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Maintaining a Healthy Pacific

Maintaining a Healthy Pacific

How might PACER- Plus impact on the health of Pacific Island women?

Claire Slatter

How might PACER- Plus impact on the health of Pacific Island women?

Claire Slatter

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PACER PlusPACER Plus Primarily a free trade agreement Conceived (and is being pushed) by Australia

and NZ who stand to benefit most from it Aimed at liberalizing trade betw PICs & Aust &

NZ Primarily by reducing/eliminating tariffs & other

barriers to goods and services supplied by Australian and NZ companies and firms

Australia and NZ are expected to reciprocate by opening their markets to goods and services produced in the PICS

But trade balance is overwhelmingly in favour of Australia and NZ – likely to tip even further in their favour through PACER Plus

Primarily a free trade agreement Conceived (and is being pushed) by Australia

and NZ who stand to benefit most from it Aimed at liberalizing trade betw PICs & Aust &

NZ Primarily by reducing/eliminating tariffs & other

barriers to goods and services supplied by Australian and NZ companies and firms

Australia and NZ are expected to reciprocate by opening their markets to goods and services produced in the PICS

But trade balance is overwhelmingly in favour of Australia and NZ – likely to tip even further in their favour through PACER Plus

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Likely demands of Australia and NZ under PACER Plus

Likely demands of Australia and NZ under PACER Plus

Market access for goods produced by Australian and NZ companies

Market access for services supplied by Australian & NZ firms/companies (including in the health and education sectors)

Investment access (and access to other resource bases e.g. land, natural resources, capital)

Market access for goods produced by Australian and NZ companies

Market access for services supplied by Australian & NZ firms/companies (including in the health and education sectors)

Investment access (and access to other resource bases e.g. land, natural resources, capital)

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Current problems in PIC health systemsCurrent problems in PIC health systems Shortage of medical personnel

Globalization of health care Emigration of experienced medical personnel (Fiji, Samoa and

Tonga) –> Australian & NZ (Feb 2008 – 160 doctors reported by MoH to have left Fiji; 5 doctors in Nadi Hospital;

Labour migration of nurses (privately contracted, short-term, informal care work – open recruitment of nurses by agencies from Australia)

As many Fiji doctors and nurses working abroad as in Fiji Several studies/papers (Kelsey, Narsey, McClellan, Connell,

Naidu)

Triple burden of disease –communicable diseases, NCDs (diabetes, cardiovascular diseases and cancer) and injuries.

Budgetary allocations to public health systems Reduced per capita allocations to health Largest allocation to emoluments (58%) High expenditure on curative cf preventive services Shortage of drugs, equipment and other medical supplies

High reliance on curative services abroad

Shortage of medical personnel Globalization of health care

Emigration of experienced medical personnel (Fiji, Samoa and Tonga) –> Australian & NZ (Feb 2008 – 160 doctors reported by MoH to have left Fiji; 5 doctors in Nadi Hospital;

Labour migration of nurses (privately contracted, short-term, informal care work – open recruitment of nurses by agencies from Australia)

As many Fiji doctors and nurses working abroad as in Fiji Several studies/papers (Kelsey, Narsey, McClellan, Connell,

Naidu)

Triple burden of disease –communicable diseases, NCDs (diabetes, cardiovascular diseases and cancer) and injuries.

Budgetary allocations to public health systems Reduced per capita allocations to health Largest allocation to emoluments (58%) High expenditure on curative cf preventive services Shortage of drugs, equipment and other medical supplies

High reliance on curative services abroad

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Health Sector reformsHealth Sector reforms Part of donor-driven public sector reforms Decentralized outpatient services Separation of administrative and medical functions

and personnel Privatization of outpatient services Private health providers Health financing reforms

National Health Accounts Health Master Plans User pays (exemptions <5;>60; chronically ill;

communicable diseases) Social health insurance (earnings-based contributions

from formal sector employees; an alternative to more universal tax-financed health system financed through taxes and non tax government revenue)

Part of donor-driven public sector reforms Decentralized outpatient services Separation of administrative and medical functions

and personnel Privatization of outpatient services Private health providers Health financing reforms

National Health Accounts Health Master Plans User pays (exemptions <5;>60; chronically ill;

communicable diseases) Social health insurance (earnings-based contributions

from formal sector employees; an alternative to more universal tax-financed health system financed through taxes and non tax government revenue)

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Some trade-related health issues

Some trade-related health issues

Reduced tariffs -> government revenue -> reduced capacity for social provisioning (e.g. in health services)

Increased VAT or GST to compensate for lost revenue -> increase health costs (services, supplies, drugs – Sarah Meade study)

Increased privatization of health -> declining quality of health care in public health system (health personnel tend to move from (or between) public to private

Unhealthy food imports from Australia and NZ Fatty waste-products from the meat industry (namely

lamb/mutton flaps, lard) - a lucrative export earner for the NZ and Australian meat industries

Other unhealthy processed food imports (e.g. SPAM) Access to health services in Australia and NZ?

Reduced tariffs -> government revenue -> reduced capacity for social provisioning (e.g. in health services)

Increased VAT or GST to compensate for lost revenue -> increase health costs (services, supplies, drugs – Sarah Meade study)

Increased privatization of health -> declining quality of health care in public health system (health personnel tend to move from (or between) public to private

Unhealthy food imports from Australia and NZ Fatty waste-products from the meat industry (namely

lamb/mutton flaps, lard) - a lucrative export earner for the NZ and Australian meat industries

Other unhealthy processed food imports (e.g. SPAM) Access to health services in Australia and NZ?

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Gender implicationsGender implications Major health problems affecting women

Cancers (cervical and breast) NCDs – lifestyle diseases Diabetes, hyper-tension, obesity STIs Reproductive health problems

Health services important to women Early detection screening services for female cancers Community health Maternal health care Reproductive health services

Weakened public health systems, cost-barriers to accessing health services, including treatment not available locally, affect women most

Poor preventive health services – including public health education and awareness also leave women particularly disadvantaged

Major health problems affecting women Cancers (cervical and breast) NCDs – lifestyle diseases Diabetes, hyper-tension, obesity STIs Reproductive health problems

Health services important to women Early detection screening services for female cancers Community health Maternal health care Reproductive health services

Weakened public health systems, cost-barriers to accessing health services, including treatment not available locally, affect women most

Poor preventive health services – including public health education and awareness also leave women particularly disadvantaged

Health does not just mean the absence of disease

For women, the health implications of poverty include: living with stress (their own and their

partners – VAW is known to increase in families in economic crisis)

being unable to access treatment Self treating with traditional medicine Relying on prayer for a cure

The PACER Plus gender implications in health? Apart from implications of restrictive IP (which could reduce PIC’s access to generic drugs), would be speculating.

Health does not just mean the absence of disease

For women, the health implications of poverty include: living with stress (their own and their

partners – VAW is known to increase in families in economic crisis)

being unable to access treatment Self treating with traditional medicine Relying on prayer for a cure

The PACER Plus gender implications in health? Apart from implications of restrictive IP (which could reduce PIC’s access to generic drugs), would be speculating.

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