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How wealth and greed are destroying our health and environment and what’s to be
done?
Fran Baum
People’s Health Movement
Southgate Institute for Health Society & Equity
Flinders University
Adelaide, Australia
Richest woman in the world –accumulating as much in a second as many Africans earn in a year
Global oligarchy of wealthy – across borders
Avoiding tax
Making profit without accounting for health, social & environmental impact
My Argument
• There is lots of evidence on inequities and health inequities – shows things are growing much more unequal in last decades
• Commission on Social Determinants of Health summarised evidence and areas for action
• Why doesn’t action happen?– Distractions – behaviour, trickle down, need for growth
– Corporate power and capitalist system that underpins inequities
– Manufacturing consent
• What’s to be done
Per capita income in low-, middle- and high-income countries: GNI per capita and PPP income per capita (GNI) ($US equivalent): 2003-2009
Source: World Bank - World Development Reports 2005-2011
Gaps Widening
Global wealth distribution 2000(Baum 2008: 418 quoting Davies et al 2006:47)
Region Pop Share Wealth per adult
Wealth Share
North America
6.1 190,653 34.3
Europe 14.9 67,232 29.5
Africa 10.2 3,558 1.1
World 100 33,893 100
Life expectancy at birth by World and UN region: 1960 -2005
World Bank 2006: Disease and Mortality in Sub-Saharan Africa. 2nd edition
Gap Widening
Under 5 mortality rates/1000 live births; low-, middle- and high-income countries: 1990 - 2009
Source: World Bank - World Development Reports 2005-2011
Percentage reduction in rates of infant mortality (under 1 year) per 1000 live births by region from 1955 to 2005
Clark, R. (2011) World health inequality: Convergence, divergence, and development. Social Science & Medicine 72: 617-624
Commission on the Social Determinants of Health
• Launched 28th August 2008 by Dr. Margaret Chan, Director General, WHO in Geneva
• "Health inequity really is a matter of life and death" Margaret Chan
• Equity from the start• Healthy places- healthy people• Fair employment –decent work• Social protection across the life course• Universal health care
• Health Equity in All Policies• Fair financing
• Market responsibility• Political empowerment – inclusion and voice• Good global governance
• Monitoring, research, training • Building a global movement
Full report downloadable at http://www.who.int/social_determinants/en/
Daily Living Conditions
Power, Money and Resources
Knowledge, Monitoring and Skills
CSDH – Action Areas
How is it that inequities are tolerated and there has been little follow through on CSDH and other health equity reports?
• Distractions – behaviour, trickle down, need for growth
• Corporate power and capitalist system that underpins inequities
• Manufacturing consent – inequities seen as part of natural order
Distractions
• Trickle down – eventually everyone will benefit and true there has been progress in extending life expectancy
• Myth of the need for growth – so excesses of capitalism are necessary because economic growth is crucial at all costs
• Behaviours explain inequities – especially evident in terms of health inequities
Do we need growth for health?
US compared to Costa Rica Indicator (2005) US Costa Rica
Life expectancy at birth
77 79
Infant MR 7 11
Happy Planet Index (Life satisfaction, LE, Ecological footprint) (NEF)
28.83 (rank 150th)
66.0 (rank 3rd)
Gross National Income per capita (US$)
41,440 4,470
Health expenditure per capita (US$)
5,711 350
Source: Baum (2007) based on World Bank, 2007
Lessons from low income high health countries: Not what you spend but how
you spend it
• Universal provision of services (not targeted at poor)
• Strong public sector• Education especially for girls• Distribution of resources crucial• Strong PHC• Support for Indigenous agriculture
Werner and Sanders, 1997; UNICEF, 1988
Distraction: focus on behaviour• “the tendency for policy to start off
recognizing the need for action on upstream social determinants of health inequalities only to drift downstream to focus largely on individual lifestyle factors”. Popay, Whitehead and Hunter, 2010
Most health policies based on behaviouralism – with focus on individual and blaming victim for their health status This approach is very compatible with neo-liberalism