A radical change is needed for the health of the planet and the people
The International Association of Health Policy in Europe (IAHPE) held its 18th conference on 21-24 September, supported by TWHA, under the title “European health policies in the era of capitalist crisis and restructuring”. IAHPE is a scientific organisation that gathers a number of well-known scientists and academics sharing a vision captured in the slogan "capitalism is bad for our health". A founding member of the People's Health Movement, the organisation offers a space for producing and exchanging knowledge on health that is outside the mainstream narrative, and links health to broader issues such as economic policy and politics.
Turkish activists call for international solidarity
The topics discussed included health policies in Europe and globally, increasingly shaped by privatisation which leads to higher health expenditure, worsening working conditions, and lower accessibility of services especially for the most deprived. The case of reproductive rights in Turkey was highlighted as an example. As a consequence of health sector reforms introduced in the early 2000s, coupled with rising social conservatism, abortion and contraceptive rights of women are compromised. To address this, the speaker made a strong call to develop a transnational analysis and create transnational solidarities, as shown by the International Safe Abortion Day held on September 28th to demand access to safe and legal abortion now across the world.
Greece, Argentina & Cuba: similar problems, different strategies
Researchers from different countries analysed the examples of Greece and Cuba to discuss the impact of economic crises on health. TWHA's president Pol De Vos presented an original analysis on the different response to harsh economic conditions by Cuba (facing in 1989 the fall of the Soviet Union and the embargo by the US) and Greece (following the 2008 economic crisis and the structural adjustments imposed by the Troika). The response was very different, as was the impact on health.
Cuba's strategy focused on the state's action and responsibilities, while Greece went on a path of privatisation and huge cuts to public expenditure: while health in Cuba continued to ameliorate for most indicators, in Greece it deteriorated in several areas. Although a direct comparison of health indicators cannot be made, given the diversity of the two contexts and historical periods, it is a powerful illustrative case of how public policies can revert or enhance the impact on health of adverse general conditions.
During his presentation, Pol insisted that “everything starts with political will of the government to put the right to health of the population at the centre of its policies. Cuba has demonstrated that deliberate action by the government can protect people’s health, even in very difficult circumstances.”.
What are the enabling or disabling conditions to implement progressive public policies in health?
Participants discussed deeply around the conditions needed to put in place and sustain progressive public health policies, meaning both universal access to decent health care services and action on the social determinants of health (housing, education, environment, etc.). The case of the state of Mexico City during the government of López Obrador (2000-2006), exposed by Asa Cristina Laurell who was at the time Health Secretary of the city, was particularly relevant. The left wing government of the state managed to implement public policies aiming to increase the living conditions of the poor in the city, as well as to promote their access to quality health care. A huge effort was made, including through community participation, to increase the number, equipment and staff of healthcare centres, coupled with a strong reversal of the previous system of corruption and patronage. The results were clearly visible in terms of better health indicators for the population. However, as a new government took power, most changes were reversed and the private health sector gained new strength, with rising inequalities.
This demonstrates that, in order to advance on a non-capitalistic agenda, a strong commitment is needed that cannot, once and for all, be 'secured' within a specific political formation. When asked what she would do differently if given a second chance to be in power, Asa Cristina said "When you get in these situations you have a lot of acute problems and tend to postpone what is not immediately needed. Looking back now, I would have tried to push much harder to construct a stronger popular participation. I would have tried to really give to the new health policy more profound roots in the population and amongst workers".
System change needed for health equity
The conference overarching message was that, without a system change away from neoliberalist commercialisation and privatisation, towards emphasizing health and social well-being, it will be difficult to achieve stable health gains especially in terms of health equity. And to achieve this change, both the production of alternative knowledge and the link with social movements is extremely important. “It's often easier to imagine the end of the world than it is to imagine the end of our economic system”, warned Professor Howard Waitzkin in his closing lecture. However, such vision of a radically different future is what we need to conceive – and achieve – health for the people, and for our planet.