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Health Studies
Anne- Emanuelle Birn

KEY QUESTIONS 1) What features of contemporary globalization are new? Old/ongoing: th th  Promotion of free trade 17 -18 century  Appalling factory conditions 19 century (factory workers)  Communications/transportation revolution 19 century (steam engine)  Transnationalism (colonialism)  Cocacolisation New: (Exam Question: What is particularly new about globalization?)  Internationalization of finance (mostly speculative) o Speculative capital flows o Moving around money that doesn’t exist  Rate of increase in social inequalities o South East Asian Crisis 2) What is Neoliberal Globalization? Neoliberal Globalization:::Promotion of free markets/removal of trade barriers o Reduction of subsides for the poor o Cost recovery fees for essential services o Privatization of public assets o Weakened role of government o High military expenditures o Growing dominance of Western-based transnational capital - Political order dominated by the logic of the market 3) What are the major pathways thru which globalization affects health? Globalization influences health and generates health inequities thru 5 major pathways: 1. Trade liberalization and the world trade regime (WTO)  Trade liberalization changes employment patterns in variety of ways;  farmers pushed out by agribusiness, others are deindustralized, others industrialized but subjected to social stratification heightens exposure/suscept to disease.  trade liberalization unequally affects agricultural workers and small-scale entrepreneurs who have no safety net, women, and children, jobs for these workers poorly regulated  greater labor mobility of professionals led to their emigration from poor countries 2. Global reorganization of production and labor markets  The global reorganization of production and labor markets has resulted in the exportation of jobs and entire industries to areas where regulation is lax.  This contributed to a “race to the bottom” in which jobs are lost from industrialized countries (unemployment, stress, poor hlt outcomes) and are relocated to poor countries where wages are inadequate and labor organizing is suppressed. 3. Debt crises and structural adjustment of developing country economies  Due to the debt crisis & imposition of structural adjustment policies on many economies of the developing world, the ability of the govt to invest in public hlt, education, water and sanitation, nutrition been constrained  High debt-servicing payments limit public provision of social goods, while loan conditionalities have stipulated decreased food subsidies, reduced state investment in social programs and decreased public sector incomes, disproportionately affecting women and marginalized communities as a whole. 4. Environmental damage  As commodification—turning nonmarketable/public goods H2O into market commodities—intensifies under neoliberalism, the environment suffers  Under pressures of neoliberal globalization, environmental regulation is unenforced or nonexistent in many locations 5. Financial liberalization  Financial liberalization exposes national economies to the uncertainties created by large and volatile capital flows and intensifies the effect of inequality on the social determinants of hlt  w/1+ trillion US$ in daily transactions= instability in countries, sudden currency devaluations, evaporating purchasing power, and undermining livelihoods of millions of people 4) What would happen to health if the WTO did not exist? Trade affects the determinants of health and disease in variety of ways: 1) Increased fluidity of global production aids transfer of outdated production technologies to poorer countries, poses hazards to both unprotected employed pop and whole pop 2) Labor market “flexibility” seen in EPZs if often pretense for minimal regulation, anti-union legislation, and unsafe working conditions, and relaxed trade rules can result in importation of poorly regulated/contaminated goods 3) Leads to increased exposure to infectious diseases thru rapid cross border contamination, disruption of animal habitats thru rapid urban growth (increasing exposure to disease w/animal hosts SARS) and unregulated food production and markets (avian flu) 4) Raises probability of developing chronic diseases thru the marketing of unhealthy products like tobacco and alcohol, thru promo of unhealthy behavs like fast food, and thru increased environmental degradation 5) Can reduce the provision/distribution of health related goods, services, personnel (Ex extended patent protection lead to decreased access to medical technologies, trade treaties restrict national govts from investing in/regulating health care) 5) Which WTO agreement has the greatest implications for public health? 1) Agreement  Extended patent protection limits access to essential meds. Higher resulting cost of drugs on Trade- drains money from PHC and other determinants of hlt, must abide by patents for a min period Related of 20 years Intellectual  Hurts the producers of generic meds in developing countries and millions who cant afford to Property buy patented drugs (S.Africa’s fight for ARVs) Rights  TRIPS inhibits generic drug protection, which lower costs, ensure constant, sufficient supply of (TRIPS): meds. TRIPS prioritizes profits ova human well-being **great >>Lrg producers of generics Mexico, India and Brazil implications**  2001, Doha Declaration agreed that TRIPS should be operate in a way that supports the right of countries to protect public health and promote access to meds for all in times of emergency/cant prevent membs from taking measures to protect hlt  Some countries use the flexibilities of TRIPS agreement to challenge high cost of patent- protected drugs, Countries that declare public hlt emergencies can break patent barriers by getting compulsory licenses or thru parallel imports  EX: Zimbabwe issued licenses for import or local production of ARVs, lead to price reductions b/w 60-90%. 2) Agreement on  allows each country to set its own standards for food and drug safety regulations but requires Sanitary and them to be based on a scientific risk assessment w/o discriminating b/w domestic and Phytosanitary imported food products, these are costly Measures (SPS)  EX Cdn, US, Brazil set up a WTO dispute to compel EU to permit imports of hormone-treated beef despite EU prohibition on this, EU lost but its member countries still don’t allow these imports and must pay millions a yr in trade sanctions. In effect SPS places free trade above human hlt and safety 3) Technical  requires that any regulatory barrier to the free flow of goods be as “least trade restrictive as Barriers to Trade possible”, that like products be treated alike, and that intl. standards be exceeded only if Agreement (TBT) “justified on specific hlt grounds”  EX Cdn used TBT to charge France ban on asbestos products as discriminatory b/c asbestos is a “like product” to glass fiber insulation, we lost in the only eg of WTO favoring hlt over trade 4) General  locks in privatization levels in service sectors (hlt care, education, enviro’al services)—reduces Agreement on access to services by poorer ppl, Trade in Services  indirectly creates incentives for foreign investors to lobby for privatization (GATS) * greatest  treats human services that are key social determinants of hlt as commodities subject to trade im
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