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Issue Papers

Conclusion - Globalisation and the Impact on Health - A Third World View - Issue Papers

Globalisation and the Impact on Health
A Third World View - Conclusion

 
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Evelyne Hong

August 2000 
 

 
 
Conclusion
 

Globalisation has led to increased environmental threats; the marginalisation of local communities; increased migration; urbanisation; land use patterns which affect the soil, deforestation, monoculture, soil depletion, and loss of biodiversity; pollution of the seas and farmlands from chemicalised agriculture; resource depletion; malnutrition; and the curative emphasis in health care and public health with increased reliance on technologies like drugs, vaccines, and chemicals. Integration of markets has resulted in new products and new lifestyles especially toxic products like tobacco, alcohol, contaminated foods, junk foods, dangerous medicines, the trafficking in drugs, organ trade, antipersonal landmines, light weapons, pornographic materials and the like. These developments have far reaching implications on the spread of disease and public health.

Clearly the effects of the global economy have been devastating for societies everywhere. Globalisation as institutionalised in the WTO, IMF-WB acting on the pressures of the TNCs and their governments has led to the disempowerment of nation states and the collapse of their economies. Governments especially in the Third World are burdened with debt, economic decline and environmental disasters: this makes it almost impossible to achieve any meaningful social development for their peoples. Poverty has increased and the gap between the rich and poor have widened; unemployment is a fact of life; communities have disintegrated; traditional family structures have broken down, there is more homelessness and destitution, violence in all forms is escalating; environmental problems and diseases are beyond control.

Increasingly peoples have come to recognise that this system is not working; where people are devalued and life has no social meaning; where institutions are given unbridled powers to facilitate corporations to accumulate and concentrate wealth and immiserate the lives of the majority. They are reacting against this system demanding changes and seeking alternatives: that foster justice and equity; happiness and fulfillment; promote ecological principles, values of cooperation, community, love, caring, and respect for life and diversity.

Many citizen groups and individuals are now working together in various networks and coalitions to bring about change at different levels.

Global Level Initiatives
 

Reform of the WTO
 

Seattle and its aftermath have inspired and encouraged social movements that the process has begun to meet the challenges of the next century. There is now an international call to ‘roll back the power and authority of the WTO’ which demands include:

• opposition to a New Round and to bring in new issues such as investment, competition, government procurement, and biotechnology;

• a full review of the WTO Agreements and their impact on social, environmental and health policies;

• removal of all critical issues that affect the environment, public health, safety, and the rights, welfare and basic needs of people from the WTO. Thus WTO rules must not apply to issues like food security, water resources, basic social services, health and safety, and animal protection;

• national governments should be sufficiently informed about the impacts and have capacities to analyse and give inputs as part of democratic governance. National interests is more than just economic and trade interests;

• disputes on issues concerning health and public safety, labour rights and environmental concerns should be shifted to appropriate fora like the specialised UN agencies, ILO, WHO, FAO rather than being dealt behind the closed door dispute settlement body of the WTO;

• removal of TRIPs from WTO as intellectual property rights is not related to trade and should not be in a trade agreement that leads to the private appropriation of knowledge, undermines biodiversity, deprives people of essential medicines, threatens food security and sustainable agriculture, and keeps the South from developing their technological capacity. Patenting of life forms must be prohibited from all national and international laws;

• Third World countries should enhance their domestic legal capability to deal with the dispute settlement process instead of relying on the law firms of the North which charge heavy fees eg. regional cooperation to set up a legal centre to prepare and defend cases should be considered;

• given the fact that the WTO is the single institution which will have the largest impact on health, there is a need for WHO to play a major role in international health policies especially in the WTO negotiations. This is all the more necessary when the WTO provides the potential for the development of corporate self-regulatory measures eg. the pharmaceutical industry has set the agenda in the International Conference on Harmonisation (ICH) of Technical Requirements for Registration of Pharmaceuticals for Human Use which was set outside the WHO (in fact WHO was sidelined to observer status). This is of crucial importance as the WTO makes reference in the TBT Agreement to international standards, which will be exploited by corporate interests. Since the WTO calls for the least restrictive trade practices, and the downward harmonising of laws, environmental, social and health standards will be subordinated leading to the use of the lowest standards.

 

Debt Cancellation
 

This campaign has successfully brought together groups of every political stripe including secular and religious groups. Debt has been defined as illegitimate because it was contracted by dictatorships and corrupt governments; immoral as governments to pay their debt have to sacrifice the health of their peoples, reduce education, worker wages, damage the environment and threatens the survival of present and future generations.

The Jubilee 2000 is calling for:

• The cancellation of all Multilateral (owed to the IFIs) Bilateral (owed to individual governments) and Commercial (owed to international commercial banks) debts;

• An international court or tribunal to judge these odious, immoral debts and order their cancellation. The Brazilian Jubilee 2000 has called for an international mobilisation to propose to the UN General Assembly that a joint suit be brought before the International Court of justice at The Hague; to seek a judgement on the processes that give rise to foreign debt, and factors that cause it to grow, such as unilateral decisions by creditor nations to raise interest rates;

Others have called for:

• The control of the process dealing with debt be removed from the IMF, WB and the Paris Club. (The Paris Club is the name given to the regular gatherings of creditor nations who meet with debtor countries to discuss terms of rescheduling, refinancing and writing down of debts);

• The use of structural adjustment conditionality to force trade liberalisation in the Third World must be halted;

• Northern governments must honour their commitment to give 0.7 percent of GNP to AID: donors only allocate $55 billion or 0.25 percent of their total GNP of $22 trillion. Only four of the 21 donor countries have met the UN target namely Denmark 0.99 percent; Norway 0.91 percent; the Netherlands 0.8 percent; and Sweden 0.72 percent. The USA remained at the bottom at 0.1 percent of GNP. For most third World countries aid is the only source for national development especially for social development in health and education;

• All multilateral and bilateral aid, grants, projects and programmes must have social, environmental and health audits eg the World Bank is exporting hazardous incinerators as part of its aid programme to the Third World;

• The North must honour the 20:20 Compact under the Social Summit that requires Northern States to allocate 20 percent of ODA to basic social programmes with mutual Third World Partners who will do the same from national budgets;

• The North must reverse the transfer of resources from the South to the North (already made worse by debt servicing and SAPs, rising military expenditures and poor returns on investment) with fair terms of trade, eg better market access and fair prices for the Third World’s primary commodities;

• Northern governments must stem the corrupt practices of transnational corporations, the bribe givers in the South. These practices undermine national development, increase debt, disadvantage smaller domestic firms, manipulate contracts for projects that benefit the elite few and the company and increasing inequality and poverty; bypass the domestic process, damage the environment and circumvent laws;

• Nothern governments must facilitate and ensure that the ill gotten gains of corrupt regimes must be exposed and repatriated from private banks in the North.

Democratisation of the UN
 

At the Havana Summit some 40 Ministers from the South have called for a fair share in the UN’s decision making process if they are to improve their lot. They called for:

• Permanent membership in the Security Council for the South and the elimination of the veto;

• Transparency in the Security Council and an early warning system to prevent emerging conflicts;

• Reaffirming the UN Charter’s provisions on respect for sovereignty, sovereign equality, non-intervention in internal affairs and self-determination;

• The primacy of the UN General Assembly and the reform of the Bretton Woods Institutions to allow the South to participate in the decision making process given the major impact of their policies on those nations’ economies;

• Many groups have also made the same call for full democratic participation of member States in the UN system;

• End the sanctions on Iraq;

• The WHO, ILO, FAO, UNICEF, UNESCO must be provided adequate resources and support; shrinking funds have made them rely on extra budgetary funds (voluntary funding) eg more than half of WHO’s (and FAO’s) budget is from this source for special programmes like AIDs and essential drugs; these funds should not be used by donors to influence policy and decision making in the special agencies thus undermining their work;

• In July 2000, an international coalition of NGOs wrote letters to the UN Secretary General and heads of UN agencies who are associated with the Global Compact to reevaluate their partnerships with the corporate sector (with tarnished records on human rights, labour and the environment) which include Nike, Shell, BP Amoco, Rio Tinto Plc and Novartis. The NGOs charge that the Global Compact which includes the UNHCHR, ILO, UNEP UNDP and UNICEF is promoting a vision of corporate-driven globalisation that threatens the mission and integrity of the UN (Third World Network 31 July 2000). In 1999 UNDP was found to have solicited funds from corporations under the Global Sustainable Development Facility. The corporate sponsors include Rio Tinto Plc, Asea, Brown Boveri, Dow Chemical, Citibank and Stat Oil Norway. WHO should not renew its ties with Ciba Geigy and Galactina S.A. or forged partnerships and alliances with corporations;

• The US government must fulfil its commitments and pay up the $1.8 billion it owes to the UN, to allow the latter to carry out its functions instead of seeking money from the corporate sector.

Stengthening the Role of WHO
 

It has been shown that all socioeconomic activities impinge on health. Health can only improve if there is a serious commitment to address the real issues that affect its enhancement namely the global economic forces that have led to inequality, poverty, and poor quality of life from environmental degradation. Clearly poverty is the most important factor affecting health. Health is more important than to be simply dealt by the Ministry of Health in each country. Today’s health problems are more complex and challenging. In the light of this, social movements, and concerned peoples should call on their governments that WHO, deal with member States not at the level of their Health Ministries alone. With this in mind WHO should:

• Call for an international meeting or Forum to discuss the impacts of Globalisation on Health; or for the UN General Assembly to convene such a meeting;

• Call on governments to support and strengthen the efforts of WHO which is under threat from both corporate lobbies and their Northern governments who are trying to roll back WHO’s initiatives for better health namely, in The Revised Drug Strategy and the Framework Convention on Tobacco Control. Even the Code on Baby Food has been under attack and, Third World governments have come under pressure to abandon it;

• WHO must affirm and promote the spirit of Alma Ata: primary health care continues to be undermined by ‘new health approaches’, ‘new public health’ more ‘Round Tables’ and more renewal strategies for Health for All. Despite the subversion of Alma Ata ‘Health for all through primary health care’ is imperative for the Third World and especially relevant in the face of the global economic threats that we are confronted with today;

• Should with the help of member States and social movements ensure that all health regulations and treaties eg. Cartegena Protocol, Convention on Biological Diversity and the Basel Convention, to protect the health of peoples are not superseded by international rules and regulations which destroy government’s attempts to protect peoples’ livelihoods, health and environment;

• Should cooperate with other UN agencies to study, assess and monitor the environmental and health impact of climate change, liberalisation, SAPs, and the WTO Agreements e.g. TRIPs, GATs and the AOA;

• Must assist governments to formulate policies, programmes and provide expertise to help formulate and strengthen laws relating to the environment, health and social well being, and women eg GMOs, use of genetic technologies in diagnostic procedures and therapy;

• Should be provided with adequate resources and support by the members to be effective in global health work. WHO’ grants have stagnated at around $900 million a year, compared to the World Bank which is now the single largest source of funds for health with an active portfolio of $9.2 billion by the end of 1996. WHO must take back its leadership role as the directing and coordinating authority on world health, which has been usurped by the World Bank. This is crucial as the World Bank’s health policies promoted in the name of health reforms driven by economic outcomes are opposed to WHO’s health for all strategy and emphasis on health outcomes;

• Must ensure and enforce its independence and integrity from corporate and donor interests and the pressure of Northern governments in its work.

National Level Initiatives
 

Role of Government
 

The current free market model is weakening public institutions and governments’ responsibility and capacity to ensure equity, democracy, security and well being: increasingly functions of government are hijacked by the TNCs and the WTO which are undemocratic, unaccountable and non-transparent in their activities. In this era of globalisation, good governance is of first imperative: Third World governments must:

• promote self reliance and support traditional and indigenous health systems (including homebased healing traditions) and the recognition of women’s crucial role as healthcare providers;

• promote self-reliance in agriculture and support traditional and local sustainable farming practices and organic agriculture. For example countries like Cuba have proven that organic farming is not only sustainable; it has increased yields of small farmers: it has successfully developed a biological pest control programme and established 173 vermicompost centres across the country producing 93,000 tons of natural compost yearly;

• honour their commitment to Alma Alta and Health for All; they have a fundamental responsibility to provide universal access to human needs and services according to peoples’ needs not means: health (including mental and social well-being) services must be universal, comprehensive and people centred not market driven;

• The Essential Drugs List must be implemented to foster safer, efficacious and cheaper medicines use. In many countries public spending on drugs take up some 40 percent of the annual health budget: over 70 percent of the drugs that the TNCs sell to the Third World are non essential: out of some 270,000 pharmaceutical products on the global market, WHO has compiled a list of about 300 or so essential drugs that are needed to treat virtually all human ailments; in all Third World countries, irrational and hazardous medicines proliferate the market; some $7 billion can be saved with the EDL that could be spent on better health measures when EDL is used;

• Drugs should not benefit only the rich minority. Governments whose countries are burdened with AIDs eg SS Africa, Brazil, Thailand and Haiti, should be allowed to obtain cheaper drugs through compulsory licensing and parallel importing without being threatened and bullied by the US. If the US and the North are sincere they should pressure their drug companies to reduce the prices of these life saving medicines instead of the former offering $1 billion loans to SS Africa which would further increase their debt problems, to buy drugs at world market prices (Swarns, Aug 23, 2000). The high prices of AIDs drugs cannot be justified: most of them were discovered in public laboratories and developed in clinical trials supported by public funds. Ninety five percent of HIV afflicted people are in the Third World: WHO estimates that by 2000, there will be 40 million living with AIDs in 2000 and some 16 million children orphaned (who lost their mother or parents to AIDs);

• Reform the medical and health curriculum to make them socially relevant and people centred. Third World countries inherited the colonial medical model which is urban centred; based on curative care in large hospitals and ‘Western trained’ specialists who are ignorant or ignore the underlying socioeconomic causes of illness and poor health. They are often arrogant, gender insensitive and incapable of identifying with the needs of the common people (most doctors come from a higher social class background) and invariably align themselves with commercial medical interests;

• Upgrade, improve, foster and give equal importance, recognition and support to the development of indigenous systems of health through training, education, research and development, documentation and so on;

• Should cooperate together eg South-South initiatives and regional cooperation in areas like agriculture and health and pharmaceuticals.

Northern Governments must:

• Stop the manufacture and sale of light arms, antipersonnel landmines, and the like to Third World countries. Although the 1997 Mine Ban Treaty (Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction) came into force in March 1999, and has been signed by at least 138 countries, the US, Russia, and China have not signed the Treaty. These countries must honour their global responsibility as veto wielding permanent members of the UN Security Council;

• Stop the dumping of hazardous technologies and products eg incinerators, and microwave ovens which threaten public health and safety;

• Regulate the financial sector and lobby the G8 to act; a new financial architecture must be people oriented and socially inclusive and deal with global inequities and poverty that affect more than four billion people; the role of the nation state must be accorded a primary role to control global finance and the active participation of the Third World countries which have been currently marginalised and ignored.

Local Level Initiatives
 

Peoples movements should:

• Monitor the activities of their governments as to whether they are keeping their global commitments to treaties and agreements;

• Meet with Northern donors and ask for transparency in their aid policies;

• Network with groups and individuals which are working across sectors on North-South and South-South cooperation to campaign, plan strategy, share information, tactics, lobby governments and citizens;

• Monitor the activities of TNCs, the IFIs and donors in their respective countries;

• Lobby governments for better national legislation to foster peoples’ participation in nation building, protection of women, children, workers etc. For example Thailand has a provision that allows for constitutional review when the views of 50,000 citizens’ and their signatures are presented to parliament;

• To foster support and highlight local initiatives towards sustainable, ecological and self-reliant community development models. For example there are movements everywhere which are encouraging and developing the growth of local economies, protecting rural and urban communities and family life. In the North, farmers are now directly linking with urban consumers and farmers’ markets in Japan, UK and the US to benefit local economies and the environment. In the South communities are also developing alternatives, going back to organic agriculture, promoting village self-reliance and rehabilitation of degraded habitats (land and marine) for survival and livelihood;

• To actively and sincerely build second generation leadership (with gender balance); we all grow old and cannot live forever and the process of change is a long-term effort.
   

Finally, changes are not going to happen overnight. It needs a long-term plan and health activists and social movements need to prepare for a protracted struggle. For this to happen there must be a programme to nurture and groom new blood and leadership among the young. We must constantly seek cooperation and solidarity with other networks and forge links with these forces.

 

ends
 

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