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Tropical Medicine and International Health. 2006 Mar; 11(3):255-257.A lavishly sponsored Global Health Summit conference in New York organized in early November by Time magazine included a panel discussion on the pertinent issue of whether global health can be good for business,1 and in the process highlighted many of the contradictions confronting health care providers, policy makers and planners the world over. Attempts to graft compassion onto the root stock of global capitalism have been only partially successful, if at all. Certainly none of the big players in the $3 trillion plus health care industry - whether they be pharmaceutical corporations, equipment manufacturers, hospital chains or health insurers - has been able to demonstrate any long term or sustained commitment to the delivery of health care services to the billions of people in low income countries who currently lack access to them. Many of the 'Global Public Private Partnerships' favoured by the WHO appear to serve largely as public relations campaigns for the private sector 'partners' and also as a means to help them to secure and potentially expand their longer-term market for drugs and vaccines. Meanwhile some of the largest donors supporting such partnerships come from outside of the health care industry altogether - most notably Bill and Melinda Gates, whose benevolent billions also help make Microsoft's cosmic profits seem more socially acceptable. (excerpt)
BMJ. British Medical Journal. 2002 Jun 1; 324:1293.This news article states that a UN report warns that more than half of the world's population will be affected by water shortages by 2032, causing severe health consequences. The UN document is designed to set the framework for the world summit on sustainable development in Johannesburg in 2002, where key issues for discussion are expected to be access to water and sanitation, energy supply, and food security in the developing world. The report warns that over- exploitation of natural resources, increasing pollution, habitat destruction, the extinction of species, and global warming are continuing with increasing intensity as a "markets first" approach spreads around the world.
In: AAWORD / AFARD 5th General Assembly (19-24 July 1999). "Visions of Gender Theories and Social Development in Africa: Harnessing Knowledge for Social Justice and Equality, [compiled by] Association of African Women for Research and Development [AAWORD]. Dakar, Senegal, AAWORD, 2001. 47-72. (AAWORD Book Series)This paper illustrates the negative impact of debt repayment in Tanzania, which, though it is one of the world’s poorest countries, has one of the highest debt repayment loads in the developing world. Debt repayment takes about 35-39% of government expenditure, a percentage four times higher than that spent on basic education and nine times more than spent on primary health care. As a result, socioeconomic indicators such as life expectancy and child mortality are very poor in Tanzania, with women and girls as the primary victims. In response, the grassroots, national, and international levels have to work together to address debt in the country. A gender-sensitive approach would be able to supervise economic relations in order to respect human rights. What’s more, these ideas reflect the concerns of women, who are often assumed to be silent and unconcerned.
In: All of us. Births and a better life: population, development and environment in a globalized world. Selections from the pages of the Earth Times, edited by Jack Freeman and Pranay Gupte. New York, New York, Earth Times Books, 1999. 152-5.The paper focuses on the economic and social development of Vietnam after the civil war. Reborn as Ho Chi Minh City after the war, the city has prospered through more than 2 decades of Communist rule. Capitalism is alive and encouraged by the government. The signs of change are everywhere in Vietnam. The cities are teeming with small shops. More local branches of American fast-food chains are lining the streets, billboards displaying advertisements of foreign products tower over the streets. Aside from economic development, Vietnam has made some progress on the social front. It was able to lower its birth rate to 3.1 in 1995, increase life expectancy to 65 years, and lower the infant mortality rate to 46/1000 in 1994. Knowledge about modern contraceptives is remarkably high. 97% have heard of at least one method. Among couples of childbearing age, 63.8% were using contraceptives in 1995. Of these, 36.9% preferred IUDs, 4.5% used condoms, and 2.9% used the pill. Almost 80% of the contraceptives are supplied by the government through the health network. Despite this success, much remains to be done. The quality of health services offered needs improvement, but the government has no adequate funds. Yet the government is determined to improve the health care system, especially reproductive health care for women.
Investing in amnesia, or fantasy and forgetfulness in the World Bank's approach to healthcare reform in sub-Saharan Africa.
JOURNAL OF DEVELOPING AREAS. 1997 Spring; 31(3):337-55.Investing in Health, the World Bank's 1993 World Development Report, and a follow-up report, "Better Health in Africa," advocate investments in Third World health sectors as a means of increasing individual productivity and strengthening economic growth. Both reports maintain that structural adjustment policies have enhanced the physical health of low-income populations by improving the fiscal health of business elites. This essay critiques the World Bank's approach through a historical analysis of health care problems in sub-Saharan Africa with an emphasis on the devastating effects of colonialism, patriarchy, and imperialism. Although these documents contain many useful recommendations for Western donors (e.g., recognition of the destructive potential of alcohol and tobacco, the need for state regulation over key parts of the health sector, and the effects of gender on health status), they reflect an "investment in amnesia" regarding historical evidence on health care reform in Africa and an erroneous assumption that Western biomedicine is politically neutral. Foreign aid has tended to serve the needs of multinational corporations rather than African populations. Recommended, in place of structural adjustment policies, are measures such as a massive rebuilding of Africa's urban infrastructure, the enforcement of minimum wage laws, the preservation of ecosystems that supply traditional medicines, attention to the ecologic and health consequences of economic growth, and a feminist-led reproductive rights movement.
PEOPLE AND DEVELOPMENT CHALLENGES. 1995 May; 2(3):10.The All China Women's Federation (ACWF) is preparing for the UN's Fourth World Conference on Women, to be held in Beijing in September 1995. Activists in China see the Conference and its accompanying NGO (nongovernmental organizations) Forum as a great opportunity to improve the status of women. The ACWF has submitted 42 issues, involving such issues as women's political involvement, women's education, violence against women, employment opportunities for women, and health care, to the Chinese government for consideration at the NGO Forum. In addition, the impact of the free market system on Chinese women is an area of concern. Women have been subject to discrimination in the work place in their susceptibility to losing their jobs if an industry closes and in joint ventures where employers fail to observe the principle of equal pay for equal work.
ECONOMIC AND POLITICAL WEEKLY. 1994 Aug 20; 29(34):2,201-4.The aim of US-promoted population policies is maintaining and securing the economic and political dominance of capitalist states. Governments of developed countries blame overpopulation in developing countries for destroying the planet and those of developing countries blame overconsumption, waste, and industrial pollution in the capitalist countries to be responsible. Developed countries and the UN profess that population control is in the interests of development and for the sake of women's rights. Many women's groups protest planned and already existing population policies and bear witness to the suffering women from developing countries experience, raising the question of choice of these policies. Sexism served as the smokescreen behind which US strategies of population control were implemented. The concept of sustainable development is also used to advance population policies in developing countries. Developed countries use this concept to maintain the status quo, agricultural countries as such, cash crop economies, dependency on food, foreign aid, and loans and to continue their exploitation in developing countries. USAID, UNFPA, and the World Bank are the major moneylenders for population control. The US targets Africa for population control because it produces 90-100% of four minerals vital to US industry. The new phase of capitalist development has shifted the state's role from its function as a nation state to facilitator of global capital. Population control policy, national security laws, and anti-trade union laws are used to create a docile and immobile pool of labor. The World Bank, the IMF, and the WTO, through their structural adjustment policies, provide the infrastructure to implement population policies and targets. Population policies focusing on targets take control away from women. People in developing countries will not accept these population policies until they have control of their lives. They need assurance of child survival and to be in a position to plan their future. The population control lobby now uses deception to thwart resistance.
HEALTH FOR THE MILLIONS. 1994 Jun; 2(3):8-10.Western development models label subsistence economies, which do not participate in the market economy on a grand scale and do not consume commodities produced for and distributed through the market, to be poor. Yet, subsistence does not always indicate a low quality of life. The Western development process has destroyed wholesome and sustainable lifestyles. In India, the Green Revolution caused many small farmers to lose their land. In comparison to traditional economies, industrial economies have longer technological chains dependent on higher energy and resource inputs and exclude large numbers of people without power to buy goods. Further, they generate new and artificial needs, necessitating increased production of industrial goods and services. They erode resource bases for survival. This erosion is marginalizing people who were traditionally in nature's economy. Developed countries did not deliver 0.15% of their GNP to development projects in developing countries as promised. The US made population growth in these countries its cause. The UN and other multinational agencies during 1962-1972, at the US's request, began to support population and family planning programs in developing countries. These countries opposed the 1st draft at the 1974 Bucharest Population Conference, but by the conference in Mexico City, most supported the need for family planning. Yet, the US politicized this conference and had a greater say in the recommendations than did developing countries. Structural adjustments and external debt repayments required of developing countries in the 1980s set them back. In fact, the number of developing countries increased from 31 to 42. The UN recognizes the right to development, but social inequalities are barriers to this right. If environmental degradation continues, poverty will only increase. Women's groups are playing a great role in preparations for the International Conference on Population and Development in Cairo in September 1994.
Washington, D.C., World Bank, 1992. xv, 109 p. (World Bank Technical Paper No. 192; Series on River Blindness Control in West Africa)In 1988 and 1989, anthropologists conducted the Land Settlement Review to examine land settlement after the Onchocerciasis Control Programme (OCP) in western Africa (Benin, Burkina Faso, Ivory Coast, Ghana, Guinea, Guinea-Bissau, Mali, Niger, Senegal, Sierra Leone, and Togo) successfully controlled river blindness. The review showed that successful onchocerciasis control caused rapidly rising migration to river valleys which once had sparse populations due to the threat of river blindness. This migration brought about a range of settlement patterns (highly controlled sponsored settlements to completely uncontrolled spontaneous settlements). It is also government to establish settlement policies. The settlers followed predictable migration patterns as well as adjustment patterns. Completely spontaneous settlements were less expensive than government-sponsored settlement and therefore were the preferable settlement option. Governments could provide basic services and infrastructure in some settlements (assisted settlements), but the settlers make most major decisions. The original population should accept the new settlers if the settlements are to be a success, so settlers should seek formal permission to settle in an area through traditional channels and government agencies. This should assure land tenure. Household income came from cropping, livestock, trading, crafts, and wage labor. Diversification was not what the government preferred, however. Settlers frequented markets to exchange goods and provide social services. Markets provided a means to integrate settlers and the host and pastoral groups. They needed to concede to land use zoning to protect forests and maintain the symbiotic relationship between pastoralists and farmers. The Land Management Program in Burkina Faso was a fine example of land use zoning.
SCIENCE. 1992 May 22; 256:1138-40.The greenhouse effect is currently the subject of great scientific debate as the upcoming UN Conference on Environment and Development will focus a great dealing of attention on it. Prominent scientists have both supported and criticized the theory, but the general consensus is that any measures that are of little or no cost should be undertaken as a form of insurance. Many scientists remember the lesson we learned with stratospheric ozone 10 years ago. Science did not predict that the manufactured chlorine compounds would interact with other natural atmospheric gases to destroy ozone at a rate 10 times what they had predicted. The greenhouse effect could easily involve a similar unknown variable. Current theories on both sides are based on sophisticated super computer models, weather data, and other observations. Because so much of the science of the greenhouse effect is theoretical, the margin for error could be quite large. Even the Bush administration has finally changed its official stance on the global warming from unequivocal denial to a measured willingness to take some steps toward limiting greenhouse gas emissions. The primary reasons for this change was a leaked report compiled by 4 agencies in which the theories supporting global warming were outlined. The report stated that some of the theories have stood up to the test of scientific scrutiny and thus some action should be taken.
INTEGRATION. 1991 Sep; (29):6-7.Providing resources for family planning programs in the USSR, where an extremely high rate of abortions threatens the lives of women, will require a multi-sectoral approach involving the government, international agencies, and the private sector. Every year, some 10-13 million of the USSR's 70 million women of fertile age undergo an abortion (only 7 million of the abortions every year are considered legal). A recent report indicates that only 15-18% of Soviet women have not had at least one abortion in their lifetimes. A result of the high rate of illegal abortions, morbidity and mortality affects many Soviet mothers. Additionally, infant mortality rates is as high as 58.5% in some areas of the USSR, a figure similar to that found in developing countries. Knowledge of modern contraception is high, but use remains low. This is due primarily to the lack of contraceptive availability. IUD's injectables, implants, and oral contraceptives are scarce. And even when oral contraceptives are available, few women opt for this method, due to the rampant misinformation and exaggeration concerning its side-effects. While the USSR does produce condoms, their quality is poor. Part of the solution to the lack of available contraception rests in the transition to a market economy. As the demand for these services increases, the market will begin meeting this demand. The government also has a important role to play, which includes the provision of information, medical and paramedical education, sex education, and service delivery. And international agencies will need to provide the necessary technical assistance.
DEVELOPMENT DIALOGUE. 1989; (2):5-38.The story of IBFAN, the International Baby Food Action Network, from its beginning with 6 members in 1979, to its status of 140 groups worldwide in 1989 is told by its founder, Annelies Allain. IBFAN celebrated its 10th anniversary in October 1989 with a week-long Forum of 350 organizers from 67 countries. IBFAN is a single-tissue grass-roots organization, almost entirely women: the issue is that bottle-feeding kills babies. It has mounted a successful campaign ending in passage of the WHO/UNICEF International Code of Marketing of Breast-milk Substitutes in 1981. With this success, the political power of the "third system," of people, as opposed to government and transnational corporations, was recognized. The most important fundamental activity of IBFAN is to amass information to make its point that million of babies, primarily in developing countries, have died from consuming powdered formula instead of breast milk. IBFAN also set out to show that milk companies have influenced medical school training, health care providers, UN and WHO policies, and governments of developing countries through advertising and tax income. IBFAN's methods are boycott, corporate marketing analysis, shareholder, resolutions, and numerous strategies invented by local activists. The baby food industry responded by forming the International Council of Infant Food Industries, headed by a former WHO Assistant Director General, and applied for registration as an official NGO with the WHO. Again in 1987 they formed the Infant Food Manufacturers Associations, headed by a former WHO staff member, and gained WHO NGO status, claiming to advance infant nutrition and adhere to the WHO Code. Ibfan's current emphasis is on combatting free infant formula given out at maternity hospitals, the most effective way to block successful lactation, is developed as well as developing countries. An effort to monitor this activity will mark the 10th anniversary of the Code in 1991.
In: Preserving the global environment: the challenge of shared leadership, edited by Jessica T. Mathews. New York, New York/London, England, W. W. Norton, 1991. 39-77.The thesis that human population growth will eventually destroy the equilibrium of the world ecosystem, because environmental strain is a nonlinear effect of the linear growth, is embellished with discussions of technology and resulting pollution, population dynamics, birth and death rates, effects of expanded education, causes of urbanization, time constraints and destabilizing effects of partial development and the debt crisis. It is suggested that the terms renewable and nonrenewable resources are paradoxical, since the nonrenewable resoureces such as minerals will always exist, while renewable ecosystems and species are limited. The competitive economy actually accelerates destruction of biological resoureces because it overvalues rare species when they have crossed the equilibrium threshold and are in decline. Technological outputs are proportional to population numbers: therefore adverse effects of population should be considered in billions, not percent increase even though it is declining. Even the United Nations does not have predictions of the effects of added billions, taking into account improved survival and decreased infant mortality. Rapid urbanization of developing countries and their debt crisis have resulted from political necessity from the point of view of governments in power, rather than mere demographics. Recommendations are suggested for U.S. policy based on these points such as enlightened political leadership, foreign aid, and scientific investment with the health of the world ecosystem in mind rather than spectacle and local political ideology.
Population and development problems: a critical assessment of conventional wisdom. The case of Zimbabwe.
ZIMBABWE JOURNAL OF ECONOMICS. 1988 Jan; 2(1):81-100.Conventional wisdom, as reflected in reports by the World Bank and the Whitsun Foundation, maintains that control of population growth is the key strategy for stimulating socioeconomic development and ending widespread poverty. The Witsun Foundation has criticized the Government of Zimbabwe for failing to include specific policies for population control in its National Transitional Development Plan. the report further expressed alarm about future availability of land to contain Zimbabwe's growing population. Communal areas are designed for a maximum of 325,000 families yet presently contain 700-800,000 families. This Malthusian, deterministic emphasis on population growth as the source of social ills ignores the broader, complex set of socioeconomic, historical, and political factors that determine material life. Any analysis of population that fails to consider the class structure of society, the type of division of labor, and forms of property and production can produce only meaningless abstractions. For example, consideration of crowding in communal areas must include consideration of inequitable patterns of land ownership in sub-Saharan Africa. Unemployment must be viewed within the context of a capitalist economic structure that relies on an industrial reserve army of labor to ensure acceptance of low wages and labor-intensive conditions. While it is accepted that population growth is creating specific and real problems in Zimbabwe and other African countries, these problems could be ameliorated by land reform and restructuring of the export-oriented colonial economies. Similarly, birth control should not be promoted as the solution to social problems, yet family planning services should be available to raise the status of women. Literacy, agrarian reform, agricultural modernization, and industrialization campaigns free from the dominance of Western capitalism represent the true solutions to Zimbabwe's problems.