Questioning the Solution

Suggestions from the Book

Key Readings Relevant to the Politics of Health Compiled by the International People’s Health Council, and HealthWrightsNote: This is a short list, mainly of books and magazines, most of which are accessibly written and should be fairly easy to find. With few exceptions, it does not include articles from journals. Many such articles pertinent to the themes in this book are listed in the endnotes located at the end of each of the four parts. We recognize that this list is very incomplete, but have tried to limit it to key writings, mainly for the concerned student or lay reader. Some of the writings are published recently, others are older, but still represent some of the best, most relevant writings in their fields. The International People’s Health Council is developing more complete lists, and would appreciate suggestions of new and important materials. So as you come across such materials, please keep us informed.

Primary Health Care and Determinants of Health

Macdonald, John. Primary Health Care: Medicine In Its Place. University of Bristol, UK. 1993. Available through Kumarian Press, 630 Oakwood Ave., Suite 119, West Hartford, CT 06110-1529, USA. Traces the development of Primary Health Care since its inception at Alma Ata in 1978 to the present, providing strong arguments for the rationale of PHC. Emphasizes the need for equity and strong community participation.

Navarro, V. “A Critique of the Ideological and Political Position of the Brandt Report and the Alma Ata Declaration.” International Journal of Health Services. Vol.14, No.2 (1984): pp 159-172.

Social Science and Medicine. “The Debate on Selective or Comprehensive Primary Health Care.” Vol 26, No 9 (1988): pp 877-878. lntroduction to and historical background of the debate. Editors question whether there is really a fundamental conceptual conflict between SPHC and CPHC. They assert that donors should support nations to develop national health systems based on primary health care. Several good papers by key critics.

Werner, David and Bower, Bill. Helping Health Workers Learn. A ‘people-centered’ guide to teaching community heath workers. Intended for those who feel that their first allegiance lies with working and poor people. Discusses (and simplifies) the awareness-raising methodologies developed by Paulo Freire.

Halstead, SB, Walsh, Julia A, and Warren, Kenneth S, eds. Good Health at Low Cost. New York: The Rockefeller Foundation, 1985. An important study investigating why certain countries – China, Kerala state in India, Sri Lanka and Costa Rica – have attained widespread good health despite low GNP per capita.

Daly, Herman. For the Common Good: Redirecting the Economy toward Community, the Environment, and a Sustainable Future. Boston: Beacon Press. 1989. Daly, a former World Bank economist who left in disgust, argues for an eco-economic model of development based on equilibrium, not growth, with full cost pricing that builds in human and environmental costs.

UNICEF (James Grant, Executive Director). State of the World’s Children. Oxford, England: Oxford University Press. Annually update progress in Child Survival. Has useful statistics and graphs on health, education and economic indicators in most of the world’s countries with year by year comparisons. Clearly presented.

McKeown, Thomas. The Role of Medicine: Dream, Mirage or Nemesis? Oxford, UK. Basil Blackwell Publisher. 1979. A superb review of how medical interventions had relatively little to do with public health improvements in Europe and the US between 1800 and 1950. Challenges myths about the contribution of biomedicine.

Sanders, David. The Struggle for Health. Hampshire, UK: Macmillan Education, 1985. A perceptive overview of the causes of widespread poor health and early death in situations of underdevelopment. It demonstrates clearly that far-reaching improvements in health depend more on social factors than on biomedical advances.

Ehrenreich, J. ed. The Cultural Crisis in Modern Medicine. Monthly Review Press. 1978. This book is a collection of writings by 14 authors divided into 3 parts: The Social Functions of Medicine, The Historical and contemporary Roots and Devastating Impact of Medical Sexism, and the Use of the Art of Healing in Promoting and Maintaining Imperialism.

Kent, George. The Politics of Children’s Survival. New York. Praeger. 1991. This book provides a clear, trenchant analysis of how ‘structural violence’ impacts the lives and mortality of children in the Third World. Kent makes a strong case for equity-oriented development and strategies that empower the poor.

Werner, David. The Life and Death of Primary Health Care, or, The McDonaldization of Alma Ata. 1993. Available from HealthWrights, 964 Hamilton Ave, Palo Alto. CA 94301. USA. Talk given to Medical Aid for the Third World. Reprinted in Third World Resurgence (see below). Gives a cogent history of the 3 major attacks on PHC since Alma Ata: Selective Primary Health Care, User Financing and Cost-Recovery Schemes, and the World Bank’s Investing In Healthreport.

Development and Social Change Issues that Affect Health

Isbister, John. Promises Not Kept: The Betrayal of Social Change in the Third World. West Hartford, Connecticut: Kumarian Press 1991. Reveals how world leaders rose to power on promises for social progress and how they blatantly broke those promises. Packed with hard-hitting facts, the book gives a chronology on how poverty evolved.

UNDP Human Development Index. Provides important, useful data on distribution of wealth and resources within and between countries, along with social indicators (rather than merely economic ones) of a populations progress and well-being. Presents a more honest (people friendly) description and analysis of global trends than does the World Bank’s World Development Report.

Watkins, Kevin. The Oxfam Poverty Report, Oxfam Publishing BEBC Distribution, PO Box 1496. Parkstone, Poole, Dorst BHI23YD, UK 1995, A comprehensive analysis of the state of poverty in the world today, this well documented book identifies the structural forces that deny people their basic economic and social rights. It outlines some of the wider policy and institutional reforms needed to create an enabling environment in which people can take self-determined action to reduce poverty.

Magazines (monthly):

Third World Resurgence. Published by Third World Network, 228 Macalister Road, 10400 Penang, Malaysia. Perhaps the best periodical critique and analysis from the Third World on development, environmental, and health issues. Aims at “fair distribution of world resources and forms of development which are ecologically sustainable and fulfill human needs.” If you subscribe to just one Third World periodical, consider this one.

The New Internationalist, Subscriptions: P0 Box 79, Hertford, SG14 1AQ, UK. “Exists to report on issues of world poverty and inequity; to focus attention on the unjust relationship between the powerful and the powerless in both rich and poor nations …” Each issue focuses on a different theme relevant to development and basic needs. Quality Varies, but many issues carry important debate on “the radical changes needed within and between nations if the basic … needs of all are to be met.”

Global Power Structures, Financial Institutions and Transnational Corporations that Impact Health

World Bank. World Development Report, 1993. Investing in Health. Oxford, UK. Oxford U. Press. 1993. This is the position paper for the World Bank’s takeover of Third World health policy planning. It calls for more equitable and efficient health Systems. But stripped of its Good Samaritan face lift, it is a rehash of the conservative strategies that have derailed Comprehensive Primary Health Care, but with the added shackles of structural adjustment, including privatization of public services and user-financed cost recovery. A masterpiece of disinformation, this market-friendly version Selective Primary Health Care has ominous implications. By tying its new policy to loans, the Bank can impose it on countries that can least afford it. In sum, the Report promotes the same top down development paradigm that has perpetuated poverty, foreign debt, and the devastating impact of structural adjustment policies.

Critical Reactions to the World Bank’s World Development Report 1993: Investing in Health:

Various papers assembled in 1993 by Health Action International-Europe. Address: Jacob van Lennepkade 334T, 1053 NJ Amsterdam, The Netherlands. This is a packet of extremely important analysis and criticism, including responses from Save the Children Fund (UK), Tony Klouda on behalf of the PHC-NGO group (IPPF, UK) and an article by Dorothy Logie and Jessica Woodroffe from the British Medical Journal, July 3,1993.

Legge, David. “Investing in the Shaping of World Health Policy,” Prepared for the AIDAB, NCEPH and PHA workshop (Canberra, Australia, Aug.31, 1993). Long, in depth review of Investing in Health (Available from HealthWrights)

Epprecht, Marc. “The World Bank, Health, and Africa” Z Magazine, Nov.1993, p.31-38. Lengthy in depth review of harm caused by World Bank health plan in Africa.

Danaher, Kevin, editor. Fifty Years is Enough: the case against the World Bank and International Monetary Fund. South End Press, Boston MA. USA, 1994. A revealing collection of essays, country studies, and statements by marginalized groups of the reversals in social progress and deepening of poverty caused by structural adjustment and other lop-sided development policies pushed by these powerful financial institutions.

Meeker-Lowry, Susan, Investing in the Common Good 1995. New Society Publishers, P0 Box 734, Montpelier, VT 05601, USA. Alternative development strategy which calls strongly for equity and participatory democratic process. Critical of the top-down, status-quo preserving strategy of the World Bank’s Investing in Health.

Tan, Michael. Dying for Drugs: Pill Power and Politics in the Philippines. Published by Health Action

Information Network HAIN, 1156 P0 Box 1665, Central Post Office, Quezon City, Philippines. 1988. One of the best books from the Third World ex:posing the exploits and abuses and double standards of the multinational drug companies. HAIN also puts out an excellent bulletin, Health Alert, which looks at many health related issue, Philippine and international, from a pro-people perspective.

Chetley, Andrew; Allain, Annelies. Protecting Infant Health: A health worker’s guide to the International code of Marketing of Breastmilk Substitutes. Published by International Baby Food Action Network (IBFAN) P0 Box 19, 10700 Penang, Malaysia. 1993 (revised). An excellent well-illustrated booklet for awareness raising in community groups.

Korten, David. When Corporations Rule the World. Kumarian Press, 630 Oakwood Ave. Suite 119, West Hartford, CT 06110-1592, USA, 1995. “A searing indictment of an unjust international world order” together with a very rational alternative strategy for “People Centered Development” (the title of his first major book). Korten is the founder of the People-Centered Development Forum, based in New York City.

Magazine (monthly):

Multinational Monitor. Subscriptions: P0 Box 19405, Washington DC 20036, USA. Excellent, balanced, well documented articles that expose the unscrupulous actions of TNCs, their influence on national and global politics, and their violations of international codes. Some articles are directly related to health concerns; almost all are at least indirectly related.