Globalisation, Inequality and Health Page 1
Inequality No question exists that the contemporary era of globalisation has been one of the great wealth producers in history. Also no question that income inequality coupled with high population growth have produced enormous maldistributions of income. Page 2
Illustrative Data Over the past 30 years, the poorest 20% of the world s population saw their share of global income decline from 2.3% to 1.4% while the share of the richest 20% rose from 70% to 85%. In 1960 the top fifth of income earners had 30 times the income of the poorest fifth in 1997, 74 times as much. Page 3
More Illustrative Data Among the world s super-rich, the assets of the 200 richest people are more than the combined income of 41% of the world s people. 2.8 billion people are living on less than two dollars a day. 1.2 billion are trying to do so on less than one dollar per day. Page 4
Even More Illustrative Data In sub-saharan Africa, 46,7% or 300 million people subsist on less than $1/day. 34% in this region are undernourished. 42% do not have access to clean water. 1970-2002 Africa borrowed $540 billion, paid back $550 billion and still owes more than $295 billion. Page 5
Poverty and Ill-Health Of the estimated 10.8 million children under 5 years of age who died globally in 2000, 41% of these child deaths were in sub-saharan Africa. In 1990, 180 deaths per 1,000 live births (SSA) compared with 9 deaths per 1,000 live births in industrialised countries. In 2000, 175 deaths per 1,000 live births (SSA) compared with 6 deaths per 1,000 live births in industrialised countries. Page 6
Declining Life Expectancies In 1990 life expectancy at birth for sub- Saharan Africa was 52 years. In 2000 it decreased to 48.7 years and by 2002 it had furthered shortened to 46.3 years. Thee is now almost a fifty year difference between country with highest life expectancy at birth (Japan at 81.5 years) and the lowest (Zambia at 32.7 years) Page 7
Globalisation and Health: Dynamicsround one Dynamics of globalisation affect health and health care systems. Migration of goods, people and germs across borders the circuits of exchange. Globalisation as Americanisation (or, the cultural imperialism aspects of globalisation) the new symbolic realities of global society and the world of goods. Growth of information society or knowledge economics whatever can be digitised can be exchanged over distance. Page 8
Some dimensions of Trade Liberalisation Trade liberalisation: increasing fluidity of casino economy and capital aggregation. Capital chased cheapest labour and most generous tax incentives across national borders. Free trade regime privileges rights of corporations over the needs of civil society including vigorous protection of intellectual property rights. Trade liberalisation promotes unchecked migration, urbanisation, and unsustainable consumption patterns. Page 9
Devolution and Evolution of the State: the beginning of round two Evolution of state forms: liberal state, welfare state, managed state, neo-liberal state. Neo-liberalism promotes deregulation; reduces state income, privileges of market and in general seeks to reduce the reach of the state. Neo liberal public policy, e.g., reductions in government spending for social programmes, rationalised in terms of contributions to societal growth. Page 10
State Tensions But corporate welfare continues to grow. Deregulation has produced largest corporate scandals in history. Justifications for neo-liberalism ring hollow after thirty years in the end, neo-liberalism is the ideological justification for the concentration of wealth. Page 11
The Emergent State Neo-liberal state and security state on a collision course. Security state with its various apparatuses of surveillance and control will result in greater state control. Anti-terrorism may come to dominate public health policy. The prevailing dynamics of globalisation are likely to change over the next two decades as open borders prove antithetical to global exchanges. Page 12
Poverty is Not Natural Like slavery and apartheid, poverty is not natural. It is man-made and it can be overcome and eradicated by the actions of human beings. And overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life. [Nelson Mandela, Feb. 4, 2005] Page 13
Next Steps Cancel debt without the imperative of structural adjustment. Fair trade Official development assistance (goal of 0.7% of GDP, Norway 1.03, USA 0.11) Illustration of coalitions to create political will for change: Make Poverty History (UK) and the One Campaign (USA) Page 14