[afro-nets] G8 and population health in Africa

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

G8 and population health in Africa
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Globalization and Health: A new, critical view
by Ronald Labonte and Ted Schrecker *

In Zambia, a woman named Chileshe is dying of AIDS. She was in-
fected by her now dead husband, who once worked in a textile
plant along with thousands of others but lost his job when Zam-
bia opened its borders to cheap, second-hand clothing. Resorting
to work as a street vendor, he would get drunk and trade money
for sex - often with women whose own husbands were somewhere
else working, or dead, and who desperately needed money for
their children. Desperation, she thought, is what makes this
disease move so swiftly; she recalls that a woman from the for-
mer Zaire passing through her village once said that the true
meaning of SIDA, the French acronym for AIDS, was "Salaire In-
suffisant Depuis des Années" (Schoepf, 1998).

Chileshe's is one of four stories we used in a report that has
just been published by Canada's Centre for Social Justice (La-
bonte, Schrecker & Sen Gupta, 2005b) to dramatize the health im-
pacts of transnational economic integration ('globalization').
It is a composite, like the stories used in the World Bank's
1995 'World Development Report'. The Centre for Social Justice
report, which grew out of a contribution to the first 'Global
Health Watch Report' (forthcoming in July at
http://www.ghwatch.org), directly challenges the elite religion
of neoliberal, market-oriented economic policy, as promoted by
agencies like the World Bank and the International Monetary
Fund. Drawing on an extensive research base, we describe the
causal pathways that link globalization to unequal and deterio-
rating health outcomes by way of increasing inequalities in ac-
cess to the social determinants of health, and policies that
tilt the economic playing field even more steeply toward the
rich countries!

Sometimes, the impact is straightforward, as when public spend-
ing cutbacks combined with onerous debt repayment terms mean
that governments opt for "cost recovery" in health care or water
and sanitation. This process played a role in Chileshe's story.
As part of a structural adjustment program attached to loans
from the International Monetary Fund, Zambia imposed user fees,
cut health staff and reduced the salaries of those who remained
- just at a time when the AIDS epidemic was surging out of con-
trol.

In other cases, the causal pathways operate less directly, by
reducing economic insecurity and magnifying inequalities. The
same adjustment program required Zambia to open its borders to
second-hand clothing in 1992. Its domestic clothing manufactur-
ers, valuable though they were as providers of employment, could
not compete with imports of used clothing with zero production
costs. Within eight years, Zambia's clothing and textile indus-
try all but disappeared, along with 30,000 jobs; large numbers
of previously employed Zambian workers were thrust into the in-
formal, ill-paid and untaxed underground economy. The World Bank
called these "unintended and regrettable consequences" of the
adjustment process (Jeter, 2002). For classical economists, the
market was working as it should: consumers get more and cheaper
stuff, and inefficient producers are driven out of business. For
the losers and the left-behind, the consequences can be deadly.
Zambia's required privatization of state !
  enterprises eliminated a further source of revenues that might
have been used to support social programs, such as education and
health care.

The Zambian government is trying to undo some of this damage.
But like many other governments, it is hampered by the rich
world's failure to cancel more of the developing world's crip-
pling debt, or to provide it with the resources it needs to sus-
tain its peoples' health. Writing about another African country,
journalist Ken Wiwa noted: "You'd need the mathematical dexter-
ity of a forensic accountant to explain why Nigeria borrowed $5
billion, paid back $16 billion, and still owes $32 billion"
(Wiwa, 2004).

Not until 1996 did the rich world respond collectively with the
so-called Heavily Indebted Poor Countries or HIPC initiative.
This has freed up more money for health and education. But much
of the HIPC countries' debt will remain unpaid and uncancelled
at the conclusion of the initiative, most of the world's poor
live in countries that are not eligible for HIPC and the price
of debt relief is often more privatization and trade liberaliza-
tion, now dressed up in the rhetoric of poverty reduction
strategies.

Development assistance is by no means a panacea. At the same
time, a wealth of experience now exists on how to make aid work
for basic needs, if the political will is there on the part of
donor and recipient countries. The most authoritative estimate
is that meeting the Millennium Development Goals' 2015 targets,
most of which are health-related, would require an additional
$60 - $120 billion a year in aid from the industrialized to the
developing world. This would represent a doubling or tripling of
current aid flows, but hardly a formidable sacrifice: less than
the cost of 57 Big Macs per Canadian per year, or 43 Big Macs
per German per year (Schrecker, Labonte & Sen Gupta, 2005a). The
cost would also be a fraction of what the United States spends
on its armed forces, or of the value of the tax breaks that the
richest Americans and Canadians have received in recent years.

Reasons exist for optimism. Both the UN Millennium Project,
which generated the cost estimates we have quoted, and the UK
Commission for Africa were emphatic about the need for more de-
velopment assistance and more effective ways of using it. In the
words of the UN Millennium Project, "Even if we don't know eve-
rything about such challenges, we know enough to achieve the
[Millennium Development] Goals. Moreover, the necessary inter-
ventions are utterly affordable" (UN Millennium Project, 2005).
Partly because the British government has placed African devel-
opment high on the agenda, this July's G8 Summit may represent a
turning point for population health in Africa, and elsewhere in
the developing world.

A minimal "health equity agenda" for the Summit (Labonte &
Schrecker, 2005) includes not only clear timetables for aid in-
creases tied to comprehensive strategies for improving popula-
tion health, but also expanded debt cancellation, acceptance of
development-friendly trade policies such as special and differ-
ential treatment (SDT), and explicit acknowledgment that human
rights - including the right to health - take precedence over
trade and financial liberalization. In addition, because of the
importance of capital flight in undermining African economies,
the G8 must quickly ratify the United Nations Convention Against
Corruption (which would provide for repatriation of assets ille-
gally shifted offshore) and pressure other industrialized coun-
tries, as well as offshore financial centres, to do the same. To
the credit of the UK Commission on Africa, it was emphatic on
these points.

Unfortunately, reasons also exist for pessimism. The Millennium
Project and the UK Commission were less emphatic in acknowledg-
ing the need for fundamental redesign of the international eco-
nomic order. Canada's finance minister, who was a member of the
UK Commission, is making breathless speeches about how Africa
needs "a strong indigenous private sector to create jobs" and
must "improve the business and investment climate . building en-
trepreneurial and marketing skills, domestic capacity and im-
proving access to finance" (Goodale, 2005). This language sug-
gests a development policy triage in which people not strong,
young, or lucky enough to make it into the entry levels of the
global marketplace (like Kenya's call centres; see Lacey, 2005),
or predatory enough to establish business alliances with foreign
corporations, are considered disposable. In the discourse of
growth through entrepreneurship those Africans who are already
seropositive, or at highest risk for HIV infection!
  because of their economic vulnerability, become invisible.

By the end of the July Summit we will have a much better sense
of whether the industrialized world is serious about improving
the health of all Africans, or whether the best it can come up
with is selective and targeted policies that represent only in-
cremental departures from a past posture of 'Fatal Indifference'
(Labonte et al., 2004).

* Ronald Labonte (rlabonte@uottawa.ca) and Ted Schrecker
(tschreck@uottawa.ca) are, respectively, Canada Research Chair
and Senior Policy Researcher at the Institute of Population
Health, University of Ottawa, Canada.