| Health is widely researched and the more prominent debates on health and the policy implications deriving from these debates all point to the same: health is a human right and it is one of the most powerful indicators of social justice in a society.
The 19th and 20th centuries experienced the emergence of public health revolutions which changed the history of health and disease in the developed world. The struggle for public health "became part of the big social reform project of the first wave of modernity in the developed world - with a focus on the key health determinants of the industrial revolution: water and sanitation, air, housing, education, safe work, better food, shorter work days, maternal care and access to family planning" (Kickbusch and Payne, 2004). This social reform transformed health in one of the most important pillars of holding the nation together. As Sorell (2003) points out, the National Health System in the UK functions "not only as a source of medical treatment but as a prime medium of national solidarity and national identity."
The right to the highest attainable standard of health - the right to health - was first reflected in the WHO Constitution (1946) and reiterated in the 1978 Declaration of Alma Ata and in the World Health Declaration adopted by the World Health Assembly in 1998. It has been firmly endorsed in a wide range of international and regional human rights instruments. In just a few months, the world will commemorate the 30th anniversary of the Alma Ata Declaration (1978) which called for Health for All by the year 2000. Yet today the world is still in the midst of a health crisis, which cuts between and within countries, along inequality lines. Thirty years ago, the health community proclaimed health determinants as the stepping stone to health for all by 2000 and as a crucial part of a development agenda. Today "health for all" has been replaced by a variety of disease-specific initiatives, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Three decades of health reforms promoting the market model and increasing privatisation have put under strong attack the values and politics of health, thereby diminishing the role of the state and people’s control and participation on national health policies. Furthermore, health systems have been badly hit and have deteriorated as a result of the health workforce crisis - a clear testimony of the failure of market-driven policies.
It is the time for a substantial change and there are spaces for policy interventions at different levels. The evidence of what is and what is not working is overwhelming. The research on health is voluminous and the knowledge to address health crises is already with us. Moreover, in these times of high interdependence among countries and when the term "development" is the highlight of all national and international events, the time for change is overdue. "A fairer world is a safer world" and health is a crucial indicator of a fair society, transforming health into an important factor for peace in the world.
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Key Reading
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Launch of the new Health Politics and Trade Unions Page (21.05.07)
Key Reading
Policy paper on health, Edlira Xhafa (2007)
The paper tries to surface some of the main areas of the political debate, which shape the discourse on health. It aims at drawing attention of the trade unions to the broader picture of health politics as a critical area for engagement with the power structures and for membership mobilisation.
Health and Social Services, PSI (1999)
The paper is one of a set of Briefing Notes for current debates on public sector issues, produced by Public Services International (PSI) the international federation of public sector trade unions.
Health in Development, Amartya Sen (1999)
This is a very interesting article, drawing the lines in between health and development and the relation in between the two. It does so, by challenging the existing thinking, which highlights the utilitarian aspect of health and placing health at the core of a discourse on freedom.
Inequalities are unhealthy, Vincente Navarro (2004)
This is a deep analysis of the social inequalities and their influence in the health status of people. It offers a deep insight on the American health system, opening up a broader debate on the crucial influence that inequality has on health, but also asserting that tackling inequalities - the equal access of people in the countries resources - is essential and part of a strategy to tackle health determinants.
Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries, John J Hall and Richard Taylor (2003)
The paper analyses the conditions for the establishment and the political implications of the Alma Ata declaration and the Primary Health Care. It brings into focus the political developments which followed the Alma Ata, articulated as Health Sector Reforms and strongly advocated from the World Bank.
People's Charter for Health, People's Health Movement (2000)
The Charter is regarded as the common tool if a worldwide citizen's movement committed to make the Alma-Ata dream reality. It calls for action at all the levels and in many areas at the same time in order for the health community to combat the global health crisis. It is an excellent document, providing the basis for action in health.
Further Information
Development and Health Determinants
Health stands at the core of a broader picture of development, as "an adequate conception of development must go much beyond the accumulation of wealth and the growth of gross national product and other income-related variables" (Sen, 1999). The Nobel Prize-winner Amartya Sen asserted in his book, Development as Freedom (1999), that as development has to be primarily concerned with enhancing the lives we lead and the freedoms we enjoy, then one of the most important freedoms that we have is the freedom from avoidable ill-health and from escapable mortality. The core importance of health in development points directly to the fact that there cannot be development without health and that the two must go hand in hand.
The development framework emphasises the importance of access to health determinants, pointing to the fact that health is more dependent on health determinants than on health infrastructure per se. The same understanding was reinforced from the Alma Ata Declaration, which asserted that much of the most influential action to create health is found in other sectors other than health. The same framework would argue that health inequities are directly related to people's unequal access to society's resources. From here the health of the population becomes more dependent on the distributive policies as Sen puts it "much depends on how the fruits of economic growth are used". Indeed, if we have to tackle health, we have to tackle health determinants, being political, social and economic, both as the underlying conditions of health for all and as a long-term strategy towards a healthy society
Publications
Renegotiating the Social Contract: Challenges to Health and Social Policy in Japan, Khoon, Chan Chee (2007)
What is a national health policy, Navarro, Vincente (2006)
An alternative world health report, Global Health Watch (2005-2006)
Creating health equity through social justice, Hofrichter, Richard (2002)
Websites
International Journal for
Equity in Health
International Journal of Health Services
Knowledge Ecology International
The Lancet
Monthly review
Oxfam
Thirld World Network
United Nations Development Programme (UNDP)
WHO Commission on Social Determinants of Health
Reforms in the Health Care Systems
The health vision, expressed by the Alma-Ata Declaration 30 years ago, to strengthen health systems from a bottom-up approach was challenged by those who argued that to achieve a measurable effect it was necessary to focus on a limited number of cost-effective interventions through selective primary health care. The World Bank report (1993) marked the change to healthcare services in poor countries. It replaced Primary Health Care with "Health Sector Reform" and focused on user pays, cost recovery, private health insurance, and public-private partnerships. The "Health Sector Reform" parted from the spirit of the Alma Ata Declaration, introducing policies, which were not debated or agreed collegially as the Alma Ata was and which took health politics away from people.
The developments of the last 30 years have been shaped by this shift in international development strategies. The emphasis on delivering cost-effective interventions from international organisations in combination with a weak role for the state, and even in some cases attempts to circumvent state involvement, has resulted in a range of selective programmes operating at the same time in countries with limited capacity to deliver. These developments were compounded by pressure for privatisation and market praise, examples of which ironically grew in number in spite of clear evidence of the need to strengthen health systems. Moreover, the preference of the rich for private health care reduces their financial participation in public health care systems, thus increasing the fiscal burden of universal coverage and access for the poor. The poor and other vulnerable groups have been particularly affected as health care has been transformed into a commodity. This policy shift has increasingly blurred the value foundation of health as human right. Thus in the last three decades the world health policy has shifted from the previous vision of "health for all" to an MDG agenda, which even within its limited scope seems to be hardly achievable.
Publications
Public sector reform and demand for human resources for health, Lethbridge, Jane (2004)
Forces and reactions in the health care, Lethbridge, Jane, PSIRU (2003)
Equity and health sector reforms: can low income countries escape the medical poverty trap, Whitehead, M. Dahlgren, G. Evans, T. (2001)
Public Service reform and their impact on health sector personnel, PSI, ILO, WHO, ICN, DSE (2000)
A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals, Devereaux, P.J.
Corrosive reforms: Failing health systems in Eastern Europe, ILO and PSI
Labour Rights and Health Care Privatisation in the Americas, PSI, IDB, World Bank
The pain of privatisation, Jane Stinson, Nancy Pollak and Marcy Cohen
Websites
To come...
Health Workforce
The crisis of health workforce lies at the core of the crisis of health care systems, as a global shortage of health workers is becoming critical in most countries. The nexus between the crises in health care systems and in health in general has become a vicious cycle. The importance of strengthening health systems has been neglected for a long time as the societies tend more to invest in technologies and drugs and not in social protection, health systems or people. Corollary, often the pressure from health budget constraints has been aggravated by the misallocation of resources within health systems, where money is being spent on the purchase of high-tech medical equipment rather than on human resources (PSI, 2004).
The global health workers shortage is an obvious threat to health systems. Three decades of "reforms" have treated health workers as a burden rather than as an asset. Health workers is many parts of the poor world were harder hit as they were at the same time under pressure due to three main factors: lack of investment, the HIV/AIDS pandemic, and migration, the latter being accelerated as a result of the first two factors. Health workers in many countries of the developed world have also seen a continues deterioration of their working life characterised by job satisfaction problems such as inadequate staffing, heavy work-loads, the increased use of overtime, a lack of sufficient support staff, inadequacy of wages and by too few workers training as nurses.
Indeed, the crisis of the health workforce as expressed by the flow of health workers across national boundaries is one of the strong indicators of the crises of health systems.
Publications
Building National, Self-Sufficient Health Systems - Facing the Challenge of the Global Health Workers' Shortage. Surfacing some of the debates on the health workforce crisis, By Edlira Xhafa (2007)
The world health report 2006 - working together for health, WHO
- Background papers to the WHO report 2006
Sustaining strategies addressing the human resources for health crisis through union participation, Xhafa, Edlira (2006)
Human Resources for Health - Overcoming the Crisis, Washington D.C.: The President and Fellows of Harvard University, Joint Learning Initiative (JLI) (2004)
The People's hospital, PSI
Policy Statement on International Migration with Particular Reference to Health Services, PSI
Who Cares? Women Health Workers in the Global Labour Market, PSI, edited by Kim Van Eyck
Websites
Global Health Workforce Alliance (GHWA)
Human Resources for Health
International Labour Organization (ILO)
Public Services International (PSI)
World Health Organisation (WHO) - Human Resources for Health
Health Governance
At the core of the debate is the fact that health is political and that spaces for policy intervention exist at different levels. A governance debate needs first to be based on the realisation that health cannot be addressed without a real involvement of people and their organisations at all the levels, and that it is essential to have an open debate about the values attached to health.
We enter an historical phase of health interdependence with the joint recognition of health as global public good and of the fact that "no individual or nation state can fully guarantee its own health" (Kaul et al., 1999:297) thus cooperation among nations becomes mandatory.
In these times of excessive wealth creation and accumulation, and when it costs about $30-$40 per capita to provide basic healthcare coverage in a low-income country, access to health care becomes a very contentious political issue. The solutions become clear and sustainable if seen from a perspective of redistributive justice. And in that context it would seem appropriate to gradually shift to social health-insurance systems, which operate on the bases of solidarity contributions among high-income and low-income groups. This would be the main source for financing universal health access.
As different interventions are proposed, the importance of the state and the public sector becomes essential, calling in fact for a reliable and accountable mechanism for global governance and a strengthened public sector at all levels.
Publications
Action on global health: addressing global health governance challenges, Kickbusch, Ilona (2005)
Extending Social Security to Developing Countries, Frye, Isobel (2005)
Constructing global public health in the 21st century, Kickbusch, Ilona and Payne, Lea (2004)
Seven deadly sins: reflections on donor failings, Birdsall N. (2004)
The need for common values, principles and objectives for health policy in a changing Europe, Kickbusch, Ilona. (2004)
The world situation and WHO, Navarro, V. in The Lancet. Vol. 363, April 17, 2004
Influence and Opportunity: Reflections on the US Role in Global Public Health, Kickbusch. Ilona (2002)
The WTO and the General Agreement on Trade and Services: What is it at stake for public health?, PSI and EI
Websites
Geneva Forum - Towards global access to health
Globalisation and health Journal
International Labour Organization (ILO)
Kickbusch Ilona
The Center for Policy Analysis on Trade and Health
Trade unions and other social movements in the struggle for health
The political debate on health urges the active participation of unions as political organisations. It is important not to lose sight of the broader picture of the political inter-connectedness of issues. The history of unions has been shaped by unions' involvement and active participation in political battles for a just society. This battle is now complemented by global health movements, involving global civil society, the global health community, women and marginalised groups, all of which are very much active and dominating much of the alternative thinking on health. Nonetheless, the relevance of unions remains high, because "if the goal of social movements is to construct a world that balances liberal economic priorities with egalitarian values, such an aim only stands a chance of being accomplished if workers' organisations play a large part in the struggle" (O'Brien, 2000).At the same time these new dynamics require "a more 'social movement' unionism" which would involve "a complex interaction of local, national, regional and global responses" (Ghigliani, 2005). Such a form of unionism seeks interaction with people fighting for the right to water, food security, housing, sanitation, education, a safe and healthy working and living environment, as well as people engaged in the full range of issues affecting health. Such issues span a wide range but include the use of genetic sciences and patents, the role of international institutions and the impact of chemicals on the environment. Coordinating efforts and building on the strength of different groups is crucial and it will call at the same time for a more bottom up organisation, a greater concern for rank-and-file needs, and the extension of grassroots activity" (Ghigliani, 2005).
People and people's organisations in different parts of the world are reacting, networking and fighting for health. Indeed, peoples' opposition to the political elite around the world is forging the belief that another world is possible, and so is health for all (Katz, 2005).
This part of the website is work in progress and presents some of the initiatives taken by unions and other social movements engaging in health. We would appreciate your help and participation to send us more information of your union being involved in health policy making and reforms or other relevant initiatives.
Publications
To come...
Websites
Action on antibiotic resistance (ReAct)
American Federation of State, County and Municipal Employees (AFSCME)
Global Equity Gauge Alliance
Health Action International (HAI) Africa
Health Global Access Project (Health GAP)
People's Health Movement
Self-Employed Women's Association (SEWA)
Service Employees International Union (SEIU)
Last update: 21 May 2007
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Global Union Research Network - GURN