Now I am as suspicious as you might be that this is window dressing for the most part... Marta
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When I heard Judy had taken a job at the WB (about a year or two ago), I was instantly depressed. I tried to talk to Mary Lou about it, but we were not getting along and had too many disagreement over the past---mostly dating from the early approachment the ADA crew performed with the first Bush administration, sucking up to evil repugnants as an expediency, etc. In many respects I don't feel like I have much a right to criticize or speak out about various disabled political matters because I am not disabled and the policies do not directly effect me.
But leaving that aside, what I worried about is that Judy is too optimistic, positive, and lacks the political cynicism required to see when disability policy is being manipulated for the benefit of and from the interest of established power. In this case, what I can see is the transfer and expansion of the corporatization of health care and social service delivery systems through a myriad of companies in the business. In other words the whole healthcare-industrial complex of drug companies, dme manufacturers, healthcare supplies, nursing homes, hospitals, and HMOs.
The connection with the WB goes like this (pure neoliberalism). Making this US styled healthcare industrial complex `accessible' to `developing' economies, while insisting these economies `reform' by dismantling any socialized or government run facilities, and turning them over on the cheap to US corporate healthcare---making that process the condition of WB financial support. The other methods might be to have developing countries' nationalized funding cut off from community clinics, rural doctors, etc and turned over to US styled HMOs to make the `service delivery' more `efficient'. In other words have the governments pay the fucking HMO to exploit their poor for them.
I don't know the technicalities or the jargon that goes along with these kinds of WB `development' schemes or really how they in fact work. But the above are the kinds of things I would look out for, by reading between the lines.
Since Cuba tried to make themselves a model of how to provide healthcare to a third world people with a first world level of care, I would look to the Cubans and others (I don't know who the others are) who have some track record on how to do health care without US corporate interests lurking in the background.
Maybe Patrick Bond can write a few words on how SA is doing. What I think is going on from the nasty US corporate view is these bastards are trying to figure out methods to expand their very profitable model. I think they are using the AIDS drug distribution regime as a testing ground to get their foot in the door on how to `develop' the rest of the healthcare delivery system. From their point of view, most of the world is nothing but a giant disease opportunity to exploit for fun and profit.
Oh yeah, the other place to sniff around is the baby formula trip. Giant US baby food makers tried a long time ago to push formula against beast feeding as part of `modernization' ---but most of that was from the 60s-70s.
Anyway these are examples or models of what I think is behind the WB interest in `disability' issues. I automatically give the WB zero credibility for any `humanitarian' interest.
Now, Judy will think she and others can control and manage how development funding is used in areas of disability and healthcare. I am sure she is aware of some of this. But she sees it through the lens of her own experience, which has been good. Wheelchairs and medical care and attitudes have changed over the last thirty years--no doubt about it. However, what I don't think she sees is the ground effect in poor communities the way I have seen it. Not because I am disabled, but because I worked in those communities and tried to deliver good service and failed. In fact, I was systematically prevented from delivering the best because the third party provider system won't pay the DME companies, and neither will the private HMOs. This has created or rather replicated a two tier healthcare system where the bottom gets practically nothing and the top gets the Steve Reeves treatment (fifty doctors and specialists for every poop cross-wise).
I mean literally two tiers. One person can almost die from setting in their own feces surrounded by junk food packages with the tv blaring, stoned on meds, while another is busy delivering lectures in sociology and living the hip academic life---and they can live right down the block from each other. I can get paid to work for hours on the academic chair over some minor electrical problem, and then be told to forget about a crummy loaner push chair for the person rotting away. (Of course I get paid shit, while the sales crew get the big bucks and provide nothing by hand shakes and smiles, so naturally I am hostile.)
So that's the kind of tier system that will get expanded and celebrated as `progress'. The only real antidote is developing social and political awareness in developing countries, so disabled, their families and friends became activists in their own lives and political milieu and are in a political position to socially engineer their own system. You know self-determination and all that..
CG