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Posted by plosmedicine on 30 Mar 2009 at 23:59 GMT

Author: Maria Rubio
Position: Tropical Medicine
Additional Authors: Jose Luis Portero
Submitted Date: August 31, 2006
Published Date: September 4, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Gorik Ooms shares light on the controversial use of the concept of sustainability by development agencies [1]. International organizations involved in foreign aid and local governments support health policies that decrease the size, the potential and the budget of the public health sector and hamper the access to health through fee-for-service systems. Under the so-called Health Sector Reform Agenda, out-of-pocket charges make unsustainable the cost of health care for the poorest. Health insurances have a minor effect in the health of the poor because the system generates permanently barriers to access health care or the services are not really functioning. It is arguable that a complex instrument, as health insurance, can be valuable in societies with depleted governmental funds, rundown health services and high index of poverty and inequity. So, free health care is the only affordable and sustainable option for the poorest.

In the other hand, Medicins Sans Frontieres (MSF) fosters the illusion of independent aid in a vast world full of necessities, makes irrelevant political views through the flag of neutrality and digests the lecture of conflicts for the taste of the white man tears. MSF knows that their projects, as most of the projects, are not sustainable and therefore rejects sustainability as an argument to act. But MSF does concern about sustainability as the organization calls for stronger national commitment and more international aid for health through emergency development. Under the oratory MSF assumes that the governments have the power for an appropriate answer.

Sustainability is not alone. Community development, grassroots democracy, social justice, human rights, humanitarianism or empowerment are the conceptual ideas that back the illusion of aid in the Western civil society. They are rhetoric terms that could sound even radical but, paradoxically, due to their apolitical approaches, make international aid and cooperation harmless for governments and policies that generate injustice. Moreover, postmodernism appeals for individual attention and marginalizes collective political actions that could have greater impact.

Solomon R. Benatar wrote in this journal that poor health reflects systemic dysfunction in a complex world and calls the attention to address the complex system forces that sustain poverty and poor health [2]. We are far from addressing this complex system forces that remain, unfortunately in good health. At the end, we might need politics rather than the illusion of independent aid.


1. Ooms G (2006) Health development versus medical relief: The illusion versus the irrelevance of sustainability. PLoS Med 3(8): e345. DOI: 10.1371 journal.pmed.0030345

2. Benatar SR (2005) Moral imagination: The missing component in global health. PLoS Med 2(12): e400.

Competing interests declared: We declare that we have no competing interest