New head of WHO warns against market oriented strategies

By Gustavo Capdevila, IPS, 28 April 1998

GENEVA, Apr 28 (IPS)—Former Norwegian prime minister Gro Harlem Brundtland warned Asian governments against the risk of prescribing for the health sector the same neoliberal formulas that have been applied to the economy.

In a seminar held during the Asian Development Bank’s (ADB) annual meeting of the board of governors, which will run through May 1 in Geneva, Brundtland said governments should beware. There is a danger that the very market oriented strategies that have been successful for many sectors of the economy in Asia will be transferred without much thought to the health sector.

The message to decision makers in Asia at this crucial stage is this: Don’t sacrifice health in the quest for budget cuts. The long term expenses will go beyond the short term gains, said Brundtland, who has been elected as the World Health Organisation’s (WHO) new director-general.

Brundtland’s designation is pending approval by the World Health Assembly, which meets here May 10-16.

In Tuesday’s seminar, organised by WHO and the ADB to assess the state of the health sector in Asia and the Pacific rim region, Brundtland said that in the future WHO will have the relationship between health, health policies and economic development as an underpinning of its contribution.

In order for WHO to be the world’s leading advocate for health, we need to provide the evidence that health is essential. Not only as a moral obligation, an ethical obligation, a human right. But also because it is pure and sound economics, she said.

Improvements in health lead to increases in per capita GDP and higher rates of growth, and the effects of improved health are likely to be greatest for the most vulnerable—the poorest and those with little education, Brundtland added.

She cited a study of rubber plantation workers in Indonesia, which showed that around half the workers were anemic, resulting in 20 percent lower productivity. But the work output of those who received a simple iron supplement increased nearly to the levels of the non-anemic workers. Weighed against the costs of intervention, the productivity gains were enormously high, she stressed.

Brundtland’s speech stood in contrast to the free-market stance that predominated at the ADB assembly, as she warned that Asia’s substantial—and growing—reliance on private financing mechanisms, including private voluntary insurance, in the health sector brought risks of an enormous rise in costs.

Her argument was based on the experience of the industrialised countries grouped in the Organisation for Economic Cooperation and Development (OECD).

The experience of several OECD countries shows that costs can be contained while still providing quality services to the entire population, she maintained. Attempts to reduce public expenditures by transferring health financing to private sources may prove self-defeating.

Brundtland pointed out that the U.S. government, with its substantial emphasis on private financing, nonetheless spends about the same percentage of its GDP on health as do the governments of Norway and Britain—the difference being that the U.S. health sector as a whole consumes twice the percent of GDP.

Achieving universal coverage and controlling costs require a strong public presence in health finance, she argued.

Brundtland added that Asia and the WHO should combine forces to wage all-out battles against tuberculosis, the AIDS-causing human immunodeficiency virus (HIV), and tobacco consumption.

Sri Lankan President Chandrika Kumaratunga, meanwhile, stressed the strides her country has taken in health. But she told the seminar that the greatest challenge that the Sri Lankan health sustem faces today is perhaps the whole new sphere of need that has arisen as a consequence of the 14-year-long civil war, which has devastated the country.

WHO Deputy Director-General Fernando Antezana underlined that returns on investment in the social sector are enormous, although not easily quantifiable. They include peace and security, sustainable development, and improved health and quality of life for all, which in turn will stimulate economic growth.