AFRO-NETS> Equity in Health and the Globalization of the World's Economy

[Claudio Schuftan <aviva@netnam.vn>]

Equity in Health and the Globalization of the World's Economy
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24 KEY STATEMENTS

1. Structural Adjustment and Globalization have fostered social ex-
clusion and a polarization in a direction opposite to greater equity 
in health. 

2. Inequities in health result in decreased access/utilization of 
services by the poor. 

3. Social exclusion with its despair and worry results in chronic 
stress; the latter damages health as much as meager income and poor 
access to services. 

4. Levels of income are lower today in 70 developing countries than 
in the 1960s. The poorest 20% of the world's population gets 1.3% of 
the global income. Today also, 1.3 billion people survive on less 
than US$ 1 a day and 1.6 billion people are worse off today than they 
were 30 years ago. 

5. But these indicators only tell a part of the story of inequity; we 
do not routinely measure other. 

6. On issues of inequity we procrastinate, but the underlying power 
play of politics cannot be ignored; we must deal with the latter, be-
cause equity in health is inseparable from equity in society; equity 
in health cannot be achieved in isolation. 

7. Globalization is a process we cannot wish away. And globalization 
does not have a human face; power differentials are at its crux. 

8. The market approach fostered by globalization rewards those with 
purchasing power, or with commodities or services to sell; poor peo-
ple and nations have neither. Globalization has become a feast for 
the rich and a tragedy for the poor. 

9. When government expenditures in health in developing countries are 
shrinking, the forces of globalization (e.g. the World Bank) have 
them pushing for a greater role of market forces in the production 
and distribution of health: the solution is to commercialize, com-
moditize and privatize health. 

10. Market forces alone (with people paying for their own care) have 
failed to deliver minimum acceptable health care for all anywhere. 

11. Because people are already paying for care, the WB and others as-
sumes people are willing to pay. But willingness does not mean abil-
ity! 

12. In the fee for service system being imposed on poor countries, 
equity is clearly being sacrificed in the name of a not yet proven 
greater efficiency. 

13. Providing health care on the basis of need is being replaced by a 
system based on cost recovery where exemptions for the poor have not 
worked. 

14. Safety nets set up in health are nothing but a way to manage pov-
erty attenuating social unrest; they do not address the causes of 
poverty. 

15. Health policy makers can no longer make decisions that conflict 
with the equity goal. The choice is a moral one and cannot be made by 
the medical establishment only. 

16. The politics of health will override all other efforts to bring 
us Health for All. (Equity is the forgotten key thrust of Alma Ata!). 

17. Most government health actions are overwhelmingly dis-empowering 
at a time when only empowerment of beneficiaries will bring more eq-
uity. 

18. We need to propose actions that empower those most in need; the 
costs of inaction are enormous. 

19. We also need to demystify medical knowledge so people can better 
deal with health and disease. 

20. Countering the forces of Globalization is a step towards equity; 
it is wrong to look for an accommodation to fit greater health into 
an inherently inequitable system. 

21. Growth and equity need not be trade-offs; progress will not come 
simply from 'liberalizing' the economics of health. 

22. The current brand of liberalization is morally unacceptable and 
economically inefficient. 

23. A renewed commitment and resolve to foster empowering community-
based activities will have to guide our actions. Ultimately, people 
will have to negotiate and bargain by themselves. 

24. Localization is the countervailing citizen's agenda to protect 
people's health.

In all this, what will count are not our words, but our deeds.

Claudio Schuftan 
Hanoi, Vietnam
mailto:aviva@netnam.vn

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