environment, global health and development filepag. 1 © università bocconi environment, global...

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Environment, Global Healthand Development

Prof. Eduardo Missoni

CERGAS – Global Health and Development Group


Development: what is it?

The idea of “Development” an “evocativeconcept”

US President Truman 1949 development asopposed to under-development

The” Washington Consensus” -Development as synonym of “economicgrowth”.

What does GDP measure?


What does GNP measure?

We will find neithernational purpose norpersonal satisfaction in amere continuation ofeconomic progress, in anendless amassing ofworldly goods. We cannotmeasure national spirit bythe Dow Jones Average,nor national achievementby the Gross NationalProduct


What does GNP measure?

GNP includes air pollution, and ambulances toclear our highways from carnage. It counts speciallocks for our doors and jails for the people whobreak them.

GNP includes the destruction of the redwoods andthe death of Lake Superior. It grows with theproduction of napalm and missiles and nuclearwarheads…. It includes… the broadcasting oftelevision programs which glorify violence to sellgoods to our children.


What does GNP not measure?

It does not allow for the health of our families, the quality oftheir education, or the joy of their play. It is indifferent to thedecency of our factories and the safety of our streets alike.It does not include the beauty of our poetry, or the strengthof our marriages, the intelligence of our public debate or theintegrity of our public officials…

The Gross National Product measures neither our wit norour courage, neither our wisdom nor our learning, neitherour compassion nor our devotion to our country.

It measures everything, in short, except that which makeslife worthwhile

Robert Kennedy


The growth society - the neoliberal model

indefinite growth implies indefinite production ofcommercial goods– “merci” in Italian, as distinct from “beni”

production absorbes energy and non renewablenatural resources

production is linked to consumption consumption produces waste waste produces pollution today’s polluted and polluting society needs

consumers rather than citizens


The growth society - the neoliberal model

media serving the growth society induce increasingconsumption

constant need for market expansion andexploitation of limited resources nurtures conflicts

increasing interconnectedness basis foraccelerated globalization (the global neoliberalmodel)

the growth society intimately related to theenvironmental crisis and its impact on humanhealth


What does GDP measure?

Growth for the sake of growthis the ideology of the cancercell

Edward Abbey


Redefining Development

Sustainable? Human? The biological metaphora

– not a cancer cell but a cell growing into anorganised and harmonious living being

– with specialised interdependent functions– concerned about future generations

“de-growth”? (S. Latouche) Gross National Happiness? (Bhutan)


Health

Health is a state of complete physical,mental and social well-being, not merely

the absence of disease


WHO 1948

The enjoyment of the highest attainablestandard of health is one of the fundamentalrights.

The health of all peoples is fundamental tothe attainment of peace and security.

Unequal development in different countriesin the promotion of health and control ofdisease is a common danger.


1960s -1970s - New theories of developmentchallenge the “growth economy” “Basic needs approach”; New International

Economic Order…Health for All by the year 2000 1978 Alma Ata: “Primary Health Care is the

key to attaining the target as part ofdevelopment in the spirit of social justice”

“a true revolution in thinking” “Health for all isa value system with primary health care asthe strategic component” (Dr. Mahler)


But the neoliberal model prevails and influencesglobal health policies: selective PHC selective implementation of single measures

for survival or disease control “campaigns”: cheaper, more “visible”; mask

lack of political will disease approach responds to donors

convenience


.…attention moves from health to diseases

National Health Systems (and WHO!) arereorganised (and fragmented) into “verticalprograms”

Public health action is disarticulated Costs multiply and resources are wasted Links with other aspects of development are

lost


The neoliberal model influences global healthpolicies:

1981 WHO/UNICEF International Code of Marketing ofBreast-milk Substitutes adopted (34th WHA)– sole opposing vote coming from the United States of America: code

perceived as interference in marketing practices

Essential Drug Program opposed by leading US-basedpharmaceutical companies;– 1985 United States withholds contribution to WHO's regular budget.

WHO's regular budget is frozen– increasing dependance on extrabudgetary funds

negotatiated bilaterally with most infuential donors


The neoliberal model influences global healthpolicies: World Bank’s responsibilities

1979 - World Bank creates Population, Health and NutritionDepartment

Structural Adjustment Policies– social spending cuts, privatisation, abolition of protectionist barriers– collapse of health systems

1987 - Financing Health Services in Developing Countries:An Agenda for Reform– single recipe Health Sector Reform (user fees, privatisation of health

services, private insurance schemes, decentralisation)

1993 - World Development Report 1993: Investing in Health– "minimum essential package" and privatisation of health services


Main actors in Global Health

Actors Traditional Increasingimportance

(’80s and ’90s)

New andimportant

actors

Intergovernmentaland otherMultilaterals

WHO, UNICEF,UNFPA

World Bank,UNAIDS,

European Union

GPPPs(GAVI Alliance

andGlobalFund)

Bilaterals OECD-DACcountries

US, UK, etc

G8 China, India, Brasiland

other emergingeconomies

Private Philanthropicorganizations(Rockefeller,

Wellcome Trust,Aga Khan)

Corporate sectorCivil society

organizations(Oxfam, MSF)

Global philanthropy(Gates Foundation)

Civil SocietyNetworks

(People Health’sMovement)


A sense of the trend at WHO…

“We certainly need private financing. For thepast decade governments’ financialcontributions have dwindled. The mainsources of funding are the private sector andthe financial markets. And since theAmerican economy is the world’s richest, wemust make the WHO attractive to the UnitedStates and the financial markets”

David NabarroWHO DG’s Head of Cabinet


Corporate sector; Philanthropists; GPPP

Private sector– the non profit evolution toward INGOs– the Corporate Sector

Global Philanthropy– from Rockefeller to the Bill & Melinda Gates Foundation

» established in 2000» Global Health top priority» B&MGF becomes single most important non-institutional player

WTO (example: TRIPS; GATS) Global Public Private Partnerships emerge as a new

approach» 90 health-related GPPPs» GAVI» Global Fund to Fight HIV/Aids, Tuberculosis and Malaria


Global health governance (2002)

Source: Dodgson et al, 2002


GPPPs

G8

B&MGF

IHP

UNAIDS

Global health governance (2010)


2008 World Health ReportPrimary Health Care. Now more than ever Powerful forces have often driven health systems

away from their intended directions:– hospital-centrism– fragmentation– pervasive commercialization of health care

Way forward:– Equity (universal coverage)– Primary care (people-centered health systems)– Public policies for health– Leadership reforms (health governmental responsibility)


2008 - WHO Commission onSocial Determinants of Health “The development of society, rich or poor,

can be judged by the quality of itspopulation's health, how fairly health isdistributed across the social spectrum, andthe degree of protection provided fromdisadvantage as a result of ill-health”

“Growth by itself, without appropriate socialpolicies to ensure reasonable fairness in theway its benefits are distributed, brings littlebenefit to health equity”


…2009

G8 at L’Aquila a) the integrated approach to the achievement of

the health-related Millennium Development Goals(MDGs);

b) advancing the goal of universal healthcarecoverage, through Health Systems Strengthening;

c) promoting health as an outcome of all policies; d) increasing effectiveness and quantity of

international aid, including innovative financingmechanisms.


G-local actions to improve our health &protect the environment

Individuals:– green choices can be healthy choices

Academia:– produce evidence for health

Civil Society:– translate e evidence into advocacy and resposnsible citizenship

The Health Sector:– leading by example

Local Government:– creating healthy and sustainable cities and communities

National and International Leaders:– putting health /physical, mental and social wellbeing) and the

environment at the heart of public policies: Happiness society vs.Growth Society


Global Health and Development GroupCERGAS Bocconi

[email protected]

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