Inequalities between rich and poor countries, and public and private sectors within countries are a major cause of poor health ‘€“ yet the World Health Organisation (WHO) is ill-equipped to deal with this.

So says the Global Health Watch 2005-2006, written by organisations from civil society and launched in London and Ecuador this week.

According to the Watch, the WHO lacks the resources, is hampered by internal management problems and is undermined by the power games of rich nations.

In addition, it is distracted from its core aims of building universal health systems and tackling the underlying causes of ill-health by a proliferation of uncoordinated initiatives.

Mike Rowson, of the Watch called on donors to resource WHO much better and for a more rational allocation of those funds.

‘€œWe are also calling on WHO to open a public debate on its future direction, to cut down on priorities and re-inspire its staff,’€ he added.

Improving healthcare amid globalisation is an enormous challenge. Some 2,7-billion people live on less than U$2 (R14) per day (a rise of 10% over the past 18 years). Healthy life expectancy is 39 in Africa compared to 66 in the developed world.

‘€œHealth and poverty statistics record the disparities, but can only hint at the misery faced by those at the bottom of the pile,’€ said the report.

David McCoy, a managing editor of the Watch said: ‘€œThe imbalance in power between rich countries and poor countries, as well as between the unaccountable corporate sector and public bodies is an important underlying determinant of ill health. The Watch calls for a response from the global community of health workers to restore balance and democratic accountability.’€

The Watch appeals to the world community to go further than the G8 Summit’€™s focus on debt, aid and trade, and highlighted the advantages of setting up of an international tax authority to beat tax avoidance and fund health and development.

In addition, it showed how the commercialisation of healthcare has led to worse health and puts forward a 10-point plan for effective health services.

The Watch points out that health systems are vital in the fight against poverty ‘€“ apart from curing people, they can, if properly designed and managed, reduce the financial burden of illness, build social cohesion and mitigate the feelings of vulnerability and powerlessness that are at the heart of the experience of destitution.

Yet hundreds of millions still lack access to even basic care. And in most of the world, where health care has to be purchased directly out of pocket, it regularly pushes people deeper into poverty.

Developed nations give US $10 billion annually in aid to the health sector in developing countries. This is roughly the same as the amount spent on ice cream in Europe every year and equivalent to about 10% of England’€™s National Health Service (NHS) budget. Yet even this small amount of aid can cause immense problems in poorer countries, as donor programmes are often uncoordinated and focus on specific diseases to the detriment of the health system as a whole.

The report highlights the cost of Africa’€™s ‘€œsubsidy’€ to the UK’€™s NHS in the form of its skilled migrants and calls for compensation for low-income countries facing severe staff-shortages

The ‘€œWatch’€ also questions the success story painted by proponents of the current form of globalization, pointing to the increases in poverty in Africa, eastern Europe, central Asia and Latin America and a rise in income inequalities in many countries (including wealthy ones).

In Mexico, for example, the liberalisation of the corn sector under the North American Free Trade Agreement led to a flood of imports from the United States, where agribusiness is massively subsidised. Mexican corn production stagnated while prices declined. Small farmers became much poorer and some 700 000 agricultural jobs disappeared over the same period. Rural poverty rates rose to over 70%, the minimum wage lost over three quarters of its purchasing power, and infant mortality rates amongst the poor increased.

The report presents new evidence which shows that higher levels of private finance and provision lead to worse health outcomes.

The Watch, produced over the past 18 months through the collaborative efforts of more than 120 individuals and 70 organisations, is designed to act as a vehicle for civil society to promote the fulfillment of universal rights to health in poor and rich countries alike. Its production has been co-ordinated by the People’€™s Health Movement, the Durban-based Global Equity Gauge Alliance and Medact.

Its release coincides with the 2nd People’€™s Health Assembly in Cuenca, Ecuador where 2000 people have gathered to debate national and global health priorities.

Five thematic sections are highlighted in the Watch ‘€“ Health and globalisation; Healthcare services and systems; Health of vulnerable people; the wider health context; and Holding to account.

Listening to and bringing forward the voices of the excluded and marginalized are key roles for civil society worldwide and the report focuses on two groups of people ‘€“ Indigenous Peoples and people with disabilities.

According to the authors discrimination against both sets of people runs deep with indigenous peoples often seen as backward and a block on modernisation and development while people with disabilities are regarded as abnormal and denied full human rights as a result.

The 1978 Alma Ata Declaration recognized that the goal of ‘€˜Health for All’€™ would be achieved only by addressing the underlying social, economic and environmental determinants of health. Simply improving health care services would not be enough. Health care professionals and health care systems can facilitate and promote action for health in a range of different sectors.

‘€œThe wider health context’€ chapter in the report demonstrates why this approach is needed by discussing the profound health impacts of lack of access to water and education, conflict, food insecurity and climate change. Using one example the report shows that the failure to meet international targets on gender parity in primary and secondary education will, in 2005 alone, lead to the unnecessary deaths of 1 million children under 5.

The full report can be accessed at www.ghwatch.org

E-mail Anso Thom