As the official West African death toll from the worst Ebola outbreak in recorded history nears 5,000, global concerns about the infectious disease continue to mount. Analysts and medical providers, from Liberia to the United States, say that in order to address the crisis, the international community must tackle the real culprit: western-driven economic policies defunding public health systems around the world, particularly in the countries hit hardest by the outbreak.
"The neoliberal economic model assassinated public infrastructure," said Emira Woods, a Liberia native and social impact director at ThoughtWorks, a technology firm committed to social and economic justice, in an interview with Common Dreams. "A crisis of the proportion we've seen since the beginning of the Ebola catastrophe shows this model has failed."
Gutting of West African Public Health Systems
Since the 1980s, western financial institutions have given loans to third world governments on the condition those states impose austere domestic reforms and roll back public services. This approach is encapsulated in the 1981 World Bank report Accelerated Development in Sub-Saharan Africa, which presses for "structural adjustments," including rapid privatization, shrinking of public services and subsidies, and a shift towards export dependency as a solution to "slow economic growth."
"In West Africa, the resulting neoliberal economic policies sought to promote growth and prosperity through structural adjustment programs (SAPs) that generally involved contraction of government services, renewed export orientation on crops or goods deemed to have a comparative advantage, privatization of parastatal organizations, removal or reduction of many subsidies and tariffs, and currency devaluations," explain Macalester College Professor William Moseley and colleagues in a paper for the journal Proceedings of the National Academy of Sciences of the United States of America.
"What you had was a shift of public expenditures from health care, school, and essential services to a model of economic development driven by the World bank and International Monetary Fund, which said that public service provision was not passage to development, and services should be privatized," said Woods. "There was this notion that poor people can pay, and services are better provided by the private sector."
While years of war played a role in weakening public systems, it is the "war against people, driven by international financial institutions" that is largely responsible for decimating the public health care system, eroding wages and conditions for health care workers, and fueling the crisis sweeping West Africa today, says Woods. "Over the past six months to a year there have been rolling health care worker strikes in country after country—Nigeria, Sierra Leone, and Liberia," said Woods. "Nurses and doctors are risking and losing their lives but don't have protective gear needed to serve patients and save their own lives. They are on the front lines and have not had their voices heard."
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Even the World Health Organization, which is tasked by the United Nations with directing international responses to epidemics, acknowledges the detrimental impact these policies have had on public health systems. "In health, SAPs affect both the supply of health services (by insisting on cuts in health spending) and the demand for health services (by reducing household income, thus leaving people with less money for health)," states the organization. "Studies have shown that SAPs policies have slowed down improvements in, or worsened, the health status of people in countries implementing them. The results reported include worse nutritional status of children, increased incidence of infectious diseases, and higher infant and maternal mortality rates."
A "Highly Vulnerable" World
Medical responders have criticized the international community for failing to aggressively address the crisis. In a press statement issued in late August, Brice de le Vingne, Doctors Without Borders director of operations, slammed western states for their isolationist policies towards the epidemic: "Self-protection is occupying the entire focus of states that have the expertise and resources to make a dramatic difference in the affected countries. They can do more, so why don’t they?"
The WHO has recently suffered severe budget cuts that have left it weakened, under-staffed, and incapable of adequately responding to the international emergency. "There’s no doubt we’ve not been as quick and as powerful as we might have been," Dr. Marie-Paule Kieny, a WHO assistant director general, told the New York Times in an article examining the cuts.
Critics say the de-funding of public health system within western states is putting populations at risk. Despite the efforts of the Centers for Disease Control and the Obama administration to assure the U.S. public of a robust response, nurses tell a different story. Workers with the union National Nurses United have repeatedly warned that the for-profit U.S. health care system is in fact ill-prepared for an Ebola outbreak, with U.S. hospitals lacking basic protocols, training, and protective gear.
Meanwhile, Woods warns, the U.S.'s militarized response to the Ebola crisis in West Africa—including Obama's authorization on Thursday for the Pentagon to deploy reserve and National Guard troops—raises serious concerns. "If you think about the costs of sending in the military compared to putting resources into nurses and doctors and rebuilding public health infrastructure that will last, U.S. tax payers should be really questioning the tax dollars being spent and what the long-term implications are."
"The world will remain highly vulnerable to this and similar outbreaks unless all countries prioritize the universal right to health, including the international obligation of rich countries to pay their fair share in ensuring that basic health capacity is available everywhere," the global justice organization U.S. Africa Network argues. "The failure to do so is a violation of human rights and our common humanity."