็Health Governance for whom
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Promoting good governance concepts without due consideration of social equity might lead to widening social gaps.
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็Health Governance for whom
- 1. Politicized collective decision • Empowering community /citizen • Organized decision-making towards shared social goals • Demands an opening of government processes to greater and more real-time forms of public input Neoliberal concept • Pro-privatization • Limit government actions • Leading to disequalizing economic Governance for whom Transparency Participation Accountability Resource mobilization 1/4/2015 1P Suriyawongpaisal
- 2. Economic growth State building legitimacy Social mobilization democracy Rule of law Globalization : trade, politics, culture, oversea aids Francis Fukuyama 2011 1/4/2015 2P Suriyawongpaisal
- 3. 1. Equitable access to other social determinants of health(SDH) 2. Single-payer Health Care financing 3. Invest heavily in public programs 4. Improving Primary Health Care PAY THE EQUITY PREMIUM Ronald Labonté 2010 1/4/2015 3P Suriyawongpaisal
- 4. H system role Implications Selected Thai experiences • Educator/watchdog Avoid victim blaming • Anti smoking movement • Anti alcohol movement • Pluralistic media • Resource broker • Community developer • Avoid “ice-cream” sharing • Strengthen community actions • Tumbon h fund • Chevron case study • Partnership developer Engage non h sector • Asbestos ban • Inner Bkk bike lane • Advocate/catalyst Influence policy process on SDH • ThaiHealth • Folk Doctor Foundation H system roles in actions on SDH 1/4/2015 4P Suriyawongpaisal
- 5. Interactive elements of Governance should be guided by social equity goals and balanced of power Transparency Participation Accountability Resource mobilization 1/4/2015 5P Suriyawongpaisal
Editor's Notes
- Good governance usually means different things to different proponents of this term. On one hand, GG advocated by WB using neoliberal concept or new public management concept was considered gearing policy decision towards the direction of pro-privatization, limiting government actions and leading to disequalizing economic i.e., widening the social gaps locally and globally. On the other hand, GG is considered a means towards empowering community and citizen to get organized in policy-decision making towards shared social goals. This requires opening government processes to greater and more real-time public input. As a result, GG in this sense favors closing the social gaps, locally and globally. Without an awareness of such different perspectives of GG, any attempts to promote GG taking account of seemingly common elements (transparency, participation, accountability and resource mobilization) across diverse groups of proponents might not ensure equity in social and economic development. Failure to do so might jeopardize legitimacy of the state and its mechanisms leading to social chaos.
- For illustration, perhaps comparing historical development between Thailand and S.Korea may shed some light on the legitimacy concern. Starting probably at the same stage of agriculture based society as Thailand, S. Korea transformed from military dominant state to electoral democratic society with more steady and strong economic growth among OECD countries. According to Fukuyama analysis, Kwangju massacre in 1980 was a turning point replacing military rule with legitimate electoral democracy and rule of law through social mobilization of new forces comprising: trade unions, church groups, university students and other civil society groups. The new forces are a product of industrialization leading to economic growth after the Korean war. More or less, Thailand follows the same path of industrialization, economic growth and emergence of the new forces. Yet, today there is still a concern of Thailand getting stuck in the middle-income trap along with widening social gap. In political sense, Thailand has swung back and forth between electoral democratic and military dominant state during the last decade as evidence by a series of political chaos since the Asian Economic Crisis. Thailand struggle in socio-economic-political development highlights a need for legitimacy of the elements shown in this slide.
- Based on the comparison, I wish to argue that a high priority goal of h system development in Thailand and probably many other countries is the need to pay the equity premium advocated by Labonte. This constitutes equitable access to SDH other than h care; heavy investment in public programs such as housing, public transport, education; improving PHC and single-payer hc financing. So far it is evidence that Thailand has made a remarkable progress in establishing publicly financed universal h care coverage. Similar progress was also documented in tobacco control, a key risk factor for NCD. Exploratory research on the progress in these 2 areas revealed a necessity for h system role in social mobilization to put in place rule of law.
- Social mobilization may include the 5 overlapping dimensions of h system role in addressing SDH proposed by Labonte shown in this slide. Here let me share with you a few examples for illustration of the idea. Adherence to the principle of avoidance of victim blaming led the movements on tobacco and alcohol control in Thailand to mobilize public support of relevant and comprehensive legislations. The movements were made possible through h worker engagement with the conventional mass media and online social media. Allocation of budget for community-based h promotion and disease prevention at sub-district level using tumbon h fund is an example of a h care financing agency taking the role of resource broker to bypass the bureaucracy hence succeeded in overcoming the so-called ice-cream sharing phenomenon which siphons public money into the pockets of corrupted bureaucrats. In energy sector, centralized policy directives usually favor trans-national projects deemed a major threat to the well-being of local people in terms of displacement, job loss, breakdown of social bonds etc. Recently, an alliance of local community leaders, autonomous h agencies, Green Peace, and academicians succeeded in strengthening concerted community actions against a mega project proposed by Chevron to set up an on-shore operating plant involving modification of the coastline for deep sea vessels. The actions included an assessment of environmental and social impacts of the project to counteract the company sponsored EIA report, organized social events to raise public awareness of the potential adverse impacts of the project and disclosure of vote-buying practices to support the project etc. Through partnership with selected cement industry, civil society and academics locally and oversea, a series of public demonstrations and mass media campaigns have been launched and gained MOPH commitment to push for a policy decision banning use of asbestos in all relevant industries.
- I hope that those selected Thai experiences help demonstrating how h system might engage in social mobilization to address SDH for equity in socio-economic development. Through a GG lens, successful social mobilization depends on and influences: transparency in public policy processes at all levels; well-organized broad-based participation not only thru representation but also exercising voices and choices; accountability of public agencies and the state in establishing and enforcing sensible rule of law Finally resource mobilization to disproportionately favor the disadvantaged since they lack behind since the beginning of their lives. To assume this role, h workers might need to consider themselves not only a professional but also a citizen of the society.