AFRO-NETS> Is globalization dangerous to our health?

[Claudio Schuftan <aviva@netnam.vn>]

Is globalization dangerous to our health?
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by Stephen Bezruchka (adapted)

When asked about globalization, Margaret Thatcher replied: "There is 
no alternative." Her reply was shortened to "TINA," which some people 
think is a newly discovered law of nature... Yet, public resistance 
to this new corporate-centered trade is increasing. What relevance 
does this have to health? or Does globalization affect health?

Many think about the health effects of modern global trade as involv-
ing increased pollution by corporations or global warming caused by 
the increased use of fossil fuels. Others focus on the increase in 
the tobacco market penetration. The expansion of global cigarette ex-
ports is a dramatic example, totalling 223 billion cigarettes in 1975 
rising to 1.1 trillion in 1996 (a 5-fold increase). Or they might 
consider deaths from toxic exposures in poor countries as US corpora-
tions evade environmental restraints at home (Bhopal).

These effects are real, but they pale in comparison with globaliza-
tion's effect on increasing inequality, the most powerful factor af-
fecting a population's health and responsible for perhaps 14 to 18 
million deaths a year (18% of total deaths) worldwide.

DANGERS OF HIERARCHY IN HEALTH 

The health of the US population is disgracefully poor compared with 
that of other rich countries. In the ranking of countries by life ex-
pectancy in 1997, the United States stood 25th, behind all the other 
rich countries and even a few poor ones. The prevalence of smoking in 
Japan is tied with that in China as the highest in the world and 3 
times that of the United States; yet, the Japanese do not die of 
smoking-related diseases to the extent that Americans do. Lung cancer 
mortality rates in Japan are one half to one third of those in the 
United States. How does Japan do it? The answer is simple. The health 
of populations in rich countries is determined primarily not by the 
health care system-- we have the most sophisticated and expensive 
one, so it cannot be that, but rather, by the gap between the rich 
and the poor. Many recent studies show that populations with a 
greater income hierarchy are less healthy, and specifically have 
shorter lives, than populations that are more equitable. Independent 
investigators have studied many different populations and all agree: 
the strongest factor affecting health is the size of the gap between 
the rich and poor.

THE WEALTH AND INCOME GAP 

The United States has the greatest wealth and income gap of any rich 
country, which is the main explanation for its dismal health ranking 
among developed countries. We did not always fare so poorly: in 1960, 
we were 13th. As our wealth and income gap have grown, so has our 
distance from the healthiest country.

Most countries in the world are poor, with most people subsisting to 
produce their own food, often supplementing their income by sending 
family members to cities to work in factories or abroad. In some 
countries, immense wealth lines the pockets of only a few people. In 
poor countries, the evidence suggests that equitable development that 
focuses on providing basic needs is the route to improving the popu-
lation's health.

THE PROBLEMS WITH CORPORATE-CENTERED TRADE 

In the past 1 or 2 decades, world trade could be more accurately de-
scribed as trade that is corporate-centered. This change began in the 
mid-1970s and was boosted by the economic policies of Thatcher in 
Great Britain and Ronald Reagan in the United States. Today the dogma 
governing economic activity is founded on the principle that the mar-
ket knows best and should govern the world. The implicit assumptions 
are that economic transactions involve a buyer and a seller who are 
on an equal footing and that the price accurately reflects the cost. 
The influence of indirect subsidies in tipping the scales is over-
looked. In 1995 Boeing, one of the most successful corporations, re-
ceived a tax credit of more than $33 million. Microsoft increased 
profits by 71% in 1999 over the previous year, yet paid $226 million 
less in taxes. Of the world's 100 largest corporations, 20 would have 
gone bankrupt without such assistance.

The so-called free trade with and in poor countries has produced 
great wealth for multinational corporations and provided low-wage 
jobs that keep many people in poverty. Among countries, the gap be-
tween the richest and the poorest quintile was 3 to 1 in 1827, rising 
to 30 to 1 in 1960, to 60 to 1 in 1990, and to 76 to 1 in 1997. Re-
cent studies have shown that where there is increased penetration of 
foreign investment in poor countries, slower economic growth and 
greater inequality result. Global economic greed is the problem.

But what of the effects of global trade in rich countries? In the 
past 25 years, most people in the United States have seen a decline 
or stagnation in incomes after adjusting for inflation. This came 
during a period of record profits for corporations and a booming 
stock market. The United States has begun to look more and more like 
a third world economy, with a fabulously wealthy elite few surrounded 
by a mass of people not sharing in the globalized pie. The top 1% of 
families in this country holds more than 40% of the wealth.

What are the population health effects of corporate-centered economic 
policies? In rich countries, capital is abundant, whereas in poor 
countries, labor is plentiful. Production moves to poor countries 
where labor is cheapest. Free trade in goods and services leads busi-
nesses to produce goods that are capital-intensive in high-wage coun-
tries but labor-intensive in poor ones. Benefits from trade and in-
vestment generally flow to the rich countries rather than to poor 
ones, and thus, income inequality among countries is increased. 
Within poor countries, more people have been displaced from their 
subsistence economies than have been able to find jobs in the manu-
facturing sectors in overcrowded cities. In poor countries, as an 
elite profits immensely from this shift, the income gaps increase. In 
rich countries, the demand for labor is lowered, wages become rela-
tively depressed, and income inequality increases. For most of the 
world's people, it is a lose-lose situation.

Health professionals need to understand that what seems best for an 
individual patient may not benefit the population, if the goal is to 
maximize its health. Individual risk factors need to be de-emphasized 
and population risk factors addressed. The most important risk factor 
is the gap between the rich and poor. Genuine, widespread improve-
ments in health and quality of life will take structural changes in 
the distribution of income and wealth. The evidence is clear that in 
rich countries, health care has not had a major effect on reducing 
mortality in populations.

If a healthy population is our goal, health policy is taking us in 
the wrong direction. We need vigorous debate over who is subsidized 
and by how much. Changing who shares the benefits in the world econ-
omy today is the challenge of the new century. The health of our na-
tion and our people depends on it.

Summary points: Determinants of population health differ from those 
affecting individual health. Population health in rich countries is 
determined primarily by the size of the gap between rich and poor. 
The United States ranks behind all other rich countries and a few 
poor ones in health outcomes such as life expectancy. Globalization, 
or corporate-centered trade, increases the gap between the rich and 
poor within and among countries. Policies that promote substantial 
corporate subsidies and increase the rich-poor gap can be changed to 
improve population health.

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

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