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A minister of health
  1. J Breilh
  1. J Breilh, Health Research and Advisory Centre and Development Research Centre, Quito, Ecuador
  1. Correspondence to:
 Dr J Breilh;
 jbreilh{at}ceas.med.ec

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Should challenge trendy global corporatism

Regrettably it is in the so called “democracies” of the North and South where globalisation has become the scenario for market fundamentalism and an absurd race to the bottom, in which economical and social rights have been demolished and countries compete for, what will in fact, see the situation of first being the worst in human terms. The neoliberal state in those democracies has installed a process of social and cultural counter reform that deny equity in principle and in fact, consecrating a systematic violation of the codes that guarantee standards of life and dignity, which are the basis for health. Our societies have institutionalised a combination of subtle and cruel mechanisms to deprive people of means to develop their own identity and the best in their culture, turning, as such into oppressive and violent societies, with apparently democratic but essentially authoritarian governments. Cultural institutions are deteriorating, universities and educational centres are being converted in docile sources of functionalist formulas.

Under such conditions we have to mobilise all our efforts to recuperate the human and scientific nature of medicine and public health and to deconstruct the hegemonic models for research, teaching, and practice; models that conceal their lack of solidarity, imagination, and dreams, behind the shield of a variety of functionalist technologies.

The construction of a democratic process of health reform does not depend mainly on personal leadership, nor on the profile of a person that is placed at the head of a power structure, that is because good intentions and personal talent cannot revert the policies and strategies of that power structure. The reason why, with alarming repetitiveness, people with scarce talent, academic proficiency, and ethical links to their people reach leading posts of public offices, is not because the adequate profiles remain unknown, in contrast, the recruitment process of public officers and ministers, depends on political strategies that assess compliance of those officers to hegemonic policies and their willingness to accept the game rules of such power structure.

It is much more important to emphasise collective leadership and social organisation as means of health reform. The main problem resides in how to construct a parliamentary and participative process, through strategic planning, collective health monitoring, and social control of health practice and programmes. Only this way will it be possible to build up a health system based on equity (social, ethnical, and gender wise), solidarity, and collective quality monitoring. Voices from all over the world express the public demand for dismantlement of neoliberal policies, geared towards a lucrative, mercantile, and inequitable scheme of health distribution that have widened social, gender, and ethnical inequity. We must rescue our institutional expertise and the talent of health professionals for building a health system that reflects democracy and good quality of life in itself and holds straightforward human rights advocacy as fundamentals of prevention and health care.

It is time to revert that regressive “modernisation” and deconstruct the rigid and Cartesian perspective that has dominated the practical and theoretical health scenarios of care, prevention, teaching, and research, submerging us in a positivistic and techno-bureaucratic vision of science and technology; a vision that is now proposing that we erase all human meaning from health practice and convert it into an expensive merchandise, inaccessible by the vast majority of the developing world and even of the developed world.

Only under collective, well informed, leadership and only by organisational strengthening of the people and of their technical and academic allies, will we be able to implement socially equitable, high quality and universal health resources; and it is only towards that purpose, and inscribed under that logic that it makes sense to inquire about individual leader profiles; not only of health ministers, but of all health officers and leaders. Our experience is saturated by negative examples of notorious personalities—even some of democratic and well educated backgrounds—that once inserted in that power structure end up being more “holier than the Pope”, and end up using an alternative progressive lexicon, supposedly counterhegemonic, to disguise their truly neoliberal misdoings.

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