Globalization and Children’s Healthcare in the Global South

Globalization and the Undermining of the Developing Welfare State and Children’s Health


“We live in a world scarred by inequality. Something is
wrong when the richest 20 percent of the global popula-
tion receives more than 80 percent of the global income.
Something is wrong when 10 percent of a population
receives half of the national income-as happens in far
too many countries today. Something is wrong when the
average income for the richest 20 countries is 37 times
the average for the poorest 20-a gap that has more than
doubled in the past 40 years. Something is wrong when
1.2 billion people still live under less than a dollar a day
and 2.8 billion still live on less than two dollars a day.”1

James Wolfensohn, World Bank, President


Childhood is both a universal experience, and a culturally specific one.2 As globalization and the neo- liberal agenda is spread through the global South, childhood is becoming increasingly endangered by the processes of globalization. This is most pertinent in terms of health. As Liisa Malkki and Emily Martin term it, ‘environmental racism’ cuts the lifespan of these children while reducing their quality of life through pollution.3 In America, this is evident in the relationship housing patterns and the exposure to pollution, environmental, human health hazards- this variable is stratified on the basis of race, and as a rule, minorities, most particularly African- Americans suffer the most.4 On a global scale, this is more clearly evident. In a 1995 report by Lawrence Summers, then chief economist at the World Bank (now President of Harvard University), he indicated that:

“The export of pollution and toxic waste to the Third World constitutes an economically sound, ‘world- welfare enhancing trade’ that should be actively encouraged by the Bank… [Since] the measurement of the costs of health- impairing pollution depends on the foregone earnings from increased morbidity and mortality… a given amount of health impairing pollution should be done in the country with lowest cost, which will the country with lowest wages.”5

Essentially, in economic terms, pollution is a good thing for the neo- liberal agenda in the global South. Summers rejected criticisms based upon moral and social concerns, as they undermined the Bank’s goal of liberalizing national economies. This relates to children not for the messianic sentiments this can elicit, but for the impact that toxins and pollutants have on developing bodies. The World Health Organization (WHO) referred to children as “canaries in the mine,” a sort of litmus test for the environment.6 It has been estimated that 6 million children under the age of 5 have died (globally) every year in Africa, Asia, and Latin America since 1982, when Thatcher and Reagan’s neo- liberal ideology first gained prominence. This corporate triage of the global South’s children is nothing new, but there are measure that the International Monetary Fund and the World Bank can take to stall the negative effects of structural adjustment programs on developing welfare states’ health- care expenditures.

First, let us take a look at the state of health under globalization. In her article “Globalization and the Decline of the Welfare State in Less- Developed Nations,” Nita Rudra attributes the divergent well- beings of nations in the global North and the global South to the undermining of government mechanisms through economic liberalization. Using a graph, Rudra demonstrates that government spending by developed states in the North and less- developed states in the South have consistently bifurcated since 1975.7 Among those nations categorized as “less- developed” were Argentina, Botswana, Costa Rica, Greece and Kuwait. Conversely, nations considered developed states were the United States, the United Kingdom, France, Germany, Japan, Italy, and Sweden. Globalization hinders the development of welfare states as it does not regard generous welfare benefits as “good market disciplining devices on labor.” Also, “globalization discourages governments from raising revenue” via taxation- most notably, taxation of foreign direct investors.8 The pressure for these “less developed” nations to conform to the neo- liberal agenda is as strong as the nation’s desire to compete with in the global market. As the International Monetary Fund and the World Bank continue to give out conditional loans, there is no doubt that developing nations will continue to accept these loans and the structural adjustment plans that come along with them.

This ties into healthcare as the amount of money poured into welfare agencies is correlates to the monies expended on healthcare. Healthcare, access to vaccines and pharmaceuticals has been left up to the market mechanisms of demand- adjusted pricing. This is problematic as it lends the production of medicine to the frequency (or infrequency) of epidemics- especially with regard to drugs for malaria, cholera, and HIV/AIDS. Additionally, companies want growth, but this is hindered when most world economies do not have effective demand- in this sense, global health depends on the ability to “make it economically feasible for the best of American science, technology and industry to address major global health problems and enable US industry to profit…”9 The underlying logic is one that furthers the ideas favored by the Cold- War era Bretton Woods organizations; simply put, it is the idea that economic modernization would naturally lead to better overall quality of life in a developing nation.10 In its 1993 “World Development Report,” the World Bank turned this logic on its head, viewing poor health as a factor in absenteeism in the workplace and a hindrance to economic development, suggesting an influx of vaccinations and medicines to counteract common ailments and increase workplace production.11 In 1996, the World Bank’s loans for health were double the comprehensive budget of the World Health Organization. Western investment in the global South was henceforth justified by the impetus toward furthering “economic development and modernization.”12 This fits seamlessly into the liberalization of markets, as the market for pharmaceuticals would integrate developing nations further into the world markets. But this contradicts with Lawrence Summers made with regards to pollution and profit.
Now what about the children? U.C. Berkeley Professor Paula S. Fass discusses globalization as a spread of ideas that mold and distort cultural conceptions of childhood and adolescence. She expresses surprise at the absence of children from the discourse of globalism, as they are in that period of their lives when they are socialized and molded into the adults they will become. Just as social conditions and ideas socialize children, health conditions play a large factor in forming the next generation of workers and citizens. In America’s Vital Interest, illness was linked to “absenteeism, trade disruption, reduced GNP, and the redirection of resources from spending on education, infrastructure and other social programmes, leading eventually to political and economic instability.”13 What about supranational organizations and their influence and effect on children’s health in developing countries?

The World Bank’s roundabout manner in dealing with matters of children’s health in developing nation has thus far consisted of education, childhood development programs and programs targeting child labor. In 1996, the World Bank’s investments in health totaled $665- despite, or in spite of, the Bank’s stated goal of advancing human rights in its report “Development and Human Rights: The Role of the World Bank.” As a result of globalization and the imposition of economic liberalization, health outcomes are compromised to achieve economic outcomes. On the walls of the World Bank, the stated mission is to eradicate poverty, but this is not evident in the measures pursued and enforced by the Bank in developing nations. The result has been a widening divide between developing nations in the global South and the developed nations in the global North. As it is, the Bank does not address children’s health concerns unilaterally, rather it attaches them to broader imperatives aimed at productivity. By 2000, the Bank had become the largest financier of health care in developing nations. However, this was only through earmarked projects with broad aims- not specific projects targeting children’s health.14 Critics of the Bank charge that the “bank does not enhance social development, including health by encouraging countries to adopt SAPs (Structural Adjustment Plans).” In his article, Doebbler suggests a human- rights oriented policy that emphasizes the decreasing of infant mortality over adherence to a repayment schedule. He defines a human rights approach as “a strategy requiring that actors view the entitlements of individuals as rights rather than as discretionary concessions.”15
“Other elements of welfare provision, however, offer such productivity benefits and my thus be less favorably received in the face of openness. Among social policies, there are likely to include retirement, family and health- care benefits, and perhaps most obviously, passive unemployment insurance and other labor- market programs, all of which do less to encourage economic adjustment while introducing more labor- market rigidities. … productivity advantages depends on the programs and employer practices in a given country at a given time. Over longer periods of time and across countries the potential productivity benefits of programs do little to encourage sectoral adjustments that globalization necessitates.”16

Burgoon suggests similarly that welfare provision, though it may not accomplish the economic development that globalization demands, these programs are more socially beneficial than structural adjustment programs are.
The cost of illness in poor countries has been underestimated thus far. HIV rates average between 10- 15% in underdeveloped nations, which translates into a decrease in the growth rate of the gross domestic capital per capita of up to 1% a year. Tuberculosis takes away approximately $12 billion from the incomes of poor communities. Gro Harlem Brundtland, Director General of WHO, posed the question, “What would Africa’s GDP be now if malaria had been tackled 30 years ago, when effective control measures first became available?” To which he replied, “Probably about $100 billion greater than it is now, according to a report on the economic consequences of malaria presented to African leaders in Abuja earlier this year.” It is safe to say that the spread of globalization has led to a resurgence of diseases such as cholera, yellow fever and malaria in sub- Saharan Africa and malaria and dengue in South America. As as the latter quote attests, developing countries’ gross domestic production would be much higher than they are now.

Burgoon further suggests that because of the imposition of SAPs which emphasize the repayment of loans, surpluses have been directed toward the repayment of loans rather than the bolstering of the healthcare infrastructure. It seems SAP measures have not yielded the growth touted by the World Bank and the International Monetary Fund, as per capita incomes fell in over 80 countries.17 IMF Structural Adjustment Programmes require cutting government spending, which includes health care and education, while opening up the economy to multinational companies. In Tanzania, debt repayment expenditures outstrip spending on health- care. Between 1975 and 1985, in Peru, per capita food consumption fell by a quarter. In this same period, health expenditures fell 78% in Somalia as it suffered a famine caused by IMF dictated policies. It has been estimated that 6 million children under the age of 5 have died every year in Africa, Asia, and Latin America since 1982, when Thatcher and Reagan’s neo- liberal agenda first gained prominence.18

In 1991, the Manmohan Singh budget effectively cut India’s budgetary contributions to health- care. This plan disproportionately favored urban residents and urban residents were effected more than their urban counterparts. In GDP terms, India’s health expenditure, already quite low relative to the rest of the world, dropped from 1.3% to 0.9% in 1990.19 Today, India has one of the most privatized health- care infrastructures in the world, as access to health care is concentrated in the upper- middle and wealthy class. Additionally, Trade Related Intellectual Property Rights (TRIPS) protecting and privileging the production of pharmaceuticals further narrowed the scope of drugs provided to those profitable to the pharmaceutical companies. The General Agreement on Tariffs and Trade (GATT) negotiations leading to the signing of the TRIPS enabled India to develop state of the art pharmaceutical processes, but did nothing to increase the production of drugs treating diseases that occur in poverty stricken areas. These “orphan drugs” are not profitable simply because those who need the drugs do not have the effective demand to drive the production of the drugs- simply put, they cannot afford the drugs. This is not exclusive to India; only about 4% of drug research monies are allocated to the development of new medicines targeting diseases whose incidences are concentrated in developing countries. On the other end, only 10% of the $56 billion spend annually on medical research are aimed at ills affecting 90% of the world’s population. And to think drugs for the privileged, such as Viagra receive so much funding! Additionally, drugs created in the 1950s and the 1960s to treat tropical diseases are beginning to disappear from the market because of disuse in the developed world.20

In Cuba, there is a different sort of situation; one that was termed by Jerry M. Spiegel and Annalee Yassi a “Cuban health paradox.”21 In their 2004 article, they note that Cuba’s health- care system is much more advanced than comparable countries. Thus, Cuba presents a challenge to the conventional understanding of wealth is a precursor to an effective health- sector.22 Cuba’s under 5 mortality for males is 11 and for females it is 8. This is a rate approximate to those of highly developed nations in the global North. Cuba also has the highest female life expectancy relative to GDP in the Americas according to WHO 2001 data. And since 1989, trends in the health- care sector have only been positive: in ten years, hospitals have increased from 263 to 284, physicians’ offices have increased from 6000 to 15,824, and maternal homes have increased from 148 to 227, according to MINSAP (Cuban Ministry of Public Health) data.23 Additionally, Cuba’s patterns of disease are similar to those of developing nations. Cuba has the highest physician- to- population ratio, even sending doctors and health workers overseas to Africa and Asia. Other factors played a role in improving health, like literacy: before the 1959 revolution, 25% of adults were illiterate, and in 1996, the literacy rate was 97.6% among adults and 100% among primary school children. Most importantly, “the Cuban health system is almost exclusively financed by the state.” The state provides free preventative medical care, diagnostic tests and medications for hospitalized patients- despite these being on short supply. All other costs incurred by patients are subsidized heavily by the state.24 In additional to the quantity of polyclinics, accessibility is greatly enabled by their locations in neighborhoods. Spiegel and Yassi contend that “The presumption that “There Is No Alternative (TINA)” to the neo- liberal path to development and achieving good health outcomes is seriously called into question by Cuba’s experience.” In the 1970’s, as Latin American health- care systems declined under the burdens of SAPs and economic downturn, Cuba saw a steady increase in the quality of its health- care bureaucracy.25 Though isolated from the United States and having rejected the IMF and the World Bank’s conditional loans, Cuba embarked on a different path, disproving Thatcher’s assertion that there was no alternative to the neo- liberal agenda, and defying conventional wisdom that globalization and economic liberalization as beneficial to developing nations. Cuba is an important case study when looking at health care under globalization.

The IMF and the World Bank are supranational organizations capable of pursuing measures that can help reverse the current trends in health care- the hindering of the development of burgeoning welfare states in the global South, and decreased expenditures in the healthcare sector. Doebbler suggests emphasizing a decrease in child mortality rather than adherence to a strict payment schedule, the World Bank and the IMF can counteract the damage wrought by structural adjustment plans. Doebbler also argues that “a human rights approach” as “a strategy requiring that actors view the entitlements of individuals as rights rather than as discretionary concessions,” would shift the emphasis from mere profit to a greater consideration of the human capital of a developing nation. This is fundamentally at odds with the SAPs enforced by the IMF now, and this, if embraced, would present a serious challenge to globalization. That is what is necessary to bring health care to the lofty ideals of human rights as set forth by the 1948 UN Universal Declaration of Human Rights. The difference is that, rather than a sweeping term “human,” nations would use “men, women, children” to account for myriad needs and considerations.



3 Comments

  1. 1 J.A. Wolfensohn, “Building an Equitable World,” address to the Board of Governors, Prague, Czech Republic [September 26, 2000]. http://www.worldbank.org/html/extdt/am00/jdwsp-en.htm (accessed December 14, 2008)
    2 Paula S. Fass, “Children and Globalization,” Journal of Social History, vol. 36, no. 4 (April 2003), pp. 963- 977
    3 Liisa Malkki and Emily Martin, Children and the Gendered Politics of Globalization, American Ethnologist, Volume 30, No. 2, May 2003, pgs. 216- 2244 Malkki and Martin, pg. 218
    5 as cited by Malkki and Martin, pg. 218
    6 Malkki and Martin, pg. 219
    7 Nita Rudra, “Globalization and the Decline of the Welfare State in Less- Developed Countries,” International Organization, vol. 56, no. 2, (Spring 2002), pp. 411- 445 
    8 Rudra, 414
    9 King, 776
    10 Nicholas B. King, “Security, Disease, Commerce: Ideologies of Post- Colonial Global Health,” Social Studies of Science, vol. 32, no. 5/6 (October- December 2002), pp. 779
    11 King, 781
    12 King, 781, 782
    13 King, 781
    14 Curtis Francis Doebbler, “The Right to Health of Children and the World Bank,” Children’s Health and Children’s Rights, vol. 5, no. 2, (2001), pp. 128
    15 Doebbler, 122
    16 Brian Burgoon, “Globalization and Welfare Compensation: Disentangling the Ties that Bind,” International Organization, Vol. 55, No. 3 (Summer, 2001), pp. 527 (http://www.jstor.org/stable/3078656) (accessed 13-12-2008)
    17 Amit Sengupta, “Health in the Age of Globalization,” Social Scientist, vol. 31, no. 11- 12 (Nov.- Dec. 2003), pp. 67
    18 Sengupta, 69
    19 Sengupta, 72
    20 Sengupta, 76
    21 Jerry M. Spiegel and Annalee Yassi, “Lessons from the Margins of Globalization: Appreciating the Cuban Health Paradox,” Journal of Public Health Policy, Vol. 25, No. 1 (2004), pp. 85- 110
    22 Spiegel and Yassi, 86
    23 Spiegel and Yassi, 89
    24 Spiegel and Yassi, 97
    25 Speigel and Yassi, 101

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