Health Policy Reform Global Health versus Private Profit Health Policy Reform Global Health versus Private Profit John Lister First published in 2013 by Libri Publishing Copyright © John Lister ISBN 978 1 907471 78 0 The right of John Lister to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act, 1988. All rights reserved. No part of this publication may be reproduced, stored in any retrieval system or transmitted in any form or by any means, electronic, mechan- ical, photocopying, recording or otherwise, without the prior written permission of the copyright holder for which application should be addressed in the first instance to the publishers. No liability shall be attached to the author, the copyright holder or the publishers for loss or damage of any nature suffered as a result of reliance on the reproduction of any of the contents of this publication or any errors or omissions in its contents. A CIP catalogue record for this book is available from The British Library Design by Carnegie Publishing Cover design by Helen Taylor Printed in the UK by Ashford Colour Press Libri Publishing Brunel House Volunteer Way Faringdon Oxfordshire SN7 7YR Tel: +44 (0)845 873 3837 www.libripublishing.co.uk Contents Acknowledgements ix Preface xi Chapter 1: Introduction 1 Chapter 2: A framework for analysing changes 19 Chapter 3: The World Health Organization 53 Chapter 4: The World Bank and the International Monetary Fund (IMF) 79 Chapter 5: Other organisations shaping health reforms 111 Chapter 6: The ‘reform’ agenda – market-driven (cost-cutting) reforms 133 Chapter 7: The ‘reform’ agenda – market-style (ideologically driven) reforms 161 Chapter 8: The missing MDGs 225 Chapter 9: It doesn’t have to be this way – alternative approaches 249 Appendix: A toolkit for testing the content of a health policy in context 265 Bibliography 269 Index 335 PRAISE FOR HEALTH POLICY REFORM – GLOBAL HEALTH VERSUS PRIVATE PROFIT “As the global health discourse embraces the idea of universal health coverage, the political economy of health care remains largely camouflaged in ‘zombie’ ideas with deep roots in a neoliberal orthodoxy. Ironically strengthened, rather than weak- ened, by the global financial crisis, the poverty of these ideas is laid bare in Lister’s masterful, detailed and highly readable account. Re-asserting the importance of a Marxist analysis to health reforms of the past three decades, his book makes an important contribution to informed health-policy debates and should be essential reading for progressive health reformers worldwide.” Ronald Labonté, Canada Research Chair, Globalization and Health Equity, and Professor, Faculty of Medicine, Institute of Population Health, Ottawa “John Lister’s latest book is also his most ambitious – the summation of half a lifetime’s research and teaching on health and health policy by a committed scholar– activist. He pulls no punches and ideologues of the market will hate it. But they will have to raise their game if they want to criticise it in terms of evidence and logic. Lister’s knowledge of the literature, lucid reasoning and clean prose are a class act. A major achievement which everyone interested in health needs to read.” Colin Leys, Emeritus Professor of Political Studies, Queen’s University, Canada, joint author of The Plot Against the NHS “John Lister’s book is a must-read for anyone passionate about universal health care [who wants] to understand its greatest obstacle and where we must focus our fight.” Anna Marriott, Health Policy Advisor, Oxfam GB “The Soviet model of communism collapsed in the late 1980s because it became clear that the governments concerned were being run for the benefit of a tiny elite, the nomenklatura. Two decades later, it has become equally clear that the neolib- eral model of capitalism is doing the same, with wealth being concentrated in the hands of a few while the living conditions of 99 per cent of the population are being steadily degraded. Yet not content with riches beyond belief, this new global elite is mounting a sustained attack on what remains of the welfare state, with health care as one of their prime targets. In this penetrating, highly readable and extremely well- researched book, John Lister takes on the narrative being peddled by this elite and their cheerleaders and shows that there is an alternative, but it is up to us to seize it.” Professor Martin McKee CBE, Professor of European Public Health, London School of Hygiene and Tropical Medicine “Now is a critical time for public health care and health systems across the world: bank bail outs and loan agreements are being used to front market-driven reforms in public services in what is rapidly becoming a race to the bottom. John Lister’s book gives us valuable insights into the forces arrayed against universal health care and how capitalism is consuming our basic rights and entitlements. It’s up to us to organise to take them back.” Allyson Pollock, Professor of Public Health Research and Policy at Queen Mary, University of London “This is a welcome update of John Lister’s 2005 book: and an encyclopaedic, thor- oughly referenced update it is! The use of extensive direct quotes puts important issues in the words of real protagonists in our field. A critique of the ‘missing’ Millennium Development Goals addresses the serious omission of health care for the elderly (‘customers’ nobody wants) and the attitudes of the market towards mental health and towards disability (‘the hidden giants’). It goes without saying that John Lister gives us a crucial, elegant and comprehensive update on many issues as we begin to discuss what next after the MDGs.” Claudio Schuftan, People’s Health Movement, Ho Chi Minh City “John Lister’s excellent book explains how worldwide disintegration of public healthcare services into competing commercial units has passed into law, and how organised professionals, carers and users are now starting to organise resistance. It is essential reading for all students and practitioners of health and social care who want to understand the context within which they are now being condemned to work, and start changing it.” Julian Tudor Hart, author of The Political Economy of Health Care: A Clinical Perspective “John Lister has written a really important book. In meticulous detail and with enormous care, it combines a comprehensive critique of the failings of the neolib- eral approach to the provision of UK health care with a careful exploration of the links between poverty, inequality and health. The book combines a comprehensive overview with a series of high-resolution, high-definition case studies to explore illustrative examples in meticulous detail and without using doctrinaire paradigms. In all, this book is as ambitious, as all-encompassing and as undoctrinaire as to qualify as a sort of Doyal’s Political Economy of Health for the 21st century.” Professor John S Yudkin MD FRCP, Emeritus Professor of Medicine and former Director, International Health and Medical Education Centre, University College London Acknowledgements Acknowledgements As I have outlined in the Preface, a large number of people have played a part in enabling me to complete this book, so this is for them: I apologise to any who feel overlooked. And while they have inspired the strengths of the book, the weaknesses, as ever, are my responsibility alone. Huge thanks of course once again to my publishers Libri and their whole team who have again done sterling work, and in particular to main man Paul Jervis and tireless copy-editor Matt Skipper for their efforts and encouragement, and Matt’s vital eye for detail. I also want to thank Coventry University for the support which enabled me to attend a number of international conferences, and the Faculty of Health and Life Sciences and the School of Art and Design which helped me to organise a successful IAHPE conference in the University in 2009. Internationally, I want to mention Natalie Mehra and her fantastic trade-union colleagues and supporters in the Ontario Health Coalition, friends and colleagues working with Alexis Benos in the Aristotle University in Thessaloniki, and the brave Spanish anti-privatisation campaigners in CAS Madrid, all of whom have extended practical support and hospitality, welcomed me on visits and helped shape up my experience and deepen my knowledge. At home, where the fight has had to go on against the neoliberal health poli- cies of a Labour government and now a Conservative-led coalition, I am hugely grateful for the continuing support from colleagues and campaigners from Keep Our NHS Public including Wendy Savage, Jacky Davis, Louise Irvine, Peter Fisher, Ron Singer, Julian Tudor Hart and Allyson Pollock. Union activists from UNISON, Unite, BMA and others have loyally stood firm to support my own organisation, London Health Emergency, to keep it running and me still employed and annoying people after almost 30 years. I also want to thank a very select group of union offi- cials whom I won’t name, to spare any embarrassment on their behalf, but whose support has been invaluable. And thanks, too, to all the many dedicated campaigners, academics and activists I have been lucky enough to work with, all of whom work to keep the spirit of criti- cism and the principles of universal health care and social solidarity alive. But above all, I have been hugely privileged to have had such support from close family and friends for the work that I am sure they feel has consumed an unrea- sonable amount of my time and energy over the years. I could not have completed X Acknowledgements this book without the efforts and support every step of the way from my wife Sue (Professor Sue Lister, whose tremendous work on quality and service improvement has also helped inspire my work), my son Kevin and his lovely, patient family.