In stark, powerful terms, Rowden offers a unique and in-depth critique of development economics, the political economy dynamics of global foreign aid and health institutions, and how these seemingly abstract factors play out in the real world - from the highest levels of global institutions to African finance and health ministries to rural health outposts in the countryside of developing nations, and back again.
In stark, powerful terms, Rowden offers a unique and in-depth critique of development economics, the political economy dynamics of global foreign aid and health institutions, and how these seemingly abstract factors play out in the real world - from the highest levels of global institutions to African finance and health ministries to rural health outposts in the countryside of developing nations, and back again.
The Deadly Ideas of Neoliberalism: How the IMF has Undermined Public Health and the Fight Against AIDS
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The Deadly Ideas of Neoliberalism: How the IMF has Undermined Public Health and the Fight Against AIDS
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Overview
In stark, powerful terms, Rowden offers a unique and in-depth critique of development economics, the political economy dynamics of global foreign aid and health institutions, and how these seemingly abstract factors play out in the real world - from the highest levels of global institutions to African finance and health ministries to rural health outposts in the countryside of developing nations, and back again.
Product Details
| ISBN-13: | 9781848136410 |
|---|---|
| Publisher: | Bloomsbury Publishing |
| Publication date: | 07/04/2013 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 256 |
| File size: | 827 KB |
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The Deadly Ideas of Neoliberalism
How the IMF has Undermined Public Health and the Fight Against AIDS
By Rick Rowden
Zed Books Ltd
Copyright © 2009 Rick RowdenAll rights reserved.
ISBN: 978-1-84813-285-6
CHAPTER 1
THE HISTORY OF GLOBAL FUNDING TO FIGHT HIV/AIDS
The Central Intelligence Agency had notice of the impending African AIDS pandemic as early as 1987 and began studying it in earnest in 1990. In Interagency Intelligence Memorandum 91-10005 entitled 'The global AIDS disaster', the authors projected 45 million HIV infections by 2000 – inexorably fatal, the great majority in southern Africa (Gellman 2000). This prediction, though surprisingly close, was actually an underestimate – 53 million people had contracted HIV by the year 2000, 19 million of whom have died. When the CIA report was first released, it was either ignored or trivialized.
Similarly, the WHO foretold tens of millions of deaths by 2000. Despite this prediction, most of the 1990s was characterized by indifference, petty infighting and procrastination at the WHO and in other UN structures. It was not until 1996 that the UN finally established its UNAIDS programme. The moment UNAIDS was established, however, its partners, the World Bank, the WHO and UNICEF, dropped their funding for AIDS from $225 million to $40 million (ibid.).
The most telling measure of neglect by the rich countries is financial. The first US budget submitted after the 1991 CIA report appropriated only $124.5 million for all overseas AIDS control, only a portion of which went to Africa. Harvard's Center for International Development found that between 1996 and 1998, financial aid from all rich countries to sub-Saharan Africa for AIDS control projects was between $69 million and $140 million annually.
One reason for the initially low funding for HIV/AIDS was a longstanding notion among public health experts about the profound disparities in care that separated the industrialized countries from the developing ones. There had been a historical tendency to accept this separation as a fact of life, complicated by the fact that health concerns were seen as a subset within larger issues of poverty and development.
A key moment, however, occurred at the 1996 International AIDS Conference (IAC) in Vancouver, Canada, at which scientists presented startling evidence that a combination of anti-HIV drugs (known as antiretrovirals, or ARVs) could dramatically reduce the spread of the virus inside the bodies of infected people and make it possible for them to live long lives. Suddenly HIV was no longer an immediate death sentence for tens of thousands of infected men and women in wealthy countries. By mid-1997, the dramatic fear provoked by the dreaded disease had greatly subsided as people with HIV living in the industrialized countries sought treatment.
But the drugs, then priced at about $14,000 per year and requiring an additional $5,000 a year for tests and medical visits, were unaffordable for most of the world's HIV-positive population (Garrett 2007). While HIV was no longer an immediate death sentence for those in the rich countries, it remained so for millions in Africa and other low-income countries. This appalling injustice incited an already growing international AIDS activist movement, but the new reality of ARVs mobilized these networks into putting political pressure on leading drug companies to lower their prices for ARVs or waive their patents (intellectual property rights or IPRs) and allow the production of cheaper generic copies of these new medicines. The activists demanded that the Clinton administration and its counterparts in other major industrialized countries increase their foreign aid specifically for the purchase of ARVs and donate them to poor countries. The success of this political effort was demonstrable by 1999, when total donations for health-related programmes (including HIV/AIDS treatment) in sub-Saharan Africa hit $865 million, up more than tenfold in just three years (ibid.).
Social activism in South Africa played a crucial role in the development of the international HIV/AIDS movement, and in connecting activists from both rich and poor countries. Under the apartheid government in South Africa, little had been done during the early years of the epidemic (Fourie 2006), when the initial characterization of HIV/AIDS as only affecting a few vulnerable groups stigmatized the disease and obstructed the development of any coherent policy. No policy-makers anticipated the effect that the structural drivers of the virus – poverty, gender inequality and violence – would have in catalysing the spread of HIV. Although South Africa's 1994 liberation from apartheid began a new era of great hope, it was also paradoxically the catalyst for the rapid spread of HIV infection. Racial segregation, entrenched gender inequality and the disparity in the provision of education and health were a few of the factors that left South African society unprepared for the onslaught of HIV/AIDS (Fassin 2007).
The first ANC government of Nelson Mandela did little to seriously address the HIV/AIDS crisis and in 1998 refused to provide zidovudine to pregnant women because it 'simply was not cost effective to purchase expensive drugs' (ibid.). Cost would be used again and again as a rationale for blocking access to ARVs.
Nattrass (2007) documents the extraordinary influence that the anti-science denialist movement (the belief that HIV is not real or does not cause AIDS) had on the thinking and policies of President Thabo Mbeki and former minister of health Mantombazana Tshabalala-Msimang and the creation of the Treatment Action Campaign (TAC) led by Zackie Achmat. The battle of scientific reason against Mbeki's theories initially peaked in 2000, at the International AIDS Conference in Durban, when TAC mounted a Global March for Treatment Access to defend a science-based approach to government policy. The structure and function of the TAC advocacy network represent an important model. TAC's partnership with the AIDS Law Project mounted innovative lawsuits that activated the South African justice system and focused public attention on critical issues of public policy. Although TAC's major battles were waged against their own president, health minister and government, TAC was also key in linking with international networks and forging a successful global campaign to pressure pharmaceutical companies to lower their drug prices. Underlying TAC's experience is the critical role that civil society has in working in solidarity with a global network of partners to create a global advocacy movement to ensure that sound evidence-based policies are promulgated by governments and other external funders.
In 2000, activists, scientists, doctors and patients gathered in Durban, South Africa, for another international AIDS conference at which South Africa's former president, Nelson Mandela, defined the issue of supplying ARVs in moral terms, saying it would be immoral to allow 'the poor of Harare, Lagos, or Hanoi to die for lack of treatments that were keeping the rich of London, New York, and Paris alive' (Garrett 2007). A Harvard University team led by Jeffrey Sachs estimated that fewer than 40,000 sub-Saharan Africans were then receiving ARVs, even though some 25 million in the region were infected with HIV and perhaps 600,000 of them needed the drugs immediately. Advocates increased political pressure on donors for the scaling-up of ARV supplies to low-income countries but the World Bank and USAID and other donors were dismissive of the idea. The World Bank issued a report in 1997, Confronting AIDS, in which it stated it would only support efforts on the prevention side, and that treatment was not 'cost-effective' (World Bank 2007a). Andrew Natsios, then USAID director, outraged activists when he suggested that Africans would not be able to take the proper combinations of drugs in the right sequences because they did not have clocks or watches and lacked a proper concept of time.
But the Harvard team insisted that any obstacles to the rolling out of widespread HIV/AIDS treatment in poor countries could be overcome. The political momentum that had been gathered by the global advocacy movement reached a turning point at the IAC in Durban in 2000, when a consensus was shifted against a prevention-only approach and in favour of stepping up efforts to provide HIV treatment to all who need it.
In 2000, global leaders embraced a series of eight United Nations-led Millennium Development Goals (MDGs) and targets for donor aid that reflected a new-found resolve to increase foreign aid generally and for HIV/AIDS in particular, and to make the world safer, healthier and more equitable by 2015 (discussed below). MDG Goal 6 provides that, by 2015, the world will have halted and begun to reverse the global HIV epidemic, and implicit in the commitment was the need for ambitious programmes to roll out ARVs.
In the United States, the Reagan administration originally did little to address the HIV/AIDS epidemic at home in the 1980s (Shilts 1987), and during the 1990s, when there was an increased awareness of the epidemic's spread in Africa, the Clinton administration did little to address the HIV/AIDS crisis globally (Behrman 2004). In The Invisible People, Behrman documents several factors for the lacklustre response by the USA to the global crisis, including how the end of the cold war diminished Africa's strategic importance, leading the USA to scale back its foreign aid to the continent, and how all the news from Africa seemed to be about famine and civil war, making the AIDS crisis just another 'part of one long, uninterrupted narrative of death and suffering in a faraway land' (ibid.). Behrman describes former president Bill Clinton as 'responsive, engaged, and in agreement' that the USA should do all it could to help fight AIDS in Africa, but unwilling 'to expend one dime of political capital to move US policy' until after he left the White House.
By the time the Bush administration had come to power in 2001, however, US AIDS activists had built considerable momentum to get something done. Clinton's second AIDS tsar, Sandra Thurman, had used her office to raise the issue and politicize it, the US-based group Health GAP successfully pressured the Al Gore presidential campaign to pledge it would provide scaled-up assistance on HIV/AIDS, the global Jubilee 2000 advocacy network for debt cancellation for poor countries had scored astounding political victories, and the global AIDS activists had started meeting every two years at IACs, as had governments with the periodic UN General Assembly Special Sessions (UNGASS). It was the culmination of such momentum which greeted the then-incoming Bush administration, which eventually responded by considerably increasing US foreign aid from $11.4 billion in 2001 to $27.5 billion in 2005, with support for HIV/AIDS and other health programmes representing the lion's share of all aid unrelated to large increases in US aid to Iraq or Afghanistan.
After almost two years in office, the Bush administration launched a $15 billion, five-year programme to tackle HIV/AIDS, TB and malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), in February 2003. The programme targeted assistance to sixteen nations and was aimed primarily at providing ARVs for people infected with HIV. PEPFAR has been one of the largest single sources of money available for AIDS treatment in the world, providing US$15 billion over five years (PEPFAR 2004). PEPFAR money was, however, overtly influenced by the ideology of the US administration of George Bush and its conservative approach to HIV prevention, rather than based on evidence of what works to address the real prevention needs of people (GAO 2006). Despite numerous and uncontested government-funded studies discrediting PEPFAR's 'abstinence only' programmes as an exclusive HIV prevention strategy, the US Congress during the Bush administration still required that at least 33 per cent of all HIV prevention money under PEPFAR be spent on 'abstinence-until-marriage' approaches. PEPFAR's guidelines and spending requirements have constrained or blocked organizations receiving US funding from supporting programmes targeting commercial sex workers (the Prostitution Oath) or those that promote sexual and reproductive health choices (including the Mexico City Policy/Global Gag Rule), and such PEPFAR guidelines had an equally damaging impact on AIDS responses targeting key at-risk populations and on the promotion of human rights, especially of women (CHANGE 2005).
In June 2001, the international community finally officially acknowledged HIV and AIDS as a major threat to development during the UN General Assembly Special Session on HIV and AIDS (UNGASS), when 189 nations committed to jointly responding to the pandemic and meeting a clear set of targets to be reached by 2005 and 2010. The declaration, 'Global crisis – global action', contains time-bound HIV commitments for a comprehensive response; from increased leadership and resources, to targets on prevention, treatment and care. It is notable that the declaration stresses the central importance of promoting human rights, particularly of women, people living with HIV and AIDS and marginalized communities.
Soon after the UNGASS declaration, persistent campaigning by advocates led to a high-profile victory on access to generic drugs for poor countries at the October 2001 summit of the World Trade Organization (WTO). At the trade summit, activists successfully beat back the worst aspects of a proposed deal on intellectual property rights (IPRs) for patent holders and drug manufacturers under the WTO negotiations on Trade-Related Aspects of Intellectual Property Rights (TRIPs). Although still imperfect (discussed below), the final summit declaration acknowledged that the right to health should prevail over intellectual property rights.
A major advance in the international effort to fight HIV/AIDS was the launching of the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM or Global Fund) in 2002 at the UN General Assembly Special Session on AIDS in New York. The explicit purpose of the Global Fund is to dramatically and rapidly increase the level of donor aid resources to fight the three most devastating diseases in the world. The idea for such a fund had been promoted by advocates for several years and received the endorsement of then UN secretary-general Kofi Annan in 2001, when he declared the need for a global fund to fight AIDS. The UNGASS summit in New York City was met outside by thousands of AIDS activists living with HIV from New York City, Philadelphia and around the world marching in pouring rain to demand a worldwide commitment to funding the fight against AIDS, adding to the pressure on officials to take action.
Today, the Global Fund is one of the most important aid instruments, channelling resources to effectively combat diseases of the poor. It is a unique global public-private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. The Global Fund works in close collaboration with other bilateral and multilateral organizations to supplement existing efforts dealing with the three diseases. Uniquely among international institutions, it reserves a seat on its governing board for civil society representatives from both the global North and South.
The Global Fund's performance-based funding model provides an effective vehicle for scarce resources, ensuring value for money. By channelling funds through the Global Fund, donors ensure that funds are spent effectively. The Global Fund's financing model emphasizes accountability for grant targets and transparent use of funds (ICASO 2006). The fact that civil society has seats on the board is an important recognition of the political power asserted by advocacy and other civic organizations over the last few decades. In important ways, the Global Fund represents a new type of governance structure emblematic of how the growth of civil society organizations and telecommunications technology has altered contemporary norms and expectations about how public institutions ought to be governed. Today, citizens expect opportunities for civic participation, and demand greater degrees of accountability and transparency at public institutions.
Since its creation, the Global Fund has approved funding of $11.4 billion for more than 550 programmes in 136 countries. It is responsible for nearly a quarter of all international funding to fight AIDS around the world. It also provides two-thirds of the funding for tuberculosis and three-quarters of the funding for malaria.
(Continues...)
Excerpted from The Deadly Ideas of Neoliberalism by Rick Rowden. Copyright © 2009 Rick Rowden. Excerpted by permission of Zed Books Ltd.
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Table of Contents
IntroductionPart I: Emergence of HIV/AIDS and the Global Response
1. The History of Global Funding to Fight HIV/AIDS
2. The Impact of the AIDS Response on Public Health Systems
3. The Shortage of Health Care Workers and the 'Brain Drain' Problem
4. The Debate Over 'Vertical' vs. 'Horizontal' Donor Aid
5. Different Types of Health Systems, Different Types of Financing
Part II: The Neoliberal Development Model
6. The Reagan Revolution, Structural Adjustment and The Washington Consensus
7. Neoliberal Theory and its Policies
8. The Consequences for Development
Part III: Consequences for Health
9. The Demise of Public Health&Rise of Neoliberalism
10. The Consequences for Health
11. 30 Years Later: Coming Full Circle - Rediscovering Public Health
12. The IMF: Blocking Progress on Public Health
Conclusion
What People are Saying About This
The Deadly Ideas of Neoliberalism provides a powerful, compelling analysis of the little-known impact of international financial institutions on countless people suffering without access to health services around the world. Rowden's passionate interrogation of the controversial macroeconomic policies embraced by the IMF is compelling and accessible, set against the high-stakes struggle for access to HIV treatment in developing countries. This book should be required reading at the IMF. (Asia Russell, Director of International Policy, Health GAP (Global Access Project))
This book is a timely "wake-up call" that we must redouble our efforts to develop viable progressive economic alternatives to Neoliberalism. Despite the ideological fallout from the global financial crisis and recession, the main tenets of the Neoliberal economic paradigm retain decisive power to dictate public policies in developing countries and mould the consensus mindset of the international development community. The need to confront Neoliberalism is nowhere more critical than in the debate on how to expand national budgets and strengthen national capacities to stem the 'deadly' tide of global health crises such as HIV/AIDS. (Terry McKinley, CDPR, School of Oriental and African Studies)
For far too long, public health activists have allowed development discussions to be dominated by economists. Rick Rowden has written a highly accessible volume that clearly links economic policies to poor health outcomes in developing countries. His clarion call to health activists to get involved in economic debates is an urgent one. His message is clear, neoliberalism kills. Real health improvements will only come by confronting and ultimately changing neoliberal strategies that continue to have far too much influence in international policy circles. (Howard Stein, Professor, University of Michigan, July, 2009)
This book is an extraordinary achievement. It includes a careful study of the political economy of HIV/AIDS and a clear explanation of the economic policies associated with neoliberalism and the IMF. Rowden shows that neoliberalism and IMF policies bear a significant responsibility for the limitations of health policies and budgets in the poor countries and, especially, for the insufficiencies of prevention and treatment of HIV/AIDS. (Professor Alfredo Saad Filho, Head of Department of Development Studies SOAS)
The timing of Rowden's superb book couldn't be better. The global financial crisis has diminished support for health programs by wealthy countries and development organizations at the same time as developing countries are facing deep fiscal crises and severe pressure from the IMF to reduce spending. Rowden's masterful work demonstrates the dangers associated with such policies, and provides health advocates with the information, arguments and motivation they need to win the battle against policies that, quite literally, kill. (Ilene Grabel, Professor, Josef Korbel School of International Studies, University of Denver)
A masterful account of the little known link between ideologically distorted "mainstream" economic theories, IMF policies, and the deadly impact these can have on developing countries. An activist and an extremely well-read and informed student of economics, Rowden has woven a convincing and powerful tale of the human costs of bad theory and bad policy, especially in the area of public health and AIDs in the developing world. His is also an inspiring tale of how informed and dedicated activism can make a crucial difference to the lives of the least priveleged. (Gerald Epstein Professor of Economics and Co-Director, Political Economy Research Institute (PERI) University of Massachusetts, Amherst)