Global Health Watch 1 in one file

Health care systems | B1
many of the diseases associated with poverty are amenable to simple and
cost-effective interventions. However, from the standpoint of equity, resources
should be allocated first towards tackling the health problems of poor people
and only then between different programmes or interventions.
Public sector failure In many countries, the principles of Alma Ata have also
been undermined by public sector failures. Illegitimate and corrupt governments
that steal from the public purse, practise and tolerate human rights
abuses, and allocate inappropriately high budgets to the military or to projects
that benefit the elites of society are clearly one root cause of public sector
failure – although these characteristics are by no means the sole preserve of
poor countries. Corrupt and abusive regimes undermine the attainment of
health for all and clearly require political solutions arising from within the
countries themselves.
But corruption, abuse and state expenditure are far from being the consequence
of local factors alone. Enabling all countries to have stable and effective
governments that can improve people’s health requires an international
response to address the various ways in which richer countries or institutions
endorse and support corrupt governments: the arms trade; banks and tax
havens harbouring money that elites have looted from poor countries; Western
corporations paying bribes; foreign government interference and collusion
with illegitimate regimes; and the ‘legitimate’ and illegitimate economic transactions
involving the purchase of natural resources (diamonds, minerals, oil,
timber) from repressive and undemocratic countries (Pogge 2002).
Within countries, the ways in which societies organize themselves through
their political systems and how these systems support health and development
is clearly important. Some research suggests an independent positive
association between health and democracy, political rights and civil liberties
(Franco, Alvarez-Dardet and Ruiz 2004). However, the underlying mechanisms
for the association between democracy and health are complex and may also
depend on how democracy and rights are formulated and thought of – millions
of people in the United States, for instance, have the political freedom
to vote in a rich country but this is not a sufficient requirement for their
access to health care. At the same time, countries without democratic political
systems, such as China and Cuba, have achieved good and equitable
health outcomes due to their commitment to ensuring universal access to the
basic requirements of good health (Commission on the Social Determinants
of Health 2005). The ways in which different social, political and economic
systems influence the capacity for health systems to function effectively and
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