Summary: Joint Session between the Working Groups on Health Promotion and Human Development

Health and Development: a question of poverty

General Summary
Dr. Eugenio Villar opened this session with a presentation on the role of health in poverty reduction. He described the vicious and virtuous circles of the relationship between poverty and health, reported on World Health Organization studies on poverty reduction policies, and outlined the elements of a pro-poor health policy.

Dr. Louis Currat followed up with a presentation of the critical problem of the 10/90 gap in health research and stated that only 10% of research worldwide is devoted to 90% of the world's health problems. Research is urgently needed to tackle the diseases that afflict the poorest people in the world. The Global Forum for Health Research has been set up to fill this gap. Despite the disproportion, even a small shift would help significantly— for example, 1% of the US$ 73 billion invested would bring US$ 700 million to a research project on a tropical disease. Dr. Ravi Narayan, Community Health Cell, Bangalore, and People's Health Movement, presented a civil society perspective on the question of poverty that puts health in the context of the lives of the poor and identifies root causes of ill health in the larger economical and political sphere. The key point he made is that poverty is the real disease. This perspective is not different from that of WHO's famous Alma Ata Declaration on Primary Health Care. But it is very different from the perspective of today's international health community, typified by the Macroeconomics and Health report commissioned by the WHO, which is heavily influenced by neoliberal doctrine and agenda. Reminding us that next year is the 25^th anniversary of Alma Ata, Dr. Ravi Narayan urged participants to bring evidence to the Forum on Health Research that inequality, poverty, exploitation, violence and injustice cause ill health. Moreover, he pressed for a WHO Poverty and Health Commission to solve this issue. During discussions, all the three panellists unequivocally supported the perspective that poverty is the single greatest determinant of ill health and the starting point for meaningful, long-term action.

Interesting issues
The importance of adapting health work to the lives of the poor was vividly illustrated by the example of bed nets, which are widely promoted as a key strategy for nighttime protection against malaria and other insect-borne diseases. However, research showed that bites occur during the day while people are working. Apparently, when this was discovered, IEC (Information, education and communication) campaigns were recommended to persuade people to give up these survival activities and get under a net! Strategies imposed from above— which do not heed the reality of people's lives— are likely to be irrelevant, if not impracticable. But these strategies are unfortunately typical of public-private partnerships for health, which, by their very nature, have to be of mutual interest. The trouble with this arrangement is that the private sector interest does not necessarily coincide with the public health interest: the private sector may pay more attention to the 'marketing of magic medical bullets' rather than to root causes. The obvious risks of international health authorities allying themselves with private partners cannot be overstated. Militarization and nuclearization is a major problem that cannot be separated from the macroeconomic determinants of poverty: some states are critical economical areas and sources of enormous and highly concentrated power. In addition to the hazards for public health, the implications of these trends are alarming if one considers a possible inappropriate use of scarce resources and the deepening dependence between the periphery and the centre in a grossly unequal and globalized economy. In relation to the World Bank's position on tackling poverty, an interesting point was made about different approaches in different WB departments. Some departments appear to have a similar perspective to NGOs 'poverty', while others promote strategies, especially on macroeconomic issues, that directly oppose such perspectives. The departments should talk to each other and, at the very least, produce a coherent position on poverty reduction in relation to the improvements health status of the population. Cuba's success in providing primary health care was fully recognised (as was that of Sri Lanka and Kerala State in India), especially in relation to distribution economics, as promoted by the economist Amartya Sen, rather than to growth economics, as promoted by the neoliberal establishment.

Conclusions and recommendations
The World Health Organization (WHO) should be a strong advocate for the poor. Among other things, in discussions with the IMF and the WB, it should be pushing for debt cancellation and other practical measures that contribute to a rational and fair international economical order. At the World Trade Organization WHO should be the prime advocate for universal access to essential drugs. It should avoid technical solutions like the Global Alliance on Vaccines and Immunization (GAVI).

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16.12_currat_louis.ppt (20 K)

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