Global Health Watch 1 in one file

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Macro-economic factors Impoverished households Impoverishment of public sector health care systems Health sector reform and neoliberalism Selective health care Efficiency driven cost-effectiveness Biomedicalization Donor and international programmes Commercialization and segmentation Fragmentation, verticalization and disintegration of health care systems User base Inequity Inefficiency Figure B1.3 Factors undermining the PHC approach Government and bureaucratic failure
that is not dependent on their ability to pay or on the vagaries of the market. Governments are critical to ensuring that these rights are fulfilled. Public sector health services are people’s ultimate recourse for health care, especially poorer people. But public services must not become marginalized as ‘poor care for the poor’. Societies should strive instead to use the health care system to promote social solidarity and to mitigate the effects of socio-economic disparities; they must be bold enough to make the idea of universal public-funded health care systems not just acceptable but aspirational. Second, equitable and efficient health care systems require careful organization – fragmented, disorganized and market-driven health care systems are inefficient and inequitable. Public sector provision allows for direct planning of the location and types of health facilities and the organization of a coherent service to respond to the health care needs of a population. It allows the right balance to be struck between public health and clinical services, and between preventive and curative services. Third, an adequately financed public service offers the best means of breaking the link between the income of health care providers and the delivery of health care – arguably one of the most critical conditions for the development of ethical behaviour and values within health systems and for avoiding the harm associated with ‘commercial behaviour’. This is not to deny any role for non-government actors. In many countries, the lack of public sector capacity is so great that a dependence on non-government providers is unavoidable. Non-government actors can also enhance community involvement within health programmes, help ensure public sector accountability and support public sector development. It is the role of commercially-driven private sector actors and the weakening of the public sector that has clashed most fundamentally with the aim of cost-effective and equitable health for all. These arguments are based on socially-determined values. But there is also evidence that the larger the role of the public sector in health care systems, the better the outcome (Mackintosh and Koivusalo 2004). Healthy life expectancy (HALE), for instance, is significantly higher, and child mortality significantly lower, in countries with lower levels of private health expenditure relative to public expenditure, after allowing for level of economic development and the influence of AIDS in Sub-Saharan Africa (see Figure B1.4). Countries that spend more of their GDP on health through public expenditure or social insurance also have significantly better health outcomes in terms of HALE and child mortality (see Figure B1.5). Better health in richer countries is therefore associated with higher incomes and with more public and so- Approaches to health care 81
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About this book Today’s global he
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Global Health Watch 2005-2006 An al
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Contents Boxes, figures and tables
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C2.1 The facts about disability 180
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Illustrations 1 Medicine cannot dea
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Acknowledgements The following indi
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London School of Hygiene and Tropic
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Victoria, Canada; Centre for Health
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Foreword New reports on different a
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Introduction Origins The Global Hea
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Child malnutrition, death and disab
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Human rights and responsibilities A
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impacting on health. The Watch hope
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part a | Health and globalization T
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Health and globalization | A1 and h
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Health and globalization | A1 in 20
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Health and globalization | A1 is gl
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Health and globalization | A1 peopl
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Health and globalization | A1 numbe
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Health and globalization | A1 and p
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Health and globalization | A1 econo
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Health and globalization | A1 Box A
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Health and globalization | A1 half
Page 48 and 49: Health and globalization | A1 appro
Page 50 and 51: table a1 Key health concerns with W
Page 52 and 53: Health and globalization | A1 Healt
Page 54 and 55: Health and globalization | A1 merci
Page 56 and 57: Health and globalization | A1 thems
Page 58 and 59: Health and globalization | A1 Even
Page 60 and 61: Health and globalization | A1 • A
Page 62 and 63: Health and globalization | A1 non-v
Page 64 and 65: Health and globalization | A1 27-28
Page 66 and 67: Health and globalization | A1 Jenki
Page 68 and 69: Health and globalization | A1 Satte
Page 70 and 71: Health and globalization | A1 WHO (
Page 72 and 73: and regulatory authorities mandated
Page 74 and 75: Health care systems | B1 4) selecti
Page 76 and 77: Health care systems | B1 • And si
Page 78 and 79: Health care systems | B1 • declin
Page 80 and 81: Health care systems | B1 user charg
Page 82 and 83: Health care systems | B1 focus on t
Page 84 and 85: Health care systems | B1 for health
Page 86 and 87: Health care systems | B1 their cont
Page 88 and 89: Health care systems | B1 health car
Page 90 and 91: Health care systems | B1 ing servic
Page 92 and 93: Health care systems | B1 Box B1.7 G
Page 94 and 95: Health care systems | B1 many of th
Page 96 and 97: Health care systems | B1 the lack o
Page 100 and 101: Health care systems | B1 HALE 2000
Page 102 and 103: Health care systems | B1 But improv
Page 104 and 105: Health care systems | B1 high-incom
Page 106 and 107: Health care systems | B1 Structural
Page 108 and 109: Health care systems | B1 the high t
Page 110 and 111: Health care systems | B1 and histor
Page 112 and 113: Health care systems | B1 norms (Loe
Page 114 and 115: Health care systems | B1 Foster M,
Page 116 and 117: Health care systems | B1 Toole M et
Page 118 and 119: B2 | Medicines Introduction Essenti
Page 120 and 121: Health care systems | B2 of new med
Page 122 and 123: Health care systems | B2 chapter re
Page 124 and 125: Health care systems | B2 the fourth
Page 126 and 127: Health care systems | B2 agenda thr
Page 128 and 129: Health care systems | B2 nonetheles
Page 130 and 131: Health care systems | B2 decision o
Page 132 and 133: Health care systems | B2 for the an
Page 134 and 135: Health care systems | B2 expenditur
Page 136 and 137: Health care systems | B2 Medawar C
Page 138 and 139: Health care systems | B3 between he
Page 140 and 141: Severe shortage Low density Moderat
Page 142 and 143: Health care systems | B3 sector and
Page 144 and 145: Health care systems | B3 to the US,
Page 146 and 147: Health care systems | B3 500 400 30
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Health care systems | B3 have been
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Health care systems | B3 to underta
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B4 | Sexual and reproductive health
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Health care systems | B4 10 Policy-
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Health care systems | B4 women and
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Health care systems | B4 of funding
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Health care systems | B4 debate on
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Health care systems | B4 the sexual
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Health care systems | B4 perspectiv
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Health care systems | B5 genome res
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Health care systems | B5 drugs base
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Health care systems | B5 Complete f
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Health care systems | B5 when a tes
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Health care systems | B5 are allowi
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Health care systems | B5 of life sc
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part c | Health of vulnerable group
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Health of vulnerable groups | C1 me
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Health of vulnerable groups | C1 pr
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Health of vulnerable groups | C1 Th
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Health of vulnerable groups | C1 Ca
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Health of vulnerable groups | C1 Bo
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Health of vulnerable groups | C1 Pa
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Health of vulnerable groups | C2 DP
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Health of vulnerable groups | C2 di
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part d | The wider health context T
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D1 | Climate change Introduction En
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increasing quantities are now causi
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development, local availability foo
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14 Droughts threaten the food secur
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Protocol can meet their targets by
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15 Transport and travel are major d
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• Redesign trade rules. Governmen
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D2 | Water Access to enough clean w
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water consumption worldwide. Each p
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table d2.1 Top corporate players in
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16 Protesting against the privatiza
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Box D2.3 Regulating private water c
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The private sector overestimates th
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Box D2.7 US citizens told to boil t
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to water. Worse still, it does this
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References Barlow M, Clarke T (2002
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D3 | Food Undernutrition is by far
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Functional and Productive Capacity
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table d3.1 Corporate control of US
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keting and processing means that sm
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average Indian family of four reduc
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Bank’s US$ 93.5 million loan to C
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Avery N, Drake M, Lang T (1993). Cr
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D4 | Education Some 135 million chi
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ledge about health-care practices a
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2005, and on present trends about 4
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Box D4.3 Programmes that aim to emp
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• per capita public spending fall
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unable to recruit 9000 badly needed
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Gordon D et al. (2003). The distrib
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D5 | War War has an enormous and tr
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19 Chechnya destroyed. War has wide
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initiated a ‘war on terrorism’.
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an explosive force equivalent to ab
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the risk of their misuse and divers
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Box D5.3 An agenda for peace The Ha
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Machel G (1996). Impact of Armed Co
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part e | Holding to account: global
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E1 | World Health Organization The
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The sources consulted worldwide in
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Box E1.1 Milestones in WHO history
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aised by his attempts to revitalize
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• stronger internal focus on perf
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21 WHO - up in the clouds? Reaction
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in favour of so-called ‘vertical
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to speak openly, while bullying and
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velop a unified, purposeful health
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to medicines, and the mobilizing ro
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Recommendations WHO’s core purpos
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doctors, and more people with exper
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E2 | UNICEF In 2005, Carol Bellamy,
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In sum, for almost a decade, childr
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prompted a global debate on how to
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E3 | The World Bank and the Interna
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22 World Bank: the centre of world
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approach to conditionality is being
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tal policies should explicitly refe
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E4 | Big business This chapter deal
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23 The Marlboro Man was described b
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dedicated funding [Articles 5.6 and
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grass roots in building government
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24 A pack of Cerelac cereal food pu
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USAID has also funded work on breas
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(from whatever its source, and howe
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These trends in taxation are underp
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Norway Denmark Netherlands Luxembou
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Global aid trends - allocation Wher
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weapons, vehicles and military trai
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table e5.1 Value (in £) of new DFI
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OECD (2005). Development Co-operati
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25 Breaking the chains of debt: pro
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Box E6.1 Zambia: inflation or death
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have met the Fund’s conditions, a
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E7 | Essential health research Rese
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Developing national health research
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for African Medical Editors (Certai
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Neither the consultations leading u
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Box E7.4 Asking the social-politica
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• global architecture for health
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part f | Conclusions Global Health
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current debt relief mechanism - the
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agreement, and taking health and he
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ity of the now-developed countries
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tion and water are experiencing sim
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