A wake-up call for a return to nutrition basics

More than 800 million people, or about 13 percent of the global population, are classifi ed as undernourished. The defi ciency in essential nutrients is said to be the underlying cause of an estimated 3.5 million deaths each year, mostly in young children and pregnant women. Under-nutrition among pregnant women in developing
countries is reported to lead to one out of six infants born with low birth weight.

In Malaysia, diabetes has reached very alarming proportions. In the first National
Health and Morbidity Survey (NHMS)carried out in 1986, the prevalence of diabetes was 6.3 percent. Just ten years later this figure increased to 8.3 percent. Now, based on the latest NHMS III, conducted in 2006, diabetes prevalence has increased to 14.9 percent.

Diabetes Type II is strongly linked to high sugar consumption and obesity.

Nutrition can be defi ned as the process of taking in the substances needed to nourish and support life and growth. Access to nutritious food is a key element in
achieving a well-balanced nutrition. But as the world becomes more dependent on artifi cially processed food, balanced nutrition is compromised, resulting in chronic
health problems. Worsening the problem is the addition of toxic chemicals on essential food products.

Tainted milk
The recent scandal where four children in China died following the consumption of baby formula milk contaminated with the toxic chemical known as melamine should serve as a wake-up call.

Melamine, used as an ingredient in the manufacture of some plastics and fertilizers, has found its way into food products such as infant formula and confectionaries. It
is abhorrent that melamine has been deliberately added to milk to give the false
impression of higher levels of protein than actually exists.

Authorities try to allay the fears of the public by announcing that the levels of melamine in certain foods are within “permissible levels”. This term should be questioned.

Melamine is a synthetic chemical. It does not occur naturally in food. Should permissible levels be set for substances that are not naturally occurring in food?
By law, there should be a zero tolerance for melamine, as well as other synthetic toxic chemicals in food, rather than waiting for all the evidence to come in, which might be too late – when harm has already been done.

There is the danger of the cumulative doses or ingestions that enhance the harm posed by such chemicals. Furthermore, the full effects of chemicals not meant for humans may not have been studied fully, and for over a suffi ciently long period of time. It is not ethical to conduct such tests on people. In cases such as these, the *Precautionary Principle should be applied and the consumption of this chemical should be fully avoided.

In the case of infants, breast milk is the safest and healthiest choice – fully for the fi rst six months, and thereafter as a complement to solid foods right up to at
least two years. Governments and the community as a whole would need to make a commitment to move in this direction and create a supportive environment.

Buyers beware
Overall, the Consumer Association of Penang (CAP) believes that it is timely for people to move away from eating so much artifi cially-processed foods, and instead
move towards natural healthy produce and home-cooked meals. There are countless additives included in many of the highly-processed foods in the market. Foods are altered so far from their original state. We did not require all these artificial additives at one time. If really needed, there are numerous natural substances such as natural colours or flavours that can be used for food. We do not see that it is possible for the public to take any realistic precautions themselves when it comes to
products on the shelves as it is impossible for people to know which foods contain dangerous chemicals. At the very least, food manufacturers should be required
to list the common names of all additives, such as preservatives, coloring, fl avors, flavor enhancers, antioxidants and conditioners, on the food labels and outer
packaging - as opposed to using numerical or alphabet codes or merely using phrases such as “Permitted Coloring” or “Permitted Conditioners” under the ingredients list. Information on the concentrations of these additives should also be provided.

The excuse sometimes given is that there is not enough space on the food label. We ask - should there be so many additives in a product that the information cannot even fit on a label, and should this be permitted by the authorities?

In view of the rise of critical chronic diseases such as heart disease, diabetes, obesity and high blood pressure, the information on salt, sugar, saturated fats and trans fats should be listed on current food labels. These particular components should be separated out from the general “Nutrition facts” or “Nutritional Labelling” so that the public is not lulled into a false sense of security. Rather, the attention of consumers can be immediately drawn towards taking special note of these ingredients that are linked to adverse health outcomes.

In view of our country’s alarming diabetic rates, which are only expected to worsen over the coming years, CAP believes that much more needs to be done, and with greater sense of urgency. Firm action needs to be taken against the numerous sweets and confectionaries that have fl ooded the market. These products that are being marketed to children are not conducive to health. They contain basically nothing more than sugar, coloring and other additives, which are not even labeled on the
packaging. Children received no nutritional benefit from consuming these products.
Sugary soft drinks, either carbonated or non-carbonated, used to be more of a luxury in the past and they were consumed as a treat. Nowadays, these drinks are sold in abundance everywhere. Vending machines proffering these drinks are also found at many locations, including airports, hospitals and schools. It is also becoming
increasingly common to see these drinks being offered in “jumbo” portions at various restaurants and food joints.


S.M. Mohamed Idris is the president of the Consumers’ Association of Penang (CAP). The organization may be contacted at Tel. No. 60-4-8299511, or through its website at www.en.cap.org.my. Graphics from Consumer Association of Penang.

This article appeared in the Health Alert Asia Pacific newsletter, Issue 13 2008. For copies of the newsletter, please write to hain@hain.org

Nutrition in Asia and the Pacific: An Ugly Portrait

Food and nutrition are human rights. International caucuses such as the 1989 Convention on the Rights of the Child enshrine these and thus deem governments as duty-bound in ensuring that the right to food and nutrition, as part of the overall well-being of a person, is achieved by all of its citizens.

Much as food and nutrition are regarded as basic human rights, the problem of malnutrition persists in many Asian countries. In fact, the concentration of malnutrition in Asia is greatest compared to anywhere else in the world.
The Asian Development Bank reports that one in three preschool children is stunted,
rising to one out of every two children in the countries of South Asia such as India,
Bangladesh, and Nepal.

The most painful subject with regard to under nutrition is the human cost. In 1999 alone, an estimated 2.8 million child deaths in nine low-income Asian countries, or 51 percent of child deaths were associated with malnutrition. (The countries included are Bangladesh, Cambodia, PRC, India, Lao PDR, Nepal, Pakistan, Sri Lanka, and Vietnam).

Different economic, political, and cultural characteristics in the region portray different faces of malnutrition. In many countries of the Asia-Pacifi c Region, under
nutrition is the most common. In some areas however, there are also incidences of over nutrition.

Read more »

ENCOURAGE WIDER PRACTICE OF TRADITIONAL MEDICINE

Western or modern medicine is presently the dominant healthcare system in our country. However, the emphasis on private curative health measures, sophisticated technology, expensive drugs and complicated machinery has given rise to increasingly exorbitant medical costs and also the incidence of medical errors. The critical shortage of medical professionals and support staff has further strained the delivery of medical services.

The detractors of traditional medicine systems are quick to highlight adverse incidents connected to the practice of these systems. However, the public may often not be aware, or may overlook, the magnitude of problems experienced with prescribed conventional modern drugs and treatments.

For example, in the US alone, studies carried out between 1993 and 1998 revealed that there were 12,000 deaths a year from unnecessary surgery, 7,000 deaths a year from medication errors in hospitals, 20,000 deaths a year from other errors in hospitals, 80,000 deaths a year from infections in hospitals, and 106,000 deaths a year from non-error, adverse effects of medication. These deaths per year constituted the third leading cause of death in the United States - after deaths from heart disease and cancer, and way ahead of the next leading cause of death - cerebrovascular disease. (Starfield B. JAMA, 2000)

While recognizing that allopathic medicine has brought health gains to the country, it is obvious that it is becoming increasing difficult to sustain this form of healthcare.

Serious efforts should be given to considering other systems and to incorporating them into the mainstream healthcare delivery system. In other words, there should be pluralism in healthcare delivery.

We will not be alone, as many other countries are already promoting and integrating traditional systems of medicine into their national healthcare and delivery systems.

For instance, in China, traditional medicine systems are officially recognized and integrated into the healthcare system both centrally and at the provincial levels. Hospitals and colleges have been designated for the training in traditional systems.

China and Korea invested in establishing high quality educational and research institutions years ago. China runs over 40 top-level research institutions exclusively for traditional medicine.

India has been significantly increasing its budget for the promotion of traditional medicine practices such as ayurveda, sidha, unani, naturopathy, Tibetan medicine and homeopathy.

It has been reported that one in eight Singaporeans prefers traditional medical treatment over established Western medicines. There have been calls for increased research into these ancient cures.

Malaysia, being a multiracial country, had a rich base of traditional systems of healthcare which include Malay, Chinese, Indian and indigenous medicine. These non-Western or traditional systems of medicine were practiced for thousands of years before the advent of the colonial era. It was with the arrival of colonialism that they were gradually sidelined in favour of the western concept of medicine.

Now, different health systems tend to be practiced mostly in isolation from each other. By right, there need not be a rigid separation of these delivery systems.

The World Health Organization (WHO) once pointed out that traditional medicine systems serve the health needs of about 80 percent of the world’s population and the goal of health for all cannot be achieved without traditional medicines.

There is a need to move away from the present obsession with only the modern system of medicine and turn to other systems that do not depend on sophisticated technology and other expensive modes of treatment delivery.

Traditional medicine colleges could be set up within existing university frameworks. Some training in Traditional Medicine systems could also be included in the present curriculum of medical schools and teaching hospitals. This would foster better understanding of traditional medicine practices.

There could also be active promotion of traditional systems of medicine by Ministries of Health in their national health programmes. Grants, incentives and other support mechanisms for training, research and setting up of facilities could also be encouraged.

More national and international conferences on traditional medical systems could be convened in order to promote and enhance the importance and to further encourage the understanding of these health systems.


Original article from:
Consumers Association of Penang (CAP),
No. 10, Jalan Masjid Negeri
11600 Penang, Malaysia.

Melamine Poisoning: “ Tip of the Ice Cream”

Like many similar incidents in the past, the melamine poisoning scandal is just a symptom of a decadent global food system characterized mainly by corporate greed and government neglect. The government ridiculously tries to show it is doing something to address the problem by parading to the media hurriedly confiscated milk product, yet at the same time, it downplays the dangers by echoing a familiar corporate whitewash that human will have to ingest unrealistically huge volume of contaminated milk to be poisoned. Just as quickly, Nestle and other companies put out expensive adverts proclaiming that their products are safe, even without undergoing the appropriate tests. These short-sighted and self-serving knee-jerk reactions do not protect the health of consumers but perpetuates the pathetic state of affairs as far as safety is concerned.

Food safety has been a serious concern of government and corporations, particularly with the advent of corporate globalization. WTO provisions related to food safely, for example, clearly subordinate protection of health and environment to corporate interest. Countries, especially the weaker countries, are forced to import food products contaminated with toxic chemicals or substances. Any attempt to ban or restrict such harmful substances, even those already banned in other countries, is met with fierce resistance by corporate giants and their host countries. Such is the case, for example, for pesticides, artificial sweeteners and additives, GMOs, and now melamine.

Exposure to melamine and related chemicals, in fact, is not new. Melamine is a triazine synthetic chemical used, usually with formaldehyde, in a wide range of products such as kitchen dishes and utensils, formica, laminate flooring, whiteboards, furniture, cleaning agents, fabrics, glues, colorants, flames retardants, fertilizers and drugs. Melamine is also a metabolite of cyromazime, a triazine pesticide commonly used in vegetable and chicken farms. In 1987, melamine was demonstrated to be present in coffee, orange juice, fermented milk and lemon juice, originating from migration of melamine from the cup made of melamine-formadehyde resin. From 1979-1987, there was widespread melamine contamination of fish and meat meal in Italy and in 2004, there was nephrotoxicity outbreak in pets in Asia. Again, in 2007, thousand of cats and dogs, mostly in the US, became seriously ill or died of acute renal failure after eating pet food contaminated with melamine and related triazine compounds such as ammelide, ammeline trichloromelamine and cyanuric acid. Hogs, chicken and fish were also found to be contaminated with melamine and cyanuric acid. Cyanuric acid is a common disinfectant used in swimming pools together with chlorine. Cyanuric acid was used as an ingredient in herbicides and is also used in the production of melamine and sponge rubber. It is also an intermediate chemical in the bacterial degradation of melamine and in the production of chlorinated bleaches and whitening agents. Trichloromine is the chlorinated form of melamine and is mainly used as disinfectant and cleaning agent.

Melamine may cause adverse reproductive effects, may affects genetic material and may cause bladder cancer based on animal data. It may also cause skin, eye and respiratory tract irritation and irritation of the digestive tract with nausea, vomiting and diarrhea, and may damage the urinary system. Cyanuric acid and trichloromelamine have pretty much the same spectrum of toxicity as melamine. However, cyanuric acid and trichloromelamine have the greater toxicity potential, particularly, in causing kidney damage, development toxicity and cancer.

By themselves, melamine and cyanuric acid are considered to be of low acute toxicity by regulatory agencies based on standard ask assessment for each chemical. It is from this limited risk assessment that official tolerance level (e.g., “15 cups of milk per day fro several months) are derived. However, multiple source and multiple chemical exposures, including exposure to both melamine and cyanuric acid (which has been found to be much more toxic in combination), is the more likely exposure situation and this should be the basis for assessing risks to human health. Other important triazine compounds must also be considered in the assessment of risks. For example, the triazine herbicides are known to cause neuroendocrine and endocrine related developmental, reproductive and carcinogenic effects.

Despite the limited scientific data and the low acute toxicity attribute to melamine and related traizine compound, much can be said about the potential harm that these chemicals pose to animals and human being. The mechanism of rental toxicity melamine and cyanuric acid is well established and that acute or chronic exposure would likely result in adverse renal toxicity that could lead to renal failure. Existing empirical and scientific data indicate that exposure levels sufficient to cause harm likely to be reached under present circumstances. In fact, the European Food Safety Authority, despite using the conservative risk assessment methodology, came up with this statement, “ in worst case scenarios with the highest level of contamination, children with high daily consumption of milk toffee, chocolate or biscuits containing high level of milk powder would exceed the TDI (tolerable daily intake)”. This assessment did not consider potential additional exposures likely to occur in developing countries, such as, cyanuric acid in swimming pools, melamine from the pesticide cyromazine and in contaminated vegetables, fish and meat, and melamine leachate in kitchen wares. Since milk and milk products from products from China were already banned in Europe at the time of the assessment, the worst case scenario for European children did not even consider potential sources from milk and ice cream!

The extent of harm that melamine and related compounds have caused is not at this time but the problem is not just melamine and simply confiscating products will not solve the problem. Government officials should not downplay the dangers of toxic chemicals contaminating food. Mechanisms for appropriate monitoring and timely intervention should be established. Food safety should be placed high in the political agenda and greed, corporate and otherwise, eliminated. Safe food should be put in the hands of the people!

Original article by:
Romeo F. Quijano, M.D.
Professor
Department of Pharmacology and Toxicology
College of Medicine, University of the Philippines

Where does suicide stand today?

I am featuring a news item from Waiting Room, a magazine compromising news for the health and wellness-conscious and believing that information is power—that it empowers people to take control of their lives and bring about positive change in themselves and the community in which they belong. In reporting and communicating health information, its commitment is to truth, integrity, fairness, professionalism, and excellence so to help establish a responsive and responsible health-care system.

Little being done to curb suicides pushes for a wide attention regarding the soaring rates of both suicide attempts and suicides from “. . . governments that are not committing enough resources to prevention but also in part because suicides are often recorded as violent murders or accidents”.

“There are more than one million people who die by suicide each year in the world, which is more than those who die from war, terrorist attacks, and homicides every year,” Brian Mishara [president of the International Association for Suicide Prevention (IASP)] said.

According to World Health Organization (WHO), the following are the challenges and obstacles why this issue gets scant attention:

 Worldwide, the prevention of suicide has not been adequately addressed due to lack of awareness on suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, only a few countries have included prevention of suicide among their priorities.

 Reliability of suicide certification and reporting is an issue in great need of improvement.

 It is clear that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g. education, labour, police, justice, religion, law, politics, the media.

There states, in its website, that approximately one million people died from suicide: a “global” mortality rate of 16 per 100,000 or one death every 40 seconds in the year 2000. In the last 45 years, suicide rates have increased by 60 % worldwide making suicide as the third leading cause of death among those aged 15-44 years (both sexes). Mental disorders (particularly depression and substance abuse) are associated with more than 90 % of all cases of suicide. However, suicide results from many complex sociocultural factors and is more likely to occur particularly during periods of socioeconomic, family and individual crisis situations (http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/, October 2008).

In the Philippines, issues on suicide are rare and that they are only featured if there involve suicide bombings. The latest suicide rate dates back in 1993 which states that the country has a total of 2.1 (suicides per 100, 000 people), 2.5 for males while females with 1.7 (http://www.who.int/mental_health/prevention/suicide/suiciderates/en/, October 2008).

Young Adult Fertility and Sexuality Study 3 (YAFSS) has concluded that young Filipinos are capable of doing drastic acts such as committing suicide.
It is surprising to note that despite the general notion of the youth being in the prime of their life, suicide ideation is substantial with about 12.4 per cent reported that they ever thought of committing suicide. Larger percentage of females than males admitted to suicide ideation (17.1 % vs. 7.3 %) with very little difference across age group (Cruz and Berja, 2004, p. 67).

The rareness of information-drive on suicide is an attestation that it is, up to this day, considered taboo as dictated by influences coming from different cultures, societies, and religions.

If this scenario continues to persist, what will happen, then, to the advocacy which promotes suicide prevention? At surface, where does suicide really stand today? Or does it have a stance?

Perhaps, this is another “culture of silence”.

-Amanah Busran Lao
HAIN Research Associate

Citations:
• “Little being done to curb suicides”. Waiting Room: May-June 2008, page 1.
• World Health Organization. October 24, 2008 .
• World Health Organization. October 24, 2008 .
• Cruz, Grace T., Berja, Clarinda L. Non-Sexual Risk Behavior. Youth Sex and Risk Behaviors in the Philippines. Demographic Research and Development Foundation, Inc. University of the Philippines Population Institute Diliman, Quezon City

A Summary of the 2008 World Health Report “Primary Health Care: Now More Than Ever”

Primary health care was put forward thirty years ago as a set of values, rinciples and approaches aimed at raising the level of health in deprived populations. In all countries, it offered a way to improve fairness in access to health care and efficiency in the way resources were used. Primary health care embraced a holistic view of health that went well beyond a narrow medical model. It recognized that many root causes of ill health and disease lie beyond the control of the health sector and thus must be tackled through a broad whole-of-society approach. Doing so would meet several objectives: better health, less disease, greater equity, and vast improvements in the performance of health systems.

Today, health systems, even in the most developed countries, are falling short of these objectives. Although remarkable strides have been made to improve health, combat disease and lengthen life spans, people worldwide are dissatisfied with existing health systems. One of the greatest worries is about the cost of health care. This is a realistic concern since 100 million people fall into poverty each year paying for health care. Millions more are unable to access any health care.

The source of the problem is that health systems and health development agendas have evolved into a patchwork of components. This is evident in the excessive specialization in rich countries and donor-driven, single disease focused programmes in poor ones. A vast proportion of resources are spent on curative services, neglecting prevention and health promotion that could cut 70% of global disease burden. In short, health systems are unfair, disjointed, inefficient and less effective than they could be. Moreover, without substantial reorienting, today’s struggling health systems are likely to be overwhelmed by the growing challenges of aging populations, pandemics of chronic diseases, new emerging diseases such as SARS, and the impacts of climate change.

“Rather than improving their response capacity and anticipating new challenges, health systems seem to be drifting from one short-term priority to another, increasingly fragmented and without a clear sense of direction,” says World Health Report 2008 entitled Primary Health Care – Now More Than Ever.

With the publication of the report on 14 October, WHO hopes to start a global conversation on the effectiveness of primary health care as a way of reorienting national health systems. WHO Director-General, Margaret Chan, wrote in a recent editorial in the journal The Lancet: “Above all, primary health care offer(s) a way to organize the full range of health care, from households to hospitals, with prevention equally important as cure, and with resources invested rationally in the different levels of care.”

Actually, WHO hopes to revive the conversation. Primary health care was officially launched in 1978, when WHO member states signed the Alma Ata Declaration. That was 30 years ago. A few countries pursued the ideal. But, says Dr Chan: “The approach was almost immediately misunderstood.”

Primary health care was misconstrued as poor care for poor people. It was also seen as having an exclusive focus on first-level care. Some dismissed it as utopian and others thought it a threat to the medical establishment.

In the World Health Report, WHO proposes that countries make health system and health development decisions guided by four broad, interlinked policy directions. These four represent core primary health care principles.

Universal coverage: For fair and efficient systems, all people must have access to health care according to need and regardless of ability to pay. If they do not have access, health inequities produce decades of differences in life expectancies not only between countries but within countries. These inequities raise risks, especially of disease outbreaks, for all. Providing coverage to all is a financial challenge, but most systems now rely on out-of-pocket payments which is the least fair and effective method. WHO recommends financial pooling and pre-payment, such as insurance schemes. Brazil began working towards universal coverage in 1988 and now reaches 70% of its population.

People-centred services: Health systems can be reoriented to better respond to people’s needs through delivery points embedded in communities. The Islamic Republic of Iran’s 17 000 “health houses” each serve about 1500 people and are responsible for a sharp drop in mortality over the last two decades, with life expectancy increasing to 71 years in 2006 from 63 years in 1990. New Zealand’s Primary Health Care Strategy, launched in 2001, has as part of its core strategy an emphasis on prevention and management of chronic diseases. Cuba’s “polyclinics” have helped give Cubans one of the longest life expectancies (78 years) of any developing country in the world. Brazil’s Family Health Programme provides quality care to families in their homes, at clinics and in hospitals.

Healthy Public Policies: Biology alone does not explain many gaps in longevity, such as the 27-year difference in Glasgow’s rich and poor neighborhoods. In fact, much of what impacts health broadly lies outside the influence of the health sector. Ministries of trade, environment, education and others all have their impact on health, and yet little attention is generally paid to decisions in these ministries that have health impacts. WHO believes they should all be part of deliberations and that a “health in all policies” approach needs to be integrated broadly throughout governments. This will require a shift in political calculations since some of the greatest health impacts can be achieved through early childhood development programmes and education of women, but those benefits are unlikely to be seen during a single politician’s term or terms in office.

Leadership: Existing health systems will not naturally gravitate towards more fair, efficient (those that work better) and effective (those that achieve their goals) models. So, rather than command and control, leadership has to negotiate and steer. All components of society – including those not traditionally involved in health – have to be engaged, including civil society, the private sector, communities and the business sector. Health leaders need to ensure that vulnerable groups have a platform to express their needs and that these pleas are heeded. There is enormous potential to be tapped. In half of the world’s countries, health issues are the greatest personal concern for a third of the population. Wise leadership requires knowledge of what works. Yet health systems research is an area that is often severely under funded. In the United States of America, for example, health systems research claims only 0.1% of the nation’s health budget expenditure. Yet research is needed to generate the best evidence as a basis for health decision.

By aiming at these four primary health care goals, national health systems can become more coherent, more efficient, more fair and vastly more effective.

Progress is possible, in all countries. Now, more than ever, there are opportunities to start changing health systems towards primary health care in all countries. The challenges are different for countries with different income levels, but there are commonalities. There is more money being spent on health than ever before and more knowledge to address global health challenges, including better medical technology. There is also now recognition that threats and opportunities in health are shared across the world. Aid is important for some countries, but the vast majority of health spending comes from domestic sources. Even today, in Africa, 70% of all resources for health come from domestic funds. Thus most countries have the ability to start moving towards and enjoying the benefits of primary health care.

Reflections on Primary Health Care 30 years after Alma Ata and the Challenges Ahead

The recently released World Health Report on PHC (WHO Oct 2008) is an attempt to bring PHC again to the forefront of our priorities in global health. Good for that!

But the world has changed in these 30 years.

In 1978, we did not have:
· Neoliberal globalization.
· Selective, vertical health programs (many of them aggressively pushed by public-private partnerships -- PPPs that started, because they did not trust WHO…).
· A big health manpower crisis (only in part due to the AIDS pandemic).
· The magnitude of economic impediments to access to health by poor people with increasing inequities and disparities between the haves and the have nots.
· Increasing privatization and commercialization/commoditization of health services as a result of globalization *.
· Intellectual property issues (patent issues) used against the interest of poor countries and poor patients.

We also did not have:
· An energetic and active civil society.
· The People's Health Movement (PHM) and its global network.

Therefore, as a PHM member, on top of seeing PHC and Alma Ata as still alive, I think PHC-in-2008-and-beyond needs to address these (and other unmentioned) "did not have" issues as challenges at local, national and global level.

For this to happen, WHO is to recuperate its moral and political leadership in PHC, in health overall, and in proactively addressing the social determinants of health as per the recommendations of the ad-hoc WHO Commission that just released its report.

To go beyond well-meaning pronouncements, this will clearly need some internal reorganization in this UN agency. The question is whether its leadership plans such a reorientation.

PHM does not shy away from a political approach to PHC and is not really fighting its opponents; it is rather bringing the level of the discussion to a higher level. Therefore, it has published an alternative report to the World Health Report of 2008 --the Global Health Watch 2 (being released today, see www.phmovement.org ).

PHM challenges the concept that good health is an imperative for increased economic productivity: Instead, it insists and departs from the premise that health is an inalienable Human Right.
Health is not either a technical or a political issue: it is both…and pro-poor health interventions mean nothing if not concomitantly accompanied by poverty reduction actions that are pro-health.

Based on patients registers at health facilities, statistics want to make us believe that 50% of the poor choose to seek private health care. Such a fallacy hides the real fact that 50% of the poor do not seek any care (and thus escape facility-based statistics!). So, let us stop using the slogan "those who can pay should pay" without carefully weighing its meaning.

I am a perennial optimist. I hope recent developments mean a real new window of opportunity for PHC. But WHO/member states/civil society interactions will have to become more of a 'two-way street'. I am sure PHM will play its role in achieving this.

Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org
______________
*: The myth that private health providers are more efficient has to be broken once and for all. Without trying to generalize, it is still true that, in the private sector, the following facts are prevalent:
· An irrational use of drugs, of polypharmacy and an overuse of antibiotics, vitamins and steroids.
· An overuse of injectables.
· A veritable 'ultrasound epidemic'.
· An excessive numbers of cesarean sections and tonsillectomies performed.
· Private insurance companies cherry picking the healthier patients and leaving the others for the public sector to care for (or offering minimum coverage packages to the poor that end up in 1st, 2nd and 3rd class medicine).
· A penetration of transnational health corporations in developing countries using GATS provisions (that PHM denounces).
· Public hospitals opening private wards 'that will (allegedly) generate income to subsidize the public wards', but most of the times ending up being subsidized by the public sector since they undercharge private patients.
· Health tourism springing up in many countries with the consequent internal brain drain.
· A conspicuous absence of private practitioners in remote and poor areas.
· A very limited role of this sector in preventive and promotive health actions and a minimal role in TB and in AIDS, and
· A resistance of medical associations to any measures directed at regulating private practice.

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