Breaking the Grip of Globalization on Poverty-Related Ill-Health: A Perspective from the North

I should begin with an apology. I may not be the right person to speak on poverty and health in the North. First, my community health experience has mostly been in the South, mainly rural Mexico. Second, when in the North, I live in Palo Alto, California, heart of the Silicon Valley, the richest industrial complex on earth. Computers, weapons industry, NASA and BIG money!

But even the Silicon Valley has its pockets of poverty. Freeway exits and McDonald’s parking lots have clusters of sickly people with signs that say, “Homeless. Will work for food.”

And across the tracks from plush Palo Alto lies East Palo Alto—a fringe settlement that a few years ago had the highest murder rate in the nation. Its plague of crime, violence, alcoholism, drug trafficking, and broken families is clearly poverty-related.

In the last few years an effort has been made to “clean up” East Palo Alto. Police have been multiplied, substandard housing condemned, and neighborhoods gentrified.

 

But the clean-up has been a mixed blessing. As the middle class moves in, rents skyrocket. Now low-income workers can’t afford to live anywhere in the area.

Recently a disturbing photo appeared in the International Herald Tribune [Feb 21 2000]. It shows a new kind of homeless people in Silicon Valley—persons with full-time jobs who sleep at night on city buses, dubbed “rolling hotels.” But why? Because in the Silicon Valley a small apartment rents for $1700 dollars a month. On the minimum wage of $5.75 an hour, who can afford that? There are 20,000 homeless people in the county, a third with full-time jobs!

Poverty Can be Absolute or Relative

Absolute poverty occurs mainly in the South, where 1.3 billion people live on less than US$1 dollar a day and are unable to secure even the bare necessities of life B adequate food, water, shelter and heath care. WHO calls poverty the World’s biggest killer. Malnutrition linked to poverty contributes to 55% of the 12 million deaths of children annually.

But even in wealthy consumer societies—and most strikingly in the United States—the deepening poverty affecting the under-class can have a devastating impact, not only on the health of the poor, but also on society as a whole.

As in the rest of the world, the income gap in the US keeps growing. High-paid industrial managers now earn 150 times as much as the average worker, up from 70 times as much 10 years ago. Real wages of low-paid workers have decreased, as has job security.

Why Focus on the United States?

In looking at the impact of poverty on health in the North, I will focus first on the United States, for two reasons:

1. The US is the extreme example of socio-political inequity: a very rich nation with a large impoverished underclass. It has the widest income gap in the North. And despite its growing economy, it provides the fewest health and welfare benefits to citizens in need. Hence it has the worst health indicators.

2. The increasingly deregulated “free market” economy in the US, with its reversals of social progress and erosion of democracy, has done more to polarize society than to end poverty. Yet this same economic model is being imposed on the South, at huge human and environmental costs. Far from bringing Health for All, if this paradigm of imbalanced growth continues unchecked, not only are the life-sustaining ecosystems of the planet in danger, but also the health and survival of all humanity, rich and poor alike.

For these reasons, breaking the grip of poverty on health in the South requires coming to grips with the structural causes of poverty and social injustice in the North, especially the United States.

Situational Analysis of Poverty and Poverty-Related Health Problems in the USA

Let us look at some of the facts.

Human Poverty Index

As we can see in the following graph, of 17 industrialized countries the US has the highest level of poverty. It also has the widest income disparity and the highest rate of child mortality.

 

Although child mortality in industrialized countries tends to be much lower than in poor countries, some rich countries have substantially more child deaths than others. America takes the lead.

 

Poverty as a Determinant of Poor Health

On observing the above graphs, note that poverty and child mortality rates tend to correlate closely. In terms of overall well-being, Sweden is one of the world leaders, with both poverty and child mortality rates at half those of the United States. But why? Sweden has one of the world’s most comprehensive public welfare systems, based on strong political commitment to meeting all people’s basic needs and assuring a decent quality of life. This commitment is sustained through high progressive taxation.

In the US, poverty rates for vulnerable group—notably children and single-mother households—are worse than in other industrialized countries. This is partly explained by the nation’s huge—and growing—income disparity. Today 1 of every 4 American children lives below the poverty line. In the North, this high rate is matched only by the former Soviet Union.

More alarming still, in the US nearly 60% of single mothers live in poverty, compared to 30% in Russia and 5% in Sweden.

 

And in the last 2 decades, welfare assistance has been sharply reduced. Across the board, social progress has been rolled back. Taxes have been lowered for the rich and raised for the poor. Government subsidies for wealthy corporations are much greater than for destitute citizens. Regulations to prevent corporations from harmfully exploiting people and the environment have been dangerously weakened.

 

This role-back of social progress is now being globalized. In virtually every country, the welfare system is under attack, public services have been privatized, and relative poverty has deepened. Britain’s National Health Service is under fire. Even Sweden has suffered conservative setbacks.

But nowhere has the imposition of the deregulated market system had higher social costs than in the Former Soviet Union (FSU). With the conversion from Communism to Capitalism, poverty has increased 7-fold. A third of the population now live in poverty. [Nation, Mar 27, 2000, p. 20] Deteriorating living conditions have caused a resurgence of tuberculosis and other “diseases of squalor.” Life expectancy has fallen by 5 years [from 70 in 1990 to 65 in 1997]. Adding to the plight of the poor, public services have been sharply cut back. With privatization of hospitals, millions cannot afford services.

By comparison, in the United States:

• Today 35.5 million Americans live below the poverty line.

• In the 1990s, cutbacks in public assistance for low-income children pushed an additional 1.1 million children into poverty. Every year over 10,000 American children die of poverty-related causes.

• One of every 10 US households suffer from “food insecurity.” One in 5 children don’t get enough to eat. Yet 55% of Americans are overweight.

• The immunization rate in the US is 58%, with only 10% coverage in some inner-cities. (By comparison, many poor countries have coverage of 80% or higher.)

• 43 million North-Americans have no health insurance, up 1.5 million since 1996. The high cost of profit-oriented services and private insurance makes it hard for the poor to get care.

The growing socioeconomic inequality in the US is leading to signs of system failure.

 

• For example, many mothers of young children have to work outside the home, not because of “women’s liberation” but because their husbands’ wages can no longer support the family. As a result, millions of children spend less time with their mothers. Today only 15% of American mothers exclusively breast feed their babies.

• As relative poverty increases, the numbers of homeless persons, street children, and juvenile prostitutes have escalated. The murder rate in the US has increased 6 times faster than the population.

Structural Adjustment in the USA

We hear a lot about Structural Adjustment Programs in the Third World. But similar measures have increased hardships for the poor in the United States. America’s “Structural Adjustments” include:

• privatization of many public services, including prisons,

• cutbacks in state welfare, food supplements, and “Head Start” programs,

• deregulation of corporations, leading to monopolistic mergers and down-sizing for higher profits, and

• overall weakening of the role of government, on the theory that “free market forces” will automatically lead to the best of all possible worlds.

Poverty and racism are causes of poor health. In a study conducted by the National Center for Health Statistics, researchers comparing the health impact of poverty, race, and single-parent households, found that in the US “poverty has the strongest effect on children’s health.” Poor children are 3.6 times more likely than more affluent children to be unhealthy.

 

Nevertheless, racism in the US contributes in a big way to poverty and poor health. Blacks and Hispanics are disproportionately poor, unemployed, underpaid, and lack adequate health care.

• 35% of Hispanics and 43 % of African-Americans live below the poverty line.

• Infant mortality in White Americans is 8 per 1000; in African Americans it is 18 per 1000. And the racial disparity is growing.

 

• African-American children born in Chicago, Detroit, and Philadelphia are more likely to die before their first birthday than are children in Shanghai, Jamaica, Costa Rica or Chile. And life expectancy for men in Harlem, NY is lower than in Bangladesh.

• Law enforcement is also racially biased. For similar crimes, African-Americans are more severely punished than Whites. The rate of teen-agers in jail is 44 times greater for Blacks than for Whites.

• Over half of all young children with AIDS in the US are African-American.

As the gap between rich and poor widens, social unrest, crime, and violence increase. And so do authoritarian measures of social control. Many US states have passed laws authorizing that for some crimes children as young as 12 or 14 years old be tried and sentenced as adults.

 

Military Spending is a Big Threat to Health, Directly and Indirectly

The giant military expenditure of the US far exceeds that of any other nation, as shown in the graph below.

 

America’s monumental “defense” budget diverts for weapons and wars trillions of dollars desperately needed for health care and poverty alleviation.

The private US arms industry supplies 55% of all weapons sales to Third World countries. As America’s biggest business, it has a powerful political lobby. It has donated over $50 million to Congressmen in the last 2 years. This helps explain why the US government, over the next 5 years, will increase “defense” spending back to Cold War levels. It also explains why the government spends an incredible 7.9 billion dollars to subsidize arms exports. And why Congress has dragged its heels in signing nuclear disarmament and landmine treaties. In the US money not only talks. It buys votes!

Good Health at Low Cost

What options are there to the US development model based on economic growth for the rich?

 

In 1985 the Rockefeller Foundation underwrote a study called “Good Health at Low Cost” to find out “why certain poor countries have achieved acceptable health statistics in spite of very low national incomes.” They looked at Costa Rica, China, Sri Lanka and Kerala State in India. Although quite different politically, what these four countries had in common was a strong commitment to equity. Each put the basic needs of all people as its first priority, rather than lopsided economic growth. Each country provided universal primary education and primary health care for all. And most important, each tried to make sure that everyone, regardless of circumstances, had enough to eat.

Spiritual Poverty

In the United States, and increasingly around the world, poverty is not just economic. A pervasive *spiritual poverty—*or loss of connection with a harmonious whole—cuts across all socioeconomic classes.

Symptomatic of this spreading poverty-of-spirit (or existential despair) in highly polarized consumer societies is the disturbing increase of mental illness, depression, substance abuse, hate crimes, and outbreaks of random violence (such as the fatal shootings by kids at Columbine High School).

But rather than seek to heal our disheartening social order, more and more persons are jailed. Today, with 5% of the planet’s population, the US has 25% of the world’s prison inmates. Another profit-driven industry!

A core indicator of profound societal dysfunction is the high rate of suicide, especially among the young.

A census conducted by former US Surgeon General C Everett Coop showed that the suicide rate for teens has doubled since 1968. Today 1 in 10 adolescent boys and 1 in 5 girls attempt suicide! Such self-destruction in the prime of life is an alarming sign of system failure in a perniciously inequitable society.

Equity as a Determinant of Good Health

The “Good Health at Low Cost” study showed the importance of equity for health in poor countries. In rich countries recent studies show similar findings. There is growing evidence that the health of populations is determined more by relative economic equality than by average income per capita (or GNP). A study in the United States shows that overall health is better in those states with less disparity in wealth. States with a wide income gap have poorer health, even when their average income is higher. A study comparing the European nations shows the same. Noted researcher Richard Wilkenson of the University of Sussex, England, notes that “The countries with the longest life expectancy are not the wealthiest, but those with the smallest spread of income and the smallest proportion of the population in relative poverty.”

 

These findings should sound an alarm in today’s world where income disparity is widening both within countries and between them.

But What Can be Done? What Approaches Can NGOs—Or Any of Us—Take to Help Reduce Poverty and Improve Health?

Approaching this question, we should recall the words of Martin Luther King:

History is the long and tragic story of the fact that privileged groups seldom give up their privileges voluntarily.

What King meant was that far-reaching change of unfair social structures is not likely to be initiated from the top down. It must come from the bottom up.

Transformation of the globalized inequality of today will require a whole new dimension of international interaction by a wide assortment of people’s movements, unions, and progressive NGOs.

We must face the fact that such transformation will be a long uphill battle. It will take timeCtime that some of us can ill-afford. Every day, hundreds of children are dying from hunger and preventable disease. We cannot turn our back on their plight while working to “transform the world.” As Gabriela Mistral wisely noted, the child cannot wait—his name is Today.

Therefore, in our commitment to building a healthier world, one of our first steps must be to facilitate a process whereby sick and hungry persons find ways to cope. The next step is to confront some of the underlying causes of poverty and ill-health by trying to reform specific unjust policies and laws. The third step, emerging from the first two, is to work toward structural changes of the unfair system itself. In sum:

The collective struggle for change tends to evolve along 3 interconnected levels of action:

1. DEVELOPING COPING STRATEGIES

2. REFORMING UNFAIR STRUCTURES

3. TRANSFORMING UNJUST SYSTEMS

However, a word of warning! It is important that coping measures and reforms are facilitated in a manner that helps prepare the way for more far-reaching transformation of unfair systems. Famine relief can be a life-saving emergency measure. Yet it must not blind us to the need for famine prevention. Both are needed.

Unfortunately, many conservative forces are at work—ranging from the international financial institutions to right-wing NGOs—which often introduce “safety nets” and cosmetic reforms with the purpose of perpetuating rather than substantially changing the unfair status quo.

Consider, for example, the proposals to reform MEDICARE, America’s government-subsidized health insurance that inadequately covers medical costs for the elderly and disabled. Minor reforms of MEDICARE are repeatedly proposed by conservative politicians in order to pacify public demand for a national health plan. If we lend support to these stop-gap reforms—and perhaps we should—it is important we do so in ways that increase public awareness about the advantages of ultimately replacing MEDICARE with a National Health Plan for all.

Likewise, the World Bank invests in coping strategies and cosmetic reforms (like giving Structural Adjustment “a human face”), yet it strongly opposes efforts to transform the elitist global economy. Currently the World Bank is finalizing its latest plan for “Attacking Poverty.” While the plan includes some worthy safety nets and policy reforms, it proposes very little to change—or even regulate—the neoliberal market system that deepens poverty. Nor does the Bank adequately question it’s own role in imposing adjustment and trade policies that further polarize society. Already, the Bank’s health policy reforms have led to extensive privatization of medical care and cost-recovery schemes that reduce services for the poor. Now there is danger that the Bank’s strategy for “Attacking Poverty” may further entrench the globalized “Attack on the Poor.”

Therefore, in addressing poverty and poor health, we need to confront the intrinsic contradictions in the"health policy reforms" and “poverty alleviation strategies” promoted by the controlling class. We must question the legitimacy of World Bank’s take-over of health policy planning from the World Health Organization. And we must join in the public protests against inhumane and environmentally ill-conceived policies of the Bank, IMF, and World Trade Organization.

Possibilities for Action

It is easy to get discouraged in today’s top-heavy world. The globalized power of the ruling class is so vast and its mechanisms of social control so over-arching that some folks claim our current course of polarized global development is inevitable. But within the system lie the seeds of its undoing. Its unbridled growth-at-all-costs paradigm is humanly and ecologically unsustainable. What is inevitable is far-reaching change. We must pray that such change happens in time Y and take collective action to hasten the process.

Indeed, we live at an exciting point in history. A new kind of global solidarity is beginning to form, a groundswell toward a more humane and sustainable paradigm of development.

There are many areas and levels of action in which community groups, people’s organizations, and progressive NGOs can engage. Any activity that brings people together to discuss their problems, explore underlying causes, and work collectively toward solutions helps lay the foundation for building a healthier, more equitable world.

Thousands of different groups, movements and NGOs are RIGHT NOW actively addressing scores of different concerns, ranging from environmental protection, to health for all, to debt forgiveness, to watch-dogging of corporate greed, to gender equality, and human rights. It is crucial that all these diverse initiatives recognize their common concerns, reach across traditional barriers, and form a united front for structural change.

Prerequisites for Building a Healthy, Poverty-Free Society

In working collectively for healthier, more equitable social structures, it may help if we look toward 4 interrelated goals:

1. The recognition of Health for All—and the praxis of Health Care for All— as a fundamental human right.

2. A basic-needs model of economic and social development that includes freedom from poverty and hunger and gives top priority to sustainable human and environmental well-being.

3. Democratization of high-level decision-making, especially for decisions that determine people’s health and quality of life.

4. Mobilization of a critical mass of well-informed people who share a political commitment to equity (that is to say, to equal rights and opportunities for all people).

These 4 goals are, of course, interdependent. Advancing toward any one goal necessitates advancing toward the others.

Let us look at each goal, and identify some of the key actions or initiatives that can bring us closer to breaking the grip of poverty on health. Mind you, the following actions for change are not just pipe-dreams. For each example cited below, organized initiatives are presently being taken by diverse NGOs and people’s organizations around the world. An enormous diversity of popular action for change is underway. Our challenge is to bring the diverse elements more closely together. In unity lies strength.

Toward the Goal of: Health for All

Key actions or objectives worth struggling for, include:

1. Comprehensive Primary Health Care as advocated in the Alma Ata Declaration;

4. In the North, defense of National Health Services, now under attack;

5. In the United States, campaigning for a Single-Payer National Health Plan that guarantees basic health services for all.

6. Internationally, an Essential Drug Policy with teeth, which will regulate prices, supply, and research so as to provide basic medicines to all who need them;

7. Ecological safeguards, control of toxic waste, clean and limited energy use, and other measures to insure a healthy and sustainable environment.

Toward the Goal of: Equitable Economic and Social Development

Actions and objectives worth struggling for, include:

2. Regulation of corporations and restructuring of trade policies so as to put top priority on human and environmental needs.

8. Cancellation of debt of poor countries, using the liberated monies for the public good (not for weapons, luxury imports, or enrichment of the ruling elite).

9. Progressive income taxes sufficient to narrow the huge gap between rich and poor and to provide funds for universal education, health care, and public services.

10. Regulation and taxation of speculative financial transactions (the global casino), in order to reduce obscene concentration of wealth and avoid repeated speculation-driven crashes of national economies.

For example, the proposed Tobin Tax of 1/4% on international financial transactions, could generate over US$300 billion annually—enough, according to the UN, to eliminate the worst forms of poverty and environmental destruction worldwide.

11. “Eco-economics” with “full-cost pricing” and other measures to safeguard the health of ecosystems and renewal of natural resources.

12. “Fair trade, not Free Trade.” People-centered and environment-friendly “adjustments” of the World Bank, IMF and World Trade Organization, with regulatory input by people’s organizations.

13. Cut-backs in military spending, and strong international restrictions on the weapons industry as well as other “killer industries” including tobacco, alcohol, and infant formula.

14. Energy conservation, especially in the energy-greedy North. (According to the Rocky Mountain Institute, in the United States technology already exists to reduce energy consumption by over 60% with no sacrifice in life-style, and at a savings of trillions of dollars that could be used for universal health care and to end poverty. What blocks such planet-saving policies is the powerful lobby of the oil industry.)

15. Redirection of International Aid so that it favors community development and small worker-owned production units, rather than macro-development projects to inflate corporate profit.

Toward the Goal of: Democratization

There is some truth in the observation that “Corporations Rule the World.” Most of the giant transnationals are based in the North, mainly the United States. Through their powerful political lobby they have strong influence on national and global policies. Their financial manipulation of public elections via huge campaign donations—in essence, the bribing of candidates—has so deeply eroded democratic process that most Americans no longer vote.

You may be asking, “What does campaign financing have to do with poor people’s health?” I would answer, “At least as much as doctors and hospitals.” The biggest crises facing humanity today— hich include the widening gap between rich and poor, the role-back of progressive social policies, our inability to curb looming ecological disasters, and the deepening of poverty-related poor health, crime, and violence—are all rooted in the erosion of democracy that results, in part, from the purchase of politicians by those with big money.

Therefore, in working toward a healthier, more participatory democratic process:

Key actions and objectives worth struggling for include:

3. Campaign-financing reforms

16. The democratization of information sharing

Let me explain what I mean by this and why it is crucial.

Numerous NGOs—such as Common Cause in the US—are working hard for election-campaign finance reforms. But so far little headway has been made. Most politicians vote against measures that would reduce their corporate donations.

 

Likewise, at the international level, efforts to democratize the World Bank, IMF, and World Trade Organization through official channels have been largely ineffective. Hence the need for street rallies and protests.

In today’s low-intensity democracies, disinformation has become the dominant means of social control. The mass media are owned by the same club of giant corporations that profit from hand- uns, landmines, tobacco, deforestation, petrol-guzzling recreation vehicles, Gulf Wars, Star Wars, and from the globalized economy that puts corporate profits before human needs. Both through its advertizing and control of the mass media, the Corporate Power Structure distorts the news and methodically brainwashes the public. Reality becomes mirage.

To adequately understand and confront the factors that endanger our well-being, democratization of information sharing is essential. To see beyond the forked tongue of the mass media, we need more people-to-people avenues of communication, such as the alternative press, community television and radio, and (for those who can afford it) electronic mail.

E-mail and the Internet already have played a key role in international support of people-centered struggles against poverty-intensifying free-trade agreements. Examples include the Zapatista uprising in Mexico against the North American Free Trade Agreement (NAFTA), and the worldwide protest against the Multilateral Agreement on Investment (MAI).

The need for “people-centered struggles” brings us to our forth goal: Mobilization.

Toward the Goal of: Mobilization

Thomas Jefferson (one of the authors of the United States Constitution), made the observation that to keep democracy alive, Revolutions must be repeated every 20 years.

Indeed, the US Constitution states that when government acts undemocratically against the interests of its people, citizens have the right to rise up in opposition. The same right of active opposition should also apply internationally to undemocratic policies and trade agreements that deepen socioeconomic disparity or endanger the health of humanity and the planet.

Today, in fact, the world is ruled by an undemocratic power structure that wantonly endangers ecosystems and perpetuates poverty and ill-health for a large part of humanity. To realize constructive change in the face of such monumental odds, the mobilization of a critical mass of concerned people is key. The time has come for a social revolution of global proportion. Let us pray that it be as non-violent as possible.

Yet non-violence does not preclude confrontation. When institutionalized democracy fails, people of conscience need to organize extra-mural democracy through demonstrations, rallies, and protests. Such protests both raise public awareness of situations obscured by the mass media, and they put pressure on the ruling elite to be more accountable, transparent, and responsive to human and environmental needs.

Let’s look at a couple of examples.

1. The Battle in Seattle

From the perspective of mass mobilization for change, the so-called “Battle in Seattle” was a major breakthrough. Last November tens of thousands of people gathered in Seattle, Washington to protest the anti-people, anti-environment policies of the World Trade Organization. This massive demonstration, accompanied by public lectures and street theater, put vital global issues in the international spotlight, and actually succeeded in blocking (or at least delaying) the introduction of more inequitable policies.

Key to the impact of the Seattle Protest was that diverse groups, including hundreds of NGOs from many sectors and causes, united. The rallying cry, “Teamsters and Turtles!” symbolized how labor unions and environmentalists were able to rise above traditional disputes and join in solidarity over more fundamental concerns. Equally important, the protest was international, with people’s movements and progressive NGOs from over 60 countries.

The Battle in Seattle embodied a more direct and confrontational form of democratic action than do official elections. In the long run, by reinvigorating the disillusioned citizenry, such mass rallies may fuel the popular demand for making public elections more truly democratic.

2. The People’s Health Assembly

Concerned with equity and health, another seminal grassroots initiative of international dimension is now underway. This is the “People’s Health Assembly” or PHA, a broad new movement committed to giving a “voice to the people” in decisions affecting their health and well-being.

For information on the PHA contact:

People’s Health Assembly (PHA)
PHA Secretariat, c/o Janet Maychin
CI ROAP, 250-A Jalan Air Itam
10460 Penang, Malaysia
tel: 604-229 1396; fax: 604-228 6506
E-mail: [phasec@pha2000.org]