Macroeconomic Justice for Healthy Communities
We advocate for investment in public sector health systems through macroeconomic justice, including international lending practices and trade agreements that embrace health as a human right.
Today, macroeconomic policies imposed as conditions on international lending constrain many developing countries and have a direct impact on people’s health. The long-term effects of these policies can severely impair a country’s ability to build effective health systems or respond to health emergencies.
Following the oil crisis in the 1970s and the initiation of aggressive lending by commercial banks, the developing world faced mounting debts. In response, International Financing Institutions (IFIs), such as the World Bank and the International Monetary Fund (IMF) began to implement strict conditions on their loans, underscoring privatization and deregulation, among other neoliberal principles. These structural adjustment programs (SAPs) included cuts to subsidies on basic food products, fuel, water and sanitation, public transportation and medicines, and often placed salary caps and hiring limits on the public sector, resulting in reduced ability to recruit and deploy health workers.
Health systems in poor countries were hard hit by the reduction in public spending and by the increased debt and interest rates that came along with loans. In many countries, structural adjustment programs implemented fees in public hospitals and clinics that had previously offered care free of charge. These user fees reduced access to care, especially for the marginal communities.
While there have been some improvements, macroeconomic policies continue to play a critical role in influencing what resources are available for ministries of health. The outbreak of several public health emergencies, such as Ebola, have underlined the urgent need for further reform and debt cancellation.
It is essential to understand the relationship between macroeconomic policy, trade, and health, as well as what we as concerned citizens can do to lift these crushing restrictions and allow governments to invest in their health system.
Trade & Public Health
International trade agreements, which are often negotiated in secret and without the presence of civil society at the table, often include policies that favor multinational corporations (such as pharmaceutical companies) at the expense of affordable, easy access to medications for the poor and most vulnerable people.
In 2019, HAI joined the Washington Fair Trade Coalition, and others to help organize an event commemorating the 20th anniversary of the “Battle for Seattle” WTO protests. HAI led a session on Trade & Public Health
Sign ons & Resolutions
- Call On President Biden to Support COVID-19 WTO Waiver to Boost Vaccines, Treatments, Worldwide, petition to the Biden Administration, February 8, 2021 [Sign-on]
- Support for the Robust International Response to Pandemic Act (H.R.6581), letter to the United States Congress, 2020 [Sign-on]
- Call On Heads of State and Government to Reclaim Comprehensive Public Health, open letter to world leaders, November 30, 2020 [Sign-on]
- Call On the IMF to Stop Promoting Austerity in the Coronavirus Recovery Period, statement to the IMF and World Bank, October 6, 2020 [Sign-on]
- Call to Urgently Prioritise International Funding Support for the Recruitment of Human Resources for Health in Resource-Limited Contexts Amid COVID-19, open letter to GAVI, GFATM, GFF, IMF, World Bank, and WHO, April 22, 2020 [Sign-on]
- Civil Society Priorities in the NAFTA Renegotiation, open letter to United States Congress, March 21, 2018 [Sign-on]
- Reducing Income Inequality to Advance Health, APHA resolution policy statement, November 7, 2017 [Resolution]
- Improving Health by Increasing the Minimum Wage, APHA resolution policy statement, November 1, 2016 [Resolution]
- Development Letter on TPP & TPA, letter to United States Congress, April 30, 2015 [Sign-on]
- Opposition to Fast Track Bill “The Bipartisan Congressional Trade Priorities and Accountability Act”, open letter to representatives in the United States Congress, April 27, 2015 [Sign-on]
- Letter to Senator Ron Wyden: Oppose Fast Track on TPP, presented to Senator Wyden, September 10, 2014 [Sign-on]
- Letter Opposing Fast Track for the TPP, open letter to the United States Congress, January 14, 2014 [Sign-on]
- Letter on G33 Proposal for Greater Public Spending for Food Supply and Price Stability, open letter to the United State Trade Representative, November 26, 2013 [Sign-on]
- Strengthening and Updating Social Security to Protect Our Nation’s Health, APHA resolution policy statements November 5, 2013 [Resolution]
- Civil Society Letter to Members of the WTO Concerning a Further Extension of the Transition Period for Least Developed Countries (LDCs) Under Article 66.1 of the TRIPS Agreement, open letter to the World Trade Organization, February 21, 2013 [Sign-on]
- AFR Letter: Support Financial Transaction Tax, open letter presented to Senator Patty Murray and Representative Jeb Hensarling, October 21, 2011 [Sign-on]
- Women’s Letter to Christine Lagarde, open letter to the former IMF Managing Director, August 22, 2011 [Sign-on]
- Support for a Financial Speculation Tax, letter to the Obama Administration, February 17, 2011 [Sign-on]
- U.S. Groups Join Global Call to Tax Speculators, letter to President Obama, February 16, 2011 [Sign-on]
- G-20: Take Action on Financial Transaction Taxes, statement to G-20 leaders, October 27, 2010 [Sign-on]
- Community Global Fund Replenishment Letter to Secretary Clinton, open letter to US Secretary of State, September 14, 2010 [Sign-on]
- Public Health Response: Request for Public Comment on the Scope of Viewpoints Represented on the Industry Trade Advisory Committees, letter to the United States Trade Representative Department of Commerce, May 25, 2010 [Sign-on]
- Public Health Call for Representation on Trade Advisory Committees, letter to former United States Trade Representative Ron Kirk and Department of Commerce Secretary Gary Locke, December 2, 2010 [Sign-on]
- Please Co-Sponsor HR 2293, The Public Health Trade Advisory Committee Act, letter to the US Congress, 2009 [Sign-on]
- Currency Transaction Levy Sign-on, letter to US lawmakers, September 14, 2009 [Sign-on]
- Letter to President Obama G-20 Summit, letter to the Obama Administration, March 30, 2009 [Sign-on]
- Preconditioning Gold Sales on Reform of IMF Policy in Developing Countries, letter to the Executive Director to the IMF, October 8, 2008 [Sign-on]
- A Civil Society Call for IMF Policy Reform, letter to the IMF, November 11, 2008 [Sign-on]
Statements & Publications
- NGOs, austerity, and universal health coverage in Mozambique, Global Health, 2019 [Publication]
- Austerity and the “sector-wide approach” to health: The Mozambique Experience, Soc Sci Med, 2017 [Publication]
- Mozambique’s Debt and the International Monetary Fund’s Influence on Poverty, Education, and Health, Int J Health Serv, 2016 [Publication]
- A Novel Method for Verifying War Mortality while Estimating Iraqi Deaths for the Iran-Iraq War through Operation Desert Storm (1980-1993), PLoS One, 2016 [Publication]
- An Anthropology of Aid in Africa, Lancet, 2015 [Publication]
- The IMF’s role in the Ebola outbreak: The long-term consequences of structural adjustment, Bretton Woods Observer, 2015 [Op-Ed]
- Health and Justice in a Time of Austerity, AJPH, 2015 [Op-Ed]
- The role of nonphysician clinicians in the rapid expansion of HIV care in Mozambique, J Acquir Immune Defic Syndr, 2009 [Publication]
- International NGOs in the Mozambique health sector: the” velvet glove” of privatization, Unhealthy Health Policy, 2004 [Publication]
Op-Eds, News & Events
- Coronavirus Vaccines: Waive Patents, Share Know-HowThe Seattle Times, 2021 [Letter to the Editor]
- What caused the West African Ebola outbreak? Healio: Infectious Disease News, 2017 [Op-Ed]
WHO WE FIGHT ALONGSIDE
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Our mission is to promote policies and support programs that strengthen government primary health care and foster social, economic, and health equity for all. Our vision is a just world that promotes health and well-being, including universal access to quality health care.
Health Alliance International began in 1987 as a US-based international solidarity organization committed to supporting the public sector provision of health care for all. Over 35 years, HAI conducted programs in 17 countries, with flagship programs in Mozambique, Côte d'Ivoire, and Timor-Leste.
In line with HAI’s commitment to support and strengthen local public health leadership, as of October 2021, HAI fully transitioned global operations and active programs to locally-based, locally-led NGOs. Learn more about this shift toward local autonomy and equity in global health.