By guest contributors Rashi Jhunjhunwala, MD MA; Arturo Cervantes Trejo MD MPH DrPH; Pablo Tarcisio Uribe-Leitz MD MPH; John Lindsay-Poland, Keith Martin…
By guest contributors Chiara Bodini and Ronald Labonté
Global Health Watch 6 (GHW6) is the latest edition of People’s Health Movement’s flagship publication, released every 3 years in collaboration with like-minded organizations and the voluntary effort of over 100 contributors from all over the world. Written in the shadow of a global pandemic (the book’s subtitle), it describes how and why the pandemic deepened inequities in health and access to healthcare. But it also looks beyond the pandemic to what is needed to create a fairer, healthier, and environmentally sustainable future.
The book begins with a short synopsis of the state of the world’s political and economic health and its pre-pandemic crises of inequalities, climate, and migration. We assess the state of post-pandemic ‘recovery’ plans before describing the kind of ‘postgrowth’ or ‘degrowth’ economy needed to safeguard planetary health. Pandemic-related gendered health inequalities are given close attention with a focus on South Asia, across a spectrum of gender identities beyond cisgender women to include trans, intersex, and non-binary persons.
In keeping with previous GHW editions, several chapters focus on health systems. Two issues predominate: the continuing eclipse of comprehensive primary health care by the financialized focus on universal health coverage, and the slow but persisting privatization of health and social care services. The evidence-based conclusion: our health future must be public; but it is an activist public that needs to make it so. Such activism (so far) has proved unsuccessful in finalizing a ‘TRIPS waiver’ that would allow rapid scale up and affordability of COVID-19 vaccines. Blocking or stalling on a waiver by some governments generated a ‘vaccine apartheid’ (rich countries scoop up most of the COVID-19 vaccines while poor countries wait) that characterized all of 2021. Supply may now be of less concern, but not so cost. And with other therapeutic needs persisting (pandemic or otherwise) the struggle to democratize and equalize access to medicines is far from over.
Two novel health systems analyses feature in this edition. The first addresses the digital revolution in health, not simply in diagnostics and ‘personalized medicine’ but, worryingly, in the corollary rise in ‘surveillance capitalism’ and in Big Tech potentially profiting from our personal health data. The second analysis focuses on mental health challenges, generally and as worsened by the pandemic, emphasizing the need for primary prevention (dealing with the determinants of mental ill-health at a systems level) and expanding the use of therapeutic alternatives to drugs and institutionalization.
GHWs always explore key social determinants of health, those hierarchic, gendered, racialized, and economically stratified systems of social oppression and marginalization. This edition begins with a dissection of austerity’s grip on most country’s fiscal policies, supported by (once again) neoliberally-tinged policy advice or loan conditionalities by the International Monetary Fund (IMF). There are options to reverse this, although the recent rise in inflation has fiscal hawks (once again) beating the drum of government spending restraint. Labour markets, in turn, remain upheaved, with ‘gig’ or precarious work still commonplace, unemployment rates high (if declining slightly with ‘recovery’), and private sector unionization still falling in most OECD countries. Renewed labour activism is giving hope that conditions in the low-wage sector could improve via unionization drives and increased minimum wages.
COVID-19 may have pivoted our attention back to infectious diseases, but the ‘slow-motion disaster’ of non-communicable diseases remains, along with the persistence (and global spread) of unhealthy commodities (ultra-processed foods, tobacco products, alcohol) produced and marketed by commercial, capital-accumulating transnational corporations. Health activists’ deeper understanding of the strategies employed by purveyors of these ‘commercial determinants of health’ is leading to more effective (and successful) counter-measures. Where health activism faces its fiercest opposition is challenging the dominant development model based on extractivism, growth, and consumption. People in poor and Indigenous communities are the worst affected, with fossil fuels the most immediate but far from solitary concern. GHW6, in proposing an alternative development model, knits together examples of popular and successful resistance against extractivism in eight different global territories. The growth in unhealthy (industrialized) foods and the unsustainable extraction of planetary resources are brought together in a separate analysis of the broken state of global food systems. With food prices and shortages rising rapidly, a critical struggle in the short-term will be the extent to which agroecology can prevent technical/corporate solutions and their underpinning economic interests from dominating global food governance.
Completed several months before the Russian invasion of Ukraine, a final contribution on the social determinants theme reviews the state of global conflict and the prospects for revitalizing the global peace movement. It reminds us of the extent of health carnage perpetrated in two of the world’s worst conflict zones (Yemen and Syria), and how these proxy wars are underwritten by state and commercial interests in the arms trade. More recent wars in Ukraine and Tigray may have different geopolitical causes, but the arms trade industries remain the ultimate victors.
The book’s final section concerns the parlous state of global governance for health, further frayed by the pandemic’s hyper-nationalist response. It looks first at the World Health Organization, which remains in fiscal jeopardy and under critical review for its handling of the pandemic. Whether its efforts now to create a new pandemic treaty allow it to re-assert some global health leaderships is moot. The World Bank and IMF are interrogated for their welcome moderation in rhetoric (they now speak of ‘investing in people’) but less so for contradiction in practice (continuing to bankroll private health financing in many low-income countries, while preaching post-pandemic public sector prudence). New trade and investment regimes outside of the World Trade Organization are given a critical look.
The final chapter in this section takes a hard look at the slow erosion in public global governance via the rise in ’multistakeholderism’, an idea heavily promoted by the World Economic Forum and its concept of ‘stakeholder capitalism.’ While superficially appealing, such governance models must first ensure that a few powerful and wealthy ‘stakeholders’ do not dominate global debate, dialogue, and decision-making in what this chapter calls ‘the great takeover’.
The final chapter draws attention to the many examples of health activism sprinkled throughout the book. A key theme threading throughout GHW6 is that of convergence: “a coming-together of people, organizations, and movements who share similar concerns about health and are critical of the role of neoliberal globalization plays in sustaining health inequities.” There is no certainty that such a convergence will create the eco-just world that drives the efforts of progressive social movements. But these efforts are as much ends in themselves as they are essential means to create a healthier future; and this edition, as with all previous GHWs, is a modest attempt to honor them.
Global Health Watch 6 will be officially launched April 27 in Madrid (zoom link: https://bit.ly/3utYVGb). It is available as an eBook (PDF) as of April 21 (https://www.bloomsbury.com/ca/global-health-watch-6-9781913441241/).
About the authors:
Chiara Bodini is a founding member of the Centre for International and Intercultural Health (CSI) of the University of Bologna, Italy, a long standing activist of the People’s Health Movement and co-editor of Global Health Watch 6.
Ronald Labonté is Professor in the School of Public Health and Epidemiology, University of Ottawa. He is Editor-in-Chief of the BMC journal, Globalization and Health, active with the People’s Health Movement, a frequent contributor to its flagship publication Global Health Watch, and a co-editor of its 6th edition.