TY - JOUR
AB - On the cover of Dying for Growth, a young, disheveled girl with jet-black hair in an oversized pink nightgown stands in a garbage dump. Modern skyscrapers grace the skyline in the not-so-distant background. In the book's introduction, we learn that the little girl, who lives in the dump on the outskirts of Guatemala City, had approached the photographer and asked him to please teach her how to read. In Dying for Growth, the editors and their colleagues investigate the relationship between the gross inequality captured in the photo, neoliberal policies that have shaped the global political economy for the past 20 years, and the consequences for the health of the poor. The editors and many of the writers are associated with Partners in Health/The Institute for Health and Social Justice (http://www.pih.org) affiliated with the Program in Infectious Disease and Social Change at Harvard Medical School. Since the "Debt Crisis" of the 1970s and 1980s, the architecture of the political and economic relationship between the Third and First World has been codified in neoliberal structural adjustment plans designed by the International Monetary Fund (IMF) and the World Bank and in trade agreements such as the North American Free Trade Agreement (NAFTA). In theory, neoliberal policies aim to facilitate market-led growth by integrating a Third World economy into the world economy, minimizing the role of the state in the economy, and thus freeing the "invisible hand" of market-guided investment to maximize profits and growth. The heart of the book is a series of case studies (Haiti, sub-Saharan Africa, Peru, Russia, Mexico, El Salvador, and Bhopal, India) that examine the effects of these policies on poverty and public health. If the poor were to benefit from neoliberal policies, Dying for Growth argues, Mexico should provide an exemplary case. With constant encouragement from the United States, Mexico has aggressively implemented neoliberal policies for more than 20 years. The maquiladora sector of the economy, industrial plants owned by transnational corporations (TNCs) manufacturing products to export primarily to the United States, has grown quickly since the implementation of NAFTA, but this has been at the expense of other sectors of the economy. Competition with TNCs has undermined 30 000 small businesses and millions of subsistence farmers. Millions of permanently displaced peasants have made their way to urban shantytowns or tried to immigrate to the United States. Extremely high levels of industrial pollution, overcrowded living conditions, and inadequate sanitation and infrastructure characterize the "maquila" cities that have burgeoned along the US border. Standard public health indices in the border region lag far behind their counterparts in the United States and even behind poorer regions in Mexico. After undergoing this revolutionary transformation of the economy, the working class of Mexico is now poorer. Between 1980 and 1998, the purchasing power of the minimum wage fell 68% and real wages have fallen 25%. On the other hand, there are now more billionaires in Mexico than ever before. In contrast to Mexico, the case of Russia is unique in that neoliberal reforms were implemented in a relatively well-educated industrial society. The authors persuasively argue that following the demise of the USSR, neoliberal policies, encouraged by IMF and US advisors, contributed to the dramatic collapse of public welfare and an ongoing public health crisis of epic proportion. The death rate increased dramatically. Life expectancy for males plummeted from 63.8 to 57.6 years between the years of 1990 to 1994, and a number of studies have documented the marked deterioration of the nutritional status of the people. The incidence of diseases such as diphtheria, childhood measles, whooping cough, tuberculosis, scurvy, pediculosis, and rickets has risen astronomically. The key features of the neoliberal policies included liberalization of prices, stabilization of prices through tight fiscal and monetary policy, privatization of state companies, stopping state industrial planning, elimination of the comprehensive system of social guarantees, and removal of barriers from international trade and investment. According to the authors, no policy had the stated effect. For example, the conservative fiscal and monetary policy contributed to the ensuing depression, resulted in severe cuts in health and education, and denied needed investment capital to modernize Russian industries. Privatization resulted in a fire sale of state assets to corrupt insiders, no increase in business efficiency, closings of many factories, and massive capital flight. Russia continues to languish in the worst depression experienced by an industrialized state in modern history, and most of its population has been returned to Third World living conditions. Dying for Growth has three other sections that merit more attention than space permits. First, two chapters are dedicated to "exploring the impact of TNC activities on the health of the poor and marginalized people." Through their virtual monopoly control on trade and credit and their influence over governments, TNCs are "the dominant institution of our time." The massive expansion of tobacco advertising and promotion by tobacco corporations throughout the world, encouraged by the US government, is one example of the corporate pursuit of profits knowingly undermining the health of humanity. The increase in the global incidence of tobacco smoking will "prematurely kill almost 10 percent of the world's population." Second, there is an excellent chapter on the "War on Drugs," which the authors persuasively argue has little to do with promoting public health. The war has done little to curtail the drug trade but has provided lucrative profit opportunities for TNCs (eg, drug-money laundering, military contracts, and prisons building and operations) and a pretext for controlling poor populations (paramilitary death squads in the Third World and prisons in the United States). Last, there is a section on alternative policies. In one chapter, the incredible public health accomplishments of Cuba are highlighted. Cuba exceeds all other Latin American countries and poorer sections of the United States in most health indexes with, for instance, lower infant mortality, a higher life expectancy, fewer people per doctor, and a higher literacy rate. Dying for Growth is a call to health practitioners and researchers to renew their commitment to the majority of humanity that lives under the suffocating pall of poverty and insecurity. The editors quote the 1995 World Health Organization World Health Report: "Around the world poverty is the chief cause of reduced life expectancy, of handicap and disability, and of starvation." However, as Dying for Growth documents, poverty is not inevitable but the result of social choices. The editors note, "In its 1998 annual report, the United Nations Development Programme (UNDP) calculated that it would take less than four percent of the combined wealth of the 225 richest individuals in the world to achieve and maintain access to basic education, basic health care, reproductive health care, adequate food, safe water, and adequate sanitation for all living on the planet." Eliminating this gross inequality is the public health challenge of the 21st century.
TI - Global Health: Dying for Growth: Global Inequality and the Health of the Poor
JF - JAMA
DO - 10.1001/jama.288.5.641-JBK0807-2-1
DA - 2002-08-07
UR - https://www.deepdyve.com/lp/american-medical-association/global-health-dying-for-growth-global-inequality-and-the-health-of-the-mvt2yTXCJA
SP - 641
EP - 643
VL - 288
IS - 5
DP - DeepDyve
ER -