Health, Trade and Human Rights

Using Film and Other Visual Media in Graduate and Medical Education, v. 2

Theodore H. MacDonald, Archbishop Desmond Tutu, Grace H. Chickadonz

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315347486
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This work contains forewords by Desmond M. Tutu, Archbishop Emeritus, Cape Town, South Africa and Mogobe Ramose, Chairperson and Professor of Philosophy, Department of Philosophy, University of South Africa. "Health, Trade and Human Rights" shows how a policy of 'free' rather than 'fair' trade increasingly undermines Third World health. It clearly illustrates how the looming environmental crisis combined with growing levels of health inequity will have adverse effects and details precisely how the 'basic human rights' enshrined in the UN Charter have gradually become subsidiary to the dictates of free trade, enforced by the World Trade Organisation. This groundbreaking new book argues the need for impartial, data-based, and transnational arbitration of equity in health and other human rights - and suggests how this might be accomplished without violence to national rights, with an emphasis on 'regional free trade'. "Health, Trade and Human Rights" provides vital, thought provoking information for general readers with an interest in the Third World and social welfare. Academics and students studying development, international studies and public health will find it invaluable, as will healthcare professionals, international healthcare organisations, care agencies, and international charities. Policy makers and shapers in communities and government will find the content revelatory as will political activists and those with an interest in equality and globalisation. '[The book] criticises the basis, the method and the extent to which the politics of wealth continues to undermine and violate the right of the poor to good health. The combination of experience with scientific rigour is presented in accessible everyday language. It is seductive; inviting the curiosity of the reader to last until the very end of the book. MacDonald's message is clear and unambiguous: war is no longer the father of all things. Instead, justice is the mother of all peace.' - Mogobe Ramose, in his Foreword. 'Astonishingly accessible, informing and inspiring. Statistically sound, penetratingly. accurate, admirably balanced. Theodore MacDonald writes with passion, as well as with sense. Much of what he has to say is drawn from his own experience working as a medical doctor and a mathematician in a broad range of the world's poorest nations. But overarching that is a powerful insight into social and economic issues, along with well-honed skills as a communicator. I am pleased to recommend this splendid book.' - Desmond M. Tutu, in his Foreword.

Chapter 1

What are the problems?

The link with imperialism

Christian scriptures teach us that ‘The poor ye always have with you’ (Matthew 26: 11), but they do not go on to say that the gap between the rich and poor of the world has been increasing almost uninterruptedly in the two millennia since Jesus reputedly uttered those words. In the early nineteenth century the hope and expectation among many European thinkers was that – with the benefits of science – the gap might soon begin to close. But the very reverse has happened. In fact, since the Industrial Revolution (say, from the 1760s) the poverty gap between the first and the third worlds has accelerated exponentially. The huge advantages conferred on the first world by computer technology and automation processes through the twentieth century have reflected themselves in an even greater rate of wealth differential between the rich and the poor. As this book will show, these phenomena are well documented and are evident even over comparatively short time intervals. For example, the proportion of people with access to safe water and rudimentary sanitation in rural Africa dropped from 60% in 2000 to only 43% by 2002. Indeed, in Africa’s poorest countries income per person has fallen by 25% over the last 25 years (Matthiason and Townsend, 2005).

Of course, virtually from the beginning of recorded history (and no doubt before), trade and health have been inextricably linked, although the links were rarely anticipated beforehand, were often not observed for years after they had started to occur and were infrequently understood when they were observed. At the purely local level, one can cite many well-known examples – arsenic poisoning among tea-tasters in the seventeenth century, mercury poisoning associated with the haberdashery trade as late as the nineteenth century (viz. the Mad Hatter in Lewis Carroll’s Alice’s Adventures in Wonderland, published in 1865) (Dodgson, 1983). Even further back in time, we note the ruinous impact on the health of people who dyed togas in squid ink for the élite of the Roman Empire. We do not lack for examples.

As trade became international, and ineluctably associated with the imperialistic ventures of the industrialised world nations over much of the rest of the world, the link between trade and health became even more obvious. This was because, by and large, colonised peoples were accorded far fewer human rights than their masters enjoyed. They were given less protection from work-related accidents, poorer food and less of it. Also, the movement of ships and people from one part of the world to another facilitated the spread of disease. We only have to think of the dire impact of bubonic plague (the ‘Black Death’) even as far back as the fifth century bc in Greece.

But today such potentially negative effects of global trade on health are so much greater because of the ease, speed and volume of international air travel. Pandemics such as human immunodeficiency virus or acquired immune deficiency syndrome (HIV/AIDS) now threaten us all, as do various virulent forms of influenza, to say nothing of resurgent tuberculosis. It is sobering to remind the reader that, until the 1960s, many of us thought that tuberculosis had been effectively eradicated from Europe and North America.

European imperialism in Africa, Asia and the Americas, mainly between the sixteenth and nineteenth centuries, tended to create a situation in which the great bulk of such health problems impinged on the natives of colonised territories while, with astute planning and foresight, the majority of the benefits of trade accrued to the European moneyed classes. The eclipse of the major European colonial adventures (say, after 1945) did not see a reduction in these inequities. Rather, they have greatly increased. First-world corporations and governments have developed much more efficient forms of imperialism, most of it now controlled from the USA rather than from Europe. Without being too flippant, a US-based trans-national corporation can effectively subvert the entire economy of a third-world country by sending an e-mail between two banks. There is no more need of a globe-encircling navy or vast standing armies in garrisons all over the globe.

The negative effect on human rights (such as health, access to water and food, education and so on) through the exploitation of the third world to facilitate trade has been enormous. Subsequent chapters will deal more specifically with the details. Trade, for instance, has never been disassociated with war, but wars have been pretty well constant since 1945. Many of these conflicts are remote from first-world consciousness (our media is thoughtfully selective in this regard) and routinely the bulk of casualties are now borne by the civilian population rather than by the military.

Whose WHO?

The World Health Organization (WHO) was established as a United Nations (UN) body in the closing days of World War II and as a pivotal part of the UN’s broader remit to oversee a more stable and just international order, with world peace and human rights as its major objectives. Health was unambiguously recognised as a ‘basic human right’, as was education. Universal access to health was seen as fundamental to this objective. Through the 1950s, 1960s and 1970s, the WHO was widely perceived as the vanguard of this noble enterprise, in which medically trained personnel from a variety of nations cooperated in defining international health agendas and in elaborating impressively successful drives against scourges such as poliomyelitis and smallpox. Among the director-generals of the WHO in those forward-looking days were such eminent figures as Dr GH Brundtland, Dr H Nakajima and Dr H Mahler. The latter, Dr Halfdan Mahler, in particular, was the energetic proponent of the ‘Health for All 2000 (HFA 2000)’ campaign, which emphasised primary healthcare* for all by the year 2000. This campaign was announced at the 1977 meeting of the World Health Assembly at Alma Ata in the Crimea, not far from Scutari where Florence Nightingale achieved such fame (WHO, 1978).

The underlying principles of primary healthcare were agreed at that meeting as follows.

• Universal access to healthcare on the basis of need alone.
• Care with the emphasis on prevention of disease and on personal and community health promotion.
• Full co-operation between various social and medical agencies in mediating healthcare. This is referred to as ‘inter-sectorality’ and can include a wide range of input – sporting, cultural, educational and so forth.
• Cost effectiveness at the administrative level (usually government-financed) and presenting no financial barrier to patient access.

Thirty-eight objectives were optimistically set out under the title ‘Health for All 2000’. The aims were not achieved by 2000, not through any lack of commitment on the part of Mahler and his predecessors, but because by the late 1980s the WHO had already conceded too much ground to globalised financial initiatives, which regarded the interests of international trade as transcending health for all. Indeed, soon after Mahler retired from the WHO, the argument that primary healthcare is so costly that financial bases for trade to pay for it had to have priority was gaining favour. By 1989 it was generally realised that the ‘Health for All 2000’ objectives were not going to be met in time. Some of these were deferred until 2015, whereas others simply disappeared.

Truly, until the mid 1980s, the WHO seemed to transcend politics and commerce in pursuit of its heroic objectives. It was focused on the widespread application – to as many of the world’s people as possible – of primary healthcare. Its methods were based purely on health needs and the elaboration of efficient means of meeting them.

At that time, then, the answer to the question: ‘Whose WHO?’ would have been ‘Everyone’s’, but things have changed. After Mahler, the post of Director-General of the WHO has been held by people who felt that the aims and strategies of the WHO should be focused less on the meticulous collection of medical statistics as a basis for meeting clinical needs and more on optimising the affected nations’ capacity to align their infrastructures with the needs of globalised trade and finance.

The situation is worse than this for, as we shall see in Chapter 2, nations are not even free to organise their trading relations within or between small blocs of contiguous territories, but increasingly must follow the dictates of the World Trade Organization (WTO). Without going into detail at this point, the WTO appears to be the ultimate expression of democracy in that every member country has equal voting rights. But the devil is in the detail, for there is no limit to the number of lawyers and other informed representatives that a country may send abroad to meetings (both formal and informal) to promote their nation’s case. The USA can (and does) send out hundreds of such representatives, compared to every one (or none) in the case of many third-world nations. Very small nations, like St Lucia fighting for a fair share of the banana trade, are clearly at a great disadvantage. In most WTO mediations between claims from the USA and some smaller third-world country, the odds are overwhelmingly stacked in favour of US interests.

But what does the WTO have to do with the WHO, or with health generally? As previously noted, the WHO has found itself gradually moving away from its early 1980s stance on the primacy of health as a basic human right to one of health being necessarily subject to adjustments to nations’ infrastructures as required by the needs of international trade. In other words, health is becoming seen as commodity that can be bargained for. It is now very much a matter of relative values and of political decisions with the WTO, rather than the WHO, calling the shots.

This is so much the case that, in the WTO Council, the WHO is only represented by a non-voting ‘observer’. Trade, especially globalised trade, more often than not determines a poorer nation’s ‘rights’ to health. So, in 2006, if we are faced with the question ‘Whose WHO?’, the answer is no longer ‘Everyone’s’ but that of ‘The bankers and capitalist corporations of the first world.’

Health planning for international trade

In this context let us consider the rather unwieldy terms ‘horizontalisation’ and ‘verticalisation’. The first refers to the situation in which a nation sets out to mediate healthcare as promulgated at Alma Ata – as a basic human right applicable to as many of its people as possible. For instance, routine immunisation programmes, widespread access to mother and child clinics, universal sex and health education programmes in schools, and free and compulsory school attendance are examples of horizontalisation. It is routine in first-world nations, but is rare in the third world. Cuba is an outstanding counter-example to this (see Chapter 6). The second refers to a situation in which a nation concentrates its access to healthcare to those areas of the country most crucial to its trade and money-generating activities.

There are various third-world countries which have attempted to organise horizontalisation but which have eventually been compelled by World Bank and/or International Monetary Fund (IMF) debt repayment conditions (as discussed in Chapter 2) to give it up. Sometimes verticalisation has led to rather bizarre results. Take the case of Zambia, for instance. In 1973 a number of WHO reports were written trying to account for why antimalaria programmes, to which until 1970 malaria had been responding well in that country, were suddenly failing. It was found that the main reason was that Zambia, in order to meet the conditions for a loan from the IMF, had instituted verticalisation and hence terminated malaria control in rural areas (WHO, 1973). One could cite many other health inequities which arise from prioritising the needs of globalised trade, and some of these will be discussed in subsequent chapters. But, before specifying further problems as they affect third-world health, let us consider one immense problem which really involves an effective mechanism by which the first world is being massively aided financially by the third: the first world has been systematically using the third world as a reservoir of professionally trained health staff for its hospitals.

The ‘brain drain’ from the third to the first world

Any reader who has recently been a hospital patient in a major first-world city, such as London or New York, will have been struck by the high proportion of doctors and nurses, and other medical staff, who have had their training abroad. This author found, as a patient in some of London’s leading hospitals, that a command of Spanish and/or Tagalog was almost a requirement in order to communicate with the large number of staff from the Philippines. Swahili and one or two West African languages would also not have gone amiss. In short, the UK’s National Health Service (NHS), which serves its people...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Foreword, by Mogobe Ramose
• Foreword, by Desmond M Tutu
• Preface
• Acknowledgements
• Dedication
• 1 What are the problems?
• 2 First-world finance: third-world poverty
• 3 The environment: our ultimate arbitrator
• 4 Mothers, milk and money
• 5 The third-world face of HIV/AIDS
• 6 What are the solutions?
• Index