Third World Health: Hostage to First World Wealth

312 Pages·2018·121.668 MB·English

by  MacDonald, Theodore

Third World Health
Hostage to first world wealth
Theodore H MacDonald lmus bsc, ma втһ, PhD, md
Professor (emeritus), formerly Director of Postgraduate Studies in Health,
Brunei University; Member of the Institute of Human Rights and Social Justice,
Metropolitan University of London; Fellow Royal Society of Medicine
Foreword by
Desmond M Tutu
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
First published 2005 by Radcliffe Publishing
Published 2018 by CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2005 Theodore H MacDonald
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
ISBN-13: 978-1-85775-769-9 (pbk)
This book contains information obtained from authentic and highly regarded sources.
While all reasonable efforts have been made to publish reliable data and information,
neither the author[s] nor the publisher can accept any legal responsibility or liability for
any errors or omissions that may be made. The publishers wish to make clear that any
views or opinions expressed in this book by individual editors, authors or contributors
are personal to them and do not necessarily reflect the views/opinions of the publishers.
The information or guidance contained in this book is intended for use by medical,
scientific or health-care professionals and is provided strictly as a supplement to the
medical or other professional's own judgement, their knowledge of the patient's medical
history, relevant manufacturer's instructions and the appropriate best practice
guidelines. Because of the rapid advances in medical science, any information or advice
on dosages, procedures or diagnoses should be independently verified. The reader is
strongly urged to consult the relevant national drug formulary and the drug companies'
and device or material manufacturers' printed instructions, and their websites, before
administering or utilizing any of the drugs, devices or materials mentioned in this book.
This book does not indicate whether a particular treatment is appropriate or suitable for
a particular individual. Ultimately it is the sole responsibility of the medical professional
to make his or her own professional judgements, so as to advise and treat patients
appropriately. The authors and publishers have also attempted to trace the copyright
holders of all material reproduced in this publication and apologize to copyright holders
if permission to publish in this form has not been obtained. If any copyright material has
not been acknowledged please write and let us know so we may rectify in any future
reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted,
reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other
means, now known or hereafter invented, including photocopying, microfilming, and
recording, or in any information storage or retrieval system, without written permission
from the publishers.
Trademark Notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent to
infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http:/ /www.crcpress.com
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
Typeset by Advance Typesetting Ltd, Oxford
Contents
Foreword ix
Acknowledgements xi
Introduction 1
Chapter 1 Health and poverty 3
Life and death in Cambodia 3
Comparative wealth of nations 4
TRIPS 7
WHO and TRIPS 8
Healthcare and health promotion 9
Within-community variation and between-community variation 11
Within-poor-community variation 13
References 14
Chapter 2 Problems caused by inequities in wealth and
by environmental damage 19
The Christmas 2004 earthquake and tsunamis 19
The broad picture 21
War as a solution? 22
Global finance 22
Water, water everywhere - but not to drink 23
How about a game of golf? 24
What about climate change? 23
Implications 27
Attendant consequences of lack of global control 28
Financial consequences 29
Big tidal waves and tsunamis 30
References 31
Chapter 3 Mortgaging the third world 33
Holding health hostage 33
Squeezed between 'upstream' and 'downstream' forces 34
The IMF and the World Bank 35
Origins of the IMF and World Bank 37
Structural adjustment 38
Sequence of events behind the debt crisis 40
Some consequences of the debt crisis 41
Jubilee 2000: a Christian Aid initiative 42
Environmental is international 43
Collective vs individual 44
Are the drug trade and debt linked? 46
iv Contents
How can the first world protect itself? 47
Upholding the banks 48
Lowering standards in the first world 49
A simple explanation of compound interest 50
First the goods, then the people 53
Impact of emigration on a society's health 54
Impact of immigration on first world social health 55
Wars, health promotion and the debt 56
References 61
Chapter 4 The conflict between global health and global finance:
a case study approach 63
Addressing health inequalities 63
Reinforcing global inequalities 64
Case study 1: Uganda 66
Case study 2: privatising pharmaceutical provision in India 67
Privatisation, trade and the global market 68
The impact of global finance on global health 69
Possible solutions 71
Cancellation of world debt 71
Accountability and sovereignty 72
Collective vs individual 72
Enforceable social charters and lobbying for change 73
Free trade vs fair trade and the WTO 74
Conclusion 76
References 76
Chapter 5 The third world helping itself - community health
programmes 79
Forms of financing healthcare 79
Involving the community 80
What about the poorest of the poor in Nepal? 81
Trafficking for prostitution in Nepal 83
Similar community-based health programmes elsewhere 83
India 84
Men having the snip 85
Kerala - a sustained success story 86
Pakistan 86
Youth resource centres 88
The youth resource centre health camps 88
Pakistan and the refugees from Afghanistan 89
Sri Lanka and the condom 90
One more society vulnerable to HIV/AIDS 91
References 91
Contents v
Chapter 6 Poverty, health and finance 93
Measuring poverty 93
What about measures of health inequality? 94
Establishing an agenda for global equity in health 93
The Maximin principle 95
Analysis of health financing strategies 96
Making locally financed policies 'pro-poor' 96
Tax-based financing 99
Social insurance funding 100
Private health insurance cover 101
User fees 102
Community-based health insurance 103
References 104
Chapter 7 Popular opposition to the inequities 105
Scepticism about the G7/G8 105
Genoa G8 Summit protest 107
Globalisation perceived as inimical to equity 108
Diversity within the movement 109
Organisation within the movement 110
Influences on the movement 111
Other direct confrontations 112
Law enforcement reaction 112
Influence on the developing world 113
Criticism 113
The Iraq War and its impact on the movement 115
Useful websites 115
References 116
Chapter 8 Milk and imperialism 117
Links between global health and Western wealth 117
Support for third world services 117
Market forces, SAPs and private enterprise 118
Status of breastfeeding in the third world 119
Breastfeeding as part of the health promotion agenda 119
Third world economics and breastfeeding 120
Addressing the global decline in breastfeeding rates 121
Professional opposition to breastfeeding 122
Impact on the third world 122
The World Health Organization's response 124
Breastfeeding vs market forces 125
The breastfeeding issue worldwide 126
Nestle and its impact on the third world 128
Nestlé's use of the HIV/AIDS pandemic 130
Other questionable practices revealed by IBFAN 131
References 134
vi Contents
Chapter 9 The impact of first world wealth on third world health:
British American Tobacco in China 135
Smoking - a third world problem? 135
Why BAT needs the third world 137
Related negative impacts on health 139
A closer look at how BAT benefits in China 139
First world finance bodies in the Chinese tobacco trade 141
The Asian Monetary Fund 142
The Chinese National Tobacco Corporation (CNTC) and
Western multinationals 143
Targeting Chinese health with Western advertising 143
BAT's denial of the health risks vs the statistical evidence 144
China's attempts to sustain health policies 145
Conclusion and recommendations 147
References 148
Chapter 10 The tobacco impact worldwide 151
Beyond China 151
The tobacco pandemic 151
A conceptual framework for tobacco use 152
Are we winning? 154
A brief account of BUGA UP 155
Trying to measure smoking initiation among minors 157
Profiles of female tobacco use 159
Other indicators used in tobacco surveillance 160
References 161
Chapter 11 The third world and HIV/AIDS 163
The changing HIV/AIDS pandemic in the third world 163
Third world women and AIDS 166
Back to Africa 167
The Zimbabwe situation until 2002 168
Health promotion, empowerment and African women 169
HIV/AIDS in the African context 169
Why women are especially vulnerable 170
Local culture and HIV prevention 171
Male condoms: culture and consequences 172
Are female condoms the answer? 173
Sexually transmitted diseases as an 'acceptable risk' 174
Impact of the lack of basic education 174
Empowering function of local advocacy groups 175
Entrenching poverty - an SAP bequest 176
Solutions to the women's health crisis 177
A diluted WHO target on HIV/AIDS 178
What is to be done? 179
References 180
Contents vii
Chapter 12 Peru - a detailed case study of one third world country
until 2000 183
About Peru 183
Movement into debt 183
The economic and political context 184
Peru under Fujimori ( 1990-2000) 186
Fujimori's conservatism 189
Health in Peru under adjustment 190
Circumventing impacts on health of SAPs 193
Conclusion 195
References 196
Chapter 13 Cuba - model or monster? 199
Cuba in the news 199
Who are the 'elderly Cubans'? 200
Some background 202
People-centred government 203
Cuba as 'virus' 204
The long blockade 205
President Bush tightens the noose 207
Can Cuban public health survive the blockade? 208
Health promotion and social attitudes 209
Differences in the Cuban context 210
The vulnerability of Cuban health promotion 211
Dollar-earning Cubans rally to promote health 213
Potential of the Cuban experience 214
HIV/AIDS in Zimbabwe - Cuba's response 215
Cuban doctors in post-apartheid South Africa 216
References 218
Chapter 14 Possible routes to global health equity 219
Capitalism and first world consumerism: the underlying problems 219
Targets set vs targets measurable 220
An international role for Health Impact Assessment 221
International Association for Impact Assessment and HuIA 221
The politics/health interface 222
A conspectus of possible strategies 223
Unsustainability 224
The problems of comparative measures 225
Specifics of food supply and health 226
Varying health promotion parameters 227
Is capitalism actually an option? 228
The optimistic view as a solution 230
Pre-political Greening 231
Can Green political power survive bureaucracy? 232
Organising for transnational government 233
References 235
viii Contents
Appendices
A The regression line explained 237
В The compound interest formula explained 241
C Protecting breastfeeding from unethical marketing 243
D Nutrition league table 245
E Peru's Letter of Intent 247
F A New Framework and Guidelines Enshrining A Fundamental
Human Right to the Highest Attainable Standard of Health 255
G State of the IBFAN Code country by country 275
H WHO HFA (2000) Targets for Equity in Health 277
Index 287
Foreword
My country was until the end of apartheid rule regarded by many as a 'third world'
country because of the way in which the great majority of its citizens were
compelled to live. Of course, it was not a third world nation for the white minority,
most of whom enjoyed enviable health and educational facilities and a high economic
standard of life. South Africa is still, in many respects, a third world nation, ravaged
by HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syn­
drome), and we are progressing only slowly in overcoming many of the deficits of
our once-divided society. I therefore identify with many of the issues raised in this
book. The author's thorough analysis of the HIV/AIDS pandemic in Africa and
elsewhere is not only statistically sound but intimately reflects his concern with the
need for international equity.
Theodore MacDonald writes with passion, as well as with sense. Much of what he
has to say is drawn from his own experience working as a medical doctor and a
mathematician in a broad range of the world's poorest nations. But overarching
that is a powerful insight into social and economic issues, along with well-honed
skills as a communicator. His thorough knowledge of history and politics has enabled
him to contextualise what he has witnessed and laboured to remedy. His writing
style is astonishingly accessible, informing and inspiring the lay reader as much as
the professional. The analyses underpinning both his exposition and his arguments
are penetratingly accurate and embrace a wide readership. Where he feels that lay
readers may be disadvantaged, he convincingly explains such technical matters as
compound interest on loans, relevant statistical arguments, etc. It is regrettable but
true that many books which address the issues herein from a position committed to
equity are under-powered with respect to evidence and analytical rigour. Such
certainly does not characterise the present volume.
The author deals in an admirably balanced style with vexatious issues which, in
less experienced hands, could easily lead to shrill political rhetoric and narrow
sectarian argument. But MacDonald clearly feels that the issues are far too import­
ant for ideological point-scoring. To him, the crucial thing is to equip the reader, lay
or professional, not only with the facts but also with an insight into how they came
about. Readers are often made aware of some particularly outrageous violation of
human rights with respect to international trade - and the enormous health and
social deficits which ensue - but this book allows us to see beyond these particulars
to the consequences of sitting back and doing nothing. MacDonald persuades us of
our power to influence local events, to develop an informed community stance on
environmental issues, etc.
In discussing solutions, the author strongly makes the point that it is too easy to
allow one's commitment to global justice to be siphoned off into something completely
negative, like anti-Americanism. As he points out, the United States is the most
powerful nation on earth and has a history of sustained commitment to the values
of democracy, accountability and justice. He argues that we need to delve behind
the actions of some of its large corporations: the globalisation of finance under terms
favourable to corporate greed and exploitation. As a nation, the United States has
contributed, and continues to do so, massively to human culture and civilisation. It