Public health workforce, economics and human rights

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Public health workforce, economics and human
rights

• Presentation by
• Lanny Smith, MD, MPH, DTMH
• Montefiore Residency Programs in Primary Care and
  Social Medicine, AECOM
• Peoples Health Movement, PHM
• Doctors for Global Health, DGH
• 28 April 2009
• WFPHA 12th World Congress on Public Health,
  Istanbul

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Health Human Rights

• Article 25.
• (1) Everyone has the right to a standard of
  living adequate for the health and well-being of
  himself and of his family, including food,
  clothing, housing and medical care and necessary
  social services, and the right to security in the
  event of unemployment, sickness, disability,
  widowhood, old age or other lack of livelihood in
  circumstances beyond his control.
• (2) Motherhood and childhood are entitled to
  special care and assistance. All children,
  whether born in or out of wedlock, shall enjoy
  the same social protection.

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brain drain intercontinental, continental or
within country

• Article 13. UDHR.
• (1) Everyone has the right to freedom of movement
  and residence within the borders of each state.
• (2) Everyone has the right to leave any country,
  including his own, and to return to his country.

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Public Sector spending caps (resulting in caps on
state-employed public health professionals and
their pay) imposed by the World Bank and
International Monetary Fund part of Structural
Adjustment Programs and Poverty Reduction
Strategy Papers
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• "Blocking Progress How the Fight against
  HIV/AIDS is being Undermined by the World Bank
  and International Monetary Fund" A policy
  briefing by ActionAid International USA, Global
  AIDS Alliance, Student Global AIDS Campaign, and
  RESULTS Educational Fund
• 28 September 2004

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http//www.africaaction.org/newsroom/release.php?o
preaddocumentid3849type2issues2

• Latvia has suffered most dramatically, with the
  IMF withholding a promised loan installment of
  200 million last month because public spending
  was not being cut fast enough. "Our economy is
  falling apart they say it will shrink 12
  percent this year, our government has cut the
  budget by 40 percent but the IMF is demanding a
  deficit target of 5 percent of GDP! To reach
  this we will have to shut down our hospitals and
  cut pensions. People are scared, and they are
  taking to the streets to protest these draconian
  measures," said Inga Paparde of the Latvian AIDS
  activist group Association HIV.LV.

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• But Latvia is not alone. Surveys of credit and
  loan arrangements for countries ranging from
  Pakistan to Malawi demonstrate that while the IMF
  is supporting fiscal stimulus for industrialized
  countries, it is demanding that most of the world
  cut public sector expenditures, hike interest
  rates, and reduce deficits the opposite of the
  cure recommended for the United States and
  Europe.

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School of Americas/Western Hemisphere Institute
for Security Cooperation

• Operation Condor was founded in secret and
  remained a mystery until after democracy had
  returned to South America. According to documents
  later discovered in Paraguay, it was established
  at a military intelligence meeting in Chile on 25
  November 1975 - Gen Pinochet's 60th birthday.
  Delegates from five other countries were there
  Argentina, Brazil, Bolivia, Paraguay and
  Uruguay.http//news.bbc.co.uk/2/hi/americas/372072
  4.stm
• Over its 59 years, the SOA has trained over
  60,000 Latin American soldiers in
  counterinsurgency techniques, sniper training,
  commando and psychological warfare, military
  intelligence and interrogation tactics. These
  graduates have consistently used their skills to
  wage a war against their own people.
  http//www.soaw.org/

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Military/Industrial/ Humanitarian/Development
Complex

• More than 2,000 doctors have been kidnapped or
  murdered since 2003 and 12,000 doctors have fled
  the country, according to the Brookings Institute
  Iraq Index.
• "The Iraq health system is bleeding," said Salam
  Ismael, a doctor with the humanitarian group
  Doctors for Iraq, from Baghdad.

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the purposeful under-training and relentless
head-hunting of health professionals by the
industrialized world
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http//www.nytimes.com/2009/04/27/health/policy/27
care.html?_r1reftodayspaper

• Shortage of Doctors an Obstacle to Obama Goals
• By ROBERT PEAR
• The Obama administration is pouring hundreds of
  millions of dollars into community health
  centers. But Mary K. Wakefield, the new
  administrator of the Health Resources and
  Services Administration, said many clinics were
  having difficulty finding doctors and nurses to
  fill vacancies.
• April 26, 2009

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http//physiciansforhumanrights.org/library/docume
nts/reports/report-2004-july.pdf

• Physicians from Africa appear to be especially
  likely to serve the US inner-city poor. Some
  93 of physicians from sub-Saharan Africa
  working in the USA practice in urban areas,
  compared to 87 of US-born physicians.383

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http//physiciansforhumanrights.org/library/docume
nts/reports/report-2004-july.pdf

• The perfect reimbursement mechanism would take
  into account full effects of brain drain. The
  medical education costs alone would not fully
  compensate the source country in terms of the
  most important measure, which is not the
  financial loss, but the health impact.

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Doctors for Global Health (DGH)www.dghonline.org

• Works at the synergy of health, human
  rights, education and art
• In Kisoro, Uganda, with Mbarara University of
  Science and Technology and the Health Ministry
• Together with Albert Einstein College of
  Medicine, AECOM.

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http//ngocodeofconduct.org/

• Articles of the NGO Code of Conduct for
• Health Systems Strengthening
• I. NGOs will engage in hiring practices that
  ensure long-term health system sustainability.
• II. NGOs will enact employee compensation
  practices that strengthen the public sector.
• III. NGOs pledge to create and maintain human
  resources training and support systems that are
  good for the countries where they work.
• IV. NGOs will minimize the NGO management burden
  for ministries.
• V. NGOs will support Ministries of Health as they
  engage with communities.
• VI. NGOs will advocate for policies that promote
  and support the public sector.

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Peoples Health Movement, PHM www.phmovement.org

• Pushing the international health research agenda
  towards equity and effectivenessThe Lancet,
  Volume 364, Issue 9445, Pages 1630-1631D.McCoy,
  D.Sanders, F.Baum, T.Narayan, D.Legge
• IPHU, International Peoples Health University

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• Marcha Blanca in El Salvador against
  privatization, 23 October 2002, had more than
  15,000 participants

• artículos 65 y 66 Es deber del Estado garantizar
  el goce de la salud, mediante un sistema de
  Seguridad Social financiado por patronos,
  trabajadores y el estado mismo, así como
  proporcionar un servicio de salud gratuito a
  quienes no se incorporen en él.

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AIDS Activists protest to IMF/World Bank 2004

• Dear Mr. Rato and Mr. WolfensohnWe are people
  with AIDS and their advocates from over 35
  countries. We write to express our concern that
  policies driven by macroeconomic concerns are
  constraining the money available to combat
  HIV/AIDS and meet other critical needs of
  populations in developing countries. Even before
  a new policy is adopted, we urge you to
  immediately encourage flexibility in budget
  ceilings in health, education, and other sectors
  central to human development, as well as to urge
  that countries implement a moratorium on any
  restrictions on hiring, salary, and benefits in
  these sectors.

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• Fight the power on Youth AIDS Day
• By Emily Hoffman, On behalf of the Student Global
  AIDS Campaign
• On Feb. 26, 2005, more than 4,000 students and
  young people from across the country converged on
  Washington, DC for the Student March Against AIDS
  organized by the Student Global AIDS Campaign
  (SGAC) with partner organizations. Rallying first
  at the White House and then marching two miles up
  Constitution Avenue to a closing rally at the
  Capitol, student marchers could be heard chanting
  from blocks away as traffic was halted and
  tourists flocked to the streets to see what was
  going on.

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Latin American Medical School, ELAM, Havana, Cuba

• 104 Americans on full scholarships currently
  studying medicine in Cuba alongside their peers
  from 27 countries
• 300 graduates from Brazil
• gt4,500 graduates from 30
• ELAM is a 6-year program, 10 semesters 9,094
  hours,
• On July 25, 2008 the Medical Board of California,
  USA, granted recognition of ELAM

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Tesshekkur ederim! For Information on PHM and
DGH

• PHM www.phmovement.org
• Liberation Medicine, see Doctors for Global
  Health www.dghonline.org
• Social Medicine, see www.socialmedicine.info
• And Montefiore RPSM www.socialmedicine.org
• lannysmith_at_post.harvard.edu