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Aiuti allo sviluppo. La scelta canadese fa riflettere
L’agenzia canadese per lo sviluppo internazionale (CIDA) fin qui guidata da un ministro ad hoc (Ministro della Cooperazione Internazionale) verrà dunque accorpata in un ministero degli esteri rinominato, per l’appunto, Dipartimento degli affari esteri, il commercio e lo sviluppo (in Canada i ministeri sono denominati dipartimenti). La rivista Vita ne dà la notizia con un articolo di Gabriella Meroni che riporta anche le reazioni favorevoli di chi sostiene che si tratti di una scelta opportuna data l’inefficacia degli aiuti e quindi l’inutilità dell’agenzia.
La scelta canadese offre almeno due spunti di riflessione. Il primo, sull’efficacia degli aiuti, s’inquadra in una più generale discussione sulla finalità e le modalità della cooperazione internazionale allo sviluppo. Il secondo, assume particolare rilevanza nel dibattito riavviatosi in Italia nella scorsa legislatura circa la configurazione istituzionale più adeguata alla formulazione e gestione di quelle politiche in un’auspicabile ripresa del processo di riforma del settore.
Per quanto riguarda l’efficacia, …. leggi oltre
Posted in Cooperazione allo sviluppo
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Golpe
Seconda parte dell’intervista raccolta dal Raid Risoluzione della sezione ASSORAIDER di Milano 2 a Eduardo Missoni, segretario generale dell’Organizzazione Mondiale del Movimento Scout dal 2004 al 2007.
La privatizzazione della salute globale
Intervista di Gianluca Cafagna.
Il Professor Missoni aiuta a far luce sul “perché” e sul “come” i nuovi attori globali, come alcuni rappresentanti della filantropia e le partnerships pubblico-privato, influenzano le politiche e i programmi di salute globale, limitando l’attività di promozione di politiche regolatorie e linee guida da parte dell’Organizzazione Mondiale della Sanità.
Come si diventa Segretario Generale dello Scoutismo Mondiale
Prima parte dell’intervista raccolta dal Raid Risoluzione della sezione ASSORAIDER di Milano 2 a Eduardo Missoni, segretario generale dell’Organizzazione Mondiale del Movimento Scout dal 2004 al 2007.
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Auguri! Felicidades! Best Wishes!
Christmas 2012 – New Year 2013
Navidad 2012 – Año Nuevo 2013
(Texto en español más abajo)
Dear friends,
Christmas is a time for reflection and renewed hope for christianity, nevertheless in this time of the year the interchange of good wishes has become universal. The medium is global, but my desire to share thoughts is very personal because with each and every one of you I shared a part of The Road; sometimes only a few steps.
“Small steps lead to great accomplishments” I wrote with some good friends many years ago, while planning the future, all of us being committed to “leave the world a little better than we found it”. Every time that I analyze the present, I doubt that we reached that goal, beyond our nearest circle. Trusting that each one of us “did his/her best” is the main consolation. However those who were granted the capability to critically analyze the reality, together with the talents to change it, inevitably have to face a greater social responsibility.
Once again I wish that all of us can take up that responsibility and together build local, national and global communities where the rights and the value of every human being are recognized and nobody is left out.
Best wishes!
Eduardo
www.eduardomissoni.info
* * * * *
Queridas amigas, queridos amigos,
la Navidad es un momento de reflexión y renovada esperanza para la cristiandad, pero en este periodo del año se ha vuelto universal el desearse felicidades. El medio es global, pero el compartir pretende ser personal porque a cada una/uno de ustedes me une una parte más o menos larga del Camino hecho; a veces sólo unos pocos pasos.
“Es por pequeños pasos que se alcanzan los logros más grandes” escribía hace muchos años, cuando construía proyectos de futuro con unos amigos igualmente convencidos de querer “dejar el mundo un poco mejor de como lo encontramos” . Cada vez que reflexiono sobre el presente, me pregunto – con más de una duda – si lo hemos logrado, más allá de nuestro entorno más próximo. Mi consuelo es pensar que cada una/o de nosotros ha hecho “todo lo que de ella/él dependa”. Por otro lado, quienes recibieron el don de saber analizar críticamente la realidad y también los talentos para cambiarla, tienen inevitablemente una mayor responsabilidad social.
Mi deseo es – una vez más – que todas/todos podamos asumirnos esa responsabilidad, para construir juntos comunidades locales, nacionales y globales donde ese reconozcan los derechos y el valor de todas las personas y donde no se deje afuera a nadie.
Felicidades!
Eduardo
www.eduardomissoni.info
* * * * *
Una nuova organizzazione per la salute globale: l’OMS
Il ruolo dell’Oms è stato messo a dura prova negli ultimi anni dal rapido modificarsi dello scenario globale, con nuove priorità sanitarie e con l’emergere di nuove forme di collaborazione pubblico-privato, con annessi conflitti di interesse. Una riforma è dunque necessaria, ma non tutti sembrano volerla. Eppure il suo ruolo guida è insostituibile. Passa però da provvedimenti per la qualità della gestione e la stabilità finanziaria dell’organizzazione, dal recupero di sostegno e fiducia degli Stati membri, dalla drastica riduzione della dipendenza dal settore privato.
Il 26 maggio si sono conclusi a Ginevra i lavori della sessantacinquesima Assemblea mondiale della sanità, massimo organo dell’Organizzazione mondiale della sanità. L’Oms è l’agenzia specializzata della Nazioni Unite cui nel 1948 si assegnò l’obiettivo del “raggiungimento per tutte le popolazioni del più alto livello possibile di salute”, assicurandole a tal fine considerevoli poteri normativi e il mandato “di agire come l’autorità di direzione e coordinamento del lavoro internazionale in salute”. (1)
LE NUOVE SFIDE
Un ruolo messo a dura prova soprattutto negli ultimi anni dal rapido modificarsi dello scenario globale sia in termini di priorità sanitarie, sia sul piano della governance. ...leggi oltre...
A Global Health expert at head of the World Bank
(Published in Italian by LaVoce.info on 24.4.2012)
That the US President's candidate to the Presidency of the World Bank, Jim Yong Kim, was the one selected for the job on April 16th 2012 by the Board of Directors of the global economic institution is no news. (1) The novelty is that President Obama proposed a Global Health expert, medical doctor and anthropologist, not an economist. (2)
WHO IS JIM YONG KIM
The week before the appointment, the Wall Street Journal reported the “rebellion” of “ a long list of development experts, government officials and news organizations around the world” elicited by Obama's decision. (3) According to those opposers the other two candidates, the Nigerian Finance Minister Ngozi Okonjo-Iweala, and the former Finance Minister of Colombia, José Antonio Ocampo, were better qualified for the job, given Kim's lack of experience in financial and economic issues at the core of the World Bank activity. It is also the first time in history that the choice of the candidate is contested.
Former professor of Social Medicine and Global Health at Harvard Medical School, in 2009 Kim became the President of Dartmouth College. Before he was at the World Health Organization (WHO) initially as the adviser to the Director General and later as the Director of the HIV/AIDS Programme. In 1987, together with Paul Farmer he was the co-founder of the American NGO Partners in Health well known for its community health programmes in several poor countries, starting with Haiti, and for advocating universal access to care.
Apart from his professional background, one cannot omit to notice the criticism Kim moved in the past to neoliberism. In the book Dying for Growth, published in the year 2000, together with the other co-editors Kim criticised economic growth as the only mean to reduce poverty and improve quality of life: “The quest for growth in GDP and corporate profits has in fact worsened the life of millions of women and men”. (4) The book attacked the structural roots of inequalities in global health and identified in capitalism, and specifically in neoliberism, and in those development policies the cause of the negative impact on health.
Later, Kim's activities and scientific production were mainly focussed on Aids and tuberculosis and especially on the access to treatment for these pathologies, often linking those issues with social justice.
“If we really believe in health as a human right, what are we actually doing to realize that right? In other words, – asked Kim in an interview in 2008 – what are we doing to make sure that people have access to clean water, to housing, to employment and to health care?” . (5) Kim is convinced that to solve those problems a system perspective is needed. To those who say that the financial crisis does not allow any longer to invest in health services for the poorest, he answers that this represents “a fundamental mistake. The economic downturn will force us to move even more quickly toward collaboration with experts in systems management and operational strategies.”. In Kim's opinion the commitment to reach the Millennium Development Goals represents “our most important investment to ensure productivity and political stability in the world.”.
A STRONG SIGNAL
It will be interesting to se to which extent Kim will be able to negotiate a higher attention of the World Bank to social development issues. But what can we expect from Kim as a leader of a complex organization?
“Being a doctor was useful to me from day to day – Kim likes to repeat referring to the period he spent at WHO – but being an anthropologist was useful every day”. (6) In his opinion, that organization is “one of the most complicated bureaucracies in the world”, thus a good training field. (7) The World Bank is doubtfully less complicated. “The task of anthropology, which is to understand deeply and to find a path toward empathy for people who have very different perspectives from your own, is both difficult and critically important in organizations like the WHO”.
A negotiating capacity that others have read with a critical eye, attributing to Kim, not without some dosis of sarcasm , “astonishing successes” in “creatively mediate the tension between ideological rigor and pragmatic accommodation”. “He has been quite willing to support the profitability of already very wealthy corporations if it means saving a life in the here and now.” wrote the American Anthropologist in 2011 in a short analysis of Kim's career. (8)
Kim's appointment does not interrupt the tradition of the American leadership at the head of the World Bank, but – probably without drastic transformations – it could be a strong signal toward alternative approaches to development. On the day of his election, Kim said that he wants a World Bank that “delivers more powerful results to support sustained growth, prioritizes evidence-based solutions over ideology, amplifies the voices of developing countries and draws on the expertise and experience of the people we serve.”. (9) Also President Obama said to be confident that Kim will bring to the Bank “a passion for and deep knowledge of development, a commitment to sustained economic growth” but also “the ability to respond to complex challenges and seize new opportunities”. (10)
A Global Health expert guiding the Institution whose motto is “Working for a World free of Poverty”, does not mean having definitively overcome the neoliberal approach and finally measure development according to equity and social determinants of health, however it could be a first step to strengthen inside the Bank the debate on those issues and bring economics nearer to the real need of the population. (11)
(1)The 25 members of the Board, however, did not express a unanimous vote. Among the BRICS, India, China and Russia supported Jim Yong Kim, while Brazil and South Africa supported the Nigerian candidate. Lesley Wroughton, “World Bank picks health expert Kim as president”, Reuters, Washington, 16.4.2012 (http://www.reuters.com/article/2012/04/16/us-worldbank-idUSBRE83F0XF20120416?feedType=RSS&feedName=topNews&rpc=71)
In over sixty years of its history, the Bank has always been led by a US citizen, following the non written agreement between the US and its European allies, that in exchange have always maintained a European at the head of the International Monetary Fund. Together, on the basis of the existing weighted vote mechanism, United States and Europe together have about 50% of the votes.
(2) Global Health is an emerging area for interdisciplinary studies, research and practice that considers the effects of globalization on health -understood in the comprehensive meaning of a complete state of physical, mental and social well-being- and the achievement of equity in health for all people worldwide, emphasizing transnational health issues, determinants and solutions, and their interactions with national and local systems. (www.cergas.unibocconi.it/globalhealth)
(3) Sudeep Reddy, “Criticism Over U.S.'s World Bank Pick Swells”, Wall Street Journal, 8.4.2012 (http://online.wsj.com/article/SB10001424052702304587704577331611782367728.html). Ocampo left the competition the week before the election in support of the Nigerian candidate.
(4) Jim Young Kim, Joyce V. Millen, Alec Irwin, and John Gershaman, (eds.) Dying for Growth: Global Inequality and the Health of the Poor. Monroe, ME: Common Courage Press, 2000, p.7.
(5) Prashant Nair, “Straight talk with...Jim Yong Kim”, Nature Medicine, volume 14, number 12, december 2008, pp.1298-1299. The to following quotes are from the same interview.
(6) Jim Yong Kim, Dartsmouth's President elect public lecture titled "Tackling the World's Troubles: Global Health and the Challenge for Dartmouth" on May 26, 2009. (http://www.youtube.com/watch?v=OM5HHwp954E&feature=related)
(7) Di nuovo, un'affermazione ripresa dall'intervista a Prashant Nair, come quella che segue.
(8) G. Derrick Hodge, “Walking the Line between Accommodation and Transformation: Evaluating the Continuing Career of Jim Yong Kim”, American Anthropologist, Vol. 113, No. 1, March 2011, p.148-149.
(9) Annie Lowrey, "U.S. Candidate Is Chosen to Lead the World Bank", New York Times, 16.4.2012 (www.nytimes.com/2012/04/17/business/global/world-bank-officially-selects-kim-as-president.html?_r=2&adxnnl=1&adxnnlx=1334660549-OmDXwYmosNP1Qqk5jH09EA)
(10) Adam Aigner-Treworgy, “Kim named World Bank president”, Cnn Politics, 16.4.2012. (http://whitehouse.blogs.cnn.com/2012/04/16/kim-named-world-bank-president/)
(11) Fore an in depth reading about social determinants of health see: CSDH, "Closing the gap in a generation: health equity through action on the social determinants of health". Final Report of the Commission on Social Determinants of Health, Geneva, World Health Organization, 2008
Posted in Global Health, World Bank
Tagged development, equity, global health, social determinants, World Bank
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April 7th – World Health Day – A healthy life to add years to life
Today April 7th is the World Health Day, which coincides with the anniversary of the establishment of the World Health Organization, who turns 64 years this year. “Good health adds years to life” is the theme for this year’s world health day associated dedicated to aging.
And “Ageing well: a global priority” is the title of the editorial that the Lancet devoted to this recurrence.
Globally, we’re getting older. In no more than five years, for the first time in history, the number of people over 65 years of age will exceed that of children under 5 years. Advances in medical sciences, socio-economic development, and fertility decline have contributed to this demographic change, and countries must adapt to this change in a positive and inclusive way.
The aging of the population is often seen in negative terms and the elderly as a burden to society, it should instead be seen – writes the Lancet – as something to celebrate. The elderly may in fact still make a significant contribution to society through their experiences and knowledge, within families and through work both paid and unpaid. Unfortunately most of the elderly do not receive the care needed to prevent chronic preventable or controllable diseases, such as cardiovascular diseases. In addition, more than 250 million elderly people worldwide are suffering from moderate to severe disabilities, such as decreased vision, dementia, hearing loss and arthritis. It is estimated that every year 28-35% of the elderly suffer the consequences of falls. Although elderly abuse is a serious health problem, which largely escapes the statistics.
In today’s World Health Day, WHO aims to promote a healthy, active aging, based on healthy behaviors, healthy environments and preventive care in all ages to prevent the development of chronic diseases. In short, mobilizing for healthy aging for all, the WHO relaunches the old goal of “health for all”: it was the year 1978 and the commitm
ent was to reach it by the year 2000. Meanwhile also the WHO got older, and a lively debate on its reform is ongoing, an issue which will also be addressed by the coming World Health Assembly (in May). Next year, the WHO would become 65 years old, the hope is that the forces that have always opposed the idea of the WHO as the coordinating and directing authority of global health and thus it regulatory role, do not succeed in obtaining its retirement.
WHO Reform: threats and opportunities. A Healthier Political Functioning
The World Health Organization’s overall goal as defined in Article 1 of its Constitution is “the attainment by all peoples of the highest possible level of health”. In order to achieve its objective, the organization was endowed with extensive normative powers “to act as the directing and co-ordinating authority on international health work”. However, in the changing global scenario, the World Health Organization (WHO) has been facing increasing challenges in playing that leading role deriving from its constitutional mandate.
In December 2010 Jack Chow a former assistant director general of WHO, considering the organization as “outmoded, underfunded and overly politicized”, put forward a provoking question: “Is the WHO becoming irrelevant?” (Chow 2010) The first answer came from WHO's Director General, Dr. Margaret Chan. She explained that given “today’s crowded landscape of public health” leadership cannot be mandated but must be earned through strategic and selective engagement. “WHO can no longer aim to direct and coordinate all of the activities and policies in multiple sectors that influence public health today” she added. (WHO. The future of financing for WHO 2011)
Increased inefficiency of the global health system
On one side, with the acceleration of the globalization process the social determinants of health have been considerably affected by dynamics outside the health sector. On the other, while an unprecedented level of global funding has been directed to health issues over the last two decades, the increase was mostly driven by vertical initiatives for the control of HIV/AIDS and a few other diseases. This was associated with the mushrooming of new organizations and global public-private ventures, bilateral programs and the rise of non-state actors – over all the Bill and Melinda Gates Foundation – that often overshadowed WHO and brought to increased inefficiency of the global health system, an unsustainable fragmentation also at country level, and confusion in global health governance. Finally WHO had to face priority-setting and planning constraints imposed, among others, by the way it is financed.
Regular budgetary funds (RBFs) are provided through a series of assessed contributions from member states calculated biennially according to the UN scale of ability to pay (based on GNP and population). On the basis of the system a small number of high-income countries provide most of WHO’s core funding. Within its regulations, the WHO attempts to maintain autonomy by enforcing the rule that no single country can contribute more than 1/3 of the total RBFs. However, the US remains the largest single source, providing 22% of the RBFs. (Lee 2009)
From the 1950s additional voluntary contributions, i.e. Extrabudgetary Funds (EBFs) came to provide a vital, though highly earmarked, non flexible, source of financing for disease control and eradication programs. In the 1970s EBFs accounted for 20% of total WHO expenditure, with over half of these funds coming from other UN organizations. At least in part in response to the alleged “politicization” of UN agencies such as UNESCO and the International Labour Office (ILO), in 1982 major donors (known as the Geneva group) imposed a policy of zero real growth (adjusting for inflation) to the regular budget of all UN organizations, that remained in place until 1993 when an even more austere zero nominal growth (not inflation adjusted) was introduced. (Lee 2009) In a similar fashion, some of WHO's initiatives had been strongly opposed. “Health for all” and the Primary Health Care strategy was counteracted by the “Selective PHC”. The International Code of Marketing of Breast-milk Substitutes was adopted with the opposing vote of the United States. Finally, the Essential Drugs Program, harshly opposed by US-based pharmaceuticals companies, led the United States to withhold their contribution to WHO's regular budget in 1985. (Missoni 2009).... Read More on MMS Bullettin)
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