Financial crisis and global health
Dr Manoj Kurian
Programme Executive, Health and Healing, World Council of Churches
Friends, we are deeply appreciative of Director-General Dr Chan’s leadership in calling this critical consultation. We thank you for this opportunity to express some civil society perspectives on the topic and to participate in the ongoing discussions.
The lasting lesson that the global financial crisis will bring to society is the increasing realisation of what is of enduring value and the greatest asset that we possess: OUR PEOPLE! How economies would fare after the crisis has long past will depend very much on how governments and society as a whole are able to care for the welfare and health of their people during the crisis. Our people are best served when we work together - governments and civil society; from the international, regional, national to the local contexts.
A call to the international community
Today the fabric of human society is stretched thin. A third of the population of sub-Saharan Africa, and more than 20% of the population in South Asia have been going hungry, even before the financial crisis dawned on us. There is absolutely no room for cutbacks on social expenditure. The global financial crisis in the early 1980s and the disastrous consequences of the supposedly correctional measures on the health and welfare of society have made all of us wiser, I believe.
We do not live in isolated communities, but are part of a global village, each one of us a part of one humanity, dependent on one another for our well being. Currently many of the key campaigns to combat diseases and to keep the global public health objectives on track to achieve the Millennium Development Goals are heavily dependent on international cooperation and support. Cutting back on funding will jeopardize ongoing treatment of millions of people affected by diseases such as HIV and tuberculosis. This is not only an infringement of the fundamental rights of these individuals, but it will also potentially open up a Pandora’s box of public health disasters. Erratic and incomplete treatments compound the danger of the development of myriad multidrug-resistant strains of pathogenic organisms.
Though societies in wealthier countries have been hard hit by this financial crisis, the world cannot afford a reduction in their current commitments. We are heartened to hear the reaffirmations of the promises of many partners and we look forward to the realizations of these commitments.
A call to governments
The full impact of the crisis is not yet upon us. Past financial crises, the global financial crisis in the early 1980s, the Asian crisis in the 1990s and the Latin American crisis in 2000 have clearly shown us the critical role played by civil society in the recovery of societies. Though these contributions are invaluable, they are not necessarily reflected in the budget lines of governmental health expenditures.
As private out-of-pocket expenditures tends to decline in a recession, societal dependence on private health care declines and is replaced by services that are available at lower cost in the public sector. This is recognized. But what is not always obvious is that, in times of crisis, a significant additional burden is taken on by service providers in the nongovernmental and private not-for-profit sectors, including faith-based organizations, cooperatives and movements such as the Red Cross and Red Crescent Societies, along with the health providers in the government.
Although it is too early to tell, initial reports from several countries indicate reductions in staff and other cost-saving measures by a number of nongovernmental organizations, while demand for services has increased significantly. In some countries, government subsidies to the private not-for-profit sector (including faith-based organizations providing health services) have been diminishing, a pattern that can be further exacerbated given pressures on public sector budgets, in the context of increasing demands.
When crisis stares at communities, civil society is by their side. The cooperatives, the community centres, the mosques, temples and churches do not disappear. They remain, helping communities to cope. There are clear limitations and governments will have to identify with their primary responsibility of making public health a reality. We cannot manage alone; rather we will work shoulder to shoulder with the governments to serve people best. Governments need to recognize the assets and services that civil society provide and see them as part of their national strategy; engage them; assist and resource them; and hold them accountable.
The key role of stimulus packages as a tool to put the economies back on the track to progress has been recognized. But it is important the application of this tool goes beyond infrastructure development. In an environment when people are losing jobs and there are real reductions in wages, these stimulus packages should aim at directly filling the wage gap, taking care so that the most vulnerable in the community can benefit from them. The choice for a mother between spending her last dollar for transportation to collect the monthly medicines and feeding her starving children is no choice at all. Strengthening the public distribution system for food; provision of free or supported transportation to health-care centres; providing support for treatments; removal of user fees - these are examples of direct action which could close the wage gap.
There is ample evidence to show that the proactive policies taken by governments and the critical investments in periods of crisis drew rich dividends for communities. Hence the policies you help formulate now will have profound impacts on societies for years to come.
How are the most vulnerable faring?
The highest reaches of public health and well-being that societies can achieve are based on the firm foundation that the most vulnerable person in each society has access to dignity, respect, love and wholehearted service. In the midst of crisis there can be a tendency to neglect the most vulnerable - people in remote regions; internally displaced people who are not included in official records; communities suffering from ongoing conflicts that we avoid addressing. The welfare of the most vulnerable defies the law of averages and cannot be drowned by numbers. It stands as a poignant indicator of the level of commitment of our societies to justice and equity.
The security of humanitarian and health workers
The most innovative of schemes in the direst of times will succeed only if the workers facilitating it out in the community are valued, affirmed and safe. The promotion of sustainable peace in conflict ridden regions is fundamental and not a luxury, if a healthy society has to be rebuilt.
The level of violence that humanitarian and health workers face is largely invisible to the world. In the year 2008, world-wide, 34 United Nations staff were killed as a result of violence. But this number does not take into account the local staffs that have lost their lives. In Somalia alone, 40 humanitarian workers lost their lives last year, the majority of whom were local staffs. The loss of life is but the tip of the iceberg of molestations, harassments, injury and extreme hardships that health and humanitarian workers face. The investments required for a motivated and secure health-worker force should never be underestimated even in the toughest of times.
Hard questions to be answered
While we challenge governments and the international community, we from the civil society working on health issues have to examine ourselves in a forthright and frank manner. As our communities face this global financial crisis, are we working together with the wider civil society? Are we working closely with the governments? Are we aware of the assets that we have and we have influence over? Are we offering these - our institutional, personnel and financial assets - to the service of society in a non-partisan manner?
These questions have to be answered with honesty at all levels and we need to recommit ourselves to address this crisis.
Align assets and act with urgency and synergy
Our people are the greatest asset that society possesses. Ensuring their health and welfare even in the most difficult times takes precedent over other priorities. To achieve this we will have to work together, governments and civil society, from the international, regional, national to the local contexts. Let us be aware of the risks that we face to day; let us appreciate the assets that we all process; let us align the assets that we have influence over, and act in a sustained and synergistic manner, as a matter of urgency.