People's Health Movement PHM - re-establish health and equitable development as top priorities with comprehensive primary health care


home page contact us     

About PHM News Room Events PHM Worldwide Campaigns Publications

Charters Voices PHA 2000 Links Get Involved Spanish
 Equity and Inequity

Last Update:  March 14, 2005 

 
Quick Feedback
Has this information been
useful? Yes    No
Name
Email
Keep me informed
Thank you

 
   Background Papers
Political Economy
Equity and Inequity
Medicalisation
Environment
Communication
Framework

 

   About PHM
Africa Immunization
Environmental Links
Critical Issues
Exporting Curruption
Kerala Campaign
Healthcare Sevices
Mental Health
Time Bank Network
R & D
Principle Actors
Food Security
Holistic Health
Health-Development
Healthcare Reforms
Impact on Health
Unequal Relations
Globalization-Health
Globalization
Decentralization
Pre PHA 2000

 

Equity and inequity today: some contributing social factors - Background Papers

Equity and inequity today: some contributing social factors 
 
Nadine Gasman and Maxine Hart
 
This document inThis document in pdf formatpdf format   |  This document in doc formatdoc format 
 
 
INTRODUCTION
 
The 1999 United Nations Human Development report begins: ‘The real wealth of a nation is its people. And the purpose of development is to create an enabling environment for people to enjoy long, healthy and creative lives. This simple but powerful truth is too often forgotten in the pursuit of material and financial wealth.’ 
 
The current trend of globalisation has contradictory implications. While the last 50 years have witnessed developments that augur better for the future of humanity—child death rates have fallen by half since 1965, and a child born today can expect to live a decade longer than a child born 20 years ago; the combined primary and secondary school enrolment ratio in developing countries has more than doubled—the world faces huge amounts of deprivation and inequality. Poverty is everywhere. Measured on the human poverty index—more than a quarter of the 4.5 billion people in developing countries still do not enjoy some of life’s basic rights—survival beyond the age of 40, access to knowledge and adequate private and public services.
 
The quickening pace of globalisation has generated enormous social tensions that development policies have failed to tackle. The underlying assumption has been that once economic fundamentals are corrected, social issues will resolve themselves of their own accord, and that well-functioning markets will not just create wealth, but will also resolve problems of human welfare. 
 
Current events reveal with awful clarity the depth of this fallacy. Millions of people are poorer than ever before, with growing indices of inequality between countries and within countries. Most countries report erosion of their social fabric, with social unrest, more crime, and more violence in the home.
 
Neoliberal advisors in the 1980s developed a vision of the ideal country: its economy would be largely self-regulating through open competition between private firms; its public sector would be relatively passive—providing the minimum services necessary to conduct private business efficiently and to protect society’s weakest members. 
 
This dogmatic economic prescription, concludes the United Nations Research Institute in Social Development (UNRISD), has not only had limited value, but has been dangerous. Even those countries that have been held up as economic success stories have been social failures. Most people in highly indebted African and Latin American countries have suffered a sharp drop in living standards.
 
Between 1980 and 1990 the per capita income declined markedly in developing countries. An International Labour Organization study of 28 African countries showed that the real minimum wage fell by 20% and more than half of Africa’s people now live in absolute poverty. In most Latin American countries the real minimum wage fell by 50% or more. Coupled with this, people have suffered from severe cuts in public services—affecting nutrition, health, education and transport.
 
The UN Human Development Report of 1999 goes further: a comparison between the size of income of the fifth of the world’s people living in the richest countries and that of the fifth in the poorest showed a ratio of 74 to 1 in 1997, up from 60 to 1 in 1990 and 30 to 1 in 1960. 
 
The advocates of adjustment had hoped for a trade-off: long-term economic gain in return for short-term social cost. What they did not foresee was that the social impact could itself frustrate the desired economic effect. This temporary sacrifice for the poor is beginning to look like a permanent intensification of poverty.
 
UNRISD explains: ‘When the market goes too far in dominating social and political outcomes, the opportunities for and rewards of globalisation spread unequally and inequitably—concentrating power and wealth in a select group of people, nations and corporations, marginalising others. Globalisation in this era seeks to promote economic efficiency, generate growth and yield profits. But it fails on the goals of equity, poverty eradication and enhanced human security.’
 
Economic growth, an important input for human development, can only translate into human development if the expansion of private income is equitable, and only if growth generates public provisioning that is invested in human development—in schools and health centres rather than arms. Reduced public spending weakens institutions of redistribution—leading to inequalities.
 
 
FACTORS SHAPING INEQUALITY
 
Below are some of the major factors shaping inequality in a globalised environment:
 
Institutions
Institutions matter for development. In 1997, the World Bank warned: ‘Without adequate institutions, the potential benefits of globalisation in terms of higher growth and investment rates will either not happen, or be too concentrated, thereby increasing, rather than decreasing inequalities and social tensions’. It adds further that ‘good institutions are critical for macroeconomic stability in today’s world of global financial integration’. 
 
UNRISD states: ‘Social institutions have not just been ignored but they have been considered obstacles to progress and have been ruthlessly dismantled. This has happened at every level. At national level, many state institutions have been eroded and eliminated. And at local level, the imperatives of market forces have been undermining communities and families.’
 
The formal or semi-formal ties between states and society are increasingly unravelling, and being replaced by more diffuse arrangements. States are growing weaker, and state institutions are less able to fulfil basic responsibilities in areas that encourage personal development such as education, health, nutrition, land redistribution and welfare.
 
As states weaken, power is being transferred to institutions that ignore the social implications of their actions, while at the same time responsibility for absorbing the damage is being passed to non-governmental agencies or to communities and families that have themselves been so weakened that they are in no position to respond. 
 
Political parties have become more diffuse and fragmented, particularly in the former Eastern Bloc countries where institutional chaos is common. 
 
Trade Unions are being eroded—suffering from changes in working patterns. In countries with high unemployment, employers are finding it easier to avoid dealing with trade unions and are dealing directly with individual workers.
 
NGOs are increasing their influence and have been used to deliver services in many developing countries where governments are incapable of providing services. Accountability is thus undermined.
 
While many national institutions are being weakened, forcing communities and families to take on added burdens, other institutions are enjoying much greater freedom—without any commensurate increase in responsibility. This is especially true for Transnational corporations (TNCs), which now control 33% of the world’s productive assets, but only employ directly or indirectly 5% of the global workforce. TNCs are accused of exploiting cheap labour in developing countries, marketing dangerous products, avoiding taxation and causing serious environmental damage. Despite this, they remain untouched by any form of international regulation. In cases where national governments try to exert pressure on them, the companies move elsewhere.
 
 
Education
Persistent inequality and low quality characterise basic education systems in developing countries. Education inequalities in access to school, attendance, quality of teaching and learning outcomes—perpetuates income and social inequalities. Poor children attend poor schools, have less opportunity to complete their basic education, and perform below their counterparts in private schools.
 
Misallocation of resources, inefficiencies and lack of accountability are prominent attributes of the organisational structure of education in most countries. According to the report by the UNHDP, one in seven children of primary school age is out of school.

 

 

Corruption
Corruption seriously weakens the ability of nations to ensure wealth is distributed fairly. Corrupt officials siphon off wealth from public and private sources, and discourage investment by those who fear profits will be stolen.
 
Weak governments allow tax evasion to flourish, undermining one of the key government tools for wealth redistribution by denying governments adequate resources to alleviate poverty and assist development.
 
Underground or informal economies have grown, further reducing national tax bases and feeding criminal organisations that grow up around the informal economies.
 
 
Employment and unemployment
Expansion of trade does not always mean more employment and better wages. In the OECD countries, employment creation has lagged behind GDP growth and the expansion of trade and investment. More than 35 million people are unemployed, and another 10 million are not taken into account in the statistics since they have given up looking for a job. Among youth, one in five is unemployed. 
 
In both poor and rich countries, dislocations from economic and corporate restructuring and dismantled social protection have meant heavy job losses and worsening employment conditions. Jobs and incomes have become more precarious. The pressures of global competition have led countries and employers to adopt more flexible labour policies and work arrangements with no long-term commitment between employer and employee.
 
 
Dislocation of populations
Migration is now a major global preoccupation, although it represents nothing new. In today’s globalising world, migration is marked by uneven human opportunities and uneven human impacts. Whilst global employment opportunities are opening for some, they are closing for most others. For high-skilled labour, the market is more integrated, but the market for unskilled labour is highly restricted by national barriers. 
 
While most migrants have some choice over when and how to leave, millions of others become refugees—driven from their homes and countries by famine, drought, floods, war, civil conflict, mass persecution, environmental degradation or misguided development programmes.
 
Dislocation of populations through wars and economic crises prevents stable growth in the sending countries and leaves them dependent on uncertain remittances from migrants. In Lesotho, 60% of households send labourers to work in South African mines, leaving females to cope with managing families. People who leave are often the youngest and most enterprising—predominantly male—leaving communities with high proportions of elderly people, women and young children. 
 
An alarming outbreak of national conflicts based on race, religion or ethnic identity has fed social tensions and conflicts—especially when there are extremes of inequality between the marginal and the powerful. Inequalities are reflected in incomes, political participation, economic assets and social conditions—education, housing and employment. Apart from killing or maiming millions of people, these wars weaken or destroy societies, devastate infrastructure and the environment, and bring public services to a standstill—undoing decades of development. 
 
 
Global crime
Crime is a growth industry that is likely to intensify as a result of globalisation. Modern means of transportation, advanced communications and relaxed border controls have created opportunities for transnational crime. Organised crime is now estimated to gross US$1.5 trillion a year. Illicit trade in drugs, women, weapons and laundered money is contributing to the violence and crime that threaten neighbourhoods around the world.
 
A high proportion of modern-day criminal activity is associated with narcotic drugs. Illicit drugs have a corrosive effect in both consuming and producing countries. Drug syndicates, gangs and smugglers use any means necessary to protect their trade—whether it be murder, or bribery and corruption—undermining institutions and social systems such as traditional agricultural communities. The illegal drug trade in 1995 was estimated at about 8% of world trade. 
 
All these factors have a direct effect on families, but especially on women and children. Around the world one in every three women has experienced violence in an intimate relationships, and about 1.2 million women and girls under 18 are trafficked for prostitution each year. About 300 000 children were soldiers in the 1990s, and 6 million were injured in armed conflicts .
 
 
Families and women
The weakening of families: The family has always offered the most basic form of security. When all else fails, people have assumed that they can rely on their family members for support. This has become especially important during the current era of economic restructuring that has seriously weakened the capacity of the state to provide for those in greatest need. Unfortunately, this is happening at a time when the family itself is coming under the greatest pressure it has known. In industrialised countries, around one third of marriages end in divorce, and 20% of children are born outside marriage. Many of the current social ills are blamed on the family—from high crime to teenage pregnancies, to drug taking.
 
One of the most widely discussed changes in the structure of the family is the rising proportion of single-parent families—generally women. Female-headed households are disadvantaged, not because women lacking a sense of responsibility towards their families, but rather because social and economic factors are stacked against them—women face discrimination in property, land, income and credit. Social and economic changes in recent years have made family life even harder for women. Many more women are working outside the home—in industrial countries women make up 40% of the official labour force. The economic crisis in many countries has increased women’s workload in other ways. It has been found that women suffer more from cuts in public services—health cuts mean that women take care of sick relatives, and cuts in education mean that women spend more time supervising children, which UNRISD calls ‘invisible adjustment’. Further, women spend more time growing their own food—and this has been transferred to their daughters at the expense of attending school.
 
A current problem, which is reaching unprecedented proportions, is the number of orphans as a result of the AIDS epidemic. Since the beginning of the epidemic there have been 13.2 million orphan in the world, most of them are in Sub-Saharan Africa. These children are taken care by their extended families or emerging institutions that have not only to ensure their survival but address the psychological, health and social needs. This increasing problem can only be expected to get worse in the future.
 
 
Children
The same pressures that have taken their toll of parents have also taken their toll of children. In the industrialised countries, the period 1950–1975 saw remarkable progress for children—whether measured by health, growth rates or education. These rates of progress are being brought to a halt. There is a steady rise in school drop-out rates, more cases of physical and sexual abuse, and rises in teenage violence and suicide. Children in developing countries come under even greater pressure. Whilst child survival rates have improved enormously over the last 30 years—infant and under-five mortality rates more than halved—those who survive live under greater stress.
 
In developing countries there are some 250 million child labourers –140 million are boys and 110 million girls4. Poverty and low wages are the underlying reasons for child labour: parents earn so little that their children have to work and employers are happy to take children as they will work for even lower wages. (children’s wages may pay for their own schooling as well as keep the family together as a unit)
 
 
THE FUTURE
 
We face the challenge of setting up rules and institutions for stronger governance—local, national, regional and global—that put the health and well-being of each individual, community and nation at the centre. We need to create enough space for human, community and environmental resources to ensure that development works for people and not just for profit.
 
Globalisation expands the opportunities for unprecedented human advance for some, but shrinks those opportunities for others and erodes human security. It is integrating economies, culture and governance, but is fragmenting societies and ignoring the goals of equity, poverty eradication and human development.
 
Overcoming poverty must be seen as the main ethical and political challenge. Experience shows that the most appropriate programmes are long-term initiatives of a comprehensive/ multi-dimensional and multi-sectoral nature, aimed at breaking down the mechanisms that perpetuate poverty from one generation to another.
 
Development patterns need to be oriented to make equity—that is, the reduction of social inequality—the central pillar. This should be the basic yardstick against which we measure development. Education and employment present two master keys for development. Education has an impact on equity, development and citizenship, and therefore needs to be assigned top priority in terms of social policy and public spending, especially important is education of girls. Latin American studies have indicated that 11–12 years of schooling (completed secondary education) are required if people are to have a chance of escaping poverty. At the same time, a high-quality job- creation process needs to be put in place.
 
Some questions?

  • What are the social factors that influence the health situation in your community or countries?

  • Is violence a problem in your community?

  • What is the status of Women and children?

  • Is government responding to the people’s needs? Why?

 

Quick Feedback: Has this information been useful?

 

 

 
 Back Home Up Next [include/copyright.htm]