some countries, others are shameful and a disgrace to the 20th century
(See attached Fact Sheet) The rich are getting richer and the poor are getting sicker.
Poverty is both a cause and an effect of ill-health. Economic and social development is of basic
importance to the attainment of health for all. The promotion and protection of the health of all people
are essential o sustained economic ad social development of a. conntiy.
Experiences reported in recent years have established that strategies designed to alleviate poverty, to
relieve the suffering caused by unemployment, to generate employment and to foster social cohesion are
most likely to succeed when a multi-faceted, multi-sectoral and integrated approach is pursued. The long
term aim should be the creation of self-help environments jn which all human beings can solve their own
problems and have opportunities to earn their own way out of poverty through health and increased
productivity
Indignation leads to action
Underlying all action is the explicit recognition that to be effective, health must be addressed within the
broader framework of peace, security, literacy, employment, nutrition, safe water supplies and sanitation.
The Conference participants recognize that the ethics of all health professions provide a moral imperative
for addressing the health needs of all peoples without distinction and that the orientation of primary health
care towards equity also establishes health as a vehicle of poverty alleviation.
In view of these facts, they wish to express their great indignation and to call for urgent action to change
the present iniquitous situation.
AIM. working with, and through, its member organizations, resolves to define, coordinate, integrate, and
support country-specific action programmes in order to respond to the challenge, This is consistent with
its fundamental goals of promoting basic health care as a human right and actively working to support the
district health systems in the poorer countries,
The Conference therefore calls upon all AIM Member Institutions and Associations to convene follow-up
conferences on Health and Poverty in their own countries, bringing together representatives of all health
and development workers, appropriate agencies and organizations in order to identify and initiate specific
local and national activities. It also calls upon them to form a string world-wide network to influence
public opinion and policy makers and act to.
►
mobilize other health and development professionals to approach political leaders of their country to
urge them to make public commitments to reduce poverty and improve the health status of their
populations,
►
exchange and disseminate, information on trends in health and poverty and on successful and failed
interventions directed at tackling their causes and effects;
►
recognize, enhance and harness the potential energy resource of poor people themselves;
work for the direction of more health resources to the District level of their health care system,
►
foster and coordinate intersectoral and interagency collaboration, especially at District level;
►
work eliminate the mar ginalization of population groups such as lonely elders, disabled people and
refugees;
►
ensure that front-line health workers have appropriate training and also the ability to access and use
relevant information,
►
influence public opinion by liaising with members of the national and inteimational media;
►
lobby governments to reduce their economic dependence on harmful activities, e.g. the production and
promotion of arms and substances such as narcotics, drugs, nicotine and alcohol.
Lastly AIM recognises the enormity of the task it has set itself, and invites all other Institutions and
Associarinns of health professionals to join it and its members in this vital endeavour.
■ l . ■ 'W
':
i. -
i.aj'i
*Joc
_ : ‘J :I
i6ii
'6
Appendix
Fact Sheet
The number of the leastdeveloped countries (LDCs) (the poorest of the poor) rose from 27 in. 1975 to 48 in 1994.
Approximately 1.5 billion people tliroughout the world live in poverty and 700 million of these live in extreme
poverty. Their life expectancy is 50 years.
In richer nations, tire average life expectancy is 74 years. In developing countries it is 62 years.
Infant mrtality is 60 per cent higher in poor countries than in dveeloped natious.
Mothers in poor countries are 150 times more likely to die of complications of pregnancy and childbirth then
women in rich countries.
More than a billion people in dveeloping countries lack safe drinking water
Nearly two billion people lack access to safe sanitation.
In developing countries, 17 million people die each year from infectious and parasitic di seases. Most of these
deaths are linked with poor nutrition and an unsafe environment.
Some 240 million people (about 30% of the total population) are under-nourished.
In Brazil more than 200.000 children spend their lives on tire streets.
Even conservative estimates put tlie combined number of child prostitutes in Thailand, Sri Lanka and the
Philippines at 500,000.
In developing countries there are nearly 20 million internally displaced people.
Worldwide there are over 19 million refugees.
Around 15 mission people are believed to be HIV-positivc, some 80% of them in developing countries.
In industrialised countries on average there is 1 doctor for every 400 people. In Sib-Saharan Africa the figure is
1 per 36,000.
One-fifth of humankind, mostly in industrialized countries, has well over four-fifths of the global income.
lu the European Union countries, 44 million people (some 28% of tlie total workforce) receive less than have the
average income of their country.
Over the past 20 years, the narcotics industry has grown from a small cottage enterprise to a highly organized
multinational business employing hundreds of thousands of people and generating billions of dollars in profit.
In the USA, consumer spending on narcotics is believed to exceed tlie combined GDPs of 80 developing countries.
Across the world, there are an estimated 150 million unexploded landmines buried in unmarked locations.
In Angola alone more than 20,000 people have lost limbs due to landmine explosions.
The top five exporting countries which sell 80% of die weapons exported to developing countries are all permanent
members of the UN Security Council.
Source; the Hnnun Development Report 1095. UNDP. Oxford University Prees.
Baltimore Charter: Partnership for a Healthy Urban Future
We, participants of the International Congress on Investment Strategies for Healthy Urban Communities at
Baltimore, 15 to 17 September 1997. call for new efforts in all countries to ensure a healthy future for the urban
communities of the 21st century.
We are gravely concerned that the economic and social viability of cities will be unsustainable, without determined
action to eliminate the health gaps which exist among the conumuiities who live in them. These gaps result from
misdirecting the benefits of economic growth by the failure to give due attention to the elimination of poverty and
the fostering of human development and social cohesion. In many countries the situation is getting worse. Poverty
and growing inequality are the greatest threats to health, for all
We are concerned about the health status of individuals and families. We will focus on improving family health
and well-being, increasing immunization, diminishing infant mortality, decreasing the transmission of communicable
diseases, creating a better environment with less poverty, less environmental degradation and resource depletion,
and more security. We also seek a greater sense of personal and collective responsibility.
Inspired by the experiences shared at this Congress, we commit ourselves to mobilize others who share our
concern. These include, national, regional, city and neighborhood leaders; tire business community; universities
and tire health professions, and non-governmental organizations. Above all. we commit ourselves to ensure the
Fullest involvement of the most needy groups of our populations
Poor people peed opportunities. Above all, people need opportunities which enable them to draw on their own
creativity, energy and enthusiasm.
To this end. we propose a course of action which will draw together personal commitment, solidarity and
cooperation in a Partnership for a Healthy Future
We call on our national, regional, city, and neighborhood lenders, from both public and private sectors, to
contribute the political support, strategies, and solutions needed to ensure balanced economic development which
reduces poverty and enhances living standards for all people.
We call on members of (he business community to practice business policies which target poverty and health
gaps as barriers to lasting stability and prosperity. We urge them to share their energy and lotow-how in creating
enterprises to reduce poverty and ill-health
We call on government and members of the medical and other health professions to promote universal
access to health services. Such services should consider the adverse effects of the social conditions of the poor.
We call on our universities to research solutions and monitor progress in reducing the health inequities
which afflict our communities, taking full account of all major economic, social, cultural, environmental and
political factors
We call on national mid regional government to develop public policy to ensure a healthy future for urban
communities and to commit the necessary resources to carry out these policies.
We call on non-governmental organizations to mobilize community support and resources to build
partnerships with the public and private sectors to improve the health of all people.
Building on the contacts which we have made at this Congress, we commit ourselves to exchange information
and experiences by networking between the partnerships for a healthy future.
Finally, we call on the World Health Organization to provide Its encouragement and expertise for our
endeavors.
Turning the Tables on Poverty and Ill Health
"In the fight against poverty, we need to approach
rich and poor countries alike", stressed Dr
Brundtland, who added "From being an unproductive
consumer of public budgets, health is now gradually
seen as a central element ofproductivity itself'.
Our lack of interest in health as an economic concept
is due to complacency, she suggested. This is
"promoted by powerful interests in health care
technology, including within the health professions
themselves....Health systems have become dumping
ground for the consequences of inadequate policy".
Dr Brundtland emphasised the need for improved
policies on health which must encompass economics,
politics, the environment and social issues.
WHO’s Director-General recently spoke at a seminar
on Public Health for a New Era at the King’s Fund in
London on 14 January. In her speech to the
assembled planners, economists and public health
specialists, Dr Brundtland said:
"There is solid evidence to prove that investing wisely
in health will help the world take a giant leap out of
poverty. We can drastically reduce the global burden
of disease. If we manage, hundred of millions of
people will be better able to fulfil their potential,
enjoy their legitimate human rights and be driving
forces in development. People would benefit. The
economy would benefit. The environment would
benefit. It is a complex process - but it can be done."
Dr Brundtland added that, although the world has
long known that poverty breeds ill health, it was now
clear that ill health also perpetuates poverty:
V
.
"Turning that around we end up with a simple, but
vastly significant assertion: improved health is a key
factor for human development and again, for the
development of nations and for their economic
growth", she said. It is well-known that the poor are
the most exposed to the risks of a hazardous
environment, and the least informed about threats to
health. It is the poor who bear the brunt of crude
structural adjustment policies and unregulated
globalization, of epidemics of HIV/AIDS, malaria
and tuberculosis.
The seminar was also addressed by Amartya Sen,
winner of the 1998 Nobel Prize for Economics, Clare
Short, UK Secretary of State for International
Development, Tessa Jowell, UK Minister of State for
Public health and Sir Donald Acheson, author of the
UK's Independent Inquiry into Inequalities in Health.
A list of all Dr Brundtland's speeches is available on
the Internet by accessing the following address:
http://www.who.int/inf-dg/index.html#speeches
CONTENTS
"Turning the Tables on Poverty and Hl Health"
Mrs Brundtland speaks out
1
Editorial
2
Network Contact Address
2
The Social Summit - where are we?
2
NGO Participation in Copenhagen+5
3
Useful Contacts : NGLS
3
Summary of Kisumu meeting report
4
Name the Network
5
HSD News
6
Wellcome Trust
6
IPHNnews - March 1999 - page 1
EDITORIAL
The Social Summit - where are we?
Bringing health to the core of development - the
commitment made by Dr. Brundtland is close to the
concerns of a small advisory group which met
recently in Kenya to explore how the Network could
highlight the role of health in poverty reduction and
in sustainable human development. Ideas on this and
on other issues related to poverty and health that were
shared at the meeting are presented in this issue of
our newsletter.
The World Summit for Social Development, which
took place in Copenhagen in 1995, was an important
effort to focus world attention on social issues,
particularly eradicating world poverty. It took place
at a time when global and national politics were
dominated by market liberalization and reducing the
role of the state. Now, almost 5 years on, we must
ask ourselves - Did it do any good? We think the
short answer is Yes. But it will take time to undo the
narrow preoccupation with economics, which had 15
years head start. The number of people living in
extreme poverty continues to grow.
Conflict,
economic instability, and misgovemance, all
continue to exact a heavy toll on health.
One of the strengths of the Network is the direct
involvement of its members, at local or country level,
in activities that promote health and contribute to
reducing poverty. One of the aims of the Network is
to build partnerships with communities. This means
strengthening communities in their own efforts to
address underlying causes of poverty, social
exclusion and ill heal±. Such an approach to
addressing poverty and ill-health focuses on people
and in particular the poorest people in all countries.
In 1995, the World Summit for Social Development
strongly endorsed this approach by calling for a
people-centred sustainable development. Goals were
developed from a peoples’ perspective. Now, five
years later we need to revisit the goals and assess
how they have been implemented. We invite you to
participate in that process and to share your
experiences and insights so that the voices of those
directly involved in efforts to reduce poverty and ill
health are heard.
Editor
Contact us:
Secretariat of the International Poverty and Health
(IPHN) Network
Department of Health in Sustainable
Development t'HSD)
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27
Tel: (41 22) 7912564/2558; Fax: (41 22) 7914153
Email: skoldm@who.ch; jamesonj@who.ch
On the positive side, 107 countries now produce thenown human development reports and many have
initiated poverty eradication programmes. Financial
commitment by international financing institutions
and some governments is on the rise. The 20:20
initiative is gaining gradual commitment to its
proposal that 20 % of external aid be used for basic
social services, provided recipient countries spend
20% of their public budgets for the same purpose.
But we still have is a long way to go. Least
developed countries, particularly in Sub Saharan
Africa, are still marginalized. There is still a big gap
between the international rhetoric and action on the
ground; between the calls for sustainable
development and poverty reduction to be integrated
with policies for economic growth, and the reluctance
to put the good intentions into practice.
In June 2000 a special 4 day session of the UN
General Assembly will take place in Geneva to look
at progress made since 1995, and to identify how to
accelerate implementation of the commitments made
at Copenhagen. Preparations for this are underway.
The 37* Session of the Commission for Social
Development was held in New York from 9-19
February 1999, focusing on Social Services for All.
During this meeting, WHO called for a new initiative,
which goes beyond social services, to put health at
the centre of future development policy and practice.
Yet we must admit that health professionals also
contribute to the problem, with too many preoccupied
by biomedical and technical approaches to disease,
and not enough acknowledging their roles in fighting
poverty. Until this changes, we risk being accused of
hypocrisy in calling for others to do more for the
health of the poor.
IPHNnews - March 1999 - page 2
NGO Participation in Copenhagen+5
The Preparatory Committee (PrepCom), which will
hold two substantive sessions, is making its work
open to the participation of NGOs, including those in
consultative or roster status with ECOSOC, those
having already submitted an application to ECOSOC,
as well as others accredited to the Social Summit or
other major UN conferences and summits.
Governments are being encouraged to include
representatives of civil society in their national
preparatory processes, as well as in their delegations
to the PrepCom and the special session. Modalities
and conditions for NGO participation in the special
session will be considered at the meeting of the
PrepCom in May 1999 (see enclosed NGLS RoundUp for further information).
Calendar of Follow-Up to Copenhagen +5
• 17-28 May 1999: 1st Preparatory Committee for
Copenhagen +5 at UN/HQ New York
» February 2000: Commission for Social
Development at UN/HQ New York
• 3-14 April 2000: Second Session of the
PrepCom, at UN/HQ New York
• 26-30 June 2000: Special Session of the General
Assembly on Copenhagen +5 at UN/Geneva
1995 World Summit for Social Development
In order to share information within the Network on
activities being developed by members, we would like to
hear from you on your involvement in the follow-up of the
Social Summit
1. Are you, or your institution, involved in any way in
implementation of the Summit recommendations or in the
follow-up activities to the Summit at local, national or
international level?
2. At country level, what has been done so far to
implement the recommendations of the Social Summit?
How has health been used as an entry point to reach the
broader goals of the Social Summit, such as poverty
eradication and sustainable human development?
3. In your country, has the government included
representatives from civil society in the national
preparatory process or in the delegation to the Prep. Com
and the Special Session?
4. Will your institution be represented at the Prep. Com
which will take place from 17-28 May 1999? Have you
prepared any position paper, statement, documents or
reports for that meeting which you could share with the
Network?
USEFUL CONTACTS
The United Nations Nongovernmental Liaison
Service (NGLS) was created in 1975 with the aim of
fostering and promoting greater understanding,
dialogue and cooperation between the UN system and
NGOs on development and related issues under
review within the UN system. Initially, NGLS was
seen as a system-wide initiative to strengthen
cooperation with national and regional NGOs and
NGO networks worldwide engaged in development
information, education, and policy advocacy work.
NGLS activities deal with the entire UN sustainable
development agenda across all UN agencies,
programmes, funds and departments concerned with
economic social and humanitarian issues.
NGLS provides information, advice, guidance and
support to NGOs wishing to be more involved in the
UN system, and creates opportunities for dialogue,
interaction and increased mutual understanding and
cooperation. NGLS’s mission statement says, "The
Non-Governmental
Liaison
Service
(NGLS)
promotes dynamic partnership between the United
Nations and non-governmental organisations. By
providing information, advice, expertise and support
services, NGLS is part of the UN’s effort to
strengthen dialogue and win public support for
economic and social development". Other NGLS
activities include:
o
o
•
•
•
joint organization of meetings and other events
with NGOs and UN offices;
maintaining databases on the NGO and UN
communities;
publicizing important UN and NGO development
activities, & publishing development information/
education materials, including the Go Between
newsletter and NGLS Roundup, and information
on UN events, conferences and other activities,
e.g. follow-up to Copenhagen Social Summit;
advice to NGOs on the work of the UN system
and issues on the UN’s agenda and how to engage
in effective information and advocacy work;
monitoring and participating in research,
meetings and publications of various institutions
on the changing roles of NGOs (both north and
south), and their relations with governments and
multilateral organizations.
NGLS publications and more information from:
Mr Tony Hill, Coordinator, UN-NGLS, Palais des
Nations, CH-1211 Geneva 10, Switzerland
Tel: (41 22) 798 5850; Fax: (41 22) 788 736
Email: ngls@unctad.org
IPHNnews - March 1999 - page 3
Meeting of the Advisory Group to the
International Network on Poverty and Health
Since the idea of an International Network on Poverty
and Health was discussed and agreed on at a meeting
in London 1997, the Network has gradually gained
momentum. During 1998 many new members joined
the Network which today is made up of 200
individuals, organizations, business enterprises and
community groups.
In order to consolidate the work of the Network,
agree on key objectives and priorities, and strengthen
participation in the network of people and
organizations in the South, a meeting of a small
advisory group was held in Nairobi and Kisumu,
Kenya during November 23-26, 1998.
Statement of Purpose of the Network:
One of the important elements of the meeting and for
the continuing development of the network was
building consensus amongst the participants, of the
Statement of Purpose of the Network. These were
agreed on as follows:
•
What is the International Poverty and Health
Network?
The IPHN is a world-wide network of people and
organisations from health, business, NGOs,
government and society-in-general who exchange
experiences and share information on the most
effective approaches and solutions for health in
poverty eradication policies, strategies and actions.
•
Who is it for?
People and organisations that wish to influence
policy and action to protect and improve the health
of the world’s poor, with particular emphasis on
the poorest in all countries.
•
What is its aim?
To integrate health into poverty eradication
policies and strategies, promoting community
partnership and intersectoral action, as a means to
achieve effective and sustainable results.
The meeting discussed the main links between
poverty and health and explored some of the
contributions health can make to poverty reduction.
Experiences presented at the meeting from both
developed and developing countries pointed to the
fact that poverty has many dimensions and cannot be
viewed from an economic perspective alone.
Stronger emphasis and consideration needs to be
given to the reality of poor people as experienced and
expressed by themselves, and to the analysis of root
causes and factors that influence or determine
poverty.
Discussions evolved around issues such as the
geographic dimension to poverty which is reflected in
variations in poverty rates across regions within the
same country; the seasonal variations in poverty, a
consequence of the inter-seasonal variations in the
production of food crops leading to periods of want
and "seasons of hunger"; the link between
environmental degradation, ill-health and poverty;
and the macro dimensions to poverty including
economic and political governance.
The question of governance also led to discussions on
forms of participation and on the importance of
community involvement in political and economic
developments and of strengthening the capabilities of
civil society.
There was a broad consensus at the meeting that a
participatory approach to poverty reduction and
community development is desirable both on ethical
and operational grounds. This means listening to how
local people themselves identify the poorest
members, and involving them in the development of
strategies or policies to address poverty. Partnership
building between government, civil society, the
business community, the poor themselves, NGOs and
health professionals was emphasised as the only way
to ensure political commitment to poverty reduction
at a local, national and international level.
The meeting emphasized the need for adopting a
balanced approach to poverty reduction that
addresses both the macro level issues of economic
growth and poverty reduction, and the specific health
needs of the poorest and most vulnerable people.
During the business session of the meeting,
participants identified the stakeholders of the
Network and explored its strengths, weaknesses,
threats and opportunities. In light of these discussions
and of the discussions related to poverty and ill
health, the meeting decided on the following areas of
priority for the Network:
IPHNnews - March 1999 - page 4
1.
Mobilising Stakeholders
•
The aim of mobilising all stakeholders is to ensure
commitment by local, national and international
sectors, business, health professionals, politicians and
researchers etc to poverty reduction and improvement
of health of the poorest populations; and to ensure co
operation between the different sectors to achieve
results in priority areas. This would be done by:
•
•
•
•
•
2.
Developing a clear rationale for business
involvement in poverty and health
Involving
new actors and identifying and
involving stakeholders at local levels
Developing
country specific plans and
mobilising key stakeholders
Disseminating information and experiences.
Writing a joint letter on behalf of the Network, to
all the world’s health professional associations
(and medical journals) to join and share the
mission.
Involvement in Copenhagen Plus 5 Summit
Meeting
•
•
o
o
4.
•
o
Sharing information on what is already been
undertaken by network members and on
developments leading up to the Special Session at
the UN Assembly
Disseminating information on the main outcomes
of the 7 Summits
Consulting national governments on the
implementation of Summit agreements
Participating through the secretariat (WHO) at
the Prep. Coms of the Copenhagen plus 5 process
and
keeping
members
informed
about
developments.
Becoming involved and influencing the agenda at
national level
o
•
•
•
•
3.
Information, Research and Capacity-building
The meeting recognised the need and importance of
collating, exchanging and disseminating information
regarding heath in poverty reduction in order to
strengthen local and national and international
capacities. This would be done through:
•
Promoting evidence based research
community involvement in research
and
Strengthening the Network Development
Efforts will be made to strengthen and expand the
network through the following:
The aim of focusing on the Copenhagen plus 5
meeting is to engage the network in national and
international events and to bring health to the agenda
of poverty reduction strategies. This will be done by:
•
Collecting
research
results,
experiences,
methodologies and best practices relating to
poverty and health
Exchanging and disseminating information
through newsletters, the Internet, existing
networks, publications, national, regional and
international summits and conferences, journals,
political arenas, the media etc.
Storing and retrieving information experiences by
creating a data base and the publishing a
catalogue
Building capacity among health professionals and
people of other disciplines working with
communities in management and governance,
research skills and advocacy methodologies
Producing workable community based models of
addressing poverty and health currently
developed by Network members.
o
Communication and exchange of information
Creating a central web site for the Network with
useful links
Identifying and Mobilising the Network
Resources
Creating /linking up with networks at a national
and international level
The full report of the Kisumu Meeting will be
distributed to all Network members.
*************
Name the Network
The meeting in Kisumu was keen to come up with a
catchy acronym for the International Poverty and
Health Network - the general feeling was that
"IPHN" didn’t translate well into Spanish and French,
and was therefore too clumsy to be catchy.
After many failed attempts, we were none the wiser,
and decided to ask you, the members of the Network,
to help! What do you suggest ?? Suggestions for
both the name and the logo for the Network will be
welcomed!
The next newsletter will present a selection of the
proposals we receive and a small international group
of members will be asked to make the final decision.
So, it’s over to you!
IPHNnews - March 1999 - page 5
HSD News
EDUCATIONAL RESOURCES FROM THE
WELLCOME TRUST/ CAB INTERNATIONAL
We are delighted to inform you that our department,
Health in Sustainable Development, has a new
director. From Sweden, Mrs Eva Wallstam will be
joining us on 6 April, and on behalf of the Network
we would like to extend a warm welcome to her.
During a short visit to Geneva last week, we asked
her to write few lines to the Network:
A new CD-ROM interactive training programme
to tackle global diseases has been published by the
Wellcome Trust and CAB International (CABI),
entitled Topics in International Health (TIH). This
innovative health training tool was launched in April
1998 and is aimed at medical students, healthcare
professionals, researchers and academics in both
developed and developing countries.
"As new director of the Department of Health in
Sustainable Development I am very pleased to
convey my greetings to the IPHN members. Coming
from Sida, the Swedish Development Cooperation
Agency, where I have been the Head of the Health
Division, and from a country, Sweden, where poverty
alleviation and issues concerning economic and
social equality figure high on the agenda, I have a
strong personal commitment in these matters.
Clearly, poverty is at the root of ill-health and
suffering. Our challenge at WHO will be to define
our role in relation to governments, civil society and
other organizations in order to maximize our
contribution through global advocacy, intersectoral
action, partnerships and involvement in work at the
country level. I intend to try and contribute to raising
WHO’s profile in this area and I am looking forward
to meeting and working together with you and your
organizations as members of the IPHN."
The package currently contains 8 CDs, each focusing
on a disease or group of diseases - Leprosy, Malaria,
Tuberculosis, Trachoma, Diarrhoeal Diseases, Sickle
Cell Disease, Schistosomiasis and Sexually
Transmitted Diseases. Discs on AIDS/HIV, Nutrition
and Leishmaniasis will be published in 1999.
The CDs focus on training the user in the
epidemiology, diagnosis and treatment of disease,
and offer access to a vast amount of information
through a series of interactive tutorials, an extensive
collection of images and a comprehensive glossary of
medical and scientific terms. The package is highly
visual, fun to use, and extremely accessible, even to
those with little experience of computers.
Each disc costs £95 for developed country
institutions, (discounts on purchases of 4+ titles), and
considerably lower prices for individuals and for
those in developing countries.
Eva Wallstam
Further information on follow-up to the Copenhagen
Social Summit can be obtained by accessing:
http://www.un.org/esa/socdev/wssd.htm
Further information from Liz Woolley
Project Officer, Information for Development
Programme, CAB International (CABI)
Wallingford, Oxon 0X10 8DE, United Kingdom
Tel: 44 1491 832111 x2350; Fax: 44 1491 833508
mail:l.woolley@cabi.org; Website: http://www.cabi.org
----------------------------------------------------
--------------------------------- ------------------------------------------
I would like to become an active member of the International Poverty and Health Network
Name:
Organization
Address:
My particular areas of interest:
What I/my organization can contribute to the Network
Tel
Fax
Email
Please return the completed slip to the IPHN Secretariat at the address given on page 2 of this newsletter
IPHNnews - March 1999 - page 6
A newsletter prepared and distributed by WHO - Issue 3, July 1999
°
Integrating
health
into
development,
involving other sectors and focusing on poor
and marginalized populations. For HSD this
means identifying how best health contributes
or could contribute to development, exploring
and sharing best practices and experiences of
intersectoral action, and contributing towards
the development of integrated policies which
benefit poor and vulnerable populations.
o
Focusing on international trade, finance and
governance to address the effects of
globalization equity and health. The nature of
globalization today is reinforcing familiar as
well as creating new inequities within and
across countries. HSD will focus on the
economic (international trade and finance) and
political (effective global governance) spheres
of globalization and its impact on health. To
support the development of WHO policy in this
complex area, HSD co-ordinates a WHO- wide
technical working group on Globalization,
Trade and Health.
CONTENTS
New Developments at WHO/HSD
Editorial
Meeting the Needs of the Poorest and
Most Vulnerable
Network Factfile:
Teaching-aids At Low Cost (TALC)
CHC Bangalore
Forthcoming Events:
Peoples' Health Assembly
Think Tank on health and Development
Guest Spot:
Mr Olivier Giscard dEstaing on
BUSCO and Copenhagen Plus Five
Gender and Poverty Page
New WHO Publications:
HSD Poverty Compendium
/
2
3
4
4
5
5
6
7
8
New developments at WHO’s Department of
Health in Sustainable Development (HSD)
In the last issue of IPHNnews we were pleased to
welcome our new Director, Eva Wallstam, to HSD.
As many of you may already be aware, HSD is a
new department in WHO, created as a result of the
restructuring process at WHO that has taken place
under the leadership of Dr. Gro Harlem Brundtland.
As such, HSD also has a new mandate. As the title
suggests, HSD believes that health cannot be
considered solely as a health care issue, but must be
seen as a significant part of a broader development
agenda. In that perspective, health and development
have a reciprocal effect - health is a determinant as
well as a result of development. The mission of
HSD is to catalyze action, globally and in countries,
to integrate health into human development and
poverty reduction policies and practices. In practice
the work of HSD will be developed around three
interlinked objectives :
o Promoting pro-poor health policies and
practices.
Despite
some
development
advances, the numbers of poor world-wide
continue to increase; adequate access to health
care and services are at risk. Although all
WHO clusters contribute in varying ways to
health sector development, HSD will play a
catalytic role in developing and advocating
pro-poor approaches within health. Learning
from others will be an important part of this
work, especially from the experiences of
NGOs,
local
communities,
indigenous
populations and other groups in civil society.
Work is already underway and more is planned in
the above areas including studies and research, an
international consultation on health of indigenous
populations, participation in the Copenhagen plus 5
process, national meetings to strengthen country
networks, support of intersectoral initiatives at
IPHNnews - July 1999 - page 1
country level such as health promotion and school
health insurance in Vietnam, agriculture policy and
human
health,
community
based
health
development in Rwanda, and animal and human
health in Mongolia.
In the next issue of IPHNnews, we hope to be able
to share an update on exciting developments within
WHO as a whole with regards to health, equity and
poverty reduction. Having firmly committed itself
to the International Development Goal of reducing
poverty by half by the year 2015, WHO is in the
process of conceptualizing and defining its own role
in poverty reduction at all levels, global, regional
and country.
Several important decisions have already been
made within WHO which will support this process.
One is that WHO will establish a high-level
advisory committee on Health, Equity and Poverty
Reduction, representative of the major development
actors: governments of Least Developed Countries,
civil society organizations, development assistance
agencies, NGOs, and the private sector. Amongst
other tasks, the committee will contribute towards
the development of a WHO Policy and Strategy on
Health, Equity and Poverty Reduction. HSD, in
consultation with other clusters, is currently
developing a proposal for the way forward for
WHO in this new initiative. The process will
involve broad consultation within and outside
WHO and we look forward to involving IPHN
Network members also in this development and to
benefiting from your expertise and experience.
Contact us:
Secretariat of the International Poverty and
Health (IPHN) Network
Department of Health in Sustainable
Development (HSD)
World Health Organization
20, Avenue Appia
1211 Geneva 27
Switzerland
Editorial
In a recent issue of "To Our Health" the internal
newsletter of WHO, one of the main headlines was
the following: Health as Development: How do
we do it? What followed were more questions that
have been spurred by recent commitments WHO
has made to poverty reduction:
o
o
o
o
o
How does a world-wide health agency fight
poverty? Does it mean a total change in its
purpose and actions, or merely a change of
priorities?
Will the Organization become more political?
Will it mean the end of WHO as a technical
agency?
How can we influence country policies when
we don’t lend money?
And who should be charting this new territory?
These challenging questions, a healthy reaction to
the change process which is going on in WHO will,
of course, need to be given consideration, by WHO,
by Member States, and by partners with whom we
collaborate. The process of searching for responses
to these and other crucial questions related to health
and poverty reduction has started through
consultative processes and mechanisms.
For example, the department on Health in
Sustainable Development has been created. It has a
mandate to play a catalytic and collaborative role in
developing pro-poor health policies and practices; a
WHO Advisory Committee on Health, Equity and
Poverty reduction will be set up shortly ; WHO will
develop an overall policy on Health Equity ancj^r
Poverty Reduction.
Many more activities will come. The most
important and encouraging step has already been
taken - the political commitment has been made to
integrate poverty reduction as a major concern for
the whole organization. We are delighted to be able
to share some of the most recent developments with
you in this issue of IPHN news, but we are also
keen to receive your ideas, responses and input so
please do keep us updated!
Tel; (41 22) 7912564/2558
Fax: (41 22) 7914153
Email: skoldm@who.ch; jamesonj@who.ch
Margareta Skbld
Editor
IPHNnews - July 1999 - page 2
Bangladesh Workshop:
How can we best meet the health needs of the
poorest and most vulnerable?
This and other relevant questions were at the focus
of attention of participants attending a workshop
held recently 11-13 April, in Dhaka, Bangladesh. In
an attempt to identify viable approaches and
strategies for protecting the health of the poor,
participants exchanged experiences, explored issues
related to poverty and ill-health and agreed to
continue to network after the meeting.
The meeting, jointly organized by WHO and the
Bangladesh Institute of Development Studies
(BIDS), was attended by representatives from
national groups, civil society, institutions,
ministries
and nongovernmental organizations
(NGOs) involved in activities aimed at improving
health and well being of the poor and most
vulnerable populations.
During the course of the meeting, many problems
were identified but suggestions were also made of
possible ways to address the problems. There was
full agreement among participants that one of the
conditions for reaching the poorest people is that
concern for their health and well being is
highlighted in national health
policies. In
Bangladesh, a five year health strategy includes a
strong pro-poor agenda and discussions focused on
successes and shortcomings in the implementation
of this agenda.
The meeting recognized the important role of civil
society and notably NGOs, in public monitoring
and assessment of health policy implementation. In
order to strengthen people’s participation in health
matters, NGOs could make sure they disseminate
information and keep people and local communities
aware of developments in national policy. This
could also increase possibilities for poor people to
become involved in national health policy making.
A pro-poor national health policy should respond to
the needs of the poorest and it is at local,
community level that these needs are most felt. The
community itself is therefore best placed to identify
these needs and to collaborate with local health
authorities in developing appropriate responses.
The workshop stressed however, that improvement
of health cannot be seen as a responsibility only of
health
services or the
Health
Ministry.
Collaboration across sectors must be sought and
promoted. Other issues elaborated by the workshop
included the need for health professionals to
develop a deeper understanding of the links
between health and poverty reduction; the
importance of recognizing and developing
traditional or/and local ways of healing which
include Unani, Homeopathy, Ayurveda; and the
importance of working with the media, professional
associations and other national and international
networks to advocate the above issues and to
sensitize health professionals, policy makers and
planners to them.
One proposal which gained support of many
participants was to set up a National Health and
Poverty Network that would interact with IPHN.
BIDS, the local host of the workshop was asked to
take the lead in setting up the Network. IPHN news
welcomes this initiative and looks forward to
hearing more about the Network activities from its
members in Bangladesh.
For a copy of the full report please contact:
Department of Health in Sustainable Development
World Health Organization, 20 Avenue Appia
CH-1211 Geneva 27
Switzerland
Tel: (41 22) 7912903/2709 ; Fax: (41 22) 791 4153
Follow-up to Kisumu meeting
At the IPHN advisory group meeting held in
Kisumu in November last year, it was agreed
that a letter should be written on behalf of the
Network, to major professional associations
and medical journals around the world, inviting
them to join network and to share its goals.
The letter is currently being drafted
by
members of the Intercollegiate Forum on
Poverty and Health in the United Kingdom,
and IPHN members will receive it shortly for
comments and feedback. Please look out for it
in the mail so that it really can become a
Network initiative.
IPHNnews - July 1999 - page 3
Aims and Objectives
Name the Network
o
In the last issue of IPHNnews, we asked you to
suggest a new, catchy acronym and a logo for
the Network. So far, we have received only
two proposals!
To create awareness in the principles and
practice of Community Health among those
interested and/or involved in health and related
sectors
o
To research Community Health Policy issues,
including:
Please send your suggestions to us and well
include them in the next issue for voting. We
are counting on you!
community health care strategies
health human power training strategies
integration of medical/health systems
o
NETWORK FACTFILE
1.
To enable the formulation and implementationjpj
of community-oriented health policies through
dialogue with health planners, decision-makers
and administrators
Teaching-aids At Low-Cost (TALC)
Over the years, TALC has made a particular effort
to supply material for those providing health care to
the less well off in developing countries. TALC
distributes copies of Where There is No Doctor,
which is the most widely used book by community
health workers. It also distributes the Strategies for
Hope booklets concerned with those tackling AIDS,
and Child to Child material, a programme which
emphasizes how children can play a part in
improving not only their own, but also family and
community health.
TALC can be contacted at:
Teaching-aids At Low Cost (TALC)
P.O. Box 49
St Albans
Herts AL1 5TX
United Kingdom
Tel: (44 1727) 853 869; Fax: (44 1727) 846 852
Email: talcuk@btinternet.com
To evolve educational strategies to enhance
knowledge, skills and attitudes of people
involved in community health and development
o
To promote/support community health action
through voluntary/governmental initiatives
o
To establish a library and documentation centre
in Community Health
CHC has developed a diverse interaction among
individuals; coordinating agencies; issue-raising
health groups; development projects, networks and
training centres; government agencies and
ministries; national and international agencies.
CHC seeks collaboration with anyone involved in
Community Health.
|
CHC is the joint organizer of the November
meeting "South East Asian Dialogue on Poverty
and Health", which will take place in Bangalore
from 15-18 November 1999.
Further information from:
2.
Community Health Cell, Bangalore
The Community Health Cell grew out of a study
reflection-action project begun in Bangalore in
1984, initially supported by the Centre for NonFormal and Continuing Education, Bangalore. In
lune 1990, the Society for Community Health
Awareness, Research and Action (SOCHARA) was
established, with CHC as its functional unit.
Dr Ravi or Thelma Narayan, Coordinators
CHC Bangalore
No 367 "Srinivasa Nilaya"
lakkasandra I Main, I Block
Koramangala, Bangalore 560 034, India
Tel: (91 80) 552 5372; Fax: (91 80) 553 3358
Email, sochara@vsnl.com
IPHNnews - July 1999 - page 4
Forthcoming Events ---------1. African Community Action Network for
Health (Afri-CAN) Think-Tank on
Mobilizing all for Health and Development,
Harare, Zimbabwe 18-22 October 1999
The 1999 Afri-CAN Think-Tank will facilitate:
sharing models of best practices in health and
development
learning from each other through exchanging
experiences and discussion on emerging issues
faced by health workers
a coordinated voice to influence policy at local,
national and international levels
pooling of ideas to engender collective action.
he Think-Tank is for all those who have an
interest and an active involvement in health and
development issues, and who want to influence
health and development action in a positive way.
Invited participants include health and development
workers, managers from the public and private
sectors and of church-related programmes, policy
makers, academic institutions and community
members.
The purpose is to bring together people actively
engaged in health and development to share their
experiences on related community-based health
initiatives within the region. It also provides a
forum to help those in strategic positions at
community, local, national and global levels to
shape and influence policy.
The Think-Tank will be organized around thematic
sessions,
chaired
by
two
co-moderators
(anglophone and francophone), which allows active
participation by all. Working groups will also meet
to discuss specific areas of interest, and these will
be flexible so that individuals my join their
preferred group.
Further information (including on cost) from:
Dr Dan Kaseje,
Chairman Afri-CAN
P.O. Box 30690, Nairobi, Kenya
Tel: (254 2) 441920/ 445020/445160
Fax: (254 2) 440306
2. The People’s Health Assembly
The world is currently facing a global health crisis,
characterized by growing inequities within and
between countries. Despite medical advances and
increasing average life expectancy, there is
evidence of rising disparities in health status among
people worldwide. The many facets of poverty, the
HIV/AIDS epidemic, and other related problems
are contributing to reversals in previous health
gains, and this is associated with widening gaps in
income and shrinking access to social services, as
well as to persistent racial and gender imbalances.
The People’s Health Assembly (PHA) is a new
initiative which seeks to involve as many people as
possible in their own health agenda and setting
their own priorities.
The initiative is being
coordinated by several organizations, both within
and external to the international agencies - the
Asian Community Health Action Network,
Consumers International, the Dag Hammarskjold
Foundation, Gonoshasthaya Kendra, Health Action
International, International People's Health Council,
and the Third World Network.
Despite an abundance of rhetoric, governments and
international organizations have largely failed to
achieve their oft-stated goal of health for all, and
equitable access to health care. To try and improve
the situation, the PHA will be organized in 2000 by
a group of concerned organizations and networks to
analyse and assess the knowledge and experiences
from around the world, to identify the main
problems, trends and challenges, and ultimately to
develop strategies to combat these and bring us
closer to achieving the goal of health for all.
The overall goal of the PHA is to re-establish health
and equitable development as top priorities in local,
national and international policy-making. It will
strive to achieve this through:
o Hearing the Unheard
• Reinforcing the principle of health as a broad
cross-cutting issue
o Developing cooperation between concerned
actors in the health field
• Formulating a People's Health Charter
• Improving
the
communication
between
concerned groups and institutions
• Sharing and increasing knowledge, skills,
motivation and advocacy for change
IPHNnews - July 1999 - page 5
The People's Health Assembly event will be held
from 4-8 December 2000, near Dhaka in
Bangladesh. About 600 participants are expected,
and activities will include keynote addresses,
analytical presentations, sharing of experiences on
health practices and concerns, workshops, debates,
exhibitions, and cultural
and audio-visual
presentations. The event promises to be exciting,
vibrant and inspiring, and follow-up will include
the dissemination and promotion of the People’s
Health Charter; coordinated advocacy and lobbying
at the local, national and international levels; and
publication of materials related to the PHA.
For more information, contact:
Janet Maychin, PHA Secretariat
Consumers International Regional Office for Asia
and the Pacific (CI ROAP)
250-A Jalan Air Itam
10460 Penang, Malaysia
Tel: (604) 229 1396; Fax: (604) 228 6506
email: phasec@pha2000.org
or visit PHA’s website on: http://www.pha2000.org
GUEST SPOT
and reduce noise, to create the best possible
environment for the workers. Measures of security
related to equipment and procedures must be
rigourously studied and applied. The considerable
amount of pollution produced by certain factories
must be reduced, even if this is not yet fully
imposed by law.
Business has a considerable responsibility in
assuring the quality of its products, not only in the
food and pharmaceutical industries which have
experienced several disasters, but also for the
numerous
products
produced
for
mass
consumption. This is becoming more and more
apparent to large companies, and existing
regulations are being
standardized on an
international level The task of sensitizing smaller
businesses, and those in countries which do not yet
have these laws to this responsibility is immensef
and international cooperation can help in
accomplishing it. Exchanges of experience and
know-how can considerably reduce time and costs.
At the UN Social Summit in Copenhagen in 1995,
specific commitments were made by national and
international public authorities, as well as by
industry.
These, in particular, concern the
promotion of codes of good conduct, which
fortunately are becoming the norm, despite
ignorance, neglect and irresponsible behaviour.
Copenhagen Plus Five: Health and Business
The three pillars of development are health,
nutrition and education, and if one of these three is
lacking, there is little hope of realising economic
development and social progress.
All three
elements are pre-requisites for the creation of
wealth and the business community is becoming
more and more aware of the role it can play in the
development of these domains.
Concerning health, three important elements are the
prevention of illness, working conditions, and the
quality of the products and services produced.
Business leaders must make sure that all possible
measures are taken - vaccination, hygiene, housing,
environment - to offer their employees and their
families the best possible guarantee of good health:
in a business, it is the human capital which is the
most important. Modern working conditions must
optimise the quality of light, air, and temperature,
Maximizing profit in the short-term is too narrow
an objective to respond to the legitimate social
aspirations of our time.
On the other hand,
economic activities have more of a chance of being
sustainable when the inherent problems ar|~y
understood and dealt with in a spirit of cooperation
- from the factory floor right up to company
management level.
The same values deserve to be expressed and
underlined once again when we look at the
evolution of thinking and action over the past five
years at the meeting of the Forum Geneva 2000,
and at the United Nations General Assembly
Special Session on the Copenhagen Social Summit
which is scheduled for the end of June 2000.
by Olivier Giscard dEstaing, Chairman,
Business Council for the UN Social Summit
(BUSCO)
IPHNnews - July 1999 - page 6
Gender, Health and Poverty
The fundamental cause of poverty and deprivation
is the same - vulnerability through lack of control
over assets and entitlements. To work within a
sustainable development framework, it is essential
to have a clear understanding of the forces which
create, sustain, or reverse poverty for different
population groups, how poverty (and relative
poverty) is experienced in different ways according
to class, gender, and ethnicity, and how these
experiences are reflected, both directly and
indirectly, in health status and outcomes.
Fifty years after the WHO Constitution was first
ormulated, we now know that factors determining
ea th are not the same for men and women, who
plaj different roles in differing social contexts.
These roles are valued differently, and usually more
highly for men. This affects the degree to which
women and men have access to, and control over,
the resources and decision-making needed to
protect their health. It also results in inequitable
patterns of health status
and
use
of
health
It has been increasingly
Definitions of gender and gender analysis:
services.
accepted in recent years
that in many societies,
"Gender" is the term used to describe those
There has been a growing
being female is a particular
characteristics of women and men which are
recognition world-wide,
precondition
for
socially constructed, in contrast to those which
deprivation and reduced
including
within
the
are biologically determined. People are bom
access to resources or
(United Nations system,
male or female but learn how to be girls and
entitlements. In addition to
that equality between
boys, men and women. This learned behaviour
issues of lesser education,
women and men is
makes up gender identity and determines
status, and earning power,
necessary for health and
gender roles.
there are less obvious
sustainable development.
causes such as restrictive
Gender analysis identifies, analyses and
social norms or family
This recognition has been
informs action to address inequalities that arise
responsibilities. In brief,
demonstrated through the
from the different roles of women and men or
among all categories of
agreements reached at all
the unequal power relationships between them,
poor
and disadvantaged,
the major international
and the consequences of these inequalities on
women tend to have fewer
development conferences
their lives, their health, and their wellbeing.
choices, options, and room
of this decade.
The
Power distribution in most societies leaves
for manoeuvre often due to
method chosen by the
women with limited access to and control over
restrictions
imposed as a
international community
resources to protect their health, and with less
result
of
gendered
for working towards this
involvement in decision-making. Gender roles
perceptions
of
their
goal of greater equality is
for men, on the other hand, may expose them
capabilities/responsibilities
gender mainstreaming.
more to risk-taking behaviour or may condition
restrictions which are
them not to seek medical help when sick.
j
culturally
derived
but
In 1997, the SecretaryGender analysis in health therefore highlights
politically
sanctioned
General of the United
how inequalities of various kinds may be
through
inadequate
or
Nations
formally
detrimental to the health of both women and
inequitable
policy
and
requested
the
UN
men, examines the constraints involved, and
legislation.
organizations
and
identifies ways of addressing and overcoming
specialized agencies to
these constraints.
HSD's gender approach,
incorporate
gender
therefore, will recognize
mainstreaming into all
the particular disadvantages
their policies and programmes.
accruing to women while seeking a broader and
more accurate knowledge-base about the social and
To be successful, any mandate focusing on poor
economic
determinants of health for both men and
and marginalized populations, and pro-poor health
women. It will advocate, recommend and promote
policies and practices, must include a gender
policies and strategies at international, national and
perspective. HSD has therefore committed itself to
local level to alleviate and adjust inequity or
adopting gender perspectives and gender analysis
inequality for both sexes.
Jackie Sims
in all its work. What does this mean in practice?
IPHNnews - July 1999 - page 7
New HSD Publications
USD issues Poverty Compendium
The Department of Health in Sustainable Development, which houses
the Secretariat of the Network, has just issued a compendium of
documents entitled "Health in Poverty Reduction: Collected papers".
This compendium represents a wealth of information and research on
poverty and poverty reduction, separated into three main sections:
Links between poverty and health: analytical frameworks
and empirical results
ii) Identifying and targeting the poor
iii) Policy perspectives
i)
Included in this important document are papers by Binayak Sen,
Godfrey Gunatilleke, Guy Carrin, Debra Lipson and Margareta Skbld.
The prevailing international climate, at the mid-point of the United
Nations International Decade for Indigenous Peoples, is seen as an
opportunity to capitalize, in favour of health, on such initiatives as
the establishment of a permanent forum in the UN for indigenous
peoples , as well as the adoption of a draft universal declaration.
As part of its contribution to the UN Decade, WHO has established
an Indigenous Peoples focal unit in HSD, which has already brought
about the publication of "Health of Indigenous Peoples", a document
written by Ethel (Wara) Alderete, with contributions from WHO
and AMRO/PAHO personnel, and the UN Working Group on
Indigenous Affairs (IWGIA).
It is available free of charge from Paolo Hartmann at WHO/HSD.
(reference WHO/SDE/HSD/99.1)
---------- Sx
Sx
I would like to become an active member of the International Poverty and Health Network
Name:
My particular areas of interest:
Organization
Address:
What I/my organization can contribute to the Network
Tel
Fax........................................
Email
Please return the completed slip to the IPHN Secretariat at the address given on page 2 of this newsletter
IPHNnews - July 1999 - page 8
Message to members of the
International Poverty and Health
Network from Mrs Poonam
Khetrapal
Singh,
Executive
Director of the Cluster on
Sustainable Development and
Healthy Environments (SDE) at
WHO Geneva.
■It is with great pleasure that I
write a few words in this first
issue of IPHN news to share with
Apu some of the
recent
developments at WHO. Above all,
I am delighted to establish contact
through the newsletter to such a
broad group of committed
individuals and organizations in
many parts of the world engaged
in improving the health and
wellbeing ofpoor people.
As you may be aware, the World
Health
Organization
has
undertaken a major restructuring.
It
has
involved
grouping
programmes into nine clusters to
provide more focus and cohesion
to the work of the organization.
The cluster which I head,
Sustainable Development and
Healthy Environments, will work
to ensure that health aspects of
sustainable development and
poverty reduction are properly
addressed in formulating and
implementing public policies,
strategies and programmes at
global, regional, national and
local levels.
and as members
of the
International Poverty and Health
Network make the network a
crucial partner in our work.
In her most recent speech to
WHO staff, Dr Brundtland
stressed that the cluster will place
a special focus on "supporting
countries in promoting policies
which can address poverty as a
major cause and consequence of
ill-health ”,
"When forging a vision for health
and human development into a
new century we need to apply a
broad perspective. Democracy,
peace and human rights create the
conditions for renewed strategies
towards human development and
a lasting combat against poverty
and ill-health. It is within this
same framework that we must
strive for the full utilization of our
scientific advances. ’’
You all know the immense
challenges before us at global,
national and local levels. The
vicious circle of poverty, food
insecurity,
environmental
degradation and ill-health can
only be broken by concerted
intersectoral initiatives aimed at
placing health at the centre of
sustainable development.
While the main responsibility for
poverty reduction remains with
each government, the role of civil
society at a national and global
level is becoming increasingly
important. In recognizing the
contribution
which
NGOs,
community
groups,
health
professional associations and the
private sector make to poverty
reduction,
the
Sustainable
Development
and
Healthy
Environment cluster will work in a
variety of sectors with a wide
range of partners. The expertise,
experience and mobilizing force
which you bring, as individuals
IPHNnews - November 1998 - Page 1
With
the
words
of our
Director General, Dr Brundtland
I would like to stress the values
which will underpin our work:
I look forward to collaborating
with the Network on issues of
common concern and I assure you
of my full support.
CONTENTS
Message from Mrs P.K. Singh
Executive Director SDE
I
Editorial
2
IPHN Meeting, Kenya
2
Letters from Network Members 3
Guest Spot
4
Dr W. Addington
President ACP
Network Factfile
5
Healthlink Worldwide
IPHN Contact Information
5
Useful Websites
6
Editorial
We would like to welcome you to this, the first issue of our
newsletter IPHN news.
The newsletter is intended to be a forum for the exchange of
news and reports of activities related to the Network and its
members. As such, we will need your input. Please share
with other members what you are doing, experiences of
sustainable initiatives to improve the health of people living
in poverty, or strategies for dealing with poverty and health
which have worked. Tell us about conferences or exciting
events which will take place. Challenge us all with new
ideas, shake us up with proposals for action and let us have
your views - let's get a debate going!
The format and content of the newsletter will evolve as we
go along and you let us know what may be useful to include.
We want to give members a chance to present themselves.
Each issue of the IPHN news will therefore contain our
"Network Factfile’’ - giving information on a member
institution to enable us to get to know each other better. A
"country focus 11 or a specific experience from a country will
give information on activities in the world's poorest
countries, and letters from members will stimulate our
thinking!
Welcome to YOUR Newsletter!
Margireta Skold
Editor
IPHN Advisory Group to meet in Kisumu,
Kenya, from 23-26 November 1998
Background
With Dr Brundtland’s arrival, it is clear that poverty
reduction will be given stronger emphasis in the
development of future activities of the WHO.
Her commitment is well expressed in the speech she
made to the World Health Assembly in May where she
stressed that "We must speak out for health in
development, bringing health to the core of the
development agenda. That is where it belongs, as the
key to poverty reduction and development underpinned
by the values of equity, human dignity and human
rights".
The network is well placed to respond to
this challenge and ICO is organizing a meeting of an
advisory group made up of a few members from all
regions, to explore possible concrete contributions of
the Network to the process. The meeting will take
place from 23-26 November in Kisumu, Kenya.
The aims of the meeting are:
1. to see, hear and learn from people living in
deprived situations, and in particular to understand
their ways of coping with poverty;
2. to agree of key goals, strategies and an action plan
for 1999;
3. to explore the developing relationship of the
Network with the restructured WHO; and
4. to see how the IPHN can increase the participation
of members from the South and be more
responsive to the issues that concern the South.
* * ********* * **** ** * * *
The report of the meeting, which will also
be the basis for future Network activities,
will be distributed to all Network members.
** * * * ***** ***** * ** ***
What is the IPHN ?
The International Network on Poverty and Health (IPHN)
was created at a meeting on Poverty and Health in London
in December 1997. The broad objective of the Network is to
advocate for health as a force for reducing poverty and
improving human development, through a wide coalition
of health and educational NGOs,
international
organizations, governments, and health and developments
workers. It aims to do this by addressing the issues of
increasing inequities between countries and the widening
gap between rich and poor within countries.
The aims of the network are: to contribute to the public
debate on poverty and health and to provide collective
support to political commitments to reduce poverty and
improve the health status of populations; to recognize,
enhance and facilitate the realization of poor peoples'
potentials, enabling them to address the causes of the
problems of poverty and to transform situations which
prevent the attainment of health in its fullness; and through
its members, to enable health professionals and the health
sector to play an effective role in poverty reduction.
Current activities by members include: participatory
analyses on the socio economic determinants of ill health in
several African countries and in India, with community
strategies being developed in response to the situation; a
contribution to the Independent Inquiry on inequalities in
health by the Intercollegiate Forum on Poverty and Health in
the U.K: Conferences are also being planned in the
Philippines on the role of health professionals in poverty
reduction, and in the U.K. on health of adolescents living in
poverty. We are pleased to inform you that an increasing
number of people are expressing interest in, and joining,
the network.
IPHNnews - November 1998 - Page 2
Letters from Network members
Health implications of economic policies
Resource allocations needed for health at
national level
Implications of debt on health and health
systems
Importance of social equity to health
Raising health issues in trade and investment
negotiations
Raising the importance of capacities to stay
healthy
Health, education and well-being of women and
mothers
Drs. Ravi and Thelma Narayan, Society for
Community Health Awareness, Research and Action,
Bangalore, India have sent the following message to
Network members:
" Dearfriends of the IPHN,
Recently, all the members of the Poverty and
Health Network received a letter from us via the
IPHN secretariat informing them about the
commitment made by Dr. Gro Harlem
Brundtland, the new DG elect, in her recent
speeches at WHO - "to fighting poverty as a key
threat to people’s
health".
The network
members were invited to offer insights and
suggestions on how WHO could tackle the
^global, national and local determinants of
^poverty. Three questions were asked in the letter
to help focus the response of the members.
The responses that have come from Australia,
Bangladesh, Belgium, Finland,
France,
Germany, Ireland, Philippines, USA and the UK
have been very varied and thought provoking.
They reflect the perspectives of people and
organisations, who are concerned with the needs
of the poor. We have integrated and summarised
the responses so that a charter of ideas and
action initiatives begins to emerge. Further
responses will add to this so please let us have
your ideas if you have not already answered.
Please feel free to take any of the below ideas
further or even disagree - in that way we will
develop our ideas collectively.
Greetings from Ravi and Thelma "
Summary of responses from members
A.
At Global Level
Core Agenda: WHO should make Poverty and
Health interactions a core theme of their global
health agenda - it subsumes not only health
development but also the need to target poor and
marginalized subgroups.
2. Articulate Key Concerns: WHO's role in efforts to
reduce poverty can never be sufficient in terms of
channelling of resources, but it has got has
substantial capacities to be articulate and lobby
globally with good evidence based arguments with
respect to:
1.
WHO should renew commitment to Health For
All and Primary Health Care
4. WHO should develop country and policy analysis
at national and international level
5. WHO should work with and/ or challenge other
international institutions, NGOs and the private
sector
3.
Some specific suggestions include:
> A Peoples’ Hearing on Poverty and Health at the
Assembly
> Supporting innovative
pilot/demonstrations
project aimed at poverty reduction
> Exploring how to monitor the impact of
transnational influences on countries
B. At National Level
WHO should provide an ethical challenge to people in
government to address the conditions that contribute
to poverty and help policy makers address the
problems through intersectoral collaboration also
involving grassroots.
C.
WHO and Members of the Network
1. WHO and Network members should share
information and
sound advise on
health
promotion in poverty stricken countries including
examples of successful initiatives and expertise on
sustainable actions for health.
2. WHO should provide support for small scale pilot
projects to alleviate poverty and improve health of
the poor.
3. Network members
who have field research
capacities
and
universities
should
be
commissioned to develop research projects
suitable for inter-departmental/multi-disciplinary
research (eg. Community Health, Economics,
Development).
4. Network members should play an active role in
developing the above ideas and suggestions
IPHNnews - November 1998 - Page 3
The task force also crafted a set of tactical goals:
GUEST SPOT
Access to Health Care in the United States:
What is the Profession’s Responsibility?
What is professional responsibility? This question is
asked increasingly in the United States by physicians
and medical organizations as we confront the
unconscionable reality that 41 million Americans
have no health insurance, and that an additional 30-35
million Americans are underinsured. The uninsured
comprise urban and rural poor and an increasing
number of working people. The maddening paradox
is that the United States is experiencing one of its
greatest periods of economic growth in history.
Since the end of the health care reform debate in
1994, almost 5 million more people have become
uninsured. Indications are that those numbers will
continue to grow at the rate of almost 1 million each
year. If that trend continues, the number of people
without health insurance will approach 47 million by
the year 2005.
In September 1997, the American College of
Physicians (ACP)-American Society of Internal
Medicine (ASIM) and the American Board of Internal
Medicine (ABIM) convened a 12-member task force
to identify their collective concerns, and to advocate
for activism in the debate to address the problems of
the Nation’s uninsured. One of the major concerns is
the fact that the medical profession as a whole has
been virtually silent on the subject of the uninsured.
Commitment to Change: Commitment to Access
The task force recognized the value of collaboration to
promote physician advocacy to help America’s
growing number of uninsured, and established the
following guiding principles:
> advocating for the health care of the uninsured
> promoting universal coverage and access to
adequate health care for all
> providing an impetus and catalyst for involving
members of the profession, professional
organizations, and the public in advocating for the
needs of the uninsured
> raising
awareness
of
the
profession’s
responsibility to participate in addressing the
health care needs of all Americans
> affirming the profession’s expectations that
physicians will address unmet needs for health
care by providing uncompensated services
> to generate broader support for availability of
health care to the uninsured
> to involve all health care organizations in
contributing to the care of the uninsured
> to promote a spirit of volunteerism throughout the
profession
Over the past 10 months, task force deliberations have
identified a series of core activities for
implementation and consciousness-raising, which
focus on emphasizing the dilemma of the growing
number of America’s uninsured.
The activities
include advocacy for action and the development of
an educational portfolio and position paper to ruffle
the profession’s conscience and enhance commitment
to community service.
The task force makes the most of occasions such as
annual sessions and meetings of professional
Associations, to advocate and build awareness on
issues related to access to health care, including the
responsibility of professionals with regard to access.
Furthermore, it has plans to release a position paper
on the same theme at the end of the year which will be
widely distributed among medical organizations and
the public.
Finally, an educational portfolio on access is being
developed to be used in residency and fellowship
training programs for the purpose of raising awareness
within the primary care specialties, as well as for use
by the ACP-ASIM Board of Regents and Board of
Governors at selected chapter meetings during the
year ahead. The portfolio includes a Board of
Governors at selected chapter meetings, dynamic facts
sheet and compelling data, and recommendations for
professional activism. To personalize the issue, a
collection of patients’ stories will be published
concerning individuals with no current health
insurance. Thus, the portfolio will stimulate both
urgency and awareness of the crisis.
In summary, what is the profession’s responsibility?
The answer is clear. Because the lack of health
insurance is an established risk factor for poor medical
outcomes in the USA, the profession must lead the
effort to achieve universal access to health care. It
can do no less.
by Whitney Addington, MD, ACP-ASIM President
elect 1998-99 and Linda Blank, Vice-President,
Clinical Competence and Communications, ABIM
IPHNnews - November 1998 - Page 4
NETWORK FACTFILE
One of our "regulars" - each issue of the newsletter
will contain a short factfile - introducing the different
members and institutions of the Network to each
other.
1. Healthlink Worldwide
Healthlink Worldwide (formerly AHRTAG) aims to
improve the health of poor and vulnerable
communities by strengthening the provision, use and
impact of information. It does this by:
•
•
o
°
Communicating about health issues
Promoting the development of good policy and
practice
Providing training in information management
and dissemination
Supporting partners in health information and
publishing activities
Healthlink Worldwide works in collaboration with 30
partner organisations working in health in developing
countries. Its resource centre holds the UK’s largest
collection of practical health materials from
developing countries, with particular strengths in:
»
•
«
«
HIV and sexual health
AIDS & sexually transmitted infections care
maternal health
child health.
Healthlink Update is published every two months,
giving information on new resources in primary
health care and community based rehabilitation. It
also provides technical support to partner
organisations in, e.g. Tanzania, Namibia, India and
Brazil, to establish and develop resource centres,
information services, and learning and training
resource materials.
During 1999, Healthfink Worldwide will
be
consolidating its work with health workers, especially
on how changes in the practice of health or other
development workers affect the health of poor and
vulnerable people. More links will be developed with
organisations that represent people from poor and
vulnerable communities e.g. disabled people’s
organisations
More information on Healthlink International is
available from:
Jane Lethbridge
Executive Director
Healthlink Worldwide
Farringdon Point,
29-35 Farringdon Road
London EC1M3JP
United Kingdom
Tel: 44 171 242 0606. Fax: 44 171 242 0606.
E-mail: mailto@healthlink.org.uk
http://www.healthlink.org.uk
Specialist programmes include AIDS and sexual
health, child health and disability and regional work in
Africa, Asia, and the Middle East. The resource
centre database is available on-line free to those
working in developing countries.
Working with partners, Healthlink Worldwide
publishes regular and practical bulletins, resource
lists, manuals and publications on issues including
child health and HIV, AIDS and sexual health. These
publications reach an estimated audience of over 2
million in major languages. Some examples are Child
Health Dialogue, AIDS Action, CBR News, Health
Action.
Recent special briefing papers include:
•
Caring with Confidence - practical information
for health workers who prevent and treat HIV
infection in children
•
Tuberculosis
diagnosis.
and
children:
the
missing
IPHNnews - November 1998 - Page 5
2. IDS also houses Eldis: the Electronic
Development and Environment Information
System
Useful Websites
Each issue we will share information on some of the
websites available, each dealing with some aspect of
poverty, whether from a local, community,
organizational or national perspective. We would be
interested to hear which ones you have found most
useful, what are their areas of interest and whether
they might be of interest to other Network members.
The first two websites in this series are both based at
the University of Sussex in Brighton, UK.
•
«
•
o
1. Institute of Development Studies (IDS)
IDS is a national centre for research and teaching on
development. It was established in 1966 and is an
international authority in the field. Research and
teaching are combined with operational work,
advising governments and aid agencies, and helping
to turn theory on development into practice.
•
•
IDS serves as a forum for debate, hosting
conferences and workshops and producing a range
of publications. It has an active programme of
international collaboration, and welcomes visiting
researchers and development specialists from all
over the world.
The British Library for Development Studies is
housed at IDS. One of the world’s foremost
development libraries, it serves as both a national
and international documentation centre.
http://www.ids.ac.uk/ids/aboutids/index.html
°
ELDIS is a Gateway to Information Sources on
Development and the Environment
ELDIS offers an easy route to the latest
information on development and environmental
issues
ELDIS is a directory and gateway to electronic
information resources and is available free via the
Internet
ELDIS provides an ever increasing number of
descriptions and links to a variety of information
sources, including WWW and gopher sites,
databases, library catalogues, bibliographies, and
email
discussion
lists,
research
project
information, map and newspaper collections.
Where there is no Internet link available, other
information on the availability of databases,
CDRoms, etc. is given
ELDIS offers a data and database hosting service
http://ntl.ids.ac.uk/eldis/eldis.htm
Other Internet sources of information include :
List of international organizations working in health
and development:
http://www.digitalin.com/devpak/intlink.htm
Going Local Community Website:
http://www.dev-works.com/going.local.html
British Medical Journal: http://www.bmj.com/
I would like to become an active member of the International Poverty and Health Network
Name:
Organization
Address:
My particular areas of interest:.....,.,
.....................................
........................................ .....................................
What I/my organization can contribute
Tel
Fax
Email
......................
Please return the completed slip to the IPHN Secretariat at the address given on page 5 of this newsletter
IPHNnews - November 1998 - Page 6
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