A statement prepared for "Making Partnerships Work for Health", World Health Organization, Geneva, 26-28 October, 2005.*

People's Health Movement (PHM)

PHM identifies exploitation and marginalization of the poor as root causes of preventable disease, malnutrition and death and in this and many other respects, women and children are particularly vulnerable. This awareness guides all of our work including our position on partnerships for health.

We start with a simple observation. Partners in any endeavour must genuinely share a common goal. If they do not, the interaction is not a partnership and its precise nature must be made clear for its real value and the real risks it may pose to public health, to be properly evaluated.
With that in mind, we look first at interactions that are called ‘public private partnerships’, because they are increasingly portrayed not just as a possible arrangement – but as an innovative and unavoidable policy paradigm – to address global health problems.
The Cuenca Declaration, issued at the Second People’s Health Assembly in July 2005 in Ecuador, states: “We oppose public-private partnerships because the private sector has no place in public health policy making”. We will elaborate on this here.
The extraordinary power of the private sector, and in particular of transnational corporations (TNCs) and pharmaceutical houses under the neoliberal, corporate-led globalization process, has been identified as the major obstacle to achieving social and economic justice and therefore, also, Health for All.
TNCs already exert enormous power over governments and International Financial Institutions (IFIs). Through PPPs, they are becoming major players in many areas of public policy making, including health.
Let us clarify some fundamental democratic principles. All citizens are involved and concerned in health matters as individuals (including employees and Chief Executive Officers of TNCs). However, until recently it has been considered an unacceptable conflict of interest to include TNCs as decision makers in public policy.
WHO has always interacted – and often collaborated - with private sector and other non-state actors. What is currently subsumed under the term partnerships with the private sector includes such diverse activities as corporate donation, sponsorship, research collaboration, negotiation or public tenders, and contracting out of selected health services. It also includes global health alliances, such as GAVI, GAIN and the Global Fund for AIDS, TB and Malaria which involve high level policy interactions between UN agencies, corporations, and private foundations which propagate a business philosophy.
Many of these interactions are not fundamentally new; others are social experiments. Some, such as the outsourcing of public health services, the funding of international public health and UN agencies through corporate charity and the GAVI style health alliances are highly problematic.
What is new – and of serious concern in most current PPPs - is that industry is invited as a ‘full partner’ in decision making processes on public issues.
Today, the UN Secretary-General’s Report on Enhanced cooperation between the United Nations and all relevant partners, in particular the private sector, states that it offers to the private sector through engagement in governmental processes “opportunities to have its voice heard.”[1]
PHM argues that, in terms of both process and outcome, these developments are incompatible with democratic decision making, economic justice, emancipatory development, human rights including the right to health – and therefore the achievement of Health for All.
A second simple observation is that TNCs have a legal obligation to make a profit for shareholders. The raison d'être of private companies is completely different from that of organizations and groups working for Health for All and the meeting of people's basic needs for health as a human right.
We have only time to present the briefest summary of some of the risks to public health that this difference implies.
Public private partnerships:

  • Allow private interests to set/influence the public health agenda.
  • Sacrifice broad public health goals of prevention of disease, protection and promotion of health, and tackling of the underlying social and economic determinants of avoidable disease and death.
  • Prioritize technological interventions, cosmetic and unsustainable, which generate profit for a minority.
  • Favour short term, vertical approaches and privatization of essential public services rather than horizontal, comprehensive and sustainable public services.
  • Provide legitimacy to corporations' activities through association with UN agencies (blue-washing); blur roles and real interests.
  • Compromise public agencies, including UN agencies, and make them ‘call the tune’ for private interests of a tiny privileged minority rather than for 6 billion people.

As a policy paradigm, then, the PHM regards PPPs as fundamentally flawed. It thus follows that the actual evaluation of the effectiveness of particular PPPs in practice is of limited interest. PHM cautions that almost any project can demonstrate "effectiveness" within a narrow context using a specific set of indicators - if enough money is thrown at it by powerful actors, over a short space of time.
Evaluations of selected PPPs have been undertaken - though few of these have considered risks and harm in the widest sense - and the results have been variable. PHM’s conclusion is that PPPs are ideology-driven rather than evidence-based. If one takes privatization of health services as an example (as this is prominently promoted through PPPs), no serious studies have yet shown that privatization of health services is either efficient or effective. A wealth of evidence exists, however, to show that national, universal, publicly run and funded health services are significantly cheaper and produce far better health outcomes.
So what kind of partnerships does PHM recommend? PHM promotes a broad based holistic approach to health which involves common struggles in a spirit of solidarity. Individuals and groups with whom WHO could work as partners need to share goals and represent people's interests in terms of their right to health.
This would include health workers, public service workers, trade unions, teachers, community workers, indigenous people's movements, landless peasants' movements, community groups, solidarity movements, public interest NGOs, civil society organizations, social justice political parties, professional associations and many more.
We support solidarity between groups and organizations serving the public interest within, across and beyond the health sector in order to address the major determinants of preventable disease, malnutrition and death because it is through such arrangements that human rights and the right to health, which only some of us enjoy, have been won.
We must never forget that these rights have been won painfully and slowly, with much suffering and loss of life for the poor – and against formidable obstacles in the form of powerful, private interests.
We cite as examples the efforts undertaken by various groups working in solidarity towards Health for All to address the lack of food and water, bearing in mind that:
a) these two factors together account for well over 60% of preventable disease and death,
b) mothers and children are always the primary victims in times of shortage, and
c) that women are largely responsible for the provision of these daily essentials.
· Access to water and to essential services has been won through partnerships between public sector workers, their unions, local community groups and health workers in countless places the world over, most notably in Cochabamba, Bolivia.
· The struggle for food sovereignty, critical to adequate consumption of high quality food, is the joint struggle of landless peasants' movements, opponents of liberalization of the agricultural sector, and the tremendous worldwide movement for social and economic justice that has been meeting at the World Social Fora.
Such solidarity struggles involving collaboration between public interest groups confront the formidable and overwhelming power of TNCs that are behind the neoliberal restructuring of our world and increasing poverty and inequality – the first causes of poor health.
Referring now to this meeting at the World Health Organization:
Why are agencies and organizations with public responsibilities adopting these arrangements? For the simple reason that, today, the private sector is considered the only untapped source of funds. The term PPP encompasses essentially the hope to access funds of corporations and some hyper-rich. Under neoliberal economic regimes, public sector budgets have been slashed and tax bases destroyed. These developments are themselves the result of the influence of TNCs on governments and the international financial institutions.
The solution to this problem is not for public bodies to go knocking at the doors of the private sector, nor of the foundations of celebrity philanthropists from industry. The solution is economic justice, including an adequate tax base, both nationally and internationally, to cover all public services, as well as proper funding of public institutions such as WHO through regular budgets so that it may fulfill its international responsibilities unimpeded by corporate interests.
In relation to ‘Making Partnerships Work for Health’, we urge the World Health Organization to keep to the founding principles set out in its Constitution. In particular the following parts of the preamble:
"Informed opinion and active cooperation on the part of the public are of the utmost importance in the improvement of the health of the people."
"Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures."
The PHM urges WHO to claim its rightful place as the international health authority and to ensure, with governments, accountability to the people, not to private interests - in all matters of health. Our message is simple: Work with the people, for the people!
Together, we can achieve Health for All.
*: For reasons beyond PHM control, the statement was not read at this workshop.
[1] UN (2005). Enhanced cooperation between the United Nations and all relevant partners, in particular the private sector. Report of the Secretary-General, A/60/150, 10 August, para 20

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