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Health Sciences
Course Code
Health Sciences 1002A/B
Jessica Polzer

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HS 1002- Social Determinants of Health Class 20– Tuesday November 15, 2011 Globalization, Trade and Health Inequalities Instructor: Professor Jessica Polzer School of Health Studies Announcement • Instructions for Assignment 2 • Getting feedback on midterm exam 2 Key Concepts • Global health inequalities • Child mortality • Globalization • Neoliberalism • International Monetary Fund • World Bank • Structural Adjustment Programs • NAFTA’s Chapter 11 • ❖3 Global Health Inequalities • Are enduring health inequalities between countries • Infant mortalities • Child mortalities Child Mortality Gradients ❖5 Child Mortality ❖6 ❖7 Global Health Inequalities in • Child mortality (mortality < 5 years) – Sierra Leone – 316/1,000 live births – Iceland – 3/1,000 – Finland – 4/1,000 – Japan – 5/1,000 • Child mortality rose in 1990s by 43% in 8 Adult Mortality Rates • Probability of death for men b/w ages of 15 and 60 – Sweden 8.3% – Zimbabwe 82.1% – Lesotho 90.2% 9 Life Expectancy ❖10 “Developing” Countries • 132 “developing” countries (total: 194) • 72 are high mortality countries; 46 in Africa • Characterized by: • Profoundly low levels of income • High population density • High fertility • Wide gaps between rich and poor • High morbidity and mortality 11 Increased Morbidity and Mortality • Internal Factors • Inadequate public health infrastructures and services • Extreme poverty • Gender inequality and racism (ex: against indigenous peoples) • Failure to observe human rights • In some countries, corrupt governments ❖12 Increased Morbidity and Mortality • External Factors • Debt from banks • SAPs • Inadequate assistance from high income countries (millennium goals) • Money might not help what’s neeeded if their are strings • “Brain drain” professionals leave to work for bigger organizations ❖13 Context of Global Health Inequalities • Globalization • Structural Adjustment Programs • Role of World Bank and International Monetary Fund (IMF) • Neoliberalism ❖14 Neoliberal Policies & Health Inequalities • To understand health inequalities within and between nations best, we need to take a step back from the proximate determinants of heath to examine the social structures within which inequalities of all kinds are produced. Doing so indicates that the class structure of capitalism and in particular a specific version of capitalism, neo-liberalism, produces and exacerbates social and health inequalities within and between ❖15 Neoliberalism and Global Health Inequalities ❖16 Neoliberalism: a brief • Neoliberalism supports the idea that: –Free trade on its own produces economic growth –All social problems can be solved through market –Individuals/families should provide for themselves –Individual ownership better than collective –Economic well being is not related to individual/society well being • Neoliberalism fails to consider: 17 Supporters and critics... • Supporters of economic globalization say..... • Growing wealth will improve society and will trickle down • Critics say.... • Greater poverty effects rich as well 18 Globalization What is globalization? Economic, political, cultural • 2 important components 1. Opening up borders… to increase flow of capital 2. Changes in policies… to promote flows of capital access borders 19 What is new about globalization? • What are the features of current forms of economic globalization? –Shifts in major trade centers –70% developing countries –Scale and speed of trade b/w countries (computing technology) –Enforce binding economic rules and neolibrialism –Risk of international organizations ex: WB and IMF, world trade organization 20 World Bank • What is its main objective? • To promote development funds to worlds poorest nations • How is voting power distributed? • Voting power depends on economic contributions so richest countries have control of > 50% of the votes ❖21 International Monetary Fund (IMF) • Created in 1944 (at Bretton Woods conference) • Is a framework to promote international economic cooperation • All but a few members of the United Nations are members • Goal > to help stabilize global economy ❖22 Structural Adjustment Programs (SAP) • “conditions” that the IMF/World Bank put on their loans to countries • Conditional loans promoted by WB and IMF • What is meant by “conditional”? • You can receive a loan if you make structural adjustments to trade and social structures • What kinds of “structural adjustments”? • Reduce public spending remove government sponsored sources and promote market competition • What does this mean for health? • No longer universal rights they are commodities • Reduces countries decision for health care– they are under obligation from World Bank 23 SAPs require debtor nations to: • Open up natural resources to commercial exploitation • Cut jobs and wages for public servants • Privatize public (state-owned) enterprises • Reduce government and public spending (ex: on health care, ❖24 SAPs require debtor nations to: • Reduce trade barriers to the West • Devalue local currency • Lower earnings a country could possibly earn from their exports and imports cost more • Create “export” or “free trade” zones > we will return to this in the films Life and Debt and Maquilapolis • Zones were there are few environmental and economic policies and labor is cheap 25 Impact of SAPs on Developing Countries • Colonial histories
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