Saksar Sawasth Aur secular Haryana
How has Globalisation Affected Health in Different Countries?
Public health is an obvious casualty of this process. There is a clear contradiction between the principals of public health and neo-liberal economic theory. Public health is a "public good", i.e. its benefits cannot be individually enjoyed or computed, but have to be seen in the context of benefits that are enjoyed by the public. Thus public health outcomes are shared, and their accumulation lead to better living conditions. It does not mechanically translate into visible economic determinants, viz. income levels or rates of economic growth. Kerala, for example, has one of the lowest per capita incomes in the India but its public health indicators that approach the levels in many developed countries. The Infant Mortality Rate in Kerala is less than a third of any other large state in the country.
[It's Alarming!! Across the world, policies dictated by the forces of globalisation (in the form of structural adjustment policies in many countries) had the following specific effects on the health sector.].
But neo-liberal economic policies do not even acknowledge such benefits. The current
economic policies would rather view health as a private good that is accessed through the market.
i. A cut in the welfare investment, leading to gradual dismantling of the public health services.
ii. Introduction of service charges in public institutions, making
the services inaccessible to the poor.
iii. Handing over the responsibility of health service to the private sector and undermining the rationality of public health. The private sector on the other hand focused only on curative care.
India for instance, was forced to reduce its public health expenditure in health and to recover the cost of health services from its users by international banks.
iv. The voluntary sector, which has also stepped in to provide health services is forced to concentrate and prioritize only those areas where international aid is made available - like AIDS, population control, etc. These "fundamentals" were more sharply focused upon in 1987 by the World Bank document titled "Financing Health Services in Developing countries" which made the following
recommendations for developing countries.
1) Increase amounts paid by patients.
2) Develop private health insurance mechanisms (this requires a dismantling of state supported health services as if free or low cost health care is available there is little interest in private insurance).
3) Expand the participation of the private sector.
4) Decentralise government health care services (not real
decentralisation but an euphemism for "rolling back" of state
responsibility and passing on the burden to local communities).
These recommendations were further "fine-tuned" and reiterated by the Bank's World Development Report, 1993 titled "Investing inHealth".
[These "fundamentals" were more sharply focused upon in 1987 by our document titled "Financing Health Services in Developing countries" which made the following recommendations for developing countries. WB]
Today the Bank is the decisive voice in this regard, and the organisations like WHO and UNICEF have been reduced to playing the role of "drum beaters" of the Bank. In almost every developing country, where these prescriptions have been followed, public health conditions have deteriorated. In
Philippines health expenditure fell from 3.45% of GDP in 1985 to 2% in 1993; and in Mexico from 4.7% of GDP to 2.7% in the decade of the 80s. Even developing countries with a strong tradition of
providing comprehensive welfare benefits to its people were not spared (with the exception of
Cuba). In China health expenditure is reported to have fallen to 1% of GDP and 1.5 million TB
cases are believed to have been left untreated since the country introduced mechanisms for cost recovery. In Vietnam the number of villages with clinics and maternity centers fell from
93.1% to 75%. There have been dramatic reversals of health gains made after the Second World War. Thus the gap in the under-five death rate, considered a sensitive indicator of social and economic development, has widened between the rich countries and the poor. The under-five death rate gap increased from a ratio of 7.8 in 1978 to 12.5 in 1998. Similarly, the death rate ratio in the age group five to fourteen has also increased from 3.8 in 1950 to 7 in 1990. The impact was not limited only to poor countries.
[The involvement of the WB & IMF in moulding the policies of countries in Latin America, Africa and Asia expanded dramatically in the 1980s: by the end of 1991, 75 countries had
implemented structural adjustment policies that had an impact on the health sector].
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In a number of the developed industrial countries, inequalities in health outcomes are being
soon among the poor. In many countries, more women entered the labour force but typically at
lower wages and with inferior working conditions than for men; in many others, women were
displaced from employment as levels of unemployment increase markedly. Simultaneously, the extent
of unpaid labour in households, performed largely by women, increased as public provision of basic goods and services declined. Young children, especially girls, were increasingly withdrawn from school to join the vast and grossly underpaid informal labour market or to assist in running the household. Rising food prices, along with cuts in subsidies for the poor, meant that an increasing proportion of families with precarious resources were pushed under the poverty line, affecting women and girl children disproportionately. As the table below indicates, they had to work for longer hours to purchase the same amount of foods as before, thus getting increasingly exploited. This also meant an increase in young women - and indeed women in general - being pushed into the sex industry, now increasingly global. Given increasing levels of under nutrition, infant and child
mortality rates, which had earlier shown a decline, either stagnated or in the case of some countries, actually increased. So widespread were these effects that even the UNICEF issued calls for "a human face" to structural adjustment programme.
[*An important consequence of globalisation has been commonly described as the "feminisation of poverty" as women increasingly had to strive to hold families
together in various ways in the face of increasing pressures, chief among them are increasing poverty and insecurity.*]
In the face of such evidence, even the World Bank was forced to modify its earlier recommendations. The World Bank started talking about investing in the poor through investments in health and
education; and about the promotion of safety nets and targeted social programmes. This is a clear recognition that specific programmes are necessary to protect the poor from the consequences of structural adjustment and that economic growth by itself does not reduce the problem of poverty. But these changes in the World Bank's thinking are still too inadequate and have come too late for millions who have died as a result of the policies it had promoted. Because of these effects the last two decades of the 20th century have often been described as lost decades. In 1960, the poorest 20 per cent of the global population received 2.3 per cent of the global income. By 1991, their share had sunk to 1.4 per cent. Today, the poorest 20 per cent receive only 1.1 per cent of global income. The
Table 1
Hours Worked to Purchase 1,000 Calories Before and After SAPs
1975 1984
Barley 0.07 0.59
Sugar 0.16 0.51
Corn 0.17 0.64
Wheat flour 0.21 0.52
Dried beans 0.22 3.47
Rice 0.22 0.48
Bread 0.28 0.51
Oil 0.28 0.51
Potatoes 0.76 2.35
Onions 1.02 3.22
Milk 1.05 3.95
Source: Susan George (1990), A Fate Worse Than Debt: The World Financial Crisis
and the Poor, PIRG, New Delhi.
The ratio of income of the wealthiest 20 per cent of the people to that of the poorest 20 per cent were 30 to 1 in 1960. By 1995, that ratio stood at 82 to 1. This is based on distribution between rich and poor countries, but when the maldistribution of income within countries is taken into account, the richest 20 per cent of the world's people in 1990 got at least 150 times more than the poorest 20 per cent. The 20 per cent of the world's people who live in the highest income countries account for 86 per cent of the global consumption; the poorest 20 per cent, only 1.3 per cent. In other words, while the world had grown incomparably richer, the wealth generated had been distributed remarkably unequally.
R.S.dahiya
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