The Need to Avoid “TRIPS-Plus” Patent Clauses in Trade Agreements

The South Centre is pleased to announce the publication of Policy Brief No. 37 entitled “The Need to Avoid “TRIPS-Plus” Patent Clauses in Trade Agreements” by Martin Khor, Executive Director of the South Centre.

A recent article in a prestigious journal reminds us of how the intellectual property chapter of free trade agreements can prevent the sick from getting treatment.  This article also critiques the TPP clauses and warns that they should not be translated to national laws or copied into other FTAs being negotiated.

To access the policy brief directly, press here

Neoliberalism and changing conditions in commercialization, marketization and commodification, by Kurtar Tanyılmaz

Neoliberalism and changing conditions in commercialization, marketization and commodification

Kurtar Tanyılmaz[1]

1- Introduction

Today we live in a society where everything from air to water becomes for sale and produced for profit. From health to education and from shelter to water almost every product and/or service we know for years as “public” and as a “right” has been marketized for a long time and sold for a certain price.

What we have been experiencing for years clearly shows that the increasing tendency of commodification, which is an important aspect of neoliberalism, leads to a series of important social costs, from the unemployment to the destruction of nature, despite claims on increase of wealth. Moreover these social costs are paid by the working class constituting the majority of the population. It is critically important to understand the dynamics behind the tendency toward commodification and the conditions in which today’s capitalism is in, so that the struggles that arise against it can be successfully accomplished.

The aim of this study is to put forth that the increasing tendency of marketization in the production of public goods and services today is closely related to the tendecies of the development of capitalist mode of production in general, as well as to the structural crisis that marked the last 25-30 years of capitalism in particular.

“Public” goods and social rights in capitalism

While evaluating public goods and social rights, my starting point will be three basic premises which I will try to justify in the next section:

1- No commodity should be required intrinsically as a public good.

  1. Social rights (education, health, shelter, etc.) are not given, but “vested” rights.

3- When interpreting the history of capitalism, market-state antinomy is far from being explanatory.

The fact that the original source of wealth in a capitalist society lies in the sphere of production is the result of the dual character of a commodity in capitalist production. Every commodity, including labor power, has a contradictory nature. A commodity is produced both to meet a need (use value) and to be sold (exchange value). However in such a society where the means of production are privately owned and labor is for sale, creating exchange values (not only to sell but beyond that to sell for making profit) gets ahead of creating use values.

It is the dynamic of class struggle that fosters continously this contradiction, which is peculiar to capitalist societies. For on the one hand, the working class wants to keep the use values as much as possible under the name of “public utiliy” and on the other hand the capitalist class wants to convert these use values into exchange value as much as possible by distroying them.

We can argue that in the light of these determinations, no good or service (software program, seed, health etc.) is intrinsically public, as long as capitalist production conditions persist. Because the legitimacy of a need in bourgeois society and the widely acceptance of a need (its recognition as a right) are two separate matters. More specifically: On the one hand, capital in general needs a “healthy” labor force to work (which also serves the legitimacy of this system), on the other hand, each individual capital wants to spend less to keep workers healthy. At the same time, the capitalist’s need is to provide cheap labor, while the laborer’s need is to obtain a viable wage income. Both needs are equally legitimate in capitalism! In such an exchange relation realized on the basis of equal rights, both capital is indifferent to the reproduction of the workers (for health situation etc.) and also only to compromise with the struggle. Which side’s need will be recognized as a “right” depends on the political and class power balances in the country. In the section that reveals that the determination of normal working day is a result of intense struggles, Marx expresses the capitalists’ indifference to the labor force as follows:

In every stockjobbing swindle every one knows that some time or other the crash must come, but every one hopes that it may fall on the head of his neighbour, after he himself has caught the shower of gold and placed it in safety. Après moi le déluge! [After me, the flood] is the watchword of every capitalist and of every capitalist nation. Hence Capital is reckless of the health or length of life of the labourer, unless under compulsion from society.[2]

Marx explains in the section where he discusses the factors determining the limits of a workday, that there is no limit of the workday and therefore of the surplus labour, because of its nature based on commodity exchange and that it is power that will be determinant between equal rights:

We see then, that, apart from extremely elastic bounds, the nature of the exchange of commodities itself imposes no limit to the working-day, no limit to surplus-labour. The capitalist maintains his rights as a purchaser when he tries to make the working-day as long as possible, and to make, whenever possible, two working-days out of one. On the other hand, the peculiar nature of the commodity sold implies a limit to its consumption by the purchaser, and the labourer maintains his right as seller when he wishes to reduce the working-day to one of definite normal duration. There is here, therefore, an antinomy, right against right, both equally bearing the seal of the law of exchanges. Between equal rights force decides. Hence is it that in the history of capitalist production, the determination of what is a working-day, presents itself as the result of a struggle, a struggle between collective capital, i.e., the class of capitalists, and collective labour, i.e., the working-class.[3]

If we are to gather up our thoughts up to the present: We can assert that under the capitalist mode of production, in a given country and in a certain period, the basic factors determining whether a good or service has a “public” character and implies a “social right” and to what extent it is subject to commodification, are: 1) the requirements of capital accumulation (profitability of the conditions of production) and 2) power balance of class struggles.

The result we have is that it is class struggle that determines whether a product or service could be considered as “public”; and a “social right” is not intrinsically a “right”; actually they are vested rights. In other words, we state that the assumption that a society has general, common, and public interests, and accordingly demand for a minimum human need/right which all classes will accept and define it as legitimate, does not coincide with the capitalist reality.

On the other hand, it should be noted that almost all rights (education, health, shelter, etc.) defined as “social rights” are ultimately part of the costs of reproduction of the labor force. This point, that is, the existing social rights, in fact, are derived from the “right to work” and getting a job, being employed is the precondition of all other social rights. Because, as we shall see in the future, under the conditions when capital accumulation loses its vitality and profitability of production diminishes, structural unemployment would tend to increase. It is clear that the pressure on existing “social rights” (wage erosion, the state’s rising debts, etc.) will increase.

The main function of the state in a capitalist society is not to abolish the structural contradiction between labor and capital but rather to intervene in the direction of its existence and its continuity. In other words, it aims to “manage” the accumulation of capital in favor of profitable conditions of production; not to provide a “social consensus”. Countries (and states) themselves are embedded in capitalist economic relations. Government and state officials in a country have strong reasons to follow policies that support capital accumulation. In this respect, the understanding of capitalism on the basis of market-state dualism, which is also common today, is not realistic because it is based on the assumption that the state is independent of capital accumulation, neutral and can protect “public interest”, but actually “there is no state above the classes”. We can say that the function of the state in a capitalist economy is not being a “referre” in the context of capitalist production relations but rather being a “guard” of the system based on the basis of the private ownership of the means of production and the wage-labor-capital relation.

2 – What is neoliberalism?

The view that neoliberalism is the product of an ideology/mentality among the various left circles and currents is very common and it is also argued that its main aim is the withdrawal of the state from the economy (due to the “financial crisis” of the state). From this point of view, public expenditure is on the rise due to the high social expenditures and social wages, and the budget deficits that are caused by them are deterring private sector investments. We are convinced that neoliberalism is not a false mentality or the product of politics, and that the important historical transformations behind neoliberal transformation in world capitalism lay behind it. Before addressing this view, we would like to touch on the historical background and dynamics of the period from 1945 to 1970 when the practices of the “welfare state” were more common on the world scale. This period was historically quite a product of specific conditions and factors.

We can summarize these conditions and factors as follows:

  • The Great Depression has become is a threat to the capitalist world.

In particular, the widespread massive workers’ struggles, especially in the European countries, which followed the Second World War against the world economic crisis, which began in 1929 and deepened in many countries in Europe, were intensified.

  • The increase of the influence and hegemony of the Soviet Union on the world working class as a positive experiment of the post-October Revolution of 1917.
  • The revival of capital accumulation on the world scale in the wake of World War II.

The “welfare state” practices under these conditions and factors were the result of the international bourgeoisie having to make concessions in the face of the relative superiority of the working class in the political power balance. Let us emphasize in particular: These practices were not often the result of a policy of providing a kind of “social consensus” between social classes with the aim of stimulating demand, in the direction of continuing the existence of capital accumulation, as claimed. And even though it was not against it. Because, despite a growing public sector, capital accumulation did not slow down. A new period in which profitable production conditions prevailed (but only after the Second World War!) but also the increase in public expenditures was largely financed by taxes paid by laborers. In other words, this “concession” (increased social spending, social state practices) met the bourgeoisie not from its own pocket, but to a large extent from the taxes paid by laborers.

In summary, the period in which the state functions as a “collective insurer” was the product of specific historical conditions; It would be more appropriate to endure it as shift in the balance of forces of the class struggles during the period in favor of the laborers. As a matter of fact, in the post-1970 deepening economic crisis and under the changing conditions of power balance that have been deteriorated against the laborers, this tolerance has shifted to an immediate and brutal attack. For us, the true meaning of neoliberalism lies in the fact that the international bourgeoisie has not been able to produce a solution to the long-term crisis of the ongoing world economy since 1970s and has adopted a new strategy of attack on the working class. It is also necessary to add that the balance of power between the classes led by the collapse of the Soviet Union since the early 1990s has turned against the working class.

What is the purpose of neoliberalism?

We have noted that capitalism is going through a structural long-term crisis that has arisen as a result of the tendency of declining rate of profit, and as a consequence, the state’s “insurer” function has become a burden for capital. Although various Keynesian methods were followed, it was not possible to get out of the crisis and the international bourgeoisie had utilized neoliberal strategy as an attack to labour since the 1980s. The main goal in neoliberalism is to clean up the obstacles in front of capital accumulation so that the capitalists can make more profitable production. In other words, the aim is to eliminate the unprofitable units of the capital and to direct them to new investment areas that may be more profitable. The way to bring this strategy into life in order to eliminate all the obstacles in front of the capital logic is to atomize and discipline the world working class. For this reason, the attack against all the vested “rights” that the laborers had in the past was initiated.

In particular, it is worth emphasizing: Neoliberalism does not mean that the state has less intervention in the economy. The most important point is not the downsizing of the state, nor the strengthening of the markets against the states. One of the main tendencies of capitalist development is continuing growth of the state. As a matter of fact, in the last 25-30 years, the state (public expenditures, etc.) continued to grow. What is changing is not the function of the state in the capitalist economy (to ensure the continuity of capital accumulation), but rather the way it intervenes to the economy.

We observe that the neoliberal policies that were practiced for about 30 years since 1980s led to the following social consequences around the world:

  • The state has grown rather than to shrink (public expenditures, social expenditures).
  • Real wages tend to fall.
  • The angle between labor productivity and real wages (which approximately indicates that the exploitation rate is tendentially increasşng)
  • Fixed capital investments realized by the private sector are gradually slowing down.
  • Average profit rates continue to decline in many key sectors that are leading the global economy.
  • Unemployment rate is increasing.
  • Income distribution is deteriorating.
  • Working conditions (increasing workload, working hours, precarity, subcontracting, de-unionization) are worsening.
  • Borrowing is increasing in almost every sector from households to corporations and governments.

The meaning of neoliberalism for the health sector

Based on our findings on neoliberalism, we want to reach some conclusions about the health sector in Turkey. First of all, it is worth mentioning that health services have previously included some practices in commodification. In the past, when the stae was fully controlling the health sector many services (such as referral paper, health card, health insurance, drugs from pharmacy, sending patients to private health center for inspection etc.) Today, some of the goods and services produced in public enterprises are also preserving their commodity character. With neoliberalism commodification is more increasing, these servises are more encircled with market relations. This is one dimension of neoliberal politics in health.

The other dimension is the course of health expenditures. The share of health expenditures within national income or within the state budget does at least not decrease by years and public health expenditures are on the rise! However, when we look at who finances these public expenditures, we see the recognize the real meaning of neoliberalism much better. While the burden on public and private employers is reduced in health expenditures, the so-called private households, consiting highly from working class, are responsible for these expenditures.

There is another dimension that we particularly want to highlight. The ultimate goal of the neoliberal policies in the health sector is to open a new door of exploitation for capital through privatizations. In the first part of the article we tried to mention. The ultimate goal of commodification (marketization) is to increase the surplus value, in other words to maximize profit, not to increase productivity and/or reduce labor costs (for reasons of “savings”, “performance” criteria etc) as claimed.

This means that in the present-day capitalism under the influence of neoliberalism, the main purpose is to control the labor process (“subsumption of the capital”) to create more surplus value, by opening the public services to market relations and privatizations step by step. We can concretize these determinations through the health sector as follows: In the sphere of circulation (hospital construction via public-private-partnerships, transfer of health care services to contractors, subcontracting practices, lower wages/salaries etc. for health workers, pricing of health services, opening of private hospitals, subcontracting workers, employing imported doctors, etc.). growing commodification practices are important. These practices, on the one hand, contribute to the deterioration of the income distribution against the laborers, and on the other hand they function as a kind of “Trojan horse” of privatization. But what is more important for the capital logic is to get whole control over the labor process (diagnosis, treatments, etc.), especially in the sphere of production in order to get more surpus value from wage labour. Turning the hospital from a commercial enterprise to a large factory aims to make private sector investments profitable for medical device manufacturers, drug companies, private hospital owners. In other words, the basic strategy of neoliberal policies focused on privatization, which is called “transformation in health”, is to bring health workers as well as labourers in all public services to the real subsumption of the capital in the production/labor process. An important consequence of this transformation is increasing proletarianization of doctors and resemblance of their working conditions to the working class.

3- How to struggle?

Throughout this article we have put forward two basic views. The first is that the rights and needs have a opposite and contradictory character in bourgeois society, that rights and needs can vary according to class interests, and that the state is not above social classes and independent in defining them. Moving from here we have the following conclusion: It is not correct to define a need as a right from the beginning and lay claim to use value (to bring out a useful product in the labor process) while objecting or revolting against the exchange value (the sale of the product as a commodity). Because in capitalism, two are intertwined and form a contradictory unity and contain different class interests. To view one side of the contradiction as a “natural” right and to see the other one, that is the exchange relation, as the source of social inequality is to ignore the essence of the capitalist relations of production (that the labor power itself is for sale therefore open to exploitation in the production process).

A correct approach should try to find a solution transcending this contradiction.  This is a contradiction (between use value and exchange value) which is specific to the capitalist mode of production. The political implication of such an appraoch is that a discourse based on the slogan “health is a right” or “health is not a commodity” will not be sufficient to win the struggle. By shifting the axes of the struggle between capital and labor to the problem of between individual and state, rights-based struggles aim at reducing or removing the poverty resulting from this contradiction, rather than to abolish the capital-wage labor contradiction itself. Likewise, we believe that gains from rights struggle will be limited if they only try to rectify distribution in the sphere of circulation as a strategy to expand first the state and/or “public” sphere (by “surrounding” it, trying to democratize it) without aiming to transform production relations. If a right will be defended, it would be more appropriate to struggle over a political line that defends first the right to work (job security and removal of unemployment) and everyone else’s livable wage income.

Secondly we have tried to set forth that neoliberalism is not a failure of a certain political regime of capitalism, but rather a manifestation of and a reaction to the overaccumulation and profitability crisis deepening for a longer time. It is an expression of the crisis of the capitalist system itself. This means that policies that states are following, are not a consequence of false, “unfair” politics, which also favour financial markets. They are a part of the attack strategy to labour to open the way for the capital accumulation in crisis. We emphasized that in contemporary capitalism the real problem lies not in the state (in the policies it follows) but in the crisis of the capital. In that case, it is not possible for us to win in a struggle that only takes the state as interlocutor, does not battle against the capital and can not become independent from the capital, especially under conditions of crisis when class interests come face to face so sharply. The struggle for a health system to be shaped on the basis of social needs should be built around demands that include the right to work and job security, livable income, worker’s control, and the prohibition of subcontracting. Realizing these demands will be possible to the extent if it could be a part of a general expropriation strategy that takes possession of existing firms in public ownership, re-debates private property and aims to de-commodificate labour power.

________________

[1] Assoc. Prof. Marmara University.

[2] https://www.marxists.org/archive/marx/works/1867-c1/ch10.htm. Chapter 10, section 5. The footnote to this proposition also reveals that capital’s attitude towards workers is not unique to the neoliberal period: “But though the health of a population is so important a fact of the national capital, we are afraid it must be said that the class of employers of labour have not been the most forward to guard and cherish this treasure…. The consideration of the health of the operatives was forced upon the mill-owners.” (Times, November 5th, 1861.)

[3] https://www.marxists.org/archive/marx/works/1867-c1/ch10.htm. Chapter 10, section 1.

Commercialization, health services and academic freedom | Ticarileşme, sağlık hizmetleri ve akademik özgürlük: All the interventions at the Pre-Conference Workshop of IAHPE in collaboration with TMA (14-15/1, Ιstanbul [eng/tur]

Özgür Öztürk
Trade, Market, Commodity (eng) | Ticaret, Piyasa, Meta (tur)

Dr. Kurtar Tanyılmaz
Neoliberalizmde ticarileşme, piyasalaşma ve metalaşmada değişen durum (tur)

Onur Hamzaoglu, MD, Professor, Kocaeli Academy for Solidarity  
Saglik Hizmetlerinin Ekonomi Politigi (tur)

Elias Kondilis, Senior Lecturer in Health Systems, QMUL
Stergios Seretis, Post-doctoral Researcher, AUTh
International Trade and commercialization of healthcare services: the case of TTIP (eng)

Ozlem Ozkan, Kocaeli Dayanışma Akademisi
Commercialization and health labour force (eng) | Ticarileşme ve Sağlık Emek-Gücü (tur)

Alexis Benos, Aristotle University Selanik
Health reforms in Greece: a classic model (eng)

Prof. Kayıhan Pala, MD, PhD, Uludag University Faculty of Medicine, Department of Public Health, Bursa/Turkey
Neoliberal health reforms in Turkey (eng)

Jonathan Philippon
NHS liberalization 1989-2012: a threat to the right to health in England (eng)

İzge Günal
Corporatization of the Universities (eng) | Üniversitelerin Şirketlesmesi (tur)

Prof. Dr. Feride Aksu Tanık, IAHPE Izmir Solidarity Academy
Dehumanization of Health Services (eng) | Sağlık Hizmetlerinin İnsancıl Özelliklerini Yitirmesi (tur)

Alâeddin Şenel
Precondition of being a university: “to be” a university, to be YÖK* (Institution of Higher Education) “or not to be” (eng) | Ticarileşme, Sağlık Hizmetleri ve Akademik Özgürlük (tur)

The Course Collectives of Academics with No-Campus – İstanbul (eng) | Kampüssüzler Ders Ortakları- İstanbul (tur)

Asli Odman
The Experience of Academics for Peace (eng) | Barış İçin Akademisyenler Deneyimi (tur)

Ömer Furkan Özdemir
Assistant struggle (eng) | Asistan mucadelesi (tur)

Oturum Başkan
What to do for academic freedom? (eng) | Akademik Özgürlük İçin Ne Yapmalı? (tur)

Fit for Whose Purpose? Private Funding & Corporate Influence in the United Nations

For a look at how the balance between public and private responsibility has shifted, and what this means in the real world in terms of adherence to international standards and norms, one needs to look no further than the United Nations itself. A new Global Policy Forum Report—Fit for Whose Purpose? Private funding and corporate influence in the United Nations—details how private corporations and corporate philanthropic organizations are increasingly paying to play there. Why are corporate-led solutions to global problems seen as the way forward? How is it that measures poorly aligned with UN values receive the UN stamp of approval?

See here the full 144-Page 2015 Publication by Barbara Adams and Jens Martens

See here the excellent short blog summarizing this in Global Policy Forum

Open Lecture Series on international health and the political economy of health in London, with the support of IAHPE

International Health and Political Economy of Health (IHPEH) Research Group

OPEN LECTURES SERIES YEAR I – 2017: «Defending the right to health»

9th Feb– Dr Pol de Vos

The Cuban Health System: defending the right to health in times of economic hardship

9th Mar – Vivek Kotecha

NHS Sustainability and Transformation Plans

23rd Mar – Dr Miran Epstein

Marxism and Medical Ethics

 

 

Time of lectures |5-6pm

Venue |QMUL, Centre for Primary Care and Public Health, M. Mason seminar room, Yvonne Carter Building, 58 Turner Street, E12AB

Attendance | all lectures are free and open to the public

Information | for any query please contact Dr Elias Kondilis (e.kondilis@qmul.ac.uk) and Jonathan Filippon (j.g.filippon@qmul.ac.uk)

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About IHPEH |The International Health and Political Economy of Health Research Group is an international network of academics, researchers, activists and global health students and graduates promoting research and debate on international health and health policy issues.

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Invited Speakers

pol_de_vosDr Pol de Vos is an expert in public health policies, health services organization and health sector reform in Latin America. He is currently working at the Institute of Tropical Medicine in Antwerp-Belgium,coordinating the Postgraduate course in Tropical Medicine and International Health. Over the last 20 years he has published extensively on international health policy issues and on the Cuban health system.


15f31aaVivek Kotecha a Research Officer at the Centre for Health and the Public Interest (CHPI). He previously worked as a manager in Monitor and NHS Improvement. Prior to that he worked as a management consultant at Deloitte for 4 years. Vivek holds a BSc Economics (Hons) from the LSE and is a chartered accountant. He has recently authored and co-authored a series of CHPI reports on the impact of STPs on the NHS.

Dr Miran Epstein is a Reader in Medical Ethics at Queen Mary, University of London. miran_epsteinEpstein received his MD in 1987 from the Sackler School of Medicine, Tel Aviv University. He received his MA and PhD in history and philosophy of science, both with distinction, in 1996 and 2004, respectively, from the Cohn Institute for the History and Philosophy of Science and Ideas, Tel Aviv University. He has published extensively on a wide spectrum of issues in medical ethics and is a Key Opinion Leader On Organ Transplantation (The Transplantation Society) and a UK Emissary on behalf of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism Custodian Group.

ihpeh

14-15 January 2017: Pre-Conference Workshop of IAHPE in collaboration with TMA (+program::last version)

14-15 January 2017 / 14-15 Ocak 2017

Commercialization, health services and academic freedom / Ticarileşme, sağlık hizmetleri ve akademik özgürlük

Pre-Conference Workshop of IAHPE in collaboration with TMA / IAHPE ve TTB Ortak Etkinliği

Chamber of Medicine of Istanbul / Istanbul Tabip Odasi

> See here the whole program (last version)

iahpe istanbul.jpg

Declaración pública XIV Congreso Latinoamericano de medicina social y salud colectiva – XIX Congreso de polÍticas de salud y il encuentro latinoamericano de movimentos sociales por el derecho a la salud

Los y las participantes en el XIV Congreso Latinoamericano de Medicina Social y Salud Colectiva, XIX Congreso de Políticas de Salud y II Encuentro Latinoamericano de Movimientos Sociales por el Derecho a la Salud, reunidos en Asunción, Paraguay, entre los días 26 y 28 de octubre de 2016, presentamos a los pueblos del mundo, desde nuestra Abya Yala, las siguientes consideraciones y propuestas, de cara a la compleja situación de la salud en el mundo como resultado de la profunda crisis civilizatoria que vive la humanidad.

1. Apenas comenzando el siglo XXI asistimos a una verdadera profundización de la crisis civilizatoria. El capitalismo global, en el actual régimen de acumulación de carácter financiero, extractivista, cognitivo, patriarcal y racista, está acabando con la vida en el planeta. El capitalismo global se ha impuesto por todos los medios como la única opción de organización humana, haciéndonos creer que los seres humanos somos individuos aislados que sólo sobrevivimos compitiendo y excluyendo al otro. El proyecto moderno de la razón instrumental, que separa al ser humano de la naturaleza y que la degradada a simple recurso explotable, no ha producido más que una profunda amenaza a la misma sobrevivencia humana, mientras se profundiza la desigualdad de clase, género, etnia, generación y territorio, en medio del productivismo y el patriarcalismo rampantes. Hacemos un llamado a los pueblos, organizaciones sociales y políticas del mundo a hacer conciencia de la inviabilidad de este modo de vida al que hemos llegado por el dominio de unos pocos, y a construir una nueva relación sociedadnaturaleza que nos permita cambiar la trayectoria hegemónica actual, para hacer de la vida y la salud, del planeta y de la humanidad, el norte de nuestras acciones colectivas, partiendo de la cosmología de nuestros pueblos originarios, su visión del “buen vivir” y sus saberes ancestrales.

2. Una de las más preocupantes evidencias del impacto del nuevo régimen de acumulación sobre la salud humana y del planeta en general, y sobre la soberanía alimentaria de los pueblos, es el descomunal uso de agrotóxicos de todo tipo para el agronegocio, como parte de la reprimarización de las economías latinoamericanas. Continuaremos denunciando estos impactos y convocamos a las pueblos latinoamericanos, tanto rurales como urbanos, a rechazar este tipo de producción deletérea e injusta, y a recuperar nuestros saberes ancestrales para construir alterativas de producción agroecológica que prioricen la vida, la salud y la alimentación de los pueblos.

3. Las reglas del comercio mundial, impulsadas hoy a través de los organismos financieros y los tratados del supuesto libre comercio internacional, continúan favoreciendo y protegiendo la acumulación de capital de las grandes transnacionales, a costa de las condiciones de vida de la mayoría de la población mundial, que se expresan en las inequidades, sufrimientos y muertes evitables que constatamos en los servicios de salud. Sólo desde la oposición consciente de los pueblos organizados será posible confrontar esta tendencia, comenzando por la exigencia a los cuerpos legislativos de todos nuestros Estados de revertir o no firmar los tratados de libre comercio dominados por Estados Unidos (denominados TTP y TTIP) y la redefinición de los derechos de propiedad intelectual que obstaculizan el acceso universal a los beneficios del conocimiento humano.

4. Las clases capitalistas del Norte y del Sur Global han decidido recuperar su poder en todo el mundo, con estrategias engañosas que pasan por la manipulación de los medios masivos de comunicación, la corrupta democracia representativa, el montaje de espectáculos y la judicialización de la política. Denunciamos el uso de estas estrategias en varios países de nuestro continente, como Honduras, Paraguay, Brasil, Argentina y Venezuela, y exigimos respeto por la voluntad mayoritaria de nuestros pueblos de construir equidad y democracia radical con los gobiernos progresistas que hemos elegido en América Latina, aún con sus limitaciones y errores.

5. En el mismo sentido, denunciamos el saboteo financiero que adelantan sectores opuestos al gobierno legítimo de El Salvador, tanto en la Asamblea Legislativa como en la Corte Suprema de Justicia, mientras impulsan exigencias imposibles por parte de algunos sindicatos de empleados públicos, para llevar al sector público a una asfixia económica que desestabilice el poder ejecutivo elegido democráticamente. 6. El proyecto neoliberal hace parte de la crisis civilizatoria, en la medida en que debilita la inversión social, prioriza la designación de presupuestos para el pago de la deuda pública, destituye los derechos sociales y colectivos, mercantiliza bienes comunes, profundiza la inequidad existente y profundiza la ideología del consumismo individualista. Este proyecto se traduce en la tendencia desaforada a la privatización de los servicios de salud en todo el mundo para seguir aumentando las ganancias del complejo médicoindustrial y financiero, a costa del dolor, la discapacidad y la muerte de muchos. La agenda de reforma de los sistemas de salud, denominada “Cobertura Universal en Salud” (CUS) y promovida por el Banco Mundial y las organizaciones mundial y panamericana de la salud (OMS y OPS), no garantiza el derecho a la salud de los pueblos. Por el contrario, lo reduce a la atención individual de la enfermedad para universalizar seguros diferenciados para pobres, medios y ricos, mientras engorda los bolsillos del capital financiero asegurador, nacional y transnacional. Es necesario rechazar esta agenda y promover acuerdos sociales y políticos en todos los países alrededor de la construcción de sistemas únicos de salud, públicos, descentralizados y democráticos, en el marco de protecciones sociales universales, a partir de profundas transformaciones en las sociedades, las instituciones y los Estados, desde la democracia radical del poder de los pueblos.

7. La formación del personal de salud está atrapada por las condiciones estructurales establecidas por el complejo médicoindustrial y financiero y la mercantilización de la atención en salud. La explotación del trabajo en salud ha generado relaciones docentediscente, trabajador(a) de la salud-paciente autoritarias, verticales y violentas, rompiendo el compromiso del personal de salud con el cuidado y la recuperación de la salud. Convocamos a las comunidades académicas de las instituciones formadoras de personal en salud a revisar profundamente sus procesos para superar la reproducción de este estado de cosas y construir un nuevo compromiso con la salud y la vida, con equidad y reconocimiento de la diversidad de género, etnia, generación y territorio.

8. Las organizaciones sociales del mundo y América Latina están activadas. Son ellas las que han construido y sostenido a los gobiernos democráticos opuestos al proyecto neoliberal. Son ellas las protagonistas de la resistencia al poder de las élites capitalistas y su afán de expansión de los mercados y las ganancias. Son ellas las mejores defensoras del derecho universal a la salud, entendida ésta mucho más allá de la atención de la enfermedad como el “buen vivir” y la máxima realización de los proyectos de vida de las personas y comunidades, sin exclusión alguna, pero con el reconocimiento de la diversidad humana. Llamamos a los pueblos del mundo a fortalecer su movilización y organización para construir juntos un nuevo proyecto civilizatorio que supere las injusticias del modo capitalista de vida.

9. Rechazamos la impunidad persistente y la complicidad de los Estados, por acción u omisión, respecto de la desaparición forzada y el asesinato de luchadores(as) que soñaron con un nuevo orden mundial. Verdad y justicia para los 43 estudiantes de la Escuela Normal Rural de Ayotzinapa, México, Bertha Cáceres en Honduras, Máxima Acuña en Cajamarca Perú.

10. La indefensión, la culpabilización y la detención injusta en la que se encuentran muchas mujeres que deciden interrumpir su embarazo en varios países de América Latina es alarmante. Sólo la movilización de la sociedad logrará la necesaria legalización del aborto terapéutico y libre, eugenésico y ético en América Latina, como la mejor medida para superar esta inaceptable situación de violencia de género.

11. Agradecemos profundamente la fraternidad, la hospitalidad y el afecto recibido de nuestros queridos amigos y colegas de ALAMESParaguay durante la realización de los eventos. Asunción, Paraguay, 28 de octubre de 2016.

La Red Latinoamericana de Género y Salud Colectiva

La Red Latinoamericana de Género y Salud Colectiva de ALAMES, y su nodo Cuba, desean acompañar al pueblo cubano tras la sensible pérdida del líder Fidel Castro Ruz, dedicando unas breves palabras sobre el papel de esta figura para la Salud Pública Cubana y Latinoamericana.

El Comandante en Jefe Fidel Castro fue el primer y más extraordinario médico social de la Revolución Cubana. Desde el propio Ejército Rebelde, Fidel tuvo siempre especial interés en que se le prestara la debida atención médica a los prisioneros heridos y así lo hacía cumplir, ateniéndose siempre al cumplimiento cabal de los acuerdos de la Cruz Roja Internacional.

Cuando Fidel hablaba a sus compañeros de guerra sobre las proyecciones futuras para cuando la Revolución triunfara, en todos los planes estaba en los primeros lugares, la eliminación del hambre y la pobreza, la necesidad de asistencia médica gratuita como derecho humano, la educación para todos y todas. El ambiente rural en el que por aquel entonces se desarrollaban las acciones revolucionarias, le hacía reflexionar sobre las explicaciones epidemiológicas a tantos problemas de salud que encontraban en la población campesina, y a las diferencias en cuanto a perfiles de morbimortalidad con disparidades evidentes, entre esta población y la citadina. Desde entonces supo que el éxito sanitario se encontraba en la prevención… “No hay que esperar que las enfermedades lleguen con sus amenazas tétricas, hay que prevenirlas, hay que evitarlas”.

Fidel fue quien más impulsó la formación de profesionales de la salud en Cuba, concediéndole a ello una importancia suprema en todo momento, igual que para con las campañas de vacunación y el control de vectores. En medio de severas crisis económicas, siempre vigiló se le dedicara a las actividades del sector de la salud, recursos de toda índole, lo cual se evidenció en un sostenido incremento del presupuesto estatal dedicado a esta actividad.

Pero Fidel no solo velaba por la salud del pueblo cubano, sino que su espíritu y quehacer solidario se expresó muchas veces a lo largo de estos años de Revolución, a través de la actividad internacionalista de profesionales de la salud en cualquier lugar del mundo donde fueran necesari@s; en la creación de una Escuela Latinoamericana de Medicina y en la construcción y puesta en marcha de hospitales y centros médicos en varios países hermanos de la región.

Es que nuestro Fidel, claro y lúcido, ilustrado y sencillo, cabal y honesto, pudo comprender sin necesidad de demasiadas vueltas, que el compromiso con la salud de los pueblos era un deber de los estados, de los gobiernos y de todo proyecto social, para con el bienestar y futuro de la humanidad.

¡Gloria a Fidel!

¡Gloria de su pensamiento y acción médico-social!

27 de noviembre de 2016.

Declaración de ALAMES sobre la muerte de Fidel

La desaparición física del Comandante Fidel Castro el 25 de noviembre, al cumplirse 60 años de la partida del Granma desde Tuxpán Veracruz hacia territorio cubano, representa un momento singular para la Asociación Latinoamericana de Medicina Social.

Torrentes de tinta se escriben y escribirán por estos días para elogiarlo o para denostarlo mientras los periódicos de todos los signos no tienen más remedio que poner su foto en la tapa limitándose a elegir entre las más icónicas, las más antiguas o donde se lo vea más anciano.

La singularidad de lo que podemos expresar desde ALAMES es que en dimensiones que no alcanza ningún otro líder político, sentimos -y hay motivos de sobra para ello- que Fidel es nuestro, que es parte constitutiva de ALAMES.

No se trata de un deseo ni de un recurso retórico, lo hizo él mismo, metiéndose en el corazón de la salud, comprendiéndola como ningún otro líder desde adentro  y transformando a la salud en uno de los ejes identitarios del proceso revolucionario y del internacionalismo cubano.

Que difícil resulta seleccionar los hitos que quedan en la memoria colectiva como el haber reconstruido la educación médica cubana hasta posicionarla como una referencia mundial a partir apenas de un puñado de 12 profesores al principio de la revolución cuando los médicos y sobre todo los profesores de medicina engrosaban las filas de quienes buscaban otros horizontes en Miami.   

Como explicar esos primeros años en que las dificultades económicas, el bloqueo  y el aislamiento impuesto por EE UU no fueron una excusa para postergar la salud ni la educación y en apenas una década la isla se poblaba de médicos, de enfermeras y de policlínicos mientras la población organizada y protagónica de esta gesta comenzaba a naturalizar que la salud es un derecho, que los servicios son públicos y gratuitos, que la mortalidad infantil podía reducirse estructural y sustentablemente y que ese derecho se extendía a todo el país, a las poblaciones urbanas y a las rurales a todo lo ancho y largo de la isla.

Como explicar la fuerza con que la diplomacia cubana instalaba sus temas de agenda forzando a las grandes potencias a discutir cara a cara en cada organismo internacional sobre políticas de salud y sobre sus pobres programas de supuesta cooperación internacional. Como medir hasta qué punto logró influir en organismos internacionales de salud como la OMS o la propia OPS que por su carácter dual de Interamericana y mundial no pudo excluir a Cuba de sus países miembros.

Como ignorar ese momento dilemático a principio de los 80’s cuando la planificación sanitaria demostraba palmariamente que debía discontinuarse el ingreso a las facultades de medicina porque no había condiciones para una mayor absorción laboral. Fue entonces otro momento revelador de su perspectiva de largo plazo en el que Fidel personalmente comienza a liderar un proceso de formación de médicos de familia, nuevamente 12 pioneros que una vez ajustado y validado el proceso formativo inaugurarán en 1986 un nuevo ciclo en la revolución sanitaria.

Apenas una década después el número de médicos se había más que duplicado y ese nuevo médico especialista de las 120 familias ya representaba más del 50 % de los médicos de la isla y los equipos de salud viviendo en cada barrio, en cada localidad pasaron a engrosar el equipamiento social y a constituirse en parte de la vida cotidiana de las comunidades.

No se imaginaba al comienzo de ese proceso que apenas tres años después la URSS pudiera colapsar y mucho menos cuando pocos apostaban que la revolución cubana pudiera sobrevivirla.

Será para 1991, en una cumbre de Educación Médica en Punta del Este, allí donde 30 años antes el Che entonces Ministro de Economía había disertado, que el Viceministro de Salud responsable del área educativa va a pronunciar un diagnóstico contundente. Los grandes logros de la revolución cubana en salud los logramos antes de contar con médicos de familia pero no los perdimos durante el período especial gracias a los médicos de familia. Cabe señalar que, a la vez Cuba avanzaba importantemente en el área de la biotecnología creando productos para las necesidades de tratamiento de diversos padecimientos.

El internacionalismo ha estado en los genes mismos de la revolución cubana pero el rol de la diplomacia sanitaria llevó a Cuba a los niveles más importantes de protagonismo en cada proceso transformador, en cada crisis humanitaria. Ningún país en la historia a disposición de la humanidad la cantidad y proporción de recursos que Cuba ha ofrecido en mas de 80 países en África, en Asia, en América Latina, en el Caribe y si la sensatez lo hubiera permitido hasta en los EE UU, durante el desastre que el huracán Katrina produjo en Nueva Orleans.

En 1998 luego de los desastres de los huracanes Mitch y George el propio Fidel llegó a la conclusión que hacía falta dar un paso más, eran jóvenes de los propios países quienes podían en forma más sustentable, hacer llegar los aportes de la salud y del acompañamiento  profesional a las poblaciones más apartadas, más desprotegidas para lo cual se creó la Escuela Latinoamericana de Medicina ELAM . Una década después 25.000 médicos de 84 países, incluyendo EE. UU. Se habían graduado y muchos de ellos especializado en la ELAM.

Fue en las escalinatas de la Facultad de derecho en Buenos Aires en su visita a Argentina en mayo del 2003, donde Fidel se ocupó de explicar personalmente la concepción profundamente revolucionaria antes que humanitaria de la diplomacia médica cubana. “Dicen que los Estados Unidos pueden enviar un misil inteligente al rincón más apartado y oscuro del planeta; Cuba puede enviar un médico al rincón más apartado u oscuro del planeta”.

No se trataba de ninguna exageración, terribles desastres como el terremoto y la subsecuente epidemia de cólera en Haití en el 2010 o la epidemia de Ébola en África Occidental en el 2014 encontraron, a la cooperación cubana en la vanguardia de la cooperación.

Dos años después la portavoz del Gobierno norteamericano Marie Harf tuvo que referirse a ello “reconocemos y apreciamos la colaboración de Cuba. Francamente que un país tan pequeño esté proporcionando tantos recursos -más que muchos otros países- francamente supone una contribución muy significativa” Posteriormente el propio Secretario de Estado  John Kerry ratificó esas declaraciones y brindó más precisiones “Cuba, un país de solo 11 mi­llones de personas, ha enviado 165 profesionales de la salud y se propone enviar cerca de 300 más”.

Durante sus 30 años de existencia ALAMES fue una caja de resonancia y se sintió respaldada en esta enorme y generosa apuesta a demostrar que el derecho a la salud es posible. Cada uno de los compañeros y compañeras de ALAMES Cuba participando activamente en nuestras redes temáticas, ofreciendo sistemáticamente ser sede de nuestros Congresos,  protagonizando nuestros encuentros e iniciativas traían las fuertes resonancias de una forma particular de ser parte, de ser miembro de ALAMES representando a todo un país.

ALAMES no tiene organizaciones, estados o países miembros como asociados y por ello se solidariza con el pueblo cubano y despide a la persona que representa como nadie a esa inconmensurable gesta antiimperialista, al Comandante Fidel Castro Roux, quien ha acompañado e inspirado el devenir de ALAMES por tres décadas como se despide al primero, al fundador, al mejor de sus asociados.

¡Hasta Siempre Comandante!

 

Coordinación de ALAMES

Bogotá, Buenos Aires, Foz de Iguazú, Ciudad de México., 27 de noviembre del 2016