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Health-LATAM: Globalisation Hazardous to Public Health

By Gustavo González

SANTIAGO, Dec 1 (IPS) - The globalisation process has a negative impact on public health in Latin America, according to the diagnoses and proposals regional delegates are taking to the international People's Health Assembly (PHA 2000) next week in Bangladesh.

In response, the region has seen initiatives arise from the civil society rooted in the belief that Latin Americans, in the realm of health, can no longer allow themselves to be victims, but must instead take action to improve their circumstances.

The PHA 2000, to be held Dec 4 to Dec 8 in Gonoshasthaya Kendra, Savar, 37 km north of Dhaka, will unite 600 delegates from non-governmental organisations (NGOs) from around the world, including representatives from Latin America and the Caribbean.

The central proposal of the conference is popular participation in health policies and systems, based on the idea that ''health is a fundamental human right that cannot be exercised without a commitment for equality and social justice.''

According to the People's Health Assembly working group, globalisation entails social inequalities worldwide.

At the same time, the process consecrates the power of a few entities, such as the World Trade Organisation, World Bank, International Monetary Fund and transnational corporations.

While some people live amid excessive consumption, which damages their health and the world's ecosystems, millions suffer hunger and deprivation. This global socio-economic system is as unsustainable as it is inequitable, according to a discussion document for the Bangladesh meeting.

The critics of globalisation in Latin America also question of the impacts of this process on health, often occurring as a result of the indiscriminate liberalisation of trade and of the movements of the workforce, driven by the deterioration of labour and environmental situations.

The Latin American consumer rights movement, which held its fourth conference in October 1999 in Panama, indicated that privatisation within the health sector, imposed by new economic policies, ''tends to exclude the low-income sectors from quality medical attention.''

In a report published in May, the Economic Commission for Latin America and the Caribbean (ECLAC) said, based on a 1999 study, 83.6 million residents of the region lacked access to health services.

ECLAC, a United Nations regional agency, reports that out of the approximately 500 million Latin Americans, 217.8 million are outside of any social security system, meaning that medical attention depends exclusively on the now-reduced government sector.

The same study establishes that 17 percent of all births in Latin America occur without a health professional present, which reinforces, by extending that figure to the broader picture, the fact that more than 80 million people do not have access to health services.

The deterioration of health conditions in the region and the negative impact of globalisation are evidenced by the resurgence of diseases once thought to have been eradicated, such as malaria and smallpox, and of epidemics, such as dengue in Central America, which reappears with renewed virulence.

The consumer rights conference in Panama issued a warning about the lack of education and information programmes on the functioning of public health services and on users' rights, as well as the lack of participatory mechanisms in the design of health policy and projects.

Citizen monitoring of public and private health services is one of the fundamental demands made by consumers in the region, and will be shared with the delegates from the rest of the world at the PHA in Bangladesh next week.

Concerns about health attention also cover the lack of access to medications, due as much to costs as to geographical and cultural factors.

One of the most often cited worries, which links health with globalisation, is related to the growing presence of transnational corporations in the pharmaceutical business, with widespread imports of medicines whose quality has not been duly certified.

Health and the environment are also intertwined in the NGOs' actions against genetically modified organisms and in the campaigns launched against the use of pesticides and other toxic chemicals for agricultural or industrial purposes.

One of the policies promoted in Latin America over recent years to confront the health sector crisis has been to decentralise services, says Mexican physician René Leyva, a professor of social medicine.

But its results so far have been mixed and even contradictory, as in many cases the implementation of such measures is accompanied by profound financial crisis in public health systems.

''Under these condition, we turn to participation as one strategy to directly or indirectly finance health services,'' said Leyva.

''Another frequent occurrence is that decentralisation turns into an end in itself... However, though scant, there is also evidence that (decentralisation) has contributed to legitimising local demands and occasionally providing people with greater control over health services,'' he added.

For the organisers of the People's Health Assembly, the priorities are initiatives and actions led by the communities themselves, in terms not only of pressuring the authorities, but also of creating their own responses in the areas of education and health.

The Piaxtla project in Mexico is considered one of Latin America's standout experiences in this area. Begun in the 1960s, it operates through health workers who provide education in the poorest regions in practical approaches to resolving the community's problems.

The Child-to-Child programme is another successful initiative underway in Central America and Asia, taking place through the schools, where children learn to share knowledge and efforts in taking care of their own health. (END/IPS/tra-so/ggr/mj/ld/00)