In an increasingly globalised world, health is ever more affected by international institutions. Over the past 25 years, the World Bank, the International Monetary Fund (IMF), and the World Trade Organization (WTO) have increasingly dominated policymaking in developing countries, leading to substantial effects on health. Furthermore, global threats to health, such as HIV/AIDS, severe acute respiratory syndrome, avian influenza, and climate change, need eff ective collective action at the international level. Therefore the system of global governance is of central, and growing, importance to health. However, global governance is becoming increasingly controversial, particularly in the case of global economic institutions.
Health equity in economic and trade policies
While inequality has become a topic of increased popularity and politicization in recent years, most of the attention has focused on how 1% own an increasingly large share of the world’s wealth, rather than on inequalities between nations. In a global context in which national borders and citizenship pose few barriers to the mobility of capital, the reality is also a story of the world’s richest nations continuing to reap a disproportionate amount of the globe’s profits. Contemporary analyses of global inequality, capitalism, and development would benefit from the lessons of earlier works concerned with similar questions decades before. One example is the classic work written by Walter Rodney, How Europe Underdeveloped Africa. While some contemporary accounts recognise that the problems of African countries do not lie exclusively in Africa, they do not go far enough. Piketty’s discussion of the extraction of wealth from the African continent, for example, is largely independent from his analysis of the accumulation of wealth in other parts of the globe. For Rodney, it was impossible to explain development and the accumulation of wealth in one region without deeply understanding its relations to other regions of underdevelopment and the extraction of wealth. This relation, he argued was not accidental; it was endemic to capitalism itself.
As international development strategies struggle to address issues of human insecurity and socioeconomic inequality, inspiring alternatives are taking shape outside the traditional development discourse. The author argues that locating development strategies within the current neoliberal capitalist framework limits the possibility of success of development goals and strategies, largely designed by 'the North' and argued to be rarely successful in 'the South'. The author argues that these have potential to transform development policy in the South. This article discusses well-being economics, questioning the notion that high income and consumption constitutes genuine wealth, noting that income contributes up to the point of satisfying basic needs, after which human well-being is argued to rest on supporting the development of human potentialities through meaningful livelihoods, strengthening social relations and promoting ways of life in harmony with nature. She argues that this is being applied in the political philosophy of “buen vivir” (living well) in selected Latin American social movements and states to guide a development policy that is more inclusive of human security and their environments. The paper explores the manner in which the concept puts improvement of the quality of life, capacities and potential of the population and its harmonious coexistence with nature at the centre of the economic system, within constitutions, policies in selected countries and in relation to their impact.
After a negotiating process that lasted many days and that was closely watched by dozens of health and development NGOs, the World Health Assembly adopted a resolution on 27 May that established a working group to come up with a global strategy on intellectual property, health research and development, and new medicines for diseases that especially affect developing countries. The resolution was seen by many as the biggest achievement of this year's WHA, and was hailed by many public interest groups that had supported the developing countries, led by Kenya and Brazil, that had first advocated the resolution.
According to the authors, achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This is argued to present a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.
The emergence of an increasingly global economy suggests that the ability of individual countries to shape their own destinies is becoming more difficult. International trends and pressures now influence national, and even local, health care policy making. Researchers from the University of the Witwatersrand, South Africa, together with Oxford University, looked at the effect of globalisation on health issues in South Africa and assessed its influence compared to national and local forces.
Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. This article reviewed academic articles, grey literature, and media sources extracted from 18 databases to examine what is known about the effects of medical tourism in destination and departure countries. It found that most of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North only, focusing on the flow of patients from high-income nations to lower- and middle-income countries, biasing the findings. Five interrelated themes emerged: medical tourism was promoted as a solution to health system problems and a revenue-generating industry offering patients higher standard of care, but some studies criticised it for using scarce public resources and causing health inequity. The study concluded that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation. Additional primary research on the effects of medical tourism is needed if the industry is to develop in a manner that is beneficial to citizens of both departure and destination countries.
This report summarises the main themes, ideas and discussion points from the G20 Conference, held on 30 June 2010. The purpose of this conference was to explore options for the future for the G20 in advancing key issues in global health and development, set against a background of a G8 legacy of contributions to global health aid and the G20’s current focus on the economic crisis. Several themes emerged. First, the Global Fund noted it cannot meet its funding promises and is looking for contributors for the next three years. The Fund needs US$10 billion to sustain current levels, and $17 billion to continue to make gains in fighting HIV and AIDS, tuberculosis and malaria. The conference heard that there is a real possibility of eradicating polio in the next ten years, as just four countries still suffer from the disease, but this requires a concerted effort and political will. While it could be expensive, the long-term savings may be huge as people will no longer need to be immunised against the disease.
This discussion paper underlines a major risk in the Joint Africa-EU Strategy (JAES) implementation process so far: the perceived gradual dilution of the political substance of the new policy framework. This risk lies in contrast to the original negotiations for the JAES, where there was a much stronger commitment to negotiating political differences. It is reflected in the fact that the JAES finds it difficult (so far) to politically uplift the partnership ‘beyond Africa’, ‘beyond cooperation’ and ‘beyond institutions’. According to this paper, the dilution should be a matter of concern considering that the added value of the JAES, compared to existing policy frameworks such as the Cotonou Agreement or bilateral relations, precisely lies in its ambitious political agenda to renew and transform Africa- EU relations. Little tangible progress has been achieved in establishing the JAES as the overarching political framework for Africa-EU relations. Levels of ownership tend to be low beyond the inner circle of those concerned with the JAES. The paper argues that that the current difficulties experienced by the JAES are linked to fundamental political choices in the implementation strategies followed so far rather than to the validity of the overall vision underlying the search for a renewed Africa-EU partnership.
Aid for trade (AfT) has proved to be largely ineffective in Malawi because it has had limited success in developing the local human and institutional capacity required to enable trade, according to this article. A key contributor to this has been a failure by trade promoters and external funders to identify where Malawi stands on its development curve. AfT solutions have tended to assume that Malawi is on the same point on its development curve as Cambodia, Vietnam, Ghana or Rwanda. Yet Malawi simply does not have the scale of human capacity that is required to ensure a pro-poor business environment. It lacks the capacity to ensure businesses have affordable access to finance, business development services, inputs, information, markets, labour and technology. The core problem is that civil society, government and the development community have not adequately recognised the roles that development and trade play in their poverty reduction objectives, the author concludes.