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.
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.
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
* * * * *
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...
(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
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.
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)
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)
For better-off families, the December/January Holiday Season is a period of traditional overeating, while the millions of people who suffer from chronic lack of food and the millions of children who die of malnutrition, worldwide, remain forgotten. Yet paradoxically, diseases once associated with opulent societies and wealthy people increasingly affect both rich and poor countries.
A worldwide epidemic
Being overwei
ght and obese (fat) are among today’s leading health risk factors throughout the world, causing 4 million deaths every year. Obesity is often associated with high blood pressure, high blood glucose (diabetes), cardiovascular diseases and cardiac failure.
Until a few decades ago, obesity was considered a condition associated with high socioeconomic status. Indeed, early in the 20th century, most populations in which obesity became a public health problem were located in the developed world. Beginning in the United States and then spreading to Europe, obesity is now fast emerging as the new pandemic (or worldwide epidemic) of the XXIst century. It affects both sexes and all age groups and has a disproportionate impact upon disadvantaged population groups. By 2030, for example, more than 50 per cent of the adult population in the USA will be obese… read more
Eduardo Missoni (published on indaba-network.net)
(Texto en español más abajo)
Christmas 2011 – New Year 2012
Navidad 2011 – Año Nuevo 2012
Dear friends,
every year I add to the list of addressee of my message new colleagues and friends whom I like to thank for having shared a part of the walk. More and more, my thoughts are with young people, among whom obviously the students with whom I have the opportunity to share reflections and projects, dreams and the commitment to make them reality.
It is pleasant to think in an intergenerational community which shares knowledge and experience, as well as the commitment for social change, a growing community that renews itself from year to year building new spaces for local and global action, as in the indaba-network initiative.
Many observers have analyzed the global economic crisis that characterized the past year, and the wish we all share is obviously that the year that (according to the christian calendar) starts today will bring us back a little of serenity and opportunities to overcome present difficulties. Still few are those who explore the real roots of the crisis, which in reality is only a symptom of a much deeper crisis of values and of the societal model we live in.
A change of direction becomes progressively more urgent. Therefore I renew my wishes to see an ever growing number of people challenging that unjust and unsustainable model. Working together – notwithstanding our different ways of doing it, as different are our talents – toward a shared project of social justice and peace.
Best wishes!
Eduardo
* * * * *
Queridas amigas, queridos amigos,
cada año añado a la lista de mi mensaje nuevos colegas y amigos a quienes deseo agradecer por el camino recurrido juntos. Mi pensamientos están dedicados cada vez más a los jóvenes, entre los cuales naturalmente los estudiantes con los cuales tengo la suerte di compartir reflexiones y proyectos, así como sueños y el compromiso para que se hagan realidad.
Es bonito pensar en una comunidad intergeneracional que comparte conocimientos y experiencias, pero también el compromiso para la transformación social, una comunidad que crece y se renueva de año en año construyendo nuevos espacios de acción locales y globales como en la iniciativa de indaba-network.
Muchos han analizado la crisis económica global que ha caracterizado el año recién terminado, y el deseo que todos compartimos es naturalmente que el año que (según el calendario cristiano) comienza hoy nos devuelva un poco de serenidad y oportunidades para dejar atrás los momentos más difíciles.
Todavía son pocos quienes se interroguen sobre las raíces verdaderas de esta crisis, que es en realidad sólo un síntoma de una crisis mucho más profunda de valores y de modelo de sociedad. Un cambio de ruta es cada vez más urgente. Por lo tanto renuevo el deseo de ver crecer el número de personas que desafían ese modelo injusto y no sustentable. Trabajando juntos, aún siguiendo caminos distintos, tal como son distintos nuestros talentos, para un proyecto común de justicia social y paz.
Felicidades!
Eduardo
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