News & Media Opinion Pieces Towards Global Health Equity

Towards Global Health Equity

by Colin Butler, member of the Management Committee DEA

For three days in September (19-21) I attended a workshop at Flinders University, organised by the South Australian Community Health Research Unit, and presented by Professor Ron Labonté, who is from the University of Ottawa. Ron is acknowledged as a world authority on globalisation and health, and is a penetrating critic of many of the arguments used by market enthusiasts.

Globalisation, of course, is not new, but its scale and rate has accelerated in recent decades. This is evident in myriad ways, such as the speed of travel, the ease of communication, and the increasingly global nature of trade, ideas, media, weaponisation, and environmental change. However, the most recent phase of globalisation – that which John Gray calls “wild globalisation” has been characterised by the selective dismantling of trade barriers and by an increased polarisation between rich and poor, both within many nations and between rich and poor populations worldwide.

Supporters of economic globalisation point to the abundance of material goods and the reduction of extreme poverty in many parts of South and East Asia, as evidence of its virtues. When pressed about inequality most defenders of globalisation either argue that it is has not increased (or not by much), and even if it has, that inequality is unimportant, because “a rising tide lifts all boats”. Importantly, virtually all supporters of globalisation belong to groups who have disproportionately benefited from it. Many defenders of globalisation rely upon the approval of those who are even greater beneficiaries, in order to maintain their salaries and prestige. On the other hand, the very large numbers of people who lose because of globalisation (or who at least are minimally benefiting) are disproportionately voiceless. They have few advocates, and even fewer avenues of protest. Consider, for example the coverage of celebrities, compared to the attention paid to the hundreds of millions of people who go hungry every day (eg see http://www.hinduonnet.com/mag/2002/08/11/stories/2002081100500100.htm ).

Think of the rationale for the increasingly stratospheric salaries of CEOs. Apologists for this largesse argue that talent is scarce, and that salaries are purely determined by market forces (supply and demand). On the other hand the supply of low-skilled labour is immense; and the same market forces, claimed to be impartial, lower the wages of the low-skilled. When criticised about how lousy wages and conditions can be in developing countries, defenders of economic globalisation often argue that the alternative (eg to be a peasant in the Chinese hinterland) is even worse, and that because most such workers voluntarily accept the harsh conditions of factory life their well-being must be improving. It is true that the Chinese “floating population” (or, for that matter, many workers illegally working in this country in sweatshops) choose a bad alternative over something even worse, just as most slaves elected to work rather than die. But this does not make it right, and it should not be acceptable. While inequality is inevitable, its extent can, and should, be reduced.

But what of health and globalisation? Supporters of the health benefits of globalisation sometimes point to the ongoing increase in global life expectancy as evidence that health must also be improving. However, health-orientated critics of globalisation argue that the proportional increase in population health observed in the first few decades after World War II was far higher (even after accounting for the fact that the “fruit” was easier to pick). And, of course, life expectancy is now declining for many populations.

The workshop was terrific (about 20 people), with lots of opportunities to participate. Ron is a great motivator, able to back his arguments with considerable evidence, and very open to discuss the complexities of this issue. The course textbook (Labonté R, Schrecker T, Gupta AS, 2005. Health for some? Death, disease and disparity in a globalizing era. Toronto: Centre for Social Justice) is available as a PDF from www.socialjustice.org