Questioning the Solution: The Politics of Primary Health Care and Child Survival

Part One Makes the argument that scientific medicine as practiced today is well-suited as an instrument for furthering the ends of the West in the Third World. .... The authors describe how the implementation of the Alma Ata Declaration was progressively diluted in practice, from "Comprehensive PHC" to "Selective PHC" to a small set of specific medical interventions, until in some places it consisted only of distributing oral rehydration treatment (ORT) packets to treat dehydration from diarrhea, plainly not a long-term solution. The authors challenge the following concepts which typically surface in the philosophy of organizations such as WHO and UNICEF which are sponsored by powerful conservative entities: 1) technological solutions to fundamentally social problems 2) survival alone is a sufficient goal, in practice (i.e., 'quality of life would be ideal, of course, but that's unrealistic') 3) if we can educate the natives on the basics of nutrition and sanitation, and if they can change their ways, they'd be all right 4) UNICEF's shift from bottom-up to top-down approaches 5) "social marketing" is a viable approach, which serves economic as well as public health goals. (where "social marketing" is the mass-marketing, using conventional advertising techniques, of ostensibly beneficial goods such such as ORT packets, typically imported from the West or profiting its domestic representatives) Part Two A detailed expansion of the above points with regard to a specific intervention, ORT, as well as a lot of grounding detail on the specifics of its application and functioning, down to the level of the physiology of its absorption. Part Three Criticism of World Bank Structural Readjustment Policies .... Examines the behavior of "killer industries" - infant formula industry, pharmaceuticals, and arms industry. Examines the effects of US-style approach to health care and social equity within the US itself. Looks at alternatives in Cuba and Guyana. Argues that social equity is the real solution to population growth and AIDS. Part Four Examines markedly successful approaches to health care based on social change. Presents examples from Mozambique, Zimbabwe, Mexico, and Nicaragua. Notes that efforts in all four countries have been seriously or completely derailed through intervention by the US, which is concerned that a functioning alternative will upset the current status quo by which it maintains profits and security. The book closes with a call for a united front of grassroots efforts, and offers suggestions for teachers, writers, health workers, activists, concerned citizens.