Global Health Seminar, University College London, Saturday 12th May, 2007

Health as a Foreign Policy Saturday 12th May, 2007 University College London

Need a photo!

Medsin's Global Health Seminar was held on Saturday, with the topic of Health as a Foreign Policy and was a great success. There were fantastic talks by Rhona MacDonald, Alan Ingram, Salam Obaidi and Derek Summerfield on subjects such as security and health, conflict and health, and a personal perspective on health in Iraq. This was followed by a fascinating discussion between the Speakers and the Audience.

Introduction to health as a foreign policy – Dr Rhona MacDonald, Senior Editor, The Lancet

Rhona gave a useful overview of health as a foreign policy. She cited the recent Oslo Ministerial Declaration as an example of certain countries recognising the importance of global health as a foreign policy issue. The Ministers of Foreign Affairs of Brazil, France, Indonesia, Norway (1% of whose GDP goes to foreign aid), Senegal, South Africa and Thailand (where compulsory licensing is in place to allow universal access to ARVs) issued a statement: “We believe that health is one of the most important, yet still broadly neglected, long-term foreign policy issues of our time.” They emphasised “the right of each country to make full use of TRIPS flexibilities to ensure universal access to medicines.”

Unfortunately, not all countries are as progressive and Rhona spoke very passionately about a number of examples whereby the UK and other countries have neglected Global Health issues because of their own interest, or the interest of allied countries.

  • The UK’s refusal to sign up to ban the use of cluster bombs following their extensive use during the war in Lebanon. They were joined in their decision by the US, China and Russia. The Campaign Against Arms Trade (CAAT) has produced a useful reference document: “Who calls the shots? How government-corporate collusion drives arms exports.” Website address: http://www.caat.org.uk Disappointingly, the BMA has taken the stance that it will never have a policy on arms, the reason being that “some of their members will wish to join the army and that is their decision” (quoting Rhona paraphrasing the BMA).

  • The UK’s failure to act in response to 20-year conflict in Uganda. The crisis is most acute in northern Uganda, where Joseph Kony leads the Lord's Resistance Army (LRA) in a violent armed campaign. Human rights NGOs estimate that the LRA holds more than 3000 children captive, many as combattants. LRA military campaigns and the government's armed response have led to the displacement of an estimated 1.6 million people. The UK has failed to act because of its relationship with the Ugandan government, and draws a separation between what is happening in the North and the rest of the country.

  • Metalclad Corp. v. United Mexican States In January 1994, Canada, the United States and Mexico launched the North American Free Trade Agreement (NAFTA) and formed the world's largest free trade area. Mexico was accused of violating trade rules by denying Metalclad a licence to operate a toxic-waste treatment plant. Mexico had initially given permision for Metablad to build the plant, but later became concerned about environmental issues : health problems, birth defects and cancer. The NAFTA tribunal ruled in favour of Metalclad Corp, but a year later Mexico The B.C. Supreme Court began hearings on Monday on a multimillion-dollar dispute between Mexico petitioned the Supreme Court of British Columbia, arguing that NAFTA was never intended to limit the power of a government to protect the public from harm. The outcome was that someof the award was set aside.

Global Security and Health – Dr Alan Ingram, Lecturer in Geography, UCL

Alan has a particular research interest in “the ways that health and disease have recently been reframed by a range of actors in terms of concerns about geopolitics, globalisation and security ... including questions about how danger and security from infectious disease are represented and experienced geographically; the practical and symbolic roles of borders and migration control in managing infectious disease and related fears; and the intersection of global health concerns with geopolitical interests in strategic stability and security.” He highlighted 3 key points:

  • 1.Who benefits from linking health and security?
  • 2.Whose security is it?
  • 3.If we don’t like the definitions, change them!

He described how Dr Peter Piot (Executive Director of UNAIDS) noted how he has changed his language when approaching governments since 1996, whereby HIV is painted as a threat to national security, and this therefore made him much more influential. However, we must remember that viewing security as health can be used to restict people’s human rights. One example that comes to my mind is the restriction of movement placed on those with HIV/AIDS. There has been a definite shift in the idealogies surrounding globalhealth. HIV is now seen as a threat to U.S. security, and HIV as a global security threat was dicussed by the UN Security Council. Having issues of Global Health so high on the agenda may seem like a good thing, but Alan urged us to be cautious and that this shift in ideologies can lead to the neglect of issues of justice. He quoted the late Director-General of the WHO, Dr J.W. Lee who commented in 2003: “Today’s global health situation raises urgent questions about justice” and that the use of war metaphors actually compounds the suffering of those ill, as Susan Sontag expounds in “AIDS and its metaphors.”

Iraq: A Personal Perspective – Dr Salam Obaidi, Doctors for Iraq

Dr Obaidi, ex-orthopaedic surgeon, now activist and Masters student at the LSHTM, gave a moving testimony of his experiences during the conflict in Iraq. Dr MacDonald did not exaggerate when she described him as one of the most inspiring people she had ever met. Dr Obaidi’s aim was to give us a face to the consequences of foreign policy and to open up our eyes to the true horrors that are taking place in Iraq. For example, the use of napalm and white phosphoric bombs by the U.S. military. He showed a video of images taken from inside a US fighter plane. We saw clearly a group of civilians, women and children, walking away from the direction of the front line, towards what they considered “safety” and the fighter pilot manouvering himself to take aim, firing, and then yelling in delight at his accomplishment. Dr Obaidi has set up Doctors for Iraq, “a medical, humanitarian, right to health organisation established by a group of Iraqi doctors in Baghdad in 2003. Doctors For Iraq was established following the 2003 invasion of Iraq to provide emergency medical aid to civilians in the conflict areas of Iraq and to advocate on the right to health for patients, doctors and medical staff. We have 250 members from all religious background across Iraq, senior and junior doctors and medical students working with the organisation. What motivates us is our ambition to serve our country, improve the health situation for our fellow citizen and to develop solutions to the problems we face in the field. “ Website address: http://www.doctorsforiraq.org/index.htm He encouraged us all to come up with our own definitions, to challenge the accepted norms and beliefs...

Conflict and Health, the Wider Role of Health Professionals – Derek Summerfield, honorary Senior Lecturer, Institute of Psychology, King’s College

Dr Summerfield gave an impassioned talk on the role of health professionals in conflict. He called on us, not just as citizens, but as doctors who an added responsibility to “give voice to the voiceless”. In general, doctors come from middle-class backgrounds, are usually well-off and want to stay that way, and to practice in comfortable settings. I note myself how doctors initially opposed the formation of a National Health Service following the Second World War! Dr Summerfield cited research into the behaviour of doctors during military regimes in Chile, Uraguay and Argentina which showed that, as a profession, they turned a blind eye against torture.

  • Dr Summerfield is well-known for his letter, published in the British Medical Journal in 2004: “Does the death of an Arab weigh the same as that of a US or Israeli citizen? The Israeli army, with utter impunity, has killed more unarmed Palestinian civilians since September 2000 than the number of people who died on September 11, 2001... These statistics attract far less publicity than suicide bombings, atrocious though these are too.” Full article at here He continues to fight the cause of Palestinian civilians. He drew our attention to the impact Israel’s policies are having on the health of Palestinian civilians, namely the rises in malnutrition and anaemia, ambulances being detained at checkpoints and shot at, doctors being prevented from reaching their injured patients.

  • We were disturbed to hear that the President of the Israeli Medical Association and also Chair of the World Medical Association supports the use of torture. Dr Summerfield accused Israeli doctors, working for the security services, of aiding torture. See “Medical ethics, the Israeli Medical Association, and the state of the World Medical Association - Open letter to the BMA” here

  • Dr Summerfield advocated a boycott of Israeli universities: “Since 1967 Israel has occupied Palestinian territories by force, has built settlement there in violation of numerous United Nations resolutions and destroyed the infrastructure of Palestinian civil society. The Sepration Wall, targeted assassinations, the blood assault on Gaza, the Lebanon debacle – these and many more show the unacceptable face of Israel’s expansionist policies. Israeli universities and academics play a key role in supporting these policies, while the educational rights of Palestinians are denied. Palestinian universities are arbitrarily closed, students prevented from attending classes, academics deported, refused entry, harassed and unable to teach or research.” (From British Committee for Universities of Palestine leaflet) Website address: http://www.bricup.org.uk/

Concluding thoughts

Needless to say, Dr Summerfield’s talk raised some controversy with the audience. I don’t feel we should be afraid of this though, and would reiterate my introductory paragraph and encourage everyone there, reagrdless of their agreement or otherwise, to continue to question and criticise all that is put in front of them. As Edward Said advocated, we must “always challenge the very assumptions underpinning our discourse on critical issues of the day . . .the work and conclusions of many scholars are inextricably linked to unchallenged world views that are often based more on the distribution of power in society than on intellectual reasoning. It is these assumptions that must always be the focal points of intellectual examination.”

Last updated on Sunday 06 April 2008 at 17:05.