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AFRO-NETS> Equity in Health and the Globalization of the World's Economy
- Subject: AFRO-NETS> Equity in Health and the Globalization of the World's Economy
- From: Claudio Schuftan <firstname.lastname@example.org>
- Date: Wed, 20 Sep 2000 05:22:37 -0400 (EDT)
Equity in Health and the Globalization of the World's Economy
24 KEY STATEMENTS
1. Structural Adjustment and Globalization have fostered social ex-
clusion and a polarization in a direction opposite to greater equity
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-
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
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
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
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-
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
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
In all this, what will count are not our words, but our deeds.
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