ROLE OF THE STATE IN HEALTH As presented to the commission on health hosted by civil society at WSSD by BUPENDRA MAKAN of The Equity Project Development is inextricably linked to social justice & equity. Health is a basic human right. “It should never be that the anger of the poor, should be the finger of accusation pointed at all of us because we failed to respond to the cries of the people for food, for shelter, for the dignity of the individual” former President of South Africa, Nelson Mandela to US Congress in 1990 Poverty in a world of plenty is the greatest barrier to health as shown in the huge inequities in health status. The impact of globalisation shows that persons living in absolute poverty increased from 1,197 billion in 1987 to 1,214 billion in 1998; gap in per capita incomes between the richest & poorest countries (3:1 / 1820 -74:1 /1997) and the proportion of underweight children increasing The impact of HIV/AIDs is sweeping. 34,3 million adults & children are living with HIV/AIDS and 24,5million of these are in sub-Saharan Africa according to the 2000 UNAIDS report. More than 70% of those afflicted are living in poorest part of the world. At the same time developed countries increased the rate of recruitment for skilled workers from developing countries. Like the globalisation of world economies, health is also being globalised. Whereas the World Health Organisation, national governments and non governmental organisations were the major players in shaping health and international health, the last decade of has seen new players entering this terrain, most notably, the World Bank & the World Trade Organisation. International health is being globalised in a context of decreasing international aid that has dropped by 17% between 1992 and 1997. The civil society health caucus position paper states “there can be no sustainable development without an improvement in the health status of nations and that there can be no healthy nations without sustainable development” In this context the state should be looking at a mulititude of factors including the health status of developing nations and the impact of health problems such as HIV-AIDS, TB, Malaria, the burden of disease on children and women, the abuse of women and access to care issues for them, inequities and constraints on health resources, the consequence of war and conflict on health status, marginalisation of youth, impoverishment as a result of a debt burden and policies imposed by the International Monetary Fund and the World Bank International experience reveals that the state is not the sole custodian of health and welfare of citizens, but that civil society has a major role to play particularly in developing policies and the implementation of health and development programmes at grassroots level. What needs to be done is to address poverty through the cancellation of debt and redirection of resources to improve the health and socio-economic status of people. A primary health care approach must be adopted to revitalize health services for which public participation is critical Strategies also need to be defined to address the need for prevention of disease and water, sanitation and education provision. Health budgets need to focus on priority health diseases. Barriers to providing drugs must be removed Goverments need to support AIDS orphans with the involvement of civil society. The poaching of health care personnel needs to be stemmed. A gender sensitive approach to development is required and the abuse of women and children requires redress. A programme for peace is needed to end the spiral of wars. Health & human rights of people with special needs requires protection and in the same way youth programmes have to to be expanded. Should we accept that the notion that the world has become integrated and that isolation does not provide the answer? Development means different things to different people. The most radical definition requires one to seek both transformation of status quo along with empowerment of those that are vulnerable. We need to recognise that corporate driven globalisation is not the answer given thevisible negative impact on health. “Growth for the sake of growth is the ideology of the cancer cell”. Health is a human right and is tied to sustainability. Ill health and disease are manifestations of inequity and a denial of access to resources The biggest obstacle to sustainable development in the developing world is the burden of debt. Cancel the debt and focus on local solutions to unemployment, poverty and sustainable development. ENDS……………………………………………