When the concept of equity in health was conceived at the International Conference on Primary Health Care in 1978 – resulting in the Declaration of Alma Ata – the world was experiencing the initial phase of globalization. At the time, the implementation of the principles of Primary Health Care faced the challenges of structural adjustment in health care systems in many countries. By the mid-90s, the process of making health policies was completely overtaken by the values pushed in the structural adjustment. Among other things, investing in health was reduced to a market opportunity, and thus used to justify and promote privatization in the health sector.
Already in the initial phase of the push towards privatization, it became obvious that poor people would be disproportionately hit by the lack of access to health services. Various networks of civil society activists, professionals and academics at the national, regional and global levels were watching this dynamism and struggling for justice in health for deprived people. However, neoliberalism in the 21st century managed to challenge these efforts and gradually pushed the idea of Comprehensive Primary Health Care into the shadows. States weakened by structural adjustment programs and debt were compelled to surrender before neoliberalism.
There are multiple implications of present day neoliberalism in health, and marketization of health is certainly at these. Actors of neoliberalism, like transnational corporations and international financial institutions, are investing all possible efforts to influence health by bringing in market economy theories. In doing so, they are primarily concerned with marketing and profit accumulation, not equity and justice. In fact, inequity and injustice in health exist nowadays because market economy theories are largely applied in the field.
The notions of health technology and services are interpreted as commodities for sale in the market. People suffering from health problems are not seen as service-seekers, but as consumers. Neoliberal values equate the right to health of citizens to the right of the purchaser to buy something in the market, imposing the market theory of consumers’ sovereignty in health. This implies the ultimate right of consumers to purchase any commodity based on their capacity, thus tying the quality and quantity of health services to the purchasing capacity of consumers. Needless to say, this does not match with the spirit of equity and justice envisioned in the Declaration of Alma Ata. Consumption of health services cannot be proportionate to the direct financial contribution of citizens. The denial of equity and justice in health by the dominant market economy theory has led to the widespread disparities in health today.
The advancements in health science and technology put the world in a position where most of the diseases that posed challenges for human beings a few decades back can be easily overcome. Further scientific and technological advancement, as well as improvement in human resources for health, should mean we will be able to competently tackle future illnesses. Yet, this optimistic scenario is unlikely to happen without a decisive turn towards the ideals of Comprehensive Primary Health Care.
For more than 20 years, the People’s Health Movement (PHM) has been building a global movement, rooted in the Global South, which could bring this turn. Efforts to do so can be seen on a very local scale, where country circles focus on the most pressing health issues. But they also build up to the global level, where PHM activists continue to insist on addressing the political, commercial, and other systemic determinants of health.
It is obvious that our struggle for health today is not against the diseases alone. Instead, we are fighting against the systems which foster discrepancy and create barriers for the people to access the important achievements of health science and technology, as much as very basic health care. Our fight is for the right of people to health, not for the charity and mercy of the system and market. We are struggling for the rejection of market economy theory in health and for establishing the theory of equity and justice to defend the right of people to health. Health should not be for sale in the market.
Dr. Sharad Onta is the country coordinator of PHM Nepal and a public health care expert with extensive knowledge in health system research and policy development.
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Tags: Primary Health Care, Declaration of Alma Ata, privatization of
