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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. PACER Plus. Primarily a free trade agreement Conceived (and is being pushed) by Australia and NZ who stand to benefit most from it

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Maintaining a Healthy Pacific

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  1. Maintaining a Healthy Pacific How might PACER- Plus impact on the health of Pacific Island women? Claire Slatter

  2. 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

  3. 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)

  4. Current 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

  5. Health 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)

  6. 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?

  7. Gender 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

  8. 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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