Infectious diseases have served as an excuse to change the Global Health agenda
After the Ebola crisis, the World Health Safety has been presented as a priority focused in improving surveillance systems, instead of other approaches14/10/2017
The Brazilian Society of Tropical Medicines (BSTM) Press office interviewed Doctor in International Law and Masters in Community and European Law at Paris University, Deisy Ventura, who stressed the regretful situation for populations health in the world plan, determined by power games of large scale, involving Nations, the private sector and social movements. According to the Professor of International Law, in order to increase the interaction between Tropical Medicine and international relations aiming to deploy more effective actions, the effort to build complementary focuses between different subjects is needed, so this way, the research agenda is able to handle the complexity of the phenomena we live today. Ventura stressed the only possibility of having sanitary safety in the world agenda is the existence of well-organized national health systems, with great capillarity and of universal access, especially in low-income countries, where most of the population does not have enough income to benefit from the services provided by the private sector.
Find the full interview below:
BSMT: About the recently published book Diplomacy in Health and Global Health: Latin-American perspectives, you say the international complexity has brought new objects and challenges about which the author of this compilation aims to reflect, under the Latin-American and Caribbean perspectives, among which, deep social and sanitary inequality between countries and within these. Could you tell us more about this?
Dr. Deisy Ventura: This book provides articles from great Fiocruz-related researchers, including its organizers, who have been under the spotlight for building and disclosing a critical vision of global health governance. This is about forging an autonomous perspective of diplomacy and Global Health able to reflect the singularities of the so-called Global South, avoiding bringing without reflection the paradigms of developed countries into our reality – which, in the best-case scenario, encompasses their own interests (not necessarily the interests of their populations). On the other hand, Brazil and other nearby countries have featured cooperation experiences aiming to respond to the structural issues that affect their populations health, refuting the vertical programs of immediate response to punctual issues and the cross compliances that depict the North-South cooperation. An important part of these experiences is reported in the book. In short, in theory and in practice, the book defends a diplomacy and perception of Global Health considering the unfortunate causes of the health reality of populations worldwide, which are determined by power games of large proportions, involving Countries, private sector and social movements.
BSTM: About your global health blog, how could we increase interaction between Tropical Medicine and the international relations in order to produce actions that are more effective?
Dr. Deisy Ventura: I believe the dramatic evolution of clinical research and different other technologies creates a tremendous amount of information not always followed by a reflection that would allow us to understand them in their context. It is not easy to integrate subjects – I mean a continuum that begins with multidisciplinarity (as a juxtaposition of experts opinions in different subjects about the same object), includes interndisciplinarity (the transposition of a subjects methods over another) until reaching transdiscplinarity (development of a research object outside of the subjects). However, we must make an effort to build complementary approaches between different subjects so our research agenda is able to handle the complexity of the phenomena we have witnessed. The study about different actors in the international scene, their current interests and the decision-making processes can contribute so more effective answers, aimed towards the populations health, are conceived and implemented by States and the society.
BSTM: Venezuela has faced a deep crisis after increasing the incidence of diseases such as malaria and chikungunya and has refused aid from neighbor countries and international organizations. What kind of actions could be put in practice to reduce such damages?
Dr. Deisy Ventura: Venezuela is under a profound political and economic crisis. We must be careful with the secret agenda among the information that comes from that country, both from government and opposition. Anyway, it is fundamental to apply governmental pressure so the populations health remains a priority for all the forces involved in this conflict. It is fundamental, yet, to ensure that no restrictive measure is implemented in the borders over people trying to escape the crisis.
BSTM: During this acute crisis moment of arboviral diseases (dengue, zika, chikungunya, yellow fever, Nile fever, Oropouche, Mayaro fever), that Brazil has faced, how does the dissemination of these diseases in a global scale can affect international relations?
Dr. Deisy Ventura: Infectious diseases have been an excuse for Global Health agenda turning. Especially after the Ebola crisis, Global Health Safety became a priority, focused in enhancing surveillance systems instead of other approaches (such as social health determinants). If the 2005 International Sanitary Regulations, valid since 2007, was already considered a safety tool, a new agenda promotes an even greater Global Health securitization. The ISR, present in 196 Countries, is managed by a multilateral organization, the World Health Organization (WHO), and states the development of national abilities that require the implementation or strengthening of national health systems. As a counterweight, the Global Health Safety Agenda (GHSA), developed since 2014, is an alliance with low institutionalization that gathers over 50 countries, headed by the USA, and allocates resources that essentially serve for punctual providences focused in the surveillance field. It is not about avoiding diseases, but containing them in the Global South. As sanitarian Dominique Kerouedan (Sciences Po Paris) would ask, would this be global health or partial health?
BSTM: In your opinion, did global scale diseases lead to a rush of sanitary measures that benefit the poorest countries?
Dr. Deisy Ventura: I do not think the Ebola crisis, for example, benefitted the affected countries, in a way the WHO itself acknowledges the imminence of a new outbreak in West Africa. The international response to diseases, embodied in Public Health Emergency of International Concern (PHEIC), leans towards punctually controlling the situation, rather than solving structural problems that determine the disease propagation. On the other hand, the relation between Zika virus and congenital malformations is a more complex example. There was gain, for example, for the scientific community that received larger funding for research during the emergency. We might ask, however, if the balance was positive for Brazil. Believing it was not, considering the rights of the women and children affected by the disease, constant targets of violation, besides the potential environmental damages caused by the new rules that make the vector Brazils response priority, in fact, questioned by the Public Prosecutions Office in a suit in the Supreme Federal Court.
BSTM: Do you believe it is fundamental to strengthen health systems, globally speaking? How?
Dr. Deisy Ventura: The only possibility to have sanitary safety worldwide is the existence of well-organized national health systems, with great capillarity and universal access, especially in the poorest countries where most of the population does not have enough income to benefit from private services. The austerity discourse must be fought. Studies by David Stuckler and other researchers have demonstrated that austerity kills; countries that tried to solve economic crisis increasing social protection instead of diminishing it not only saved lives but also came out of the crises much faster.
BSTM: How do sanitary and public health problems affect migrations around the world?
Dr. Deisy Ventura: Apart from rare exceptions, the health problems are not the cause of international migrations. The migratory flows are complex and very distinct between, resulting from multiple causes. It is consensus, however, that great part of these flows is motivated by work opportunities and dignified life. The work conditions many times painful, the obstacles in migratory regulation and the inclusion difficulties in the destination country can severely affect the health of these people. The receiving Countries must invest in specific public policies in order to decrease the migrants vulnerability.
BSTM: How do you see public power neglect?
Dr. Deisy Ventura: The promises of universal prosperity and poverty reduction made by economic globalization was not fulfilled. First, servile to market interests, under a pretext of increasing global wealth and modernize economies, the governments of great part of the world have sacrificed social policies, among them, health. The result is that wealth is in fact greater than ever, but so is inequality. World wealth concentration is a disgrace, of which many political forces are complicit. Conservative sectors take advantage of the populations deception to deepen the austerity policies (read: income concentration) and strike the so harshly conquered human rights. The political agenda has been snatched, in great part of the world, by the agenda of these conservative forces. This way, instead of debating structural aspects able to produce effective impact over the populations health, the current debate in Brazil is around privatization and demands of religious sectors. It does not sound, in short, that it is neglect but deliberate intentions to exterminate the conquers of our short period of democracy.
BSTM: In your understanding, does world economic inequality also distribute the weight of sanitary emergencies?
Dr. Deisy Ventura: It all depends on what we understand by sanitary emergency. Would it be 1.5 million cases of dengue in a year in a single country or would it be a few hundreds of congenital Zika syndrome days before an international sports event? There is no comparison method for pain, suffering and rights violation. However, without a doubt there are parameters for health policies priorities. The international emergencies declared by the WHO until now are very distinct between each other. The A(H1N1) flu, between 2009 and 2010, begun in Mexico towards many countries, including the developed world. In 2014, the wild poliovirus in a region castigated by armed conflicts (Afghanistan, Pakistan, Syria, etc.) and the Ebola in West Africa were considered international emergencies. In 2016, Brazil was the epicenter of the Zika congenital syndrome. The origins of these emergencies is multi-causal and, in my opinion, exceeds economic inequality. We have at stake the food production forms, especially livestock, including the developed world; the unbalance of ecosystems worldwide; a happiness conception that implies health and environmental sacrifices in the name of production and/or excessive harmful products, among many other factors. This way, I believe there are sanitary emergencies in the developed world as well. The object of my research currently is mainly because an event is considered an emergency by the WHO, and many others are not.…