Introduction to the Politics of Health

The phrase “Politics of Health” was coined by David Werner and first introduced in Newsletter #13. The idea emerged from David’s own lived experience with the campesinos of the Sierra Madre. Wheras he had once believed that the problem of health was one of access to expert medical care and advanced technologies, he quickly realized that the root of the problem was socio-economic: the campesinos were sick because they were poor; they were poor because of intergenerational political injustices. For a good introduction to David’s ideas, see Newsletter #29.

This concern for the political underpinnings of poor health led David to join forces with others: Maria Zuniga and David Sanders to form the International People’s Health Council, and with Sanders to write Questioning the Solution. These efforts help lead to the People’s Health Movement.

David felt that the best way for groups like the IPHC and the PHM coordinate action was with good information. To that end, he built the Politics of Health Knowledge Network.

A Brief History of the Politics of Health

2002: The Origins of Politics of Health Knowledge Network

from Community Ownership: The Key to Sustainability (2002)

The Need to see the Larger Picture

I choose to believe that there is a core of goodness—or at least of common sense—in most people. At one level or another most of us, rich and poor, share an interest in helping create a world that is conducive to our mutual well-being, and the well-being of generations to come. Our survival instinct is not only personal but collective. Over the millennia we have developed brains that can think and look ahead. The “Golden Rule” exists in some form in every belief system. What goes around comes around.

On our long slow progress toward civilization, human beings have begun to discover what we might call eco-understanding. We have begun to realize that harmony, balance, fairness, and kindness provide greater security and deeper satisfaction than do selfishness, cruelty and greed. Our greatest joy comes from a shared experience which some people call love, wherein giving and receiving become one. The bigger chunk of the universe we embrace in that feeling of oneness, or love, the fuller our lives become. When we give the best of ourselves, we all benefit. What goes around comes around, but in a spiral: rising to a higher level.

Much of the inequity, cruelty, and violence in today’s world results from incomplete, distorted or false information. The road to Health for All must be paved with better understanding. There is need for more effective and honest communication. Bombarded as we all are by partial and distorted information, too often we are like the blind men who try to describe an elephant by touching different parts of it. It’s a rope, a tree, or a huge sack, depending on whether they touch its tail, its leg, or its belly. We need some way to stand back and get a more complete picture: to be more completely in touch. We need to put the different pieces of the puzzle together, and to share our perspectives openly and honestly with one another.

Getting a complete picture of what is needed to achieve Sustainable Health for All will not be easy. Some of us want to do it through market forces, with the proverbial “big stick,” or with a bag of cost-effective technological fixes, depending on our particular training and perspectives. But first we need to see the bigger picture, and learn from one another. Collectively we can begin to put together the pieces of the puzzle, until we can glimpse that colossal elephant (or turtle?) that miraculously holds up the world.

Politics of Health Knowledge Network

With this goal of collectively putting together the pieces of the global puzzle, we at HealthWrights (Workgroup for People’s Health and Rights) and the International People’s Health Council have taken on an ambitious project. We call it the “Politics of Health Knowledge Network.” The main purpose of the Politics of Health Knowledge Network will be to provide credible data, well-balanced analysis, and workable alternatives to the international community of health workers and activists who share the dream of Sustainable Health for All. It will have the following characteristics:

• It will serve as an easy-to-understand resource of relevant, accurate information for those concerned with questions of health and development policy, and social justice.
• Information will be carefully researched, fully referenced, and presented in a clear, objective, and hopefully non-rhetorical manner.
• An effort will be made to place each piece of information within the larger picture of the determinants of health, from local to global level.
• To do this, information will be organized within a map or matrix designed to show the links or causal chains between different health related issues at different levels.
• Users can enter the Network with anything from personal to global health-related concerns. From whatever entry point they can explore or follow up links in many directions. They can see how their particular issue fits into the larger context. They will also be able to see how policies and decisions in different sectors have a direct or indirect impact on health.
• Information will cover a wide range of topics and sectors that impact on health, or which either enhance or obstruct the pursuit of Sustainable Health for All. Data will cover everything from macro or global policies to first hand accounts of micro or local events, and the impact of one on the other.
• Key information will be presented as summaries and extracts. References to full articles and sources will be provided, where possible with internet links.
• Information will be presented in the form of comparative studies, data, charts, and real life stories. It will draw on credible publications, but will also include first hand accounts by people whose health and lives are jeopardized.
• The Network will stress positive alternatives and possibilities. While it will include critical analysis of current policies and practices, it will attempt to juxtapose negative situations with examples of more equitable and sustainable options. When a problem is analyzed, you can click on a “positive action” button to see possible solutions or suggestions for constructive action, with relevant resources or addresses. This emphasis on positive action will, we hope, make the Network motivational rather than depressing.
• The plan is for the Politics of Health Knowledge Network to be interactive and participatory. It will start off as an interactive web site on the Internet, but may evolve to include a paper and CD-ROM version. Its evolution and comprehensiveness will depend on the input of users, and active participation of dedicated volunteers.

2002: Announcing the “Politics of Health Knowledge Network”

from Newsletter #47 (2002)

A movement for health and social justice must go beyond “preaching to the choir”. If it is to help raise the awareness of the general public, and if its proposals are to be taken seriously by mainstream decision-makers, it is essential that the information it disseminates be objectively reported and rigorously documented. With this in mind, HealthWrights, in cooperation with the International People’s Health Council (IPHC) and the People’s Health Movement (PHM), is beginning to develop an interactive web site called the “Politics of Health Knowledge Network.”

The intent of this web site will be to supply those concerned with questions of health, development policy and social justice with an easily accessible resource of relevant information.

• The information will be carefully researched for accuracy, fully referenced, and presented in an objective (non inflammatory) manner.

• It will cover a wide range of topics and sectors relevant to the achievement of Sustainable Health and Social Justice for All.

• The information will be presented in the form of summaries and extracts (with references to the full articles or sources), comparative data, charts, stories, and selected testimonials.

• It will draw on credible publications, but whose health and lives are most affected.

• It will cover everything from global policies to first-hand accounts of local events.

The information will be organized and presented in the form of a map designed to show the links or causal chains between different occurrences at different levels, from local to global. Users will be able to enter the Knowledge Network with anything from a personal health-related concern to an international health-related issue, and from that point be able to follow connections in many directions. They will also be able to see how their particular issue or concern fits into the larger picture or global picture. They will also be able to see how policies and decisions in different sectors interact to have a farreaching impact on health.

Every effort will also be made to link analysis of curent policies and practices, with examples of more positive, equitable, and sustainable alternative. When a problem is cited, the user will be able to click on a “positive action” button, which will give examples of proposed or already implemented solutions, with ideas or suggestions for action, and relevant resources or organizations. This emphasis on positive alternatives and action will, we hope, make this Knowledge Network a motivating rather than a dispiriting instrument.

You can participate!!

The Politics of Health Knowledge Network will be interactive and participatory. Indeed its growth, evolution and refinement indeed, even its initial success – will depend on input from a wide range of users and concerned volunteers. In this context, the overall “Movement for Health and Social Justice” could play an instrumental role in the development of this Politics of Health Knowledge Network - and we very much hope it does.

To assist in the development of the Knowledge Network, we are looking for people to play the following roles:

• Representatives of like-minded groups and organizations who can help with managing/co-coordinating the project

• Volunteers who can provide key information, data, and stories, either on the general theme on Politics of Health, or on specific focal areas

• Intermediaries who can help cull, summarize, and organize information, and arrange it into the format of the overall map

• Programmers who can help develop the interactive database

• Communicators who can help spread the word about the Network and recruit contributors and volunteers

• Researchers who can search the Internet and other sources fo information on health, sustainable development, and social justice

• Fundraisers, with the hope that we can pay a few key people to help put the Politics of Health Knowledge Network together and keep improving it hope that we can pay a few key people to help put the Politics of Health Knowledge Network together and keep improving it

In summary, the main purpose of the Politics of Health Knowledge Network will be to provide credibility—through solid, well balanced analysis and comprehension of workable alternatives—to those who are currently advocating for change, but who need easy access to clearly presented, well organized and convincing information. We hope that this Knowledge Network will be an important tool for change. But to get it off the ground we need help from people like you.

2011-2014: Later Developments

At some point (still to be determined) the initial simple design was updated with a more sophisticated layout:

In 2011, the website (and HealthWrights.org itself) was re-built using a content management system (CMS) called Joomla, enabling more interactivity and participation. However, the site did not become as popular as the HW team had hoped. From the late 2000s, commercial social media like Facebook and Twitter took over the web and independent websites and blogs struggled to maintain a foothold. Even the large-scale anti-globalization network Indymedia fell into decline. The Politics of Health was no different.

Perhaps another reason for the decline of Politics of Health is the rise of data science. Whereas the Politics of Health grew out of the problem of having too little good information, we now experience the problem of having too much information. Piecemeal data collection, such as HealthWrights attempted with PoH has been replaced by “Big Data”. NGOs, corporations, and governments are routinely staffed with highly trained specialists. These activities and specialities fell outside of HealthWrights’ historical expertise.

 

Although The Politics of Health website still exists, it has been more or less inactive since about 2014. But the hard work of our team will not be in vain. Many of its essays are available already in the articles section of this site. Others we intend to gradually integrate into this site. Eventually the Politics of Health website will be retired.

Key Readings Relevant to The Politics of Health

Compiled by the International People’s Health Council, and HealthWrights

 

PRIMARY HEALTH CARE and DETERMINANTS OF HEALTH:

Werner, David; Sanders, David with Jason Weston, Steve Babb and Bill Rodriguez. Questioning the Solution: The Politics of Primary Health Care and Child Survival. HealthWrights, 2001.

Questioning the Solution analyzes why 13 million children die every year from preventable causes, and challenges conventional Primary Health Care and Child Survival Strategies. Too often, health and development planners try to use technological fixes rather than confront the social and economic inequities that perpetuate poverty, poor health, and high child mortality. As a case study, the authors show how marketing Oral Rehydration Therapy as a commercial product, rather than encouraging self-reliance, has turned this potentially life-saving technology into yet another way of exploiting and further impoverishing the poor.

Macdonald, John. Primary Health Care: Medicine In Its Place. University of Bristol, UK. 1993. Available through Kumarian Press, 630 Oakwood Ave., Suite 119, West Hartford, CT 06110-1529, USA.

Traces the development of Primary Health Care since its inception at Alma Ata in 1978 to the present, providing strong arguments for the rationale of PHC. Emphasizes the need for equity and strong community participation.

Navarro, V. “A Critique of the Ideological and Political Position of the Brandt Report and the Alma Ata Declaration.” International Journal of Health Services. Vol. 14, No. 2 (1984): pp 159-172.

Social Science and Medicine. “The Debate on Selective or Comprehensive Primary Health Care.” Vol 26, No 9 (1988): pp 877-878.

Introduction to and historical background of the debate. Editors question whether there is really a fundamental conceptual conflict between SPHC and CPHC. They assert that donors should support nations to develop national health systems based on primary health care. Several good papers by key critics.

Werner, David and Bower, Bill. Helping Health Workers Learn. A People-Centered Guide to Teaching Community Health Workers.

Intended for those who feel that their first allegiance lies with working and poor people. Discusses (and simplifies) the awareness-raising methodologies developed by Paulo Freire.

Halstead, SB, Walsh, Julia A, and Warren, Kenneth S, eds. Good Health at Low Cost. New York: The Rockefeller Foundation. 1985.

An important study investigating why certain countries—China, Kerala state in India, Sri Lanka and Costa Rica—have attained widespread good health despite low GNP per capita.

Daly, Herman. For the Common Good: Redirecting the Economy toward Community, the Environment, and a Sustainable Future. Boston: Beacon Press, 1989.

Daly, a former World Bank economist who left in disgust, argues for an eco-economic model of development based on equilibrium , not growth, with full cost pricing that builds in human and environmental costs.

UNICEF The State of the World’s Children. Oxford, England: Oxford University Press.

Annually updated progress ln Child Survival. Has useful statistics and graphs on health, education and economic indicators in most of the world’s countries with year by year comparisons. Clearly presented.

McKeown, Thomas. The Role of Medicine: Dream, Mirage or Nemesis? Oxford, UK. Basil Blackwell Publisher. 1979.

A superb review of how medical interventions had relatively little to do with public health improvements in Europe and the US between 1800 and 1950. Challenges myths about the contribution of biomedicine.

Sanders, David. The Struggle for Health. Hampshire, UK: Macmillan Education. 1985.

A perceptive overview of the causes of widespread poor health and early death in situations of underdevelopment. It demonstrates clearly that far-reaching improvements in health depend more on social factors than on biomedical advances.

Ehrenreich, J. ed. The Cultural Crisis in Modern Medicine. Monthly Review Press. 1978.

This book is a collection of writings by 14 authors divided into 3 parts: The Social Functions of Medicine, The Historical and contemporary Roots and Devastating Impact of Medical Sexism, and the Use of the Art of Healing in Promoting and Maintaining Imperialism.

Kent, George. The Politics of Children’s Survival. New York. Praeger. 1991.

This book provides a clear, trenchant analysis of how “structural violence” impacts the lives and mortality of children in the Third World. Kent makes a strong case for equity-oriented development and strategies that empower the poor.

Werner, David. The Life and Death of Primary Health Care, or, The McDonaldization of Alma Ata. 1993. Available from Healthwrights c/o Jason Weston, 3897 Hendricks Road, Lakeport CA 95453 USA, info@healthwrights.org .

Talk given to Medical Aid for the Third World. Reprinted in Third World Resurgence (see below). Gives a cogent history of the 3 major attacks on PHC since Alma Ata: Selective Primary Health Care, User Financing and Cost-Recovery Schemes, and the World Bank’s Investing In Health report.

DEVELOPMENT AND SOCIAL CHANGE: ISSUES THAT AFFECT HEALTH

Isbister, John. Promises Not Kept: The Betrayal of Social Change in the Third World. West Hartford, Connecticut: Kumarian Press 1991.

Reveals how world leaders rose to power on promises for social progress and how they blatantly broke those promises. Packed with hard-hitting facts, the book gives a chronology on how poverty evolved.

UNDP Human Development Index.

Provides important, useful data on distribution of wealth and resources within and between countries, along with social indicators (rather than merely economic ones) of a population’s progress and well-being. Presents a more honest (people friendly) description and analysis of global trends than does the World Bank’s World Development Report.

Watkins, Kevin. The Oxfam Poverty Report. Oxfam Publishing, BEBC Distribution, PO Box 1496, Parkstone, Poole, Dorst BH123YD, UK. 1995.

A comprehensive analysis of the state of poverty in the world today, this well documented book identifies the structural forces that deny people their basic economic and social rights. It outlines some of the wider policy and institutional reforms needed to create an enabling environment in which people can take self-determined action to reduce poverty.

Magazines (monthly):

Third World Resurgence. Published by Third World Network, 228 Macalister Road, 10400 Penang, Malaysia.

Perhaps the best periodical critique and analysis from the Third World on development, environmental, and health issues. Aims at “fair distribution of world resources and forms of development which are ecologically sustainable and fulfill human needs.” If you subscribe to just one Third World periodical, consider this one.

The New Internationalist. Subscriptions: PO Box 79, Hertford, SG14 1AQ, UK.

“Exists to report on issues of world poverty and inequality; to focus attention on the unjust relationship between the powerful and the powerless in both rich and poor nations " Each issue focuses on a different theme relevant to development and basic needs. Quality varies, but many issues carry important debate on “the radical changes needed within and between nations if the basic needs of all are to be met.”

GLOBAL POWER STRUCTURES, FINANCIAL INSTITUTIONS AND TRANSNATIONAL CORPORATIONS THAT IMPACT HEALTH

World Bank. World Development Report, 1993. Investing in Health. Oxford, UK. Oxford U. Press. 1993.

This is the position paper for the World Bank’s take-over of Third World health policy planning. It calls for more equitable and efficient health systems. But stripped of its Good Samaritan face lift, it is a rehash of the conservative strategies that have derailed Comprehensive Primary Health Care, but with the added shackles of structural adjustment, including privatization of public services and user-financed cost-recovery. A masterpiece of disinformation, this market-friendly version Selective Primary Health Care has ominous implications. By tying its new policy to loans, the Bank can impose it on countries that can least afford it. In sum, the Report promotes the same top-down development paradigm that has perpetuated poverty, foreign debt, and the devastating impact of structural adjustment policies.

Critical Reactions to the World Bank’s World Development Report 1993: Investing in Health.

Various papers assembled in 1993 by Health Action International–Europe. Address: Jacob van Lennepkade 334T, 1053 NJ Amsterdam, The Netherlands. This is a packet of extremely important analysis and criticism, including responses from Save the Children Fund (UK), Tony Klouda on behalf of the PHC-NGO group (IPPF, UK) and an article by Dorothy Logie and Jessica Woodroffe from the British Medical Journal, July 3, 1993.

• Legge, David. “Investing in the Shaping of World Health Policy,” Prepared for the AIDAB, NCEPH and PHA workshop (Canberra, Australia, Aug. 31, 1993).

  Long, in depth review of Investing in Health. (Available from HealthWrights)

• Epprecht, Marc. “The World Bank, Health, and Africa,” Z Magazine, Nov. 1993, p. 31-38.

  Lengthy in-depth review of harm caused by World Bank health plan in Africa.

Danaher, Kevin, editor. Fifty Years is Enough: the case against the World Bank and International Monetary Fund. South End Press, Boston MA, USA, 1994.

A revealing collection of essays, country studies, and statements by marginalized groups of the reversals in social progress and deepening of poverty caused by structural adjustment and other lop-sided development policies pushed by these powerful financial institutions.

Meeker-Lowry, Susan. Investing in the Common Good. 1995. New Society Publishers, PO Box 734, Montpelier, VT 05601, USA.

Alternative development strategy which calls strongly for equity and participatory democratic process. Critical of the top-down, status-quo preserving strategy of the World Bank’s Investing in Health report.

Tan, Michael. Dying for Drugs: Pill Power and Politics in the Philippines. Published by Health Action Information Network (HAIN), 1156 PO Box 1665, Central Post Office, Quezon City, Philippines. 1988.

One of the best books from the Third World exposing the exploits and abuses and double standards of the multinational drug companies. HAIN also puts out an excellent bulletin, Health Alert, which looks at many health related issues, Philippine and international, from a pro-people perspective.

Chetley, Andrew and Allain, Annelies. Protecting Infant Health: A Health Worker’s Guide to the International code of Marketing of Breastmilk Substitutes. Published by International Baby Food Action Network (IBFAN) PO Box 19, 10700 Penang, Malaysia. 1993 (revised).

An excellent well-illustrated booklet for awareness raising in community groups.

Korten, David. When Corporations Rule the World. Kumarian Press, 630 Oakwood Ave. Suite 119, West Hartford, CT 06110-1592, USA. 1995.

“A searing indictment of an unjust international world order” together with a very rational alternative strategy for “People Centered Development” (the title of his first major book). Korten is the founder of the People-Centered Development Forum, based in New York City.

Magazine (monthly)

Multinational Monitor. Subscriptions: PO Box 19405, Washington DC 20036, USA.

Excellent, balanced, well documented articles that expose the unscrupulous actions of transnational corporations, their influence on national and global politics, and their violations of international codes. Some articles are directly related to health concerns; almost all are at least indirectly related.

Links

• The Politics of Health (website).