do health systems serve people’s health?

A different World Is Possible . . Is It? ““IPHU – Atlanta, June 2007”IPHU – Atlanta, June 2007”

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Do Health Systems serve people’s Health?

Hani Serag

Global Secretariat Coordinator

People’s Health Movement


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“Health for All”. . Enforced Promise, Intentional, Denial, Silence . . . !

• In 1978, at the Alma-Ata Conference, 134 countries in association with WHO and UNICEF called for 'Health for All by the Year 2000' and selected PHC as the best tool to achieve it.

• Unfortunately, that dream never came true. – Health status of Third World populations has not improved. In many cases it has further

deteriorated.

– We are facing a global health crisis, characterized by growing inequalities within and between countries.

– New threats to health are continually emerging. This is compounded by negative forces of globalization which prevent the equitable distribution of resources necessary for people's health, particularly the poor.

– Within the health sector, failure to implement the principles of PHC has significantly aggravated the global health crisis.

• Governments and the international community are fully responsible for this failure.

• In particular, WHO did not inform people all over the world why was the failure and who is responsible for it!


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Declines in life expectancy between 1990 & 1999

Botswana -17.4

Zimbabwe -15.7

South Africa -13.5

Lesotho -13.0

Zambia -10.7

Swaziland -10.4

Kenya -9.4

Namibia -7.5

Congo, Dem. Rep. -5.8

Korea, Dem. Rep -5.3

Malawi -5.2

Tanzania -5.1

100 million school-age children remain out of school

more than 1,000 women still die for each 100,000 live births in twenty developing countries,


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Trends in infant mortality, 1970-1999

Region 1970 1990 1992 1997 1999Reduction 1990-1999

East Asia & Pacific 78 40 42 37 35 13%

Europe & Central Asia 28 28 23 21 25%

Latin America & Caribbean 84 41 38 32 30 27%

Middle East & North Africa 134 60 59 47 44 26%

South Asia 139 87 85 76 74 14%

Sub-Saharan Africa 137 101 100 94 92 9%

Developing countries 107 66 66 60 59 11%

OECD 20 8 7 6 6 29%

(Diff. Developing countries - OECD) 86 58 58 54 53

(Developing Countries/ OECD) 5 8 9 10 10

Source: World Bank, World Development Indicators 2001


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Infant Mortality in Sub-Saharan Africa

40

60

80

100

120

140

160

1960 1981 1999

Source: UNICEF: State of the World’s Children 2001


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U.S. Mortality Rates Among Infants, by Race/Ethnicity of Mother: 1980-2001 Source: National Center for Health Statistics


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Risk of Death by Income group in the USAIncome group 0 is the poorest and 8 the richest

Source: Technical Consultation on Measurement of Health Inequalities – Background Paper (WHO, 2001)


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Unequal Access

Source: National Center for Health Statistics

Five states with the largest percent of Uninsured Children, 2003-2005

Six States with the lowest percent of Uninsured Children, 003-2005

Texas 20.44% Vermont 5.6%

Florida 17.00% Hawaii 6.4%

New Mexico 16.77% Michigan 6.4%

Nevada 16.44% New Hampshire 6.4%

Montana 16.22% Minnesota 6.6%

Nebraska 6.6%


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WTO RegimeExample of the TRIPs and Trips+

• Imposition of stricter legislation related to pharmaceutical production and supply, being driven and reinforced by the parallel adoption and/or expansion of IPR laws as required by the WTO TRIPs, and now being made even stricter through bilateral treaties (TRIPs-Plus).

– Previously, the production and commercialization of drugs were driven by state legislation, defining what could be sold and under what conditions, for the prime purposes of setting national priorities and ensuring quality assurance.

– With this wave of new laws and increased scope of IPR regimes, conditions are being created for the private industry to control world markets and set requirements for what producers can and cannot do, and what consumers can access.


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Top 10 Pharmaceutical Companies by Sales, 2004

Company Pharma Sales 2004(US$ millions)

Company Profit /Rank 2004 (US$ millions)

Rank by Profit(2004)

1. Pfizer 46,133 11,361 1

2. GlaxoSmithKline 32,853 8,095 4

3. Sanofi-Aventis 32,208 10,122 2

4. Johnson & Johnson 22,128 8,509 3

5. Merck & Co. 21,494 5,813 5

6. AstraZeneca 21,426 3,813 8

7. F. Hoffman-La Roche 19,115 5,344 7

8. Novartis 18,497 5,767 6

9. Bristol-Meyers Squibb 15,482 2,381 9

10. Wyeth 13,964 1,234 10

Total 243,300 62,439

Source: Scrip’s Pharmaceutical League Tables 2005 provided by PJB Publications; company profit data (not necessarily limited to pharma sales) from 2005 Fortune Global 500.


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• Globally, the 1990s witnessed a dramatic increase in concentration in the pharmaceutical and other industries, with a sharp rise in further mergers and acquisitions amongst companies in these vital field continuing over the last several years in particular.

• Recent analyses indicate that what looks like buying and selling between countries is, in fact mostly the redistribution of capital among subsidiaries of the same parent multinational corporations.


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World Health Assembly Adopts Resolution Tying Public Health To Trade Policy

• India suggested adding a new paragraph urging member states, “to reflect all the flexibilities permitted under international trade agreements in national laws to address public health concerns.” It also suggested adding “multi-stakeholder” in to make the resolution read: “to promote multi-stakeholder dialogue” on trade and health.


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• The United States said the issue of flexibilities in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) was already “more than adequately covered” in other resolutions, including the research and development resolution that also was adopted today. It proposed deleting the Indian paragraph.

• Australia also said that India’s proposal was already dealt with other places in the resolution. Moreover, it said that the TRIPS Agreement offered the member countries the opportunity “to take up flexibilities but does not require them to do so.”


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• As a compromise, India proposed adding its point, in a somewhat watered-down version, to another paragraph referring to trade agreements, then reading: “using the flexibilities inherent in them.” The US suggested adding, “considering where appropriate” to be added before this.

• This was agreed and the resolution was adopted.


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Demographic and Health Indicators

• Population = 80,335,036• Birth Rate: 22.53 births/1,000• Death Rate: 5.11 deaths/1,000• Infant Mortality: 29.5 deaths/1,000 live births • Life Expectancy at Birth: total: 71.57 years

– male: 69.04 years – female: 74.22 years

• Literacy: total: 71.4% male: 83% female: 59.4%


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Health Systems: Characteristics

• Different parallel systems responding to different ideological eras.– MOH Facilities (preventive and curative) –

5000 facilities – even geographically distributed.

– University Hospitals (Curative)– Teaching Hospitals (curative)– Health Insurance facilities (mostly curative)– Other public– Private – Hospitals and clinics (curative)


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Health Insurance

• Covers 50% of the population:– Employees (Government, public sector, and

partially private sector)– Retired– School Students– Widows

• Service provision organization• Premiums are being collected by the

Ministry of Social Affairs


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Current reform

• Open door policies started one year after the last war(1974)

• Privatization process has been started long time ago in Egypt – first the industrial assets, then some infrastructure like electricity and telephones.

• Health, education and water were left public.• The “partners” of the restructure adjustment

(USAID, WB and EU) pushed for further steps.• Many reports suggested that the health care

systems in Egypt should be unified in one system based on the insurance.


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Dismantling of Health Insurance System and Organization

• The “Laws” regulating the health insurance organization and system were cancelled by a “Ministerial Decree” against the constitution!

• The Ministerial Decree converted the current organization from a service provider to a monetary organization:– To collect the premiums);– To loose its huge infra structure (each facility will be a

stand along financial unit).– To rent the health services from all kinds of providers

according to previously made criteria for quality.


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Expected consequences

• Fragmentation of the current health insurance organization into small financially separated facilities which is believed to make them unable to meet:– The cost-effectiveness criteria based on

which they will be evaluated.– The quality criteria that most probably will be

made to meet big, equipped facilities.

• Most probably they will be sold or kept not functioning.


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Expected consequences

• Different packages with different premiums

(systematically classifies people according their financial affordability).

• The new set-up will greatly meet the wishes of the multi-nationals (no more purchase medicines and equipment through a big bid – market prices will apply).


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What the insurance companies have done is to reverse the business, so that the public at large insures the insurance companies.Gerry Spence, 2004

What we call health "insurance" in this country was never designed to insure the consumer. Instead, its purpose is to insure steady, reliable incomes for health care providers. True health insurance is the economist's equivalent of a unicorn - we can describe it, but none of us has actually seen it.John C Goodman, 2004

What does Health System do? (Voices from the US)


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First People’s Health Assembly

• Several international organizations, civil society movements, NGOs and women's groups decided to work together towards “Health for All”.

• With others committed to the principles of PHC and people's perspectives, they organized the People's Health Assembly, 4-8 December 2000 in People's Health Centre of GK, Savar, Bangladesh.

• 1453 participants from 92 countries came to the Assembly, a culmination of 18 months of preparatory action around the globe, including thousands of village meetings, district level workshops and national gatherings.

• At the Assembly, they reviewed their problems and difficulties, shared their experiences and plans, and formulated and endorsed the People's Charter for Health.


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People’s Health MovementStruggle for “Health for All”through Evidence-Based Action

• Equity, ecologically-sustainable development and peace are at the heart of our vision of a better world – – a world in which a healthy life for all is a reality; – a world that respects, appreciates and celebrates all life and

diversity; – a world that enables the flowering of people's talents and

abilities to enrich each other; – a world in which people's voices guide the decisions that

shape our lives.

• There are more than enough resources to achieve this vision.


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People’s Charter for Health

Health is a social, economic and political issue and above all a fundamental human right.

Inequality, poverty, exploitation, violence and injustice are at the root of ill-health and the deaths of poor and marginalized people.

Health for all means that powerful interests have to be challenged, that globalization has to be opposed, and that political and economic priorities have to be drastically changed.


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People’s Charter for Health

• The Charter is now the common tool of a worldwide citizen's movement committed to making the Alma-Ata dream a reality.

• The charter published now in 33 languages (Arabic, Bangla, Chinese, Danish, Dutch, English, Farsi, Filipino, Finnish, French, German, Greek, Guarani, Hausa, Hindi, Indonesian, Italian, Japanese, Kannada, Malayalam, Nepalese, Ndebele, Portuguese, Quichua, Russian, Serbian, Sinhala, Spanish,

Swahili, Swedish, Turkish, Vietnamese, Urdu).

• We encourage and invite everyone who shares our concerns and aims to join us by endorsing the Charter.

http://www.phmovement.org/files/phm-pch-arabic.pdf

http://www.phmovement.org/files/phm-pch-bangla.pdf

http://www.phmovement.org/files/phm-pch-chinese.pdf

http://www.phmovement.org/files/phm-pch-danish.pdf

http://www.phmovement.org/files/phm-pch-dutch.pdf

http://www.phmovement.org/files/phm-pch-english.pdf

http://www.phmovement.org/files/phm-pch-farsi.pdf

http://www.phmovement.org/files/phm-pch-filipino.pdf

http://www.phmovement.org/files/phm-pch-finnish.pdf

http://www.phmovement.org/files/phm-pch-french.pdf

http://www.phmovement.org/files/phm-pch-german.pdf

http://www.phmovement.org/files/phm-pch-greek.pdf

http://www.phmovement.org/files/phm-pch-guarani.pdf

http://www.phmovement.org/files/phm-pch-hausa.pdf

http://www.phmovement.org/files/phm-pch-hindi.pdf

http://www.phmovement.org/files/phm-pch-indonesian.pdf

http://www.phmovement.org/files/phm-pch-italian.pdf

http://www.phmovement.org/files/phm-pch-japanese.pdf

http://www.phmovement.org/files/phm-pch-kannada.pdf

http://www.phmovement.org/files/phm-pch-malayalam.pdf

http://www.phmovement.org/files/phm-pch-nepalese.pdf

http://www.phmovement.org/files/phm-pch-ndebele.pdf

http://www.phmovement.org/files/phm-pch-portuguese.pdf

http://www.phmovement.org/files/phm-pch-quichua.pdf

do health systems serve people’s health?

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