1 / 34

Globalisation and health

Globalisation and health. David Legge IPHU (March 2008). Purpose. To explore the links between population health and ‘globalisation’ (understood as a global regime of economic governance) To draw some implications for policy-making and for strategy for public health activists.

kyrene
Download Presentation

Globalisation and health

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Globalisation and health David Legge IPHU (March 2008)

  2. Purpose • To explore the links between population health and ‘globalisation’ (understood as a global regime of economic governance) • To draw some implications for policy-making and for strategy for public health activists

  3. ‘Globalisation’ • Global village • communications, travel and transport • health concerns: communicable disease, tobacco, etc • Global economic integration • configuration of economic relationships, stocks and flows, dynamics • Global regime of governance • structures of economic and political control

  4. Globalisation as a particular configuration of economic activity • Changing patterns of production and trade, financial flows and investment, wealth accumulation and income flows • global markets, global sourcing • foreign direct investment • role of transnational corporations • increasing size and power of the financial sector • changing patterns of production and employment

  5. Globalisation as a regime of economic (and political) governance • Formal regulatory structures: multilateral institutions and agreements (UN, WHO, IMF, WB, WTO) • Empires, big powers and nation-states • Transnational corporations (and peak bodies) • Constituencies and social movements • Information, knowledges and discourses

  6. Formal regulatory structures: multilateral institutions and agreements • Bretton Woods Institutions • IMF, WB and WTO • United Nations system • EcoSoc, UNCTAD and UNDP on the economic side • WHO, UNAIDS, UNICEF on the health side • ‘Public private partnerships’ in health • GFATM, GAVI • Various conventions and agreements • WTO agreements • declarations on economic, political, cultural and social rights • Kyoto Agreement • International Health Regulations • Framework Convention on Tobacco Control

  7. Empires, big powers and nation-states • Governing the regulatory structures • WTO negotiations • regional FTAs and BITs • Occasional direct disciplinary action • trade sanctions • covert destabilisation • armed intervention • ‘Development assistance’ including funding and advice

  8. Transnational corporations (and peak bodies) • Growing in size, increasing number, carrying increasing proportion of global trade • Global reach; national sponsorship • transnational but with domestic roots • leverage also with other governments • communication media (WEF, media, markets) • Cases • big pharma and IPRs • water privatisation

  9. Constituencies and social movements • Beyond the empire, the nation-states, the international institutions and the transnationals • More diffused opinion hard to map but still influential • commonalities, identities, alliances and solidarities • nationality, ethnicity, class, caste, religion, language and race • Features • rise of global middle class • fundamentalism (and the decline of modernity) • social movements, eg environmental, womens, • solidarity movements, eg Jubilee • NGOs and CBOs

  10. Information, knowledges and discourses • Global power of • information, eg health statistics • research and analysis, eg DALYs • discourses, eg comprehensive PHC, cost-effectiveness • ideologies, eg neoliberalism, fundamentalisms • The information organizations • academic and research centres (eg Harvard SPH) • discussion fora (eg DAC of OECD) • media (eg reports, press coverage, etc) • Cases • role of the WB in promoting ‘cost-effective packages of health interventions’ • role of NGO websites in informing campaigns against big pharma

  11. Method • Review the changing dynamics and regulatory strategies regarding the global economy since WWII • Review some key reports, episodes, phases and struggles in global health in the context of changing strategies of economic regulation • Trace some of the interplay between health issues and the wider debates and struggles regarding economic regulation • Pull some themes from this review which might inform policy making and the practice of public health practitioners

  12. Framing the analysis: an economic history • 1945-1975: the ‘long boom’ • 1975-85: stagflation • 1975 onwards: looming threat of ‘over-production’ (post Fordist crisis) and rise of neoliberalism

  13. The long boom (1945-1975) • The post-WW2 environment • need for reconstruction (huge demand) • increasing productivity (motor vehicles and cheap oil) • The boom • capital and labour brought together to make things and services that people need and are able to pay for • increasing productivity (associated with new technology) frees up labour to make new things and to recycle wages as consumption (hence more profit, investment and sales) • some ‘trickle down’ to the poor (associated with Keynesian policies) and to the Third World (benefiting from trade opportunities associated with rapid growth)

  14. 1975-85 - Stagflation and the failure of Keynesianism • Recession (cyclical slowdown on top of structural over-production) • growing imbalance between productive capacity and market demand; weakening role of employment in recycling wages as consumption • Emerging inflation • cost of Vietnam war shared with the rest of the world because of role of the dollar (leads to rejection of glold standard in 1972) • increasing price pressures associated with growing monopoly power (oil with OPEC, labour with strong unions, business with monopolies associated with brand names and protected technologies) • Keynesian counter-cyclical policies ineffective but contribute to inflation • Keynesian policies increase money supply and inflation without boosting employment and local business but at the cost of budget deficits and inflation • Ascendancy of monetarism • ‘fight inflation first’ (because of the costs to business of uncertainty) • monetarism argues for sole reliance on interest rates to control the business cycle • but increased interest rates used to control inflation at a time when the economy was in recession!

  15. The debt trap sprung • 1973: OPEC price rise; oil producers flush with cash; deposited in banks • Banks send salesmen around the world lending money at low and negative interest rates (negative after taking inflation into account) • lending to corporations (but with government guarantee) in South America • lending direct to governments in Africa • 1980: interest rates escalate (peaking at 17% in the US in 1981) imposing repayment and servicing burdens that many poor countries could not carry

  16. From 1980 to the present • Two parallel dynamics • the continuing dynamic of the long boom • the looming threat of post-Fordist crisis (jobless growth, structural over-production)

  17. The threat of ‘over-production’ (and ‘post-Fordist’ crisis) • Where expanding (capital intensive) productive capacity (with stagnating employment growth) exceeds ‘demand’ owing to • saturated (‘mature’) markets and/or • markets with real needs but limited purchasing capacity • ‘Compensatory’ mechanisms which exacerbate the damage from ‘over-production’ • understood in the corporate world in terms of reduced profitability • understood in the policy world as falling growth rates • eliciting a range of corporate strategies and policy responses • many of which exacerbate the risk of crisis

  18. Reduced profitability: compensatory corporate strategies • New markets, new products and better marketing (incl commodification of family and community) • Externalise costs (including to labour and to the environment) • Increase market power (and capacity to increase prices) • Consolidate production and increase market share through mergers and acquisitions* • Reduce wages (union busting, relocation)* • Replace well paid labour with technology* • *These strategies will further reduce demand (reduce the role of employment in recycling wages into consumption)

  19. Slowing growth: compensatory policy responses • Outsource and privatise public sector service provision (new market opportunities) • Deregulate environmental controls (converting natural capital into recurrent revenue) • Force TW countries to open their markets and economies (under the slogan of free trade and open markets) • Cut taxes (in particular, reduce corporate and executive tax burden) to compete for new investment* • Labour market deregulation (union busting) to reduce labour costs* • Force repayment of debt from TW countries* • *These strategies further reduce demand

  20. Corporate and policy responses • Exacerbate the over-hang of productive capacity over effective demand • Postpone the crisis for the rich world (and rich classes) • Other unintended adverse consequences • destabilise global environment • increase unemployment and inequality • weaken family and community • decay social infrastructure • transfer value from South to North • two worlds stratification (unified global bourgeoisie but fragmented global proletariat)

  21. So what prevents the crisis from engulfing the economy globally? • The situation is already critical for millions of poorer people (in rich and poor countries) • trading regime which enforces the flow of value from poor to rich countries • policy regime enforces the divide between those who participate in the new global economy and those who are excluded • for these groups the crisis has already arrived • However, continued growth globally (albeit slower) is supported through • growth in China and India • commodification of family, community, government functions (including health care) • unsustainable exploitation of environmental ‘services’ • intensified transfer of value from periphery to centre (from South to North) • growing role of debt in sustaining demand (recycling capital as consumption) • global support for US consumption (supporting an over-valued dollar)

  22. Capital recycled as consumption through debt • Profits and savings redirected as loans: • corporate rationalisation (in particular mergers and acquisitions) financed through corporate debt • household consumption supported through increasing debt (recycling profit and savings as consumption) • Increasing size, wealth, turnover and power of the financial sector (banks, insurance, etc): • slowing growth so business redirects profit into financial sector (as portfolio investment and speculation) rather than into new direct investment • new financial derivatives increase risky lending and speculation • bidding up of asset values on borrowed or non-existent money (asset bubbles) feeds consumption expenditure (wealth effect) • privatisation of pensions (superannuation) redirects billions from tax into savings held by private financial institutions (lent on for asset speculation and consumption)

  23. Global support for US consumption • US trade deficit • imports exceed exports • US traders need to buy more foreign currency than they earn • ‘should’ lead to fall in value of dollar making US exports cheaper and imports more expensive • But China, OPEC and other corporations and countries lend to the US (by buying US govt bonds) have • kept the price of USD high • kept US consumption spending high (and inflation low) • kept the global economy ticking over • Up until the ‘sub prime mortgage’ crisis; what now?

  24. Implications of ‘sub-prime mortgage crisis’ • Extensive use of doubtful collateral (securitised debt) to support borrowing revealed • Credit squeeze: banks withhold credit because of exposure • Asset bubbles pricked; widespread loss of ‘wealth’; likelihood of recession • Foreign holders of US Govt bonds sell off or stop buying (buy oil futures instead) • Value of USD falls • Threat of global recession because of significance of US market to exporters globally

  25. Continuing transfer of value from periphery to centre (S  N) • Debt repayment • role of IMF (and SAP / PRSP) as the enforcer • Borrowing (high interest) while generating surplus (low interest) • One sided trade liberalisation • free trade in manufactured goods • protectionism for IP and agriculture • including escalating tariffs • barriers to free trade in people • Brain drain • Declining terms of trade • commodities vs manufactures

  26. Free trade - the key to growth and development? • ‘Free trade’ - a catch-all slogan obscuring countries’ and corporations’ manoevering for advantage • Regulatory framework defining ‘free trade’ discriminates in favour of the rich North • Globalised free trade risks exacerbating the crisis of overproduction • Protectionism, can have important benefits as well as drawbacks

  27. Alternative strategies of global economic management • (Really) free trade? • Global Keynesianism (UNCTAD)? • National self-sufficiency and regional (south south) trade (Amin)?

  28. Recap: exploring the links between health development and globalisation • Purpose • to explore the links between global health and the prevailing regime of global economic governance (‘globalisation’) • Method • review some key episodes in global health policies since WW2 against the • changing dynamics and pressures arising in the sphere of economic regulation • interpreted in the light of the account presented of the global economy since WW2

  29. Bretton Woods to AIDS/HIV (1944-85) • 1944: Bretton Woods (IMF, WB, GATT) • 1950s: Health development policy: DDT, doctors and hospitals, population control • 1955: Bandung Conference and birth of the Non-Aligned Movement (more confident TW voice) • 1964: UNCTAD 1 (and G77) leads to call for New International Economic Order in May 1974 • 1973: First OPEC price rise • 1977: last case of small pox • 1978: Alma-Ata Declaration (PHC, reference to NIEO) • 1975-80: Onset of stagflation, end of the long boom, emergence of monetarism • 1981: escalating interest rates, debt trap sprung • 1981: ‘Selective PHC’ (the response to Alma-Ata) • mid 1980s onwards: IMF develops and imposes SAPs • mid to late 1980s: rise of AIDS/HIV • 1987: ‘Adjustment with a Human Face’

  30. Break up of Soviet Union to Seattle (1985 - 2000) • 1989: Break up of the Soviet Union • 1991: USTR attacks Thai administration over pharmaceuticals policies • 1992: WHO: ‘Health Dimensions of Economic Reform’ • 1993: WB: ‘Investing in Health’ (virtuous cycle story, SAPs can be compatible with health development, new interventionism) • 1995: WTO established • 1995-98: OECD drive for MAI (note role of NGOs and internet; but continuing push in WTO under ‘Singapore issues’) • 1997: Sth African parallel import legislation passed, challenged (challenge defeated April 2001, note role of MSF and other NGOs and internet) • 1999: PRSPs implemented (new and improved SAPs) • 1999: WTO in Seattle: outrageous process; dramatic protests • Dec 2000: People’s Health Assembly and People’s Health Charter

  31. Treatment Action Campaign to Hong Kong (2000-05) • April 2001: Defeat of big pharma in South Africa (note role of TAC, MSF and global social movements) • April 2001: Norway Conference (WHO accepts differential pricing) • June 2001: CMH Report (warning about health and stability; virtuous cycle story repeated, ‘CTC model’ and scaled up interventionism; reliance on increased aid (and GFATM) and PRSPs) • Sept 2001: 9/11 • Nov 2001: Doha and the Statement on Public Health (especially Para 6 and compulsory licensing; note rearguard action by US) • Oct 2002: Bristol Myers Squib defeated in Thai DDI case • Mar 2003: Invasion of Iraq (US unilateralism; widespread opposition; limits to US power apparent) • Oct 2003: Negotiations for US Thai FTA commence (at risk: compulsory licensing, data access, extended IPRs) • Nov 2003: Cancun: G21+China stands up to G7; deadlock over agriculture and ‘Singapore issues’; US moves to focus on bilateral and regional FTAs • Nov 2003: Miami FTAA-lite (US knocked back by Latin America) • Jan 2004: IMF report critical of US twin deficits • July 2004: Framework for Doha Round adopted • Dec 2005: Hong Kong Ministerial

  32. Against TNA: outcomes not inevitable • Delegitimation of SAPs • Jubilee 2000 and the Drop the Debt campaigns • MAI-non! • Doha 01 - TRIPS and access • Cancun 03 – advancing the demand for agricultural reform and resisting the Singapore issues • Miami 04 – resistance to US ambitions for a FTAA • Arenas of struggle: global regulators • Delegitimation and the role of (globalised) popular movements • Another World is Possible! • Emergence of the PHM *TNA – “There is no alternative” (attributed to M Thatcher)

  33. Issues which link health policy with global economic regime • SAPs and nutrition • TRIPS and access to drugs • GATS and the building of comprehensive PHC • Health and fair trade (with special and differential treatment) • AoA and small farmers’ loss of livelihood (and health consequences) • Policy reports (such as CMH) which deny (by obscuring) the disease burden created by the prevailing regime of economic governance

  34. Another world is possible! Another US is necessary • We have • reviewed the interplay of economics and health at the global level over the past 60 years • interpreted the interplay of health and economics in relation to a particular story about the global economy over this time • drawn some conclusions about strategy for global health activists • Key conclusions • recognise, celebrate, learn from and work with popular movements for health and economic justice • keep global economic in/justice at the centre of health needs and health policy discussion

More Related