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August 2008

Squeal Again!

WHO is the mandated leader in global health. It is time to enhance WHO’s leadership role through the agenda for action on the social determinants of health and global health equity.

A report from WHO says that WHO is very important, oh yes indeed.

Bit of a surprise to see that in there, isn\’t it?

They\’re insane

Global governance mechanisms – such as the Framework Convention on Tobacco Control – are required with increasing urgency as market integration expands and accelerates circulation of and access to health-damaging commodities. Processed foods and alcohol are two prime candidates for stronger global, regional, and national regulatory controls.

Global prohibition of alcohol and trans fats. In the name of equity, of course.

Yet more!

Health is not a tradable commodity. It is a matter of rights and a public sector duty. As such, resources for health must be equitable and universal. There are three linked issues. First, experience shows that commercialization of vital social goods such as education and health care produces health inequity. Provision of such vital social goods must be governed by the public sector, rather than being left to markets.

Yup, we\’ve got to abolish the private school system globally in order to ensure health equity.

Good God!

Aid is important. While the evidence suggests that it can and does promote economic growth, and can contribute more directly to better health, the view of the Commission is that aid’s primary value is as a mechanism for the reasonable distribution of resources in the common endeavour of social development.

It doesn\’t matter what aid is spent upon, the importance is that we spend a lot because it shows we care?

Really?

This in turn implies progressive taxation – evidence shows that modest levels of redistribution have considerably greater impact on poverty reduction than economic growth alone.

It does?

Two hugely redistributionist countries, North Korea and Cuba (and their now failed Soviet counterparts) have reduced poverty more than the US, UK or Hong Kong? Really?

Trade bans too!

For example, trade policy that actively encourages the unfettered production, trade, and consumption of foods high in fats and sugars to the detriment of fruit and vegetable production is contradictory to health policy,

So, you\’re not going to be allowed to import chocolate any more. In the name of equity, of course.

Glorious!

Act to redress the health brain drain, focusing on investment in increased health human resources and training and bilateral agreements to regulate gains and losses.

That looks very much like global controls on the migration of nurses. That Phillippina cannot move to the US unless an American nurse is willing to move to Manila perhaps?

That is, she\’s a slave to the Phillippine health care system….all in the name of equity, of course.

Whoopee!

The Commission considers health care a common good, not a market commodity……In particular, it is vital to minimize out-of-pocket spending on health care.

Right, so, that\’s the French system fucked then. Pity really, because WHO itself says it\’s the best system in the world.

What a chart

Bottom of page seven of the executive summary.

Comparing generosity of welfare systems with number in poverty (measured as below 50% of median equivalised disposable income.)

The US is in the top left (low transfers, high poverty rate), the Nordics bottom right (yay! social democracy!).

What they don\’t tell us is the findning from Smeeding: that the absolute standards of living of the bottom 10% in the US are the same as the absolute standards of living of the Nordic bottom 10%.

This is the problem with an exclusive focus upon equity. No one is taking account of the costs of actually getting to that equity. The poor in the US get less help, this is true. But the better off in the US live much better than those in the Nordics….and the poor do exactly the same. In terms of human welfare (measured by living standards) which is the better system? Which is better in aggregate? I would vote for the one that gave the same standards to the poor but allowed others to get more, wouldn\’t you?

Well, bugger me

Provide quality work for men and women with a living wage that takes into account the real and current cost of healthy living.

Now the solution to health inequality is a living wage campaign? "Quality work"?

Have these people been taking too many bong hits with the sociology crowd? Just by whom and how are these to be "provided"?

Fiat from government?

Jeepers!

Ensure urban planning promotes healthy and safe behaviours equitably, through investment in active transport, retail planning to manage access to unhealthy foods, and through good environmental design and regulatory controls, including control of the number of alcohol outlets.

"manage access to unhealthy foods"? Seriously?

No planning permission for your shop if you sell transfats? They\’re seriously suggesting this as a global measure? And a limit on pubs, as a global measure?

WHO Statistics

At present, greenhouse gas emissions are determined mainly by consumption patterns in cities of the developed world. Transport and buildings contribute 21% to CO2 emissions (IPCC, 2007), agricultural activity accounts for about one fifth.

Marvellous. Transport and buildings are 21%, agriculture is 20%. The former is "mainly", the latter is not?

WHO What?

Provide quality compulsory primary and secondary education for all boys and girls, regardless of ability to pay. Identify and address the barriers to girls and boys enrolling and staying in school and abolish user fees for primary school.

In order to make the population healthier it will be necessary to ban private primary schools?

Phew!

In order to address health inequities, and inequitable conditions of daily living, it is necessary to address inequities – such as those between men and women – in the way society is organized. This requires a strong public sector that is committed, capable, and adequately financed. To achieve that requires more than strengthened government – it requires strengthened governance: legitimacy, space, and support for civil society, for an accountable private sector, and for people across society to agree public interests and reinvest in the value of collective action. In a globalized world, the need for governance dedicated to equity applies equally from the community level to global institutions.

You know, I think they might just be calling for the creation of a social democratic nirvana here?

Is it possible that they might have, umm, pre-judged the issue?

That WHO Report

Well, they certainly lay out their priorities early on.

The Commission takes a holistic view of social determinants of health. The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of peoples lives – their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities – and their chances of leading a flourishing life. This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics. Together, the structural determinants and conditions of daily life constitute the social determinants of health and are responsible for a major part of health inequities between and within countries.

No mention at all so far of the absolute level of health. Only equity counts apparently.

Cretins

Other options, including a stamp duty holiday, are being held back for further consideration.

Christ on a bike….don\’t these morons understand that uncertainty about the legal and tax environment is what cripples markets?

It doesn\’t matter what decision you take about stamp duty. Abolish it, double it, leave it as it is.

But take the decision now you cretins!

That WHO report

You know, there might just be a political motive here….you never know, eh? For it is indeed the WHO which compiles the statistics on the different health systems around the world. The statistics which place far greater weight upon equity of access and financing than upon anything so crude as the efficiency of said services actually curing disease.

Nordic countries, for example, have followed policies that encouraged equality of benefits and services, full employment, gender equity and low levels of social exclusion. This, said the Commission, is an outstanding example of what needs to be done everywhere.

You don\’t think that they might all be social democrats, do you?

I might even gird the loins and try reading the whole report.

Health inequality

Yes, health inequality is high. However, however….

This government can argue that is tackling all of the above. It can be proud of the progress made in improving overall health to the extent that life expectancy for the poorest has reached the average of just eight years ago.

Absolute health is improving. If we believe the Guardian editorial, it\’s improving fast too.

So, what should we concentrate on? Relative health or absolute?

Is it better that more people live for longer, or that people live for more equal periods of time?

I\’ve long said that I\’m not all that worried by inequality, as long as absolute levels (health, incomes, whatever) are improving.

Is there any reason why I should change my mind?

The costs of organic

Organic food is such an easy target at times like this. It is often more expensive, in terms of the pound in your purse, in the industrialised world. But it is not so in developing nations, where organic-based techniques of soil care, crop rotation and natural fertility-building are often the most effective, safe, productive and resilient ways of producing nutritious food for the local population.

Organic food is cheaper in the poor countries but not in the industrialised world?

How can this be?

Quite easily really. The major point about organic methods as opposed to conventional is that organic requires a great deal more labour. Hoeing instead of spraying weedkillers. Ploughing more, spreading muck rather than fertiliser and so on.

So in places where labour is cheap it\’s entirely possible that organic methods would be cheaper. However, that does indeed require that labour be cheap.

That is, lots of people have to live that oh so desirable peasant lifestyle in order to keep organic cheaper than the industrial substitutes.

Nice and ethical that, isn\’t it? Relying upon the sweating coolies in the fields to grow your food rather than the well fed well paid bloke on the tractor with the chemicals.