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The tsunami tragedy brings the world's attention to a disaster that, unfortunately, has been in the making for decades. Poor infrastructure and the policies of international financial institutions like the World Bank have ensured that this natural calamity would become a public health nightmare.
Though the earthquake and tidal waves destroyed some water sanitation systems, the tragic fact is that millions of people in this region of the world die regularly from water-borne infectious diseases.
International financial institutions contribute to this public health crisis in two ways.
First, their penchant for water privatization restricts access for the most vulnerable communities. The World Bank and International Monetary Fund's so-called Poverty Reduction Strategy Initiatives force developing countries to adopt "structural adjustment program" policies.
Overall, loans to the poorest countries are designed to enable the repayment of older debts to commercial banks, governments and a variety of official lenders. These policies distort economic priorities in developing countries and tend to undermine social sector spending for education, health care and other services and subsidies.
Interestingly, the countries devastated by the tsunami receiving attention for clean water distribution relief efforts are also embroiled in water privatization controversies.
· Proposed water services reform legislation in Sri Lanka met opposition in December 2003 from a powerful coalition of non-governmental organizations that contended that private control over water distribution would deny basic survival requirements to the country's poor.
· In Indonesia, a $300-million World Bank loan relies on continued privatization despite bad experiences in Jakarta, where water is of poor quality, service unreliable, and unaffordable connection charges discriminate against poor communities.
· In India, the World Bank-funded private sector programs effectively make it impossible for the poor to access water.
While the recent tsunami seriously exacerbated the problem of water and sanitation management in South Asia, access to clean water is denied to the region's majority on a daily basis.
Second, pressure from powerful countries and transnational corporations also threatens public health in Asia by pressuring governments to repeal progressive health care policies. For example, U.S. and European transnational pharmaceutical corporations and governments are lobbying India to forgo protections for public health available to it under the WTO's Trade-Related Intellectual Property Rights (TRIPS) agreement.
Under pressure, India is revising its Patents Act, which covers medicines, chemicals and food.
Health GAP, an organization that fights for the rights of people with HIV, warns that the world's supply of new affordable generic medicines will basically disappear when India implements these changes: "In the case of anti-retroviral medicines to treat HIV, Indian generic production has slashed prices by as much as 98 per cent - from approximately $10,000 per year (per person) to as little as $140 per year for an initial three-drug combination."
Likewise, the drugs for treating the water-borne diseases that may further devastate the region in the coming weeks are also on the table.
In addition, international financial institutions often advise borrowing governments to institute "cost recovery" for public services. Not only are budget cuts made in allocations to the health sector, but user fees further reduce the poor's access to health care.
Fortunately, on January 2, World Bank president James Wolfensohn reported that his agency could increase the $250 million pledged for regional reconstruction and would also look into debt relief for the poor nations worst affected by the disaster. This pledge, part of the $3 billion (and counting) promised by governments worldwide in the world's largest relief operation since the second world war, and the generous outpouring of private charity are certainly commendable. Yet more is needed.
Institutional change needs to occur within the World Bank, Asian Development Bank and other official lenders to ensure that governments can provide social services without prioritizing debt and finances above their people's health and survival. Once the televisions and newspapers stop covering the recent wreckage, the millions who will continue to die from preventable disease and without access to clean, safe drinking water must not be forgotten.