The Dearth Of Waters

I'm on the road today, on a trip to a jobsite inspection. I have just driven down from Portland to the coast, beneath a doomy, portentious sky lying like a blanket over hills soaked by rain, whipped by strong winds, and clothed with trees turning color. But my mind was entertaining a very different image as I drove.

It was a vision of a formerly green, well-watered valley, now become a parched, cracked landscape beneath a sky of brass in which hung a merciless sun. The land was littered with signs of a former prosperity and fertility that had evaporated away – plantings of trees now dead from drought, a few empty shells of decrepit buildings suggestive of a ghost town, skeletons picked clean, and a desperate, humbled mass of gaunt survivors now trying to figure out how to come to peace with their altered surroundings, that they might somehow live.

Yet their efforts were being thwarted by a small group of extremely wealthy people – the very people who had drained the valley of its life-giving water. For as the valley was being exhausted of its water, the drainers of the valley were sending their agents to seize the stored and hoarded water of the poor survivors. But not even this was enough to satisfy the exponentially increasing thirst of the rich. Thus they began even to seize the survivors to feed them into a giant machine in order to suck the moisture out of their bodies. The machine had several names. Two of its names were “Corporatocracy” and “Crony Capitalism.” Those who passed through this machine were spit back onto the landscape like so much human jerky.

Maybe it's a hokey image (a novelist I am not!). But I think it fits the economic news I've been reading lately. This week, the Oregonian newspaper is running a series on the housing and foreclosure crisis. One of their stories talks about a couple who owned three houses during the height of the real estate boom, yet is now reduced to sharing a condo with a relative and taking food stamps. While it is certainly possible to find fault with this couple for over-reaching, the article makes the telling point that the (really big) banks are getting all kinds of help from the Federal Government (really, that's us taxpayers), while the banks are giving absolutely no help to the average debtor. The Oregonian article also describes the plight of many other people who were not over-extended, yet got into trouble because of the present economic downturn, and who were given no help by the banks.

There's also a blog I recently discovered, called The Automatic Earth, which talks about how out of 4 million home mortgages in trouble so far, only around 1700 have been permanently modified under the Federal mortgage rescue program. Yet the banks were given $75 billion to help rescue distressed homeowners. (You can read more here: Don't audit the Fed, pull the rug) Lastly, I have noticed that people are finally starting to get angry about the medical insurance “industry's” attempt to force the Federal government to define “health care reform” as “forcing everyone to buy private insurance.” Many more people need to get angry, and to let their anger be known. Otherwise, we'll all be sucked dry.

But now, speaking of literal water, I have noticed that my post, The "Congress Created Dust Bowl", seems to be a bit more popular than I expected it to be. Thanks to all of you who have read and commented on it. I mention this post because of a conversation I had with a co-worker a couple of weeks ago. He talked disparagingly about how “the Federal Government is interfering with economic growth by cutting off water to California central valley farmers!” Of course, he knows my views and he was trying to get a reaction out of me.

I mentioned to him that there was a sea in the Soviet Union which the Soviet government ruined in order to promote economic growth in a certain region. Basically, they pumped the sea nearly dry over a period of a few decades. Unfortunately, I couldn't remember the name of the sea during my conversation (although the mention of this event did silence my co-worker). But now I remember: it's the Aral Sea. The Wikipedia article on the Aral Sea shows how much it has shrunk since the 1960's, and describes the corresponding ecological damage:

• The Aral Sea fishing industry, which at one time produced one-sixth of the Soviet Union's entire fish catch, has been wiped out.

• The muskrat population in some of the adjoining deltas has been wiped out.

• The sea has shrunk to ten percent of its original size and is now nearly three times as salty as the ocean.

• The dry plains left by the sea's disappearance are covered with salt and toxic chemicals, which are blown onto neighboring populations via dust storms. This has led to high rates of certain cancers and lung diseases.

These are just some of the effects of human stupidity and greed in that part of the world. Could the people demanding more irrigation water from the Sacramento River do the same thing to that river that was done to the Aral Sea?

Answering that question would not be very difficult. One would only need to know how much water was being diverted for farming, how it was being altered, and the likely effect of the diversion and altering (pollution) of the water on the river and its ecosystems. But that doesn't seem like the sort of science project that would interest Fox News or the people putting up the “Congress Created Dust Bowl” signs.

An Inmate's View Of Federal Prison

As I have written before, we live and function in an official economy which is run by a very small group of very rich people. Their goal is the continued growth of their profits; yet because of emerging constraints on the earth's natural resources, the rich can no longer grow their profits by unlimited industrial expansion. Increasingly, the only way for the rich to maintain or grow their profits is by robbing the poor.

One way of robbing the poor is by depriving them of their liberty and turning them into extremely cheap slave labor. I discussed this in an earlier post, The Replacement of Petroleum Slaves, which described how the state and Federal prison systems of the United States were being turned into a pool of slave labor with the potential to replace cheap foreign labor for industry in the event of a breakdown of globalism. In this present post, I will expand a bit on that theme, based on some confirming information I received relatively recently.

Several weeks ago I was introduced to a person who had been incarcerated in a Federal prison in the American Southwest around decade ago. I had heard something of his background before we met, and I also had an extensive body of knowledge regarding the prison-industrial complex in various American state prison systems. I wanted to see if my conclusions also applied to the Federal system, so we did an interview.

He told me that there is most definitely a “prison industry” at the Federal level, named UNICOR, also known as Federal Prison Industries. UNICOR is a “wholly owned government corporation created in 1934,” shortly after the creation of the Federal Bureau of Prisons. (Source: Federal Prison Industries, Inc. - Wikipedia) UNICOR produces goods and services from the labor of inmates of the United States Federal Bureau of Prisons. According to Federal law, UNICOR is ostensibly restricted to selling its products and services to Federal government agencies, and cannot sell to the commercial market. (More on that later.)

UNICOR produces many products, including clothing, textiles, electronics, and office furniture. My former inmate acquaintance mentioned that UNICOR's labor rates were cheaper than Chinese labor, and said that back when he was in prison, an inmate earned between 11 cents and 26 cents an hour. He also informed me that UNICOR is publicly traded – thus capable of being influenced by the profit motive.

This profit motive, and the opportunity to use the Federal prison system as an instrument of private profit, has had a predictable effect: Federal prisons try as hard as possible to find excuses to keep inmates imprisoned for as long as possible, since all able-bodied inmates who are not security risks are required to work in prison, either for UNICOR or to support prison operations. Also, according to this former inmate, many people sent to Federal prison are framed, including a highly disproportionate number of minorities. Those who are framed are easy for the other inmates to spot, because in conversation it soon becomes obvious that these people do not know how to commit a crime. Native Americans accused of crimes are predominantly judged under Federal law which is much harsher than state laws, and leads to much harsher sentences.

According to my interviewee, prisoners working for UNICOR are not provided with many of the worker safeguards common in private industry. He told me of times where he and other inmates had to dispose of or recycle old electric power transformers containing PCB's, without any protective clothing or safety measures. (By the way, this statement about inadequate worker safety is corroborated by other sources, such as “UNICOR Continues To Use Prisoners To Recycle Electronics,” The Real Cost Of Prisons Weblog, 20 April 2009; and “Prisoners and Workers Poisoned By Prison Recycling at UNICOR Are Suing,” The Real Cost Of Prisons Weblog, 11 August 2009.)

As for prison culture, my interviewee told me that gangs are largely in control at the various prison units, except for the maximum security units. However, the prison guards regularly try to instigate trouble between prison gangs. We discussed the impact of prison culture on the broader American culture. At this point, the interviewee was joined by his spouse, who talked about how with many people from minority neighborhoods being singled out for lockup, the culture and families in these neighborhoods were being ruined. Children in these neighborhoods were now being conditioned to grow up as criminals, due to corrupt and excessive application of police “enforcement” in the places where these children live.

This led to a discussion of ways in which minority culture could be repaired in the United States. My interviewee had two immediate suggestions: first, get rid of mandatory sentencing laws for non-violent crimes; and second, stop the American “war on drugs” as it is now being waged. The interviewee's spouse had suggestions for how concerned and caring volunteers could go into minority neighborhoods to provide exposure to opportunities for learning that would not otherwise be available.

For me, this interview was yet another confirmation of the deliberate breaking of poor neighborhoods and minority communities by the dominant holders of power and wealth in the U.S. It was also a confirmation of the corroding, corrupting nature and effect of growth capitalism. Truly, “the love of money is root of all the evils.” (1 Timothy 6:10) In research that I did following this interview, I found more information on UNICOR's status as a publicly traded company, as well as the efforts of state prison systems to imitate UNICOR. Here are some links:

• ““Private Prison Industry” Experiences Boom,” Leslie Berenstein, Copley News Service, 11 May 2008. This describes the public trading of UNICOR stock, among other things.

• “Dr Boyce: How Companies Make Money off Prisoners,” BLACKVOICES, 28 July 2009.

• “SLAVERY ON THE NEW PLANTATION - Hugo Pinell,” Kiilu Nyasha, December 2006.

• “UNICOR VI (GSB: DCDave's Column),” a page of footnotes accompanying a longer article on UNICOR. Note 6 is troubling, as it hints that UNICOR may be selling its goods to private parties in addition to the Federal Government, in violation of Federal law.

• “Beyond the Prison Industrial Complex: Class warfare from above,” Michael Parenti, Covert Action Quarterly, 29 August 2001. This article gives a slightly different view of the possible motives behind the recent expansion of the prison-industrial complex.

• “Workin' for the Man,” Nora Callahan, The November Coalition

One last note. We live in a time of severe economic distress, with falling tax revenues at the State and Federal levels, and states that are unable to balance their budgets. Yet you can just bet that next year, in states where the private prison industry or the prison-industrial complex has gained a foothold, there will be lobbyists pushing for an expansion of harsh mandatory sentencing laws for non-violent crimes – even though there's no longer any money to enforce such laws. I think of the mess these people have already made in California, or of the mess that people like Bill Sizemore and Kevin Mannix would like to make in Oregon.

A Fight Among Cannibals

We live and function in an “official” economy which is run by a very small group of very rich people. Their goal is continued economic “growth”, yet what that really means is continued growth of their profits. In the days before the present limits on the resource base of the global industrial economy, this growth could be achieved by industrial expansion. But now that our natural resource base has become constrained, the growth of the profits of the rich increasingly comes only by the robbing of the poor.

A prime example of this is the big ongoing Congressional song-and-dance over health care “reform.” It should be fairly obvious that universal health care is not the same as universal health “insurance.” The Congress could have aimed for universal health care for all Americans, regardless of income. The money spent on bailing out the banks and Wall Street could easily have covered the cost of universal health care. The money spent on the Iraq war could easily have covered universal health care. Even under our present arrangement, there would have been lots of change left over. And the elimination of the private insurance “industry”, combined with Federal prohibitions on unjust medical price inflation by pharmaceutical companies and hospitals would have made our care just that much more affordable.

That sort of genuine reform was never seriously attempted by anyone in Congress or the Executive Branch. The medical industry was too strong, having grown to 1/8^th of the total U.S. economy, according to this source: Health Care Reform: Problems for Human Health. The best our leaders could come up with was a proposal for a Government-run insurance plan that would have competed with private insurance companies. Private insurers are at present hideously expensive, with rates that rose at an annual rate of up to 13 percent in 2002 and 2003, and are rising at a rate of five percent per year now. The private insurers were deathly afraid of the mere possibility of Government-backed insurance, let alone genuine health care reform, and worked hard to kill this option, in a Senate Finance Committee vote which took place last week.

The Senate Finance Committee has therefore settled on a “reform” plan that would force all Americans to buy private health insurance by 2013. This plan is a “compromise” worked out by Democrats in order to appeal to Republicans who were afraid of the “Government spending taxpayer money to support socialism!!!” However, under this plan, ordinary Americans would be forced to spend:

• up to 13 percent of yearly (pre-tax) income for a family of four making up to $88,000 a year;

• over $700 a month for a family of four making $66,000 a year;

• and a tax penalty of up to $1500 a year for those who refuse to buy health insurance and whose earnings are less than 300 percent of the poverty level, and $3800 a year for those who refuse to buy health insurance and whose earnings are greater than 300 percent of the poverty level. (Source: “Reform Bill Will Address GOP Fears,” Washington Post, 15 September 2009)

And our leaders call this “fixing health care”?!

I wonder now...so many families are now heavily indebted, having been tricked into buying overpriced houses and overpriced cars, having had to make ends meet with stagnant or declining real wages while the prices of basics like food, gasoline and utilities continue to rise. So many students have been drawn heavily into debt to attend colleges whose tuition continues to rise at a rate far outpacing general inflation. So many people are now either laid off or are on involuntary part-time schedules. So many small business owners have been given the business by this present “recession” that has put them out of business. The only green shoots one sees in the vicinity of many empty and boarded-up strip mall lease spaces are the shoots of weeds rising through the cracks in the pavement. And I do see a lot more people in raggedy clothes next to freeway off-ramps, holding up signs saying something like “Please give. Anything helps. God bless!”

Is the Government going to force these people to spend $700 a month on private health insurance? Is the Government going to hit these people with a $1500 or $3800 a year tax burden if they don't buy insurance? And what kind of insurance would they buy? The insurance lobby and their Republican sock puppets would propose making insurance “affordable” by offering plans with high deductibles in order to “keep costs down.” So that means that Americans are forced to give money to private insurers, and that they get almost nothing in return? If you buy one of these plans, does that mean that eighty or ninety percent of the cost of a doctor's visit is not covered by insurance? That's like getting into an airplane and being handed a parachute the size of a handkerchief. It won't slow you down much, will it?!

Now people like Glenn Beck and the Tea Party organizers claim to be fighting for the American taxpayer. Why are they not protesting this plan to force Americans to buy private health insurance? Why isn't Fox News protesting this? Why isn't Sarah Palin outraged over this? Are the Tea Partyers all “partied-out”? Or are they on the side of the enemy, after all? And why are both Democrats and Republicans helping the insurance “industry” to rape ordinary Americans?

For a rape it is, or to use another metaphor, it is a cannibal feast. Ordinary Americans have now been reduced to little more than a pile of body parts and limbs, some of which have already been picked clean. The cannibals comprise a small group, yet among them are competing interests. Each representative of these interests wants as big a share as possible of the pile of body parts and limbs, because each competing interest wants to grow as fat as possible.

So we have the private prison lobby, which wants to grow rich locking up as many Americans as possible. But wait – if they do that, that will hurt the growth prospects of the real estate “industry,” who will not have anyone to buy their excessive housing inventory. But if people buy houses, and their wages don't rise, they won't be able to afford consumer electronics and cheap Chinese-made goods, and this would hurt Wal-Mart and other big chain stores. Now the medical/insurance complex wants its share of the cannibal feast – “hey, let's extort $700 a month from every American family to fatten ourselves!” But that will mean that people don't have money anymore to go to Starbucks or to keep their cable TV subscriptions, or to buy new cars, or to buy stocks, etc.

What to do, what to do? How will the competing cannibals sort it all out? I don't know. Perhaps they will all get into a fight with each other, killing each other off and leaving the rest of us alone. I have to confess that I would enjoy seeing such an outcome. Lord, forgive me.

Meanwhile, if you want to see an example of genuine citizen rage and not some store-bought Tea Party astroturf purchased by rich lobbyists, here's a link to a YouTube video of a woman delivering a few words to Bank of America. I must warn you that her language is not family-friendly. Yet I say “Amen” to her message. Here's the link: http://www.youtube.com/watch?v=jGC1mCS4OVo

Where There Is No Doctor (Because You Can't Afford One)

Much of this blog has focused on the ongoing economic collapse in the United States, and the warped economic arrangements that prevent ordinary people of small means from becoming resilient in the face of that collapse. American health care is just one aspect of these warped arrangements. Because health care in America is provided by a private “industry” that demands ever-increasing profits, the cost of American health care has become an ever-more-weighty and insupportable elephant on the backs of ordinary people.

Of course, this has led to the widespread suffering of ordinary people, and has generated much attention from politicians who have promised to “reform” the system. Genuine health care reform would consist of transforming American health care from a growth industry to the providing of an essential service, in all likelihood administered by the Government because of the proven untrustworthiness and selfishness of the private sector. Unfortunately, our leaders in government seem utterly unable to come to this conclusion. The best they can do is talk about providing universal health insurance (which is not the same as universal health care) to all American citizens. Their so-called “public option” would consist of a Government-run insurance program that would compete against private health insurance providers. This last week, the Finance Committee of the United States Senate voted twice to reject this “public option.” As things now stand, therefore, we ordinary people are about to be left once again at the mercy of the health care industry and its adjuncts, the pharmaceutical industry and the insurance “industry.”

But there is another option available. It is a “public” option, though it does not depend on the Government for its implementation. Who is responsible for implementing it? You are, dear reader. Today, let's talk again about citizens building a safety net of alternative systems for themselves. I must warn you that the steps of building a citizen-created health care safety net will be somewhat challenging. Some study and hard work will be required. But I have no doubt that many people will be sufficiently motivated for the task, once they find themselves thrown out of work by the present economic contraction. When their unemployment checks total less than $1300 a month and they are faced with COBRA payments of almost $1100 a month, that will be a real kick in the pants! (Source: COBRA Premiums for Family Health Coverage Consume 84 Percent of Unemployment Benefits)

By the way, health insurance payments have risen over 131 percent from 1999 to the present. COBRA payments in some states now exceed the size of mortgage payments on small to mid-sized houses. (Sources: Health Inflation Slows as Economy Tumbles, KFF Reports, and Insurance Premiums Still Rising Faster Than Inflation and Wages.) Thus, one other aim of my “public option” is that it would kill off the private health insurance “industry” in the U.S. if it were widely adopted. And that “industry” is ripe for the killing, if you ask me. (There is yet a third aim: to shut up all the "tea party" idiots now yelling about illegitimate birth certificates and "socialism!!!")

One caveat: I am not a doctor, but an engineer by training. I can't take someone's blood pressure or interpret what I would see if I stuck a tongue depressor into someone's mouth and told them to say “Ahh.” But I'd like to believe that I'm a somewhat competent systems thinker, and it seems to me that the health care problem is a systems problem with a systems solution. My proposed citizen-generated health care alternative therefore addresses three specific system concerns: preventive health care, infectious disease control and injury treatment.

Why these three concerns? What about degenerative diseases such as hypertension, Type 2 diabetes, osteoporosis, and so forth? I believe that a proper emphasis on preventive health care education and preventive health habits would greatly reduce the incidence of many degenerative diseases in the American population. If people took proper care of themselves and lived in unpolluted environments, the only threats to their health that they'd have to worry about would most likely be the threat of infectious illness and the threat of injury.

Preventive Health Care

Preventive health care consists of many elements that are already familiar to most of us, such as the development of healthy habits like eating right and exercise. If you see your body as a machine, it should be obvious that a properly maintained machine is less likely to break down in the first place. We need to learn to maintain ourselves.

Of course, part of that maintenance has to do with how we eat, and how much we eat. But another part of that maintenance consists of proper exercise. By this I don't mean the sort of “exercise” that's often sold at chain-store health clubs. I mean real, functional physical conditioning that enables people to do strenuous things without hurting themselves. My personal leanings are toward the Crossfit program (www.crossfit.com) and its teachers, although I don't agree with everything they say, and their classes are too expensive for me. (Also, I'm not quite as hardcore as they are.) But I like the fact that they encourage people to work hard, to develop functional capabilities that actually have some use, and that they are willing to train anyone for strength, from children to the elderly. By starting people off young and training them in a wide variety of fitness strategies, they help people build a solid foundation for maintained physical capability in later life, without worries about things like osteoporosis, injuries and other fractures, circulatory diseases, and diabetes.

Exercise should be a family affair. If you want strong, capable kids, you've got to work yourself to be strong and capable. I remember when I used to live in Southern California, that there was a horse/nature trail near my apartment. The trail head was right behind a County courthouse, and wound around past a medical office complex before ending again at a small man-made “lake” (a pond, really). Sometimes when I walked that trail, I would encounter a large family jogging past me. Usually their group consisted of several of the kids, the oldest of whom was in high school. But one time I think I saw the entire family – Dad, Mom and all the kids (they had many) running along in shorts and jogging shoes, with the youngest (who seemed to be around nine or ten years old) pounding along at the rear. That family was an inspiration and an example to me. May they be so to you also. So get off the couch, put out the cigarette, put down the sour-cream-and-chives potato chips, turn off the TV and start modeling some good behavior.

Dealing With Illness and Injuries

Last week's post, Communities of Healing Hands - The Hesperian Example, described the work of the Hesperian Foundation in developing simple, practical printed literature to teach untrained health care workers how to help sick and injured people. The writers of this literature strove to provide health care workers with tools that are uncomplicated, widely available, inexpensive, and easy to implement.

Ordinary Americans who want to free themselves from worry over possible medical emergencies should master this literature. As many people a hundred years ago knew how to treat a fracture, how to clear a boil, and how to deliver a baby, I think it's going to be necessary for many of us to re-learn skills like these if we don't want to be bankrupted by the medical “industry.” We are also going to have to learn to make our own medicines, and how to deal with infectious diseases. And we are going to have to learn to identify environmental factors that make people sick, and learn what to do about these.

As the Introduction to Where There Is No Doctor says, “...even where there are doctors, people can and should take the lead in their own health care...Health care is not only everyone's right, but everyone's responsibility...Informed self-care should be the main goal of any health program or activity...”

Educate, Practice and Agitate

It's time to educate ourselves, and to practice the techniques we learn through this education. Our goal should be to create community-based health care systems that work so well that we no longer need health “insurance” or special access to the overpriced products of the present health care “industry.”

If this goal appeals to you, then consider buying the Hesperian literature (or downloading it for free from their website). Start a reading/discussion circle to study this literature with friends, neighbors or co-workers. (At my job, we're going to kick off a study group for Where There Is No Doctor. Our first meeting is a week and a half from now.)

If you want an opportunity to practice what you learn, consider volunteering to provide basic health care services for the homeless, or at a local rescue mission. Document your efforts, along with any lessons learned, in a form such as a blog that allows a large audience to learn from what your doing. Try to analyze and measure the effectiveness of your efforts, and compare them to the results that would be provided by the standard American health care system.

As I have said, the Hesperian literature is written at a very basic level. But for those who want a more advanced theoretical background knowledge of health care, the Massachusetts Institute of Technology has provided online study materials for its Health Sciences and Technology curriculum under its Creative Commons-licensed OpenCourseWare. There are also many other sources of open-source or Creative Commons-licensed health care and health education information on the Web.

Lastly, we need to agitate. Where there are institutional, legal or political barriers to community-created health care, these must be publicized and those who create these barriers must be shamed. This is especially true where available cheap generic drugs are blocked from the market by powerful pharmaceutical interests and their political hired guns. I think of the way in which cheap Canadian generic drugs have been blocked from being imported to the U.S. by means of Congressional legislation. This legislation was especially ridiculous in 2006, when Republican congressmen argued that by banning the entry of cheap Canadian generics they were helping to protect the U.S. from terrorists! I wonder what drugs those Republicans had been taking...

Communities of Healing Hands - The Hesperian Example

In my last post, Making The World Sick, One Country At A Time, I stated some key facts to illustrate how the American health care system prevents ordinary citizens from achieving economic resilience and self-sufficiency by bleeding them dry. I also said that I don't really expect the U.S. Federal government to enact any serious health care reform of the kind that would lighten the financial burden on the backs of ordinary users of American health care. I then stated my opinion that over the next several years, American health care will probably come to resemble the care provided in many Third World countries. (By the way, there are signs that this is happening now.)

My post then explored the sort of care that is now provided in the Third World, as well as explaining the philosophy behind much of that care as embodied in the 1978 Alma Ata Declaration of the World Health Organization. I cited the concept of Primary Health Care (PHC) embodied in that Declaration, as “...essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford...”

I then described how rich First World entities such as the World Bank and International Monetary Fund have worked to weaken Primary Health Care in the developing world, how they have forced the governments of Third World countries to dismantle their government-provided social services, and how they have worked instead to force an American-style privatized system of health insurance coverage on the poor citizens of the developing world. This failure to achieve a universal good for the world's people has occurred because the attempt to achieve this good relied on national governments that were beholden to selfish, rich corporations and other holders of concentrated wealth.

Yet there are good examples of individuals and volunteer organizations banding together to create social safety nets, including basic affordable health care, in the Third World and in the poorer parts of the First World. These groups are often quite innovative, due to the limits on the resources at their disposal, and the work they do is worthy of high praise. In his paper, “The Life and Death of Primary Health Care,” David Werner makes mention of the good work of non-government, community-based health programs and the groups that administer them.

One such group deserves particular mention. The Hesperian Foundation (http://www.hesperian.org/), based in Berkeley, California, is a non-profit publisher of books and newsletters for community-based health care, as stated in the “About Us” section of their website. Their published information is developed in collaboration with formally-trained doctors, citizens of poor communities in the developing world, and untrained or informally trained health care workers in these communities. Their literature is very simply written and is designed for people without any formal medical training, and it not only covers the treatment of disease, but also covers the underlying social factors in building healthy communities. Their most well-known book is Where There Is No Doctor, a book that has almost become the Bible of primary health care in the developing world. Hesperian has also joined forces with the worldwide People's Health Movement to promote health for all and the widespread implementation of Primary Health Care as defined in the Alma Ata Declaration.

I recently had a chance to conduct an e-mail “interview” of the Hesperian staff, which I have included as part of this present post. My questions are written in bold type, and their answers to each question are shown immediately below that question. I would like to especially thank Hesperian staffer Ingrid Hawkinson for taking the time to reply to my e-mail inquiries and to collect all the answers to my questions. The approach set forth by the Hesperian Foundation could prove to be a vital part of the response by ordinary Americans to our present health care crisis.

In reading the “Our Philosophy” section of your website, it seems that you have incorporated all of the principles of the 1978 Alma Ata declaration of the World Health Organization. That declaration defined health as “...a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity...” and stated that health is a fundamental human right. It also went on to address the underlying societal factors that influence the health of a nation. Are you familiar with the Alma Ata Declaration, and was it an influence on your philosophy?

Yes, we are definitely familiar with the Alma Ata Declaration – we have spent the past 30 years building on the successful model of Where There Is No Doctor to create other resources that also help people discover not only the ways they can have equal access to health care, but to do so in a sustainable way that examines the social, economic, and political issues that not only block access, but make our communities unhealthy. In line with the Alma Ata Declaration, our mission is to achieve the right to health for all people.

If ordinary people put their heads together to examine their health problems, come up with solutions, and organize, so many issues will be addressed including the power balance, the state of the environment, our sense of wellbeing. . . The concept of “health” and the reasons behind poor health are woven into the fabric of our existence.

Your programs match the definition of “Primary Health Care” as stated in the Alma Ata Declaration. After that Declaration was issued, many rich First World nations protested that implementing this Primary Health Care would be too “expensive.” Yet you seem to be able to provide what rich First World governments could not. How do you do it?

What we do is very simple. We supply information that people can use in formats they can understand and easily share. Our books are developed collaboratively to ensure they make sense to the end user. Once this information is in people’s hands, they come up with solutions that work for them. So if, for instance, our readers don’t have money, our books help them figure out how to take care of their health using the resources available to them under the circumstances, and to prevent health problems before they become serious and costly.

One barrier to affordable health care is that there’s so much mysticism surrounding what doctors do. Yet the methods doctors use to diagnose and treat the most common and basic health problems are simple. In addition, the vast majority of medical information is available but not accessible. Typically, it is in dry, expensive textbooks full of elaborately constructed sentences; jargon confusing even to those studying medicine; and illustrations that depict illness rather than communicate ways for the viewer to visualize a concept or technique that will lead to its cure.

Another barrier is that many rich, first-world countries are run by governments supported by industries with a lot of money, such as the healthcare industry. And of course, if people could spend much less money on health care, they would. It’s not in the interests of governments to champion alternatives to the industries that supply their funding. Their argument -- that providing a single-payer program would be too expensive -- strikes those who are suffering right where it hurts: in their pocketbooks. The argument is illogical, yet it’s still somewhat effective because it weakens those who have the most potential to make change.

You have evolved a community-based, non-governmental approach to providing health and basic human services. Yet I am sure that you have interacted with governments in the nations where you work. Have you been able to collaborate easily with them? Are there any cases in which the relationship was strained or in which you faced opposition?

We are based in Berkeley, California, and we don’t provide health and human services – we produce materials to allow ordinary citizens to improve their health and organize for justice. We have an open copyright policy that encourages people to translate and adapt our books to suit their communities. Those who do adapt our materials negotiate with their own governments. We don’t normally work directly with other governments, though many large governmental health agencies use and distribute our materials.

Over the last two decades, the World Bank and International Monetary Fund have pushed many governments in the developing world to dismantle their social safety nets, including free health care. Have you ever encountered opposition or hindrances from the World Bank and IMF, or from First World governments, or from for-profit providers of Western medicine?

No, not that I know of.

What are some of your opinions about the present health-care reform debate in the United States?

Health care needs reforming, and as currently outlined in H.R. 676, with a single-payer system in which the government is the only health provider. In the United States, we could eliminate co-pays, deductibles, and employer contributions. At the same time, additional taxes would be added to individuals and employers (see the Healthcare-NOW website for a clear explanation of how H.R. 676 funding would work).

It is quite possible that the present recession will deepen, especially in the United States, while medical costs continue to escalate, and that there will be a sharp rise in the number of Americans without access to a doctor. If that happened, could individuals and communities in the U.S. implement the programs and approaches that the Hesperian Foundation has developed for the world's poorer countries? What would be the potential barriers and sources of opposition to such an approach?

Yes, absolutely, people in the United States could implement the approaches in our books, and some do already (people living on reservations, nurses, midwives, employees and volunteers at free clinics, travelers and sailors, professors of public health and environmental studies, ministers. . .). The only barrier is lack of knowledge and an unwillingness to change.

Is there anything you'd like to mention that I haven't covered?

• Most of our books are available for free download. We encourage you to print and share them.

• If anyone is willing to help us spread the word and spread health by posting a review, talking about our books on the radio, reviewing them in a magazine or newsletter, or by any other means, please contact Ingrid@hesperian.org.

• All profits from the sales of our books go towards printing, updating, revising, and creating more books, and also to our Gratis book program and Translations fund, both of which get health information into the hands of people around the world who might not otherwise have access to it.

• Give someone a present that really matters – send a gift of health to a poor community on behalf of a friend or loved one.

• We are currently working on a New Where There Is No Doctor for the 21^st Century, a new edition of HIV, Health and your Community, a Spanish translation of A Community Guide to Environmental Health, a Community Action for Women’s Health and Empowerment, and A Worker’s Guide to Health and Safety.

Making The World Sick, One Country At A Time

(Warning: this is a long post.)

The predicament that marks the probable end of our industrialized society has two stages. The stage most easily visualized by many of the first thinkers on this subject has its roots in the Limits To Growth scenarios first analyzed by the Club of Rome. Its most popularized images look like scenes from a dystopian science-fiction movie starring Charleton Heston or Will Smith or Mel Gibson or Harrison Ford – famine and the failure of technology; poisoned landscapes and cities with zombies running in the streets; “World of Warcraft” meets “Survivor” – in short, a “hard crash.”

However, there is a prior stage to the effects of resource scarcity: economic upheaval and contraction. The images that fit this are found in Dorothea Lange Depression-era photography; scenes from John Steinbeck's Grapes of Wrath; the Dust Bowl; tent cities; people losing jobs as the economy contracts; people being priced out of oil-based “necessities” as prices continues to increase; and people being thrown out of their homes, having their things repossessed and living under bridges due to “lack of sufficient funds.”

The second stage may be coming shortly, but the first stage is where we are now. The response to the onset of this first stage on the part of leaders in government and commerce by and large is as follows (there are, of course, exceptions): 1. A refusal to rearrange the social/political/economic systems under their control to make them more resilient in the face of the disruptions of Stage Two; and 2. A manic attempt to sustain their existing systems, which are unsustainable, and for which the writing is already on the wall. The leaders in government and commerce are now diverting all available public resources to this attempt to sustain the unsustainable.

Preparing for industrial and economic collapse in all its stages is therefore up to individual citizens. The captains of finance, economics and government will not institute the necessary changes, because such changes would reduce their power, prestige and access to wealth. This is why it's up to citizens. Yet the very nature and policies of the existing systems and their masters actively hinder the efforts of ordinary people to become resilient in the face of collapse. This hindrance comes either through government policies and laws that make resilience difficult, or through economic arrangements that bleed ordinary people dry so that they have no resources left for building resilience.

Such is the case with health care in the United States, that act of formerly selfless service embodied by the family doctors of decades ago and television doctors such as Dr Kildare, Ben Casey and Marcus Welby. This “service” has metastasized into a money-sucking “industry” so expensive that whereas the normal delivery of a live baby cost less than $100 in 1950, it now costs anywhere from $6000 to over $12000 today. According to one source, American national health spending is expected to reach $2.5 trillion in 2009, accounting for 17.6 percent of gross domestic product (GDP). Health expenditures are expected to increase at a rate of 6.2 percent per year from now to the year 2018, which is faster than even the most optimistic estimates of growth in GDP for this period. Part of the expense of American health care is due to exploding administrative costs. But there are other contributors, such as costs for prescription drugs that are rising at over twice the rate of inflation, cost increases for medical equipment and consumables, and inflation in employer-sponsored health insurance premiums which have risen at four times the rate of inflation during the past decade.

There's been much controversy this year over the possibility of Federally mandated health care reform. I really don't expect the Democratic or Republican Parties at any level of government to craft genuine reform of the sort that would lighten the economic burden for the recipients of that care. Some of our expectations regarding American “health care” may also be unrealistic, including the expectation that the Government can afford to pick up the tab for health care as it is currently practiced in the U.S. for all residents of the U.S. My suspicion is based not only on the unjustifiable rate of rise in American health care costs, but also on the fact that most of the wealth we could have devoted to equitable Government-backed health care and other safety nets has been squandered on covering the monetary losses of the rich. Our remaining tax revenues will largely be dedicated to servicing our large public debt, and the ability of our government at all levels to borrow additional money will shortly be severely curtailed.

I think it is also unrealistic for the masters of the health care “industry” - the doctors, hospitals, HMO's, insurance providers, drug companies and providers of medical technology – to expect that the system they have created can survive unbroken and unchallenged once almost no one but the rich can afford to use it. Already that system has priced 86.7 million Americans out of health care from 2007 to 2008. In 2008, at least 46.3 million Americans were without health insurance for a full year, according to the U.S. Census Bureau. In 2009 these numbers will only increase, due to the explosion of job losses, exhaustion of workers' unemployment benefits and continued escalation of insurance costs.

In short, I expect the nature and experience of health care to change drastically in the United States over the next several years. Increasingly, it will resemble the care provided in many Third World countries. Hopefully we will witness the adoption of some of the more beneficial and fair systems now operating in the Third World. Yet before we all rush to the countries of the developing world for inspiration and guidance, we need to see how the architects of the present American system of health care have attempted over the years to wreck viable, low-cost Third World alternatives. These attempts at wreckage were intended to protect and increase the revenue streams from the world's poorest people to the First World providers of expensive medical intervention and treatment.

The History of Western Medicine in the Third World

In his paper, “The Life And Death Of Primary Health Care,” David Werner writes that from colonial times until recent decades, the providing of Western medical service to the Third World was not equitable. The most expensive services were directed to the privileged, whereas health services directed at the “natives” were few, and were designed mainly to keep them healthy enough to work for the rich. But in the post-World War II era, there was a dawning awareness of health and health care as fundamental human rights. This led to efforts by rich countries to make Western medical practice more widely available in Third World countries.

However, this approach to expanded health care proved to be unsustainable, since Western medicine was too expensive even then for most Third World governments to widely support, or for indigenous peoples to use. This was partly due to the influence of budding multinational pharmaceutical corporations whose advertising induced a dependence on expensive treatments while eroding traditional forms of self-care. By the late 1970's it was widely recognized that the standard Western model of health care was failing in the developing world. This realization led to an international health care conference hosted by the World Health Organization in Almaty (formerly Alma-Ata) in the former Soviet Union in 1978.

Alma-Ata And Its Aftermath

The Alma-Ata Declaration of 1978 defined health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity...” This declaration set forth this health as a primary goal to which governments should strive, and deemed existing health inequalities to be unacceptable. In order to achieve the goal of universal health, the declaration proposed a “Primary Health Care” which was defined as “...essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford ...”

The implementation of this Primary Health Care was to involve all major elements of community life, such as sanitation, the provision of safe and healthy food, access to clean drinking water, housing and other basic needs. Very importantly, this implementation was to be community-based, “...requiring and promoting maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and...developing through appropriate education the ability of communities to participate ...”

The Alma Ata Declaration was revolutionary its emphasis on addressing the root factors of health and giving ordinary people more control over their health and lives. It proved to be too revolutionary for the heads of the governments of the First World, who systematically transformed Primary Health Care into merely another program for extending conventional Western, top-down health services into the Third World. This was accomplished by the promotion of “selective” Primary Health Care by donor countries; by the increased shifting of costs of Western medicine onto end users (ordinary poor people) via “Cost Recovery”; and the takeover of health and social policies of Third World governments by the World Bank and the International Monetary Fund (IMF), which enticed many countries into taking loans with ruinous repayment terms, then forced those debtor countries to dismantle their social safety nets as part of their repayment.

One word on “selective” Primary Health Care: one of its initiatives was the so-called “Child Survival Revolution” that focused on growth monitoring, oral rehydration therapy (ORT) (for diarrhea), breast-feeding and immunization. The approaches implemented in this “Revolution” favored expensive treatments sold by pharmaceutical corporations – especially the pre-mixed ORT packets that were pushed instead of homemade foods and liquids.

The gutting of Primary Health Care as a viable option, combined with the World Bank's forcing debtor countries to dismantle government-sponsored social safety nets, led to a deterioration of health in the developing world. In addition, the World Bank has insisted on privatization of services formerly provided by governments, and has been an active agent in expanding the role of private health insurance in Third World health care.

American-Style Health Insurance – Coming To A Country Near You

Private health insurance is a very fast-growing worldwide market. The insurance “industry” is especially interested in the developing world, where it grew more than twice as fast as in the First World from 1994 to 2004. The promotion of private health insurance is especially attractive to the Organisation for Economic Co-Operation and Development (OECD), an association of thirty nations, most of whom are the richest in the world, and whose member countries are home to the largest multinational insurance and investment firms. One OECD study notes the extensive penetration of private health insurance in Latin America, while discussing strategies such as subsidized coverage in order to boost penetration in East Asia. However, even the authors of that study admit that the introduction of private health insurance “...might also lead to cost escalation, a deterioration of public services, a reduction of the provision of preventive health care and a widening of the rich-poor divide in a country's medical system.”

Private health insurance is threatening to displace other options, partly through advertising that seeks to induce dissatisfaction with public health care, and partly through the promotion by the World Bank of so-called “free market” policies and privatization of social services in Third World countries. In fact, since 1993 the World Bank has pushed a view of Third World health care as simply a means of enhancing worker productivity for economic growth – a view that is very similar to the colonial view of the purpose of medicine in the Third World: to keep the natives healthy so they can work for the rich.

Conclusion

Because of the power held by the medical and insurance industries in the United States, I expect that the present attempts by our leaders to “reform” our health care system will turn out as badly as the attempt by the WHO to implement the Alma Ata Declaration. As that declaration was thwarted by the rich, I expect that our health care “reform” will also wind up as simply another means of moving money from the pockets of poor people into the coffers of the rich. Ah, but that's what our health care system is already...

Sources:

• “Health Insurance Costs,” National Coalition on Health Care, http://www.nchc.org/facts/cost.shtml

• “Paying The Price: The High Cost of Prescription Drugs For Uninsured Americans,” Maryland Public Interest Research Group, http://www.marylandpirg.org/home/reports/report-archives/health-care/health-care/paying-the-price-the-high-cost-of-prescription-drugs-for-uninsured-americans

• “Employer-Sponsored Health Insurance Erosion Continues, Will Likely Accelerate Through 2009,” Elise Gould, Economic Policy Institute, September 2009, http://www.epi.org/publications/entry/jobspicture_20090306/

• “The Life And Death Of Primary Health Care,” David Werner, International People's Health Council Global Summit, 1995, www.healthwrights.org/.../Life_and_Death_of_PHC-Global_Summit_Sweden.pdf

• “Health for All Beyond 2000: The Demise of the Alma-Ata Declaration And Primary Health Care in Developing Countries,” John Hall and Richard Taylor, The Medical Journal of Australia, 7 November 2002, http://www.mja.com.au/public/issues/178_01_060103/hal10723_fm.html

• “Declaration of Alma-Ata,” International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978, World Health Organization, www.who.int/hpr/NPH/docs/declaration_almaata.pdf

• “Rich Countries and World Bank Must Stop Pushing Privatized Health In Poor Countries,” OXFAM International, 12 February 2009, http://www.oxfam.org/en/pressroom/pressrelease/2009-02-12/rich-countries-world-bank-must-stop-pushing-privatized-health-to-poor

• “The IMF And The No User Fees Policy In Health,” Sandra Graham, Jamaica Observer, 15 August 2009, http://www.jamaicaobserver.com/columns/html/20090814T200000-0500_157495_OBS_THE_IMF_AND_THE_NO_USER_FEES_POLICY_IN_HEALTH_.asp

• “Private Health Insurance for the Poor in Developing Countries?”, Denis Drechsler and Johannes Jütting, OECD, August 2005

• “Is there a role for private health insurance in developing countries?”, Denis Drechsler and Johannes Jütting, German Institute for Economic Research, October 2005