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
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.
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
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
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
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.