Correspondence
financing; opposition to involvement of multinational companies and other private interest groups in international health policy making by WHO and its decision making processes; an increased WHO active presence in the governance structures of multilateral organisations whose decisions influence the global social and economic determinants of health (ie, the World Trade Organisation, the World Bank, the International Monetary Fund, amongst others); increased financial support to WHO to recruit expertise to work effectively across these other global governance sectors; and reforms to global governance, including economic governance, in line with democratic standards considered appropriate at the national level. Bottom-up (health) activism will continue to be an essential strategy for health equity, as it was to the development of Europe’s social security systems (1850–1950)2 and to the setting up and development of Brazil’s national health system in the 1980s.3 But its benefits will be limited if it is countered by inappropriate structures at the international level. The development of effective global health policies is not compatible with global neoliberal structures. People’s Health Movement’s key aims are to assist in building such evidenceinformed activism—from grassroots to policy level.4 Without a strong global movement to combat health inequity, we may end up just knowing more about its causes. We declare that we have no competing interests.
*Pol De Vos, Claudio Schuftan, David Sanders , Ronald Labonte, David Woodward, Anne-Emanuelle Birn, Chiara Bodini, Angelo Stefanini, Hani Serag
[email protected] Public Health Department, Institute of Tropical Medicine, 2000 Antwerp, Belgium (PDV); People’s Health Movement, Ho Chi Minh City, Vietnam (CS); University of Western Cape, Cape Town, South Africa (DS); University of Ottawa, Ottawa, ON, Canada (RL); New Economics Foundation, London, UK (DW); Dala Lana School of Public Health, Toronto, ON, Canada (A-EB); Center for International Health, University of
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Bologna, Bologna, Italy (CB, AS); and Global Secretariat of the People’s Health Movement, Cairo, Egypt (HS) 1
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Ottersen OP, Dasgupta J, Blouin C, et al. The political origins of health inequity: prospects for change. Lancet 2014; 383: 630–67. Kondilis E, Bodini C, De Vos P, Benos A, Stefanini A. Fiscal policies in Europe in the wake of the economic crisis: implications for health and healthcare access. Background paper for The Lancet–University of Oslo Commission on Global Governance for Health. https://www.med.uio.no/helsam/english/ research/global-governance-health/ background-papers/fiscal-policies-eu.pdf (accessed Feb 11, 2014). Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet 2011; 377: 1778–97. People’s Health Movement. People’s Charter for Health. http://www.phmovement.org (accessed April 7, 2014).
civil society, it promotes multisectoral, even multilateral effort.4 When health becomes an explicit goal and a political priority, the market will follow. I declare that I have no competing interests.
Pricivel M Carrera
[email protected] Health Technology and Services Research, University of Twente, 7522 NB Enschede, Netherlands 1 2
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In the market economy the goal of participants is to make profits. Notwithstanding the growth of corporate philanthropy and ethical consumption, market economy is, has been, and will be about profit making. Corporate management’s responsibility lies in shareholder wealth maximisation. Consumers pay for goods and services that give them the biggest return to their hard-earned money. We certainly can aspire for a softer, more inclusive economic system.1 If we want health to be a societal goal and the protection of health a concerted effort, we need to rely on and work with governments in implementing the Health in All Policies (HiAP) approach. The HiAP approach seeks to improve population health and health equity by considering the health implications of public policies across sectors including the harmful health effects of decisions.2 The HiAP approach complements the mechanisms suggested by The Lancet–University of Oslo Commission on Global Governance for Health3 in dealing with global governance for health. In stressing governmental obligation towards citizens’ health and wellbeing, the HiAP approach makes clear where the accountability for prioritising health lies.2 In underscoring the significance of effective structures, processes, and resources and engaging communities, social movements, and
Streeck W. Taking capitalism seriously. Socio-Economic Rev 2011; 9: 137–67. The Helsinki Statement on Health in All Policies. http://www.healthpromotion2013. org/images/8GCHP_Helsinki_Statement.pdf (accessed April 7, 2014). Ottersen OP, Dasgupta J, Blouin C, et al. The political origins of health inequity: prospects for change. Lancet 2014; 383: 630–67. Carrera P. The difficulty of making healthy choices and “health in all policies”. Bull World Health Organ 2014; 92: 154.
Authors’ reply We are pleased that the People’s Health Movement welcomes our report of The Lancet–University of Oslo Commission on Global Governance for Health1 and agrees with its diagnosis. “Bottom-up (health) activism will continue to be an essential strategy for health equity”, which is indeed why the People’s Health Movement is so important. We certainly see WHO as the legitimate supranational global health organisation, requiring greater support. But we do not believe that our recommendation for an Independent Scientific Monitoring Panel and a MultiStakeholder Platform on Governance for Health (MSPGH) would weaken WHO or serve to multiply multilateral organisations, as suggested. We see the former as a scientific (academic) panel, whose legitimacy derives from its independence and the quality of the evidence offered in its reports; evidence, we hope that can be used by many concerned actors, not least the People’s Health Movement and WHO. The idea to establish an MSPGH is perhaps more controversial and would certainly need to be widely discussed before concrete steps are taken. However, the concept is modelled on the UN Food and Agriculture Oragaization’s Committee on Food www.thelancet.com Vol 383 April 19, 2014
