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Fran Baum on economics and health at the WHO global health meeting

12 Jun, 13 | by BMJ

Fran Baum

Fran Baum is blogging from the 8th World Health Organization Global Health meeting. Read her other blogs here.

The day started with Cecilia Vaca Jones, the Minister of Social Development in Ecuador presenting some impressive indicators of Ecuador’s progress. They have tripled health and social spending between 2006 and 2012 with the aim of eradicating poverty. Over this period, inequities have declined and the gini co-efficient has reduced from 0.54 to 0.47. The approach has been multi-sectoral including improving housing, health, and education, and increasing pension coverage for older and disabled people.

I was pleased to hear the Canadian Greg Taylor quote Danny Broderick, senior policy officer, Health in All Policies (HiAP), South Australia as saying “Intersectoral action can sometimes be like a tug of war. HiAP has different logic—let go of the rope.” I presented a paper on the evaluation of the South Australian HiAP initiative in a session where there was interesting debate about the politics of evaluation and differing needs of policy makers and researchers. The policy makers made it clear that researchers often don’t appreciate policy makers’ requirements which are inevitably sensitive to political imperatives.

The liveliest session so far was this afternoon’s plenary on economics and health. Enis Baris discussed the World Bank’s goal of eliminating extreme poverty (which is a good thing), but he did not discuss how the current global economic order privileges profits for corporations before people’s health. As long ago as 1978 the World Health Organization called for a “New International Economic Order” in the Alma Ata Declaration, and it seems we still need this call in 2013. Baris described the World Bank’s support for a conditional cash transfer programme in Malawi, which requires recipients to test negatively for STDs/HIV in order to receive the cash. During the conference a number of participants have noted that there is increasing evidence that conditionality is not effective. The effectiveness is important, obviously, but there is a broader ethical issue about whether welfare would be conditional or whether it should be a right.

Eva Jane-Llopis (World Economic Forum) reminded us that 44% of the world’s largest economies are corporations. She described how the private sector is promoting health. Tweets from the floor showed scepticism about the altruism of the private sector and suggested that corporations should pay fair taxes and stop evading taxation if they really want to invest in health. I think what we were treated to by the World Bank and WEF representatives was a “health wash,” which involved making out that the private sector interests are in health promotion. Tax evasion is widely practised by companies. Yet the taxes avoided would provide funding for many public programmes for healthcare and the determinants of health. Ilona Kickbusch pointed out that governments should enforce corporation law and close loopholes that are exploited by corporations. She also noted that the healthcare industry is now US$6.5 trillion and growing. Clearly its interests are in providing more services not in promoting health. After all under corporation law companies have a duty to return a profit to their shareholder above all other considerations and they do this regardless of the health impact.

Fran Baum is a professor of public health. She is the director of the Southgate Institute of Health Society and Equity, Flinders University, Adelaide, Australia, and is a member of the Global Steering Committee, People’s Health Movement. She is an Australian Research Council Federation fellow.

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