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Globalization and Health Equity:
Towards Sustainable Development?
Ronald Labonté, PhD, FCAHS
Canada Research Chair, Globalization and Health Equity
University of Ottawa, Canada
Chair, Globalization Knowledge Network
WHO Commission on Social Determinants of Health
[email protected]
…there is as yet no
credible, socially just,
ecologically sustainable
scenario of continually
growing incomes for a
world of nine billion
people.
UK Sustainable Development
Commission, Prosperity without
Growth? 2009
Inequalities on the rise
• High net worth individuals
– the 24 million or so in the
world with income assets
between $1 and $50 million
• Ultra high net worth
individuals
– the 80,000 or so in the world
with income assets exceeding
$50 million
• Billionaires
– over 1,200 individuals with
income assets representing a
staggering 77 percent of total
global wealth, much of it
stashed in offshore financial
centers (tax havens)
Redistribution, regulation and rights
“Policies should provide for:
• systematic resource redistribution between countries and within
regions and countries to enable poorer countries to meet human
needs,
• effective supranational regulation to ensure that there is a social
purpose in the global economy, and
• enforceable social rights that enable citizens and residents to seek
legal redress.”
Deacon, B., Ilva, M., Koivusalo, M., Ollila, E., & Stubbs, P. (2005). Copenhagen Social Summit ten
years on: The need for effective social policies nationally, regionally and globally (GASPP Policy Brief
No. 6). Helsinki: Globalism and Social Policy Programme, STAKES. Available:
http://gaspp.stakes.fi/NR/rdonlyres/4F9C6B91-94FD-4042-B781-3DB7BB9D7496/0/policybrief6.pdf.
In the wake of the food, fuel and financial shocks, a
fourth wave of the global economic crisis began to
sweep across developing countries in 2010: fiscal
austerity (p.v).
http://www.networkideas.org/featart/sep2011/Isabel_Jingqing_Matthew.pdf
Mass protests in
Greece against the
government and the
IMF
Greece bailout
requirements:
• Cut in pensions
• Huge decrease in
public spending
• Cancel some welfare
programs
• Privatize health
system, state assets
• Raise VAT
• Soon coming to other
countries near you!
Those who support fiscal
tightening argue that it is
indispensable for restoring
the confidence of financial
markets, which is perceived
as key to economic recovery.
This is despite the almost
universal recognition that
the crisis was the result of
financial market failure in
the first place… (p.V)
UN Social
Protection
Floor
Initiative
http://www.socialsecurityextension.
org/gimi/gess/ShowTheme.do?tid=
2485
…not only directly affect
social security
beneficiaries and
consequently the
standards of living of a
large portion of the
population but also,
through aggregate
demand effects, slow
down or significantly delay
a full economic recovery
(p.7)
 all recipient governments
were expected to cut
spending
 none were given flexibility
to defer debt payments,
and
http://www.eurodad.org/uploadedFiles/Whats
_New/Reports/Bail-out%20or%20blow-out.pdf
• half were instructed to
reduce deficits and
introduce wage freezes
• all recipient governments
advised to increase VAT
(regressive) taxes, privatize
financial and energy
sectors, and deepen
liberalization
Time for a Financial Transaction Tax?
Annual tax revenues:
• 0.05% on foreign exchanges:
USD 250 billion
• 0.005% on foreign exchanges,
derivatives and over the
counter trades: USD 863
billion
• 0.05% on foreign exchanges,
derivatives and over the
counter trades: USD 8.63
trillion
…there is as yet no
credible, socially just,
ecologically sustainable
scenario of continually
growing incomes for a
world of nine billion
people.
UK Sustainable Development
Commission, Prosperity without
Growth? 2009
Growth is Not
Working
Percent changes in GHG emissions
1990-2004 by sector
Woodward, D. & Simms, A. 2006, Growth is Failing the Poor: The Unbalanced
Distribution of the Benefits and Costs of Global Economic Growth,
ST/ESA/2006/DWP/20, United Nations Department of Economic and Social
Affairs, New York, 20.
The major challenge remains
that of economic growth…the
idea of freezing the current
level of global inequality over
the next half century or more
(as the world goes about trying
to solve the climate problem)
is economically, politically and
ethically unacceptable (p.vi).
Growth is Not
Working
Percent changes in GHG emissions
1990-2004 by sector
Woodward, D. & Simms, A. 2006, Growth is Failing the Poor: The Unbalanced
Distribution of the Benefits and Costs of Global Economic Growth,
ST/ESA/2006/DWP/20, United Nations Department of Economic and Social
Affairs, New York, 20.
Trade, Technology Transfer and the
Environment
• Energy use and
transportation (essential
to global trade) the two
sectors contributing most
to climate change
• Intellectual Property
Rights can slow green
technology transfer
• USA in 2011 succeeded in
a trade dispute over
China’s subsidies for its
wind turbine
development
Ethiopia has sold
leases to 3 million
hectares of its best
farmland to foreign
companies
yet relies on 700,000
tonnes of emergency
food aid each year
Karmjeet Sekhon, project manager for Indian food
company Karuturi Global, with crops in Ethiopia's
Gambella province.
Photograph: John Vidal for the Guardian
US green stimulus:
1.5% - 3% of total
0.1% of GDP
Chinese green stimulus:
10% of total
Stern Report of minimum
public spending needed:
2% of GDP
20x the US
stimulus
Low-income countries
High-income countries
Global health diplomacy?
Oslo Ministerial
Declaration – global
health: a pressing foreign
policy issue of our time
Vol 369 - April 21, 2007.
Ministers of Foreign Affairs of
Brazil, France, Indonesia,
Norway, Senegal, South Africa,
and Thailand
What is to be done?
•
•
•
•
•
•
•
•
•
•
Radical re-regulation of financialized global economy
New forms of global taxation and closure of tax havens
More progressive national taxation
Comprehensive health and social protection
End subsidies to environmentally damaging economic activities
(internalize environmental costs)
Promote subsidies to environmentally protective economic
activities
Government purchasing to promote environmental and social
sustainability
Change trade rules to permit both, including TRIPS flexibilities for
green technologies and not simply drugs
Improve developed/developing world burden sharing through
exemptions for those below USD 9,000/year and progressive
carbon taxes on those above
Localize where possible capital flows, and water, food and other life
resources
Redistribution, regulation and rights
“Policies should provide for:
• systematic resource redistribution between countries and within
regions and countries to enable poorer countries to meet human
needs,
• effective supranational regulation to ensure that there is a social
purpose in the global economy, and
• enforceable social rights that enable citizens and residents to seek
legal redress.”
Deacon, B., Ilva, M., Koivusalo, M., Ollila, E., & Stubbs, P. (2005). Copenhagen Social Summit ten
years on: The need for effective social policies nationally, regionally and globally (GASPP Policy Brief
No. 6). Helsinki: Globalism and Social Policy Programme, STAKES. Available:
http://gaspp.stakes.fi/NR/rdonlyres/4F9C6B91-94FD-4042-B781-3DB7BB9D7496/0/policybrief6.pdf.