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;

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

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

4. 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;

5. 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:

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

2. 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).

3. 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.

4. 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.

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

6. "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.

7. 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.

8. 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.)

9. 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.

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