Enemy Of The People

This is what these countries are looking at, they’ve had a total erosion and
collapse of their public health care systems and this is the tragedy.  So the
population has very, very few doctors and nurses.  They simply cannot cope
and of course the public facilities that are there are overcrowded, they are in
terrible conditions and they are completely and utterly understaffed.  So this
problem of an epidemic was going to hit them, it could have been Ebola, it
could be something else – it could be cholera or whatever. This was actually
going to come home to hit these countries very hard indeed.  This was entirely
predictable and it’s been predictable for more than 20 years and it is what the
public health lobby and the public advocates have been talking about.  The
solution to these epidemics is not the magic bullets of vaccines and it is not
sending in the troops.  It’s structural, it’s social, it’s economic, it’s
environmental and it is putting in all the public health measures.

Tariq Ali: But the entire world capitalist system as it functions is basically

not in favour of public health services, they are in favour of privatised
solutions, privatised facilities which means that in most countries increasingly
you have a two or three tier system; you have very good quality hostpitals for
the rich and people who can afford them, you have a second tier for more
middle class people who also have to pay but not so much and their facilities
aren’t so good and then you have public hospitals, not just in Africa but in
countries like India and Pakistan and Sri Lanka, which are a total complete
disgrace and nothing is done about it on a global level at all because this is
not a priority.  I mean it is just outrageous. Do you think, I mean, given that
this is how the health system functions from what you said, the obvious
solution, medium-term and long-term, is to create a strong social
infrastructure in these countries but that is what the International Monetary
Fund asked them not to spend money on, the last four decades so what do you
think they can do?

Allyson Pollock: Well I think you are raising important issues; what is the
role of the IMF, the World Bank, the African Development Bank because
again if we look at Liberia and Sierra Leone and Guinea, which actually have
a lot of natural resources, what is happening to these countries, in terms of
their economics is that increasingly the lands are being privatised and being
occupied by foreign investors who are coming in and they are simply stripping
out the resource and the assets.  Liberia has a GDP, gross domestic product, of
a couple of billion dollars, and a population of five or six million, so how are
they meant to rebuild when actually you’ve got foreign directors coming in
and public private partnerships and great flows of money going out and you
don’t have any mechanism for redistribution because redistribution means you
are trying to build a fairer society and you are trying to put the resources back
in.

So it starts with the economy, it starts with what’s happening to the land, it
starts with the fact that palm oil and cocoa and rubber are important cash
crops and there’s land, and these ownership, has been transferred and I mean
this is very well documented by important organisations like Global Witness
but also the Oakland Foundation in the US, who have actually chartered what
is happening to the land and remember, many of the farmers, for instance in
Liberia, 70% of the population, live in rural areas. They will be subsistence
farmers so this is an issue and when you have the population spending 80% of
the money on food and then you have all these cordons around them, then of
course you have got a real problem because the poverty is actually going to be
accelerated in these countries because of the Ebola virus, because the borders
are closing and because you don’t even have economic flow any more.  So I
think we need to start with the economics because that is the cause of the
structural problems and then we’ve got the World Health Organisation, which
is the international global authority on health.  It has the law making powers
but  systematically over 20 years it has been completely starved of funds and
such funding as it gets are tied to all sorts of conditions and those conditions
are being set by large, global NGOs such as the Bill & Melinda Gates
Foundation, which have no democratic base, no accountability and which in
turn are doing untold harm through their vertical disease programmes because
they are not rooted in public health and the public health systems.  And a good
example of a vertical disease programme is when you take Ebola and then you
bring in your operation to tackle Ebola and you ignore all the other causes of
disease, such as TB or malaria, or poverty, malnutrition and at the same time
when you focus all the efforts of the industry on vaccine development.

But actually vaccines are not what these countries need.  It’s proper
redistribution and public health measures and we learn nothing from history;
that is what is shocking.  All the great reforms, all the great collapse of
infectious disease epidemics was actually not down to drugs and vaccines, it
was to redistributive measures, which included sanitation, nutrition, good
housing and actually above all a real democratisation.  And with it came
education and all the other measures that we need.  Now I’m not saying we
don’t need vaccines, but one of the big problems is that that vaccine
developments itself is now in the hands of these large very powerful
foundations like NGOs, like GAVI – the Global Alliance for Vaccine
Initiative, who in conjunction with big companies like GSK and Merck, are
out to seek patents and the reason why they like vaccines is it gives… because
vaccines mean mass immunisation, it means numbers and numbers mean
money.  And of course is being paid for by the West and Western
governments when this money could much more easily flow into the
governments themselves to re-build their health systems because we are
talking about re-building public health infrastructure and that includes putting
in community primary health care, community health systems, infection
control units at community level, putting in hospitals and training nurses and
doctors.  And the big, other big problem in all of these countries is not just a
brain-drain, because a few doctors and nurses are there, they want to leave and
that is happening also in Nigeria, or they want to work in the private sector or
they want to work for these NGOs because the money is much better and so
the whole public health system is completely hollowed out.  And this is a real
problem because the Gates Foundation, Bill & Melinda Gates, do not believe
in the public sector, they do not believe in a democratic, publically owned,
publically accountable.

Tariq Ali:  So in fact the WHO, because of governmental policies, and the
priorities of the Washington consensus, i.e.. neoliberalism, privatisation of
medicine, inability to control Big Phgarma,  has effectively ditched  what it
used to do?  In the sense that it can’t do what needs to be done, shore up,
strengthen, build if necessary in some of these countries public health
systems.

Allyson Pollock: Well, there is a very important paper recently in the British

Medical Journal, I think by David Legg, which actually sets out what has been
happening to the WHO over two decades where the US refuse to give the
funding that it should have done and then what you have is when Western
governments and the US come in, they tie it to conditionalities, which is
usually around the Bill & Melinda Gates priorities and not around the
essential public health priories and the WHO has its hands tied.  And actually
it is the world health organisation, it has got the law making powers and yet it
has never exercised these functions we are talking about democratic deficits
that are happening when large global funds like the Gates Fund or the Buffett
Fund can actually determine what the world priorities are and so distort what
the priorities should be for public health because it is tied to the economics,
they need to industrialise, they need to medicalise and they need to
pharmaceuticalise.  But there is a big backlash coming, a big backlash in the
Western world, much more critical thought about the ethicacy and the safety
and the appropriateness of the drugs and vaccines and medications and this
group is beginning to be more and more articulate and more and more and
more concerned.  But one of the big problems is that because of this huge
amount of money that the Bill & Melinda Gates Fund have, is that the
technicians, like myself, the public health tribes, have been captured because
of their success in predicated upon getting jobs, or research, tied to the
interests of the Global Fund.  So the critical thought is being hollowed out and
so at the same time are the essential public health functions because public
health is there as Ibsen would say, to be the enemy of the people, but actually
it is there to be critical, to appraise and to think rationally and to remind
everybody about what the social determinance of health are, and it is not
rocket science.  It doesn’t need magic potions or millions of dollars spent on
genetics and the laboratories, it needs very, very basic things, but they are
essential because they are what the public health infrastructures are built on.

Tariq Ali:  Contrast this, what’s going on in the bulk of the world with a tiny
country like Cuba, which has managed to construct a public health system,
which is precisely many things that you are arguing for.  It is very oriented to
preventive medicines which stop a disease from spreading, and has now
amongst the best record of both public health services and its affects in terms
of what Cuban’s citizens and increasingly because the help they have given
Venezuela, Venezuelan citizens and other South American citizens who never
used to have health are now in much better shape than many people, for
instance, in Eastern Europe which went in for big privatisation; leave alone
Africa and large parts of Asia.  You’ve studied the system I think?

Allyson Pollock: Well yes I think the Cuba’s system is very inspiriting and
anybody who has been to Cuba can’t but feel the public health benefits of it.  I
mean they are a country that really know the meaning of austerity and yet
their GDP, which is the equivalent of many of these poor countries, but they
don’t have this extraordinary inequalities because their vision and campaign
has been around public health and health for all.  So they have done
extraordinarily well and quite remarkably well.  I mean the real problem
comes as what’s happening now and will they get side-tracked by neoliberal
policies and the need to get drugs to market, and the need to sell drugs; it is a
very important time for Cuba to think about it. But actually they need to all
the time be remembering what their GDP is and what they’ve achieved with
their GP compared with some of these poorer countries in the world like
Sierra Leone and Liberia – Liberia especially.

Tariq Ali:   The other thing of course is that the Cubans have sent out a lot of
their doctors to parts of Africa, South America, to whenever there is a
disaster .  I remember during bad floods in Pakistan, really bad, a whole
team of Cuban doctors arrived and were taken to the remotest parts of the
country where women were not allowed by their menfolk to see doctors
because most doctors were male.  And when they saw the Cuban team, which
was 60% women, 40% male doctors, the men in these communities said ‘ah
you have women doctors; you are doctors, and they said, ‘yes, yes’, they say,
‘okay you can see the women whenever you want’. So amazing rapport
developed between them and the women were very pleased and so were their
kids and a Cuban doctor told me that they said to us, ‘where do you come
from you people?’ and she said, ‘we come from Cuba’.   ‘Where is that?’,
and she said, ‘it’s a tiny island in the Caribbean’ and they said, ‘who is your
leader? I mean who/what is the government’.  So they were careful because
they were on a medical mission but they said, ‘do you want to see a picture of
Fidel Castro who is our leader’ and said ‘yes’.  So they showed a picture of
Castro and the women said, ‘my god, he’s got a beard like they have in that
village 20 miles from here, do you want to go and see those beards’. 
[laughs].  But they were incredibly impressed and the entire media in
Pakistan was talking about what they’d done, they said we don’t want any
help from the government, we arrive with our tents, our equipment, all we
want is receptacles in which we can heat clean water and the rest we will do;
we will bring our medicines with us. And the thing is this is the other point
which rises that unlike the health services constructed in Western Europe
after the 2nd World War including the National Health Service, the
governments in these countries never actually set up pharmaceutical
industries to compliment those health services.  Nor did they even seriously
consider nationalising them, because that would have brought the prices of
medicine right down and they need never have charged prescriptions.  So
let’s come for a minute to a subject you know very well – the health service in
Britain and in the European Union countries, I mean what is happening to
that Allyson?  It is one thing to talk about Africa but what is happening to the
health services in Europe.

Allyson Pollock: What is happening now in Europe as many people are aware

is that, we have got neoliberal policies coming from the US both the health
care industry in the US, which have exhausted the funds of America because
health care is running it about 18, 18% of GDP, compared with 9 or 10%
average in Europe, so the European health care investors need to find new
markets and they are busy attempting to penetrate and open up the health care
systems of Europe.  And of course the biggest trophy for them is the United
Kingdom NHS because it was for a long time the most socialised of all the
health care systems.  So we’ve had devolution; so Scotland, Wales and
England all have their own health care services and Scotland and Wales which
are very tiny, they don’t cover more than 8 or 9 million people, they have
retained a national health service but England, which many people don’t
realise this, England abolished its national health service in 2012 with the
Health and Social Care Act.  What remains of the NHS is a funding stream, or
a government pair, and the NHS has now been reduced to a logo and what the
government is now doing is accelerating a break up of what remains of the
national health service under public ownerships, so closing hospitals, closing
services and privatising or contracting out.  So just as we heard in Liberia and
Guinea about how the public lands are being transferred like the enclosures to
private owners from abroad, the same thing is happening with our pubic
services, our public hospitals, our public facilities are also being enclosed in a
way and given over to private-for-profit investors and this is happening in
extraordinary speed in England.  Faster than anywhere in Europe.   And this is
a major global neoliberal project, if you like.

Tariq Ali:  To privatise health.

Allyson Pollock: Well to privatise not just the healthcare system but also
ultimately the funding.  Now in the US, just under half of that 18% GDP is
actually paid for by the government but the government is in effect a tax payer
and then channels the money into private-for-profit corporations.  The
government in England abolished the health and social care act because it
wanted to open up new funding streams. So it wants to reduce the level of
services that are available publically, create a climate of discontent with the
NHS, forcing people who are in the middle classes, that’s like you and me Ali,
to go and privately and pay either out of pocket or with our healthcare
insurance, so that we desert, we exit what is left but at the same time the
government is reducing all our entitlements because there is no longer a duty
to provide universal healthcare.  That duty that has been in place since 1948
was abolished in 2012. So that duty has now gone and so now the government
can reduce all the entitlements, reduce everything that is available and
increasingly we are going to have to pay out of pocket or though private
health insurance.  And the private health insurance industry are here, they are
here form the US and they are absolutely gearing up with the new structures
the government has put into place to move into private-for-profit health
insurance; that is what we are going to be seeing.  And actually the new
system the government is putting in place is modelled on the US and yet that
will come at huge loss and it will also be a public health catastrophe because it
will mean that many, many millions will increasingly go without care and of
course markets render people invisible, they are not seen.  Nobody knows. 
The doctor in front of you only sees the patient that come to them; it doesn’t
see the many tens of thousands who are being denied access to healthcare,
which is why in the US the doctors are not out on the street campaigning.  But
in the UK the doctors are out on the street campaigning, they are putting in,
they are standing now for the National Health Alliance Party, they are now
putting in candidates to stand against the conventional parties. And so you see
that the doctors are still prepared to fight for universal health care but once our
NHS has gone completely, it’s been abolished, but once all the remnants have
gone, you have to use the parallel of the oak tree, it seems to be blooming and
flourishing but the roots have been severed and that can take many months or
years for that to completely decay. But once it has gone the doctors will no
longer be there.  They’ll be like the  doctors in the US interested in
themselves, interested in their own pockets and not interested in universal
access to healthcare.  And this is the crime of the century, if you like, the way
in which the English coalition, both Conservative and Liberal Democrat, have
actually abolished our NHS but they have had a lot of help along the way
from the Labour government before them.
Tariq Ali:  Labour more or less set the basis for it when they were in power.

Allyson Pollock: Absolutely.  Alan Milburn the Health Secretary did this in

in 2000.  In 1997 the Labour government had its, had its chance to reverse the
privatisation and marketization policies, to get rid of the private finance
initiative and they had a very good Secretary of State who was quite
determined to some of that….

Tariq Ali:  Frank Dobson?

Allyson Pollock: Frank Dobson.  But they got rid of him extra quick and
instead of which we got Alan Milburn and his ten-year plan and now he has
gone off to join the very healthcare companies that he helped to build up. And
I mean I think that is the tragedy as when that bill was going through
parliament to abolish the NHS, many of the peers, and many of the MPs had
conflicts of interests because they had actually interest in the healthcare
companies that they were establishing.

Tariq Ali:  It is outrageous really. And Milburn himself is one of  them.

Allyson Pollock: Well, it is a travesty for democracy, it really is and as a

public health doctor it is an absolute catastrophe because at the moment we
know, people of all ages, with serious mental illnesses who cannot get access
to health care, people with stroke, people with chronic illnesses, chronic
diseases who are increasingly being denied access to healthcare and they are
voices in the wilderness, they are not being heard because there is no
collective mechanism for them to be heard any more.  And the doctors and
nurses are absolutely in despair. Now we do have solution; my colleagues
we’ve written an NHS reinstatement bill which we hope that whichever party
comes to power, they will actually run with to reinstate the NHS, so there is a
solution out there, which is drafted and written and ready, that would restore
and reinstate the NHS.

Tariq Ali:  It is perfectly legitimate to make huge profits from the basic needs
of ordinary people? 

Allyson Pollock: Yes from people’s diseases and people’s illnesses.  Well it

began with a pharmaceutical industry and the vaccine production, it is
perfectly acceptable to make profits from them, so why shouldn’t we now go
and make profits from illness and care.  But of course the NHS in England
was set up, to be redistributive.  It’s funded through taxation, which is meant
to be progressive and the money is meant to flow according to need.  But what
we are now beginning to see is that money will flow according to the needs of
shareholders and not patients, and that is a very real concern. Of course.  It is
all down to political will. Everything can be reversed but it comes down to
politics, to democracy and people making their voices heard.

Tariq Ali:  Agreed.

TARIQ ALI and ALLYSON POLLOCK

COUNTERPUNCH, WEEKEND EDITION OCTOBER 10-12, 2014