From poverty to power - Oxfam-Québec
From poverty to power - Oxfam-Québec From poverty to power - Oxfam-Québec
4 RISK AND VULNERABILITY HEALTH RISKShigher wages in richer countries. 75 The African Union estimates thatlow-income countries subsidise high-income countries to the tune of$500m every year through the loss of their health workers. 76A human security approach to reducing vulnerability to ill healthrequires action to empower poor people and communities, enablingthem where possible to prevent ill health striking, to cope with it ifthey are unsuccessful, and to recover as quickly as possible thereafter.Communities must be given much greater say in how services aredelivered.Human security also requires effective state protection, in theshape of a health system that provides universal access. Tacklinginequality means a shift to primary and rural health care and makingservices work for women, by promoting and retaining female staff andsupporting women as users of health-care services. Solving the workforcecrisis will require governments to pay decent salaries, recruitmore staff, and invest in decent health planning systems. They mustalso invigorate the public service ethos, which has taken a batteringfrom the anti-state message of governments and aid donors alike inrecent decades. Governments need to invest in free primary care,abolishing any remaining user fees, and to focus on preventive ratherthan purely curative services (health professionals the world overshare the same desire for the latest high-tech toys, when money isoften much more effectively spent on basic health education). Richcountries can help by not luring away qualified nurses and doctors, apoint discussed in Part 5.People will always fall ill, but whether sickness destroys lives islargely determined by social, political, and economic conditions. HIV,while still a personal trauma, is no longer a death sentence in richcountries. In poor ones, however, health shocks such as HIV all toooften are a cataclysmic addition to the daily toll of ill health, whichweakens and undermines poor people, communities, and countries intheir struggle for development. The chances of enjoying good healthare unforgivably skewed between rich and poor people and countries.Sickness and poverty feed off each other, and the best way to addressthem involves bringing together states and citizens, backed by theresources and global collaboration of the international community.241
FROM POVERTY TO POWERHOW CHANGE HAPPENS CASE STUDY:SOUTH AFRICA’S TREATMENT ACTION CAMPAIGN (TAC)CASE STUDYWhen nearly three dozen international pharmaceutical corporationssued in 2001 to overturn a South African law allowing theimportation of cheaper generic medicines, an upsurge ofactivism gave them such a public battering that they were forcedto drop the case. At the heart of the protests was the TreatmentAction Campaign (TAC), an organisation of HIV-positive people inSouth Africa, a country with one of the highest prevalence ratesin the world. Close to 20 per cent of its population carry the virus.Formed on International AIDS Day in 1998, TAC’s 15,000 membersare a fair cross-section of South Africa’s people: 80 per cent ofthem are unemployed, 70 per cent are women, 70 per cent are inthe 14–24 age group, and 90 per cent are black. But TAC’s cloutis far greater than its numbers or demographics suggest.After it had forced the companies to climb down and then drasticallycut the prices of antiretroviral (ARV) medicines, TAC took on theANC government. Despite the court victory, some in the government,in particular the President, Thabo Mbeki, continued toquestion the link between HIV and AIDS. Confusing politicalstatements, combined with slow delivery on the ground, underminedwhat appeared to be good plans to distribute ARVs topublic health clinics.While post-apartheid democracy made violent repression unlikely,TAC’s campaign to change government policy was still long anddifficult. TAC used legal challenges regularly and to great effect,winning a series of court victories on access to treatment basedon the 1994 Constitution, which enshrined the human right tohealth care. Official participatory structures of the postapartheidorder, such as district health committees, offeredTAC opportunities to build public support.However, South Africa’s majority rule also produced what is ineffect a one-party state, in which criticism of the ANC is easilyportrayed as an attack on democracy. Whatever their privateviews, few influential voices were willing to publicly disagreewith government policy. TAC was obliged to go beyond the courtsand use confrontational tactics. Its members broke patent rulesby importing cheaper Brazilian generic medicines in 2002 andheld repeated loud and angry demonstrations.242
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4 RISK AND VULNERABILITY HEALTH RISKShigher wages in richer countries. 75 The African Union estimates thatlow-income countries subsidise high-income countries <strong>to</strong> the tune of$500m every year through the loss of their health workers. 76A human security approach <strong>to</strong> reducing vulnerability <strong>to</strong> ill healthrequires action <strong>to</strong> em<strong>power</strong> poor people and communities, enablingthem where possible <strong>to</strong> prevent ill health striking, <strong>to</strong> cope with it ifthey are unsuccessful, and <strong>to</strong> recover as quickly as possible thereafter.Communities must be given much greater say in how services aredelivered.Human security also requires effective state protection, in theshape of a health system that provides universal access. Tacklinginequality means a shift <strong>to</strong> primary and rural health care and makingservices work for women, by promoting and retaining female staff andsupporting women as users of health-care services. Solving the workforcecrisis will require governments <strong>to</strong> pay decent salaries, recruitmore staff, and invest in decent health planning systems. They mustalso invigorate the public service ethos, which has taken a batteringfrom the anti-state message of governments and aid donors alike inrecent decades. Governments need <strong>to</strong> invest in free primary care,abolishing any remaining user fees, and <strong>to</strong> focus on preventive ratherthan purely curative services (health professionals the world overshare the same desire for the latest high-tech <strong>to</strong>ys, when money isoften much more effectively spent on basic health education). Richcountries can help by not luring away qualified nurses and doc<strong>to</strong>rs, apoint discussed in Part 5.People will always fall ill, but whether sickness destroys lives islargely determined by social, political, and economic conditions. HIV,while still a personal trauma, is no longer a death sentence in richcountries. In poor ones, however, health shocks such as HIV all <strong>to</strong>ooften are a cataclysmic addition <strong>to</strong> the daily <strong>to</strong>ll of ill health, whichweakens and undermines poor people, communities, and countries intheir struggle for development. The chances of enjoying good healthare unforgivably skewed between rich and poor people and countries.Sickness and <strong>poverty</strong> feed off each other, and the best way <strong>to</strong> addressthem involves bringing <strong>to</strong>gether states and citizens, backed by theresources and global collaboration of the international community.241