- The ongoing neoliberal global restructuring is mostly driven by a handful of political superpowers and a small and declining number of large multi-national corporations; they directly and indirectly hold the reins of the global financial system.
- So, it comes as no surprise that the unyielding “we know what’s good for you” arrogance of the ‘old’ World Bank (WB) has, most often, led to purely market-led strategies (i.e., global marketization) that, in the end, (still) increase corporate profits and do not really help poor national economies to develop and to tackle burning health problems.
- Despite the poor past record, in which international markets have become more and more concentrated in the hands of global wholesalers and retailers, governments around the world keep promoting the consolidation of free markets. (For instance, the US still has much greater faith in markets than it has in regulators, especially in the health sector).
- But the No.1 rule of the marketplace ultimately is “do-in others before they do-you-in” in a way that gets us to a further situation in which “get rich first and clean up the mess and the diseases of poverty later” becomes the norm. Over and over, the forced liberalization of markets has led to the disintegration of social protection and welfare systems –and with it has gone the respect for human rights (HR).
- We all know the market has a keen eye for private wants, but a deaf ear for public needs. (R. Heilbroner) Therefore, macroeconomic policies cannot be determined first, with social and health policies left as a subsequent task to take care of the negative human rights consequences of the former. But then, again, we know that, in neoliberal economics, tangible (and profitable) results are more important than rights.
- Poverty Reduction Strategy Papers (PRSPs) –a WB initiative with the-illusion-of-country-ownership– are a pre-condition these days for all WB/IMF concessional lending. Real grassroots participation in PRSPs (as in the setting of the MDGs), if it existed at all, has shown to decrease in the subsequent phases of program implementation and monitoring. The rural poor with a heavy disease burden were not involved and, one more time, were the deliberately unheard. Parliaments were also not involved…and keeping an oversight over such important matters makes the vital difference between an effective parliament and an assembly of talking heads.
- The bungled start of PRSPs stands in sharp contrast to the importance of the issue of eradicating poverty, malnutrition and preventable ill-health and deaths as a HR issue. Not even the rising share of grants over loans in official development assistance (ODA) has managed to reduce the incidence of poverty and. (Moreover, grants result in tax gifts to influential groups thus stimulating consumption rather than growth). Grants and debt relief alone will simply not eradicate poverty and eminently preventable diseases.
- To really eradicate the poverty at the root, we first need to break the organizational and political inertia of the working class, in good part imposed by the powers-that-be. It is elites who control the aspirations of the people excluded from global Capitalism. So, the political education of the working class cannot be impartial, because they have to take sides in support of their own class interests.
- The outcomes we seek will, in last instance, be fair and just ‘if-and-only-if’ they increase the economic (and health) wellbeing of the worst off group in society. Those who own more productive assets did not come-by them in a way that confers them a moral right to greater benefit. As poor people are the weakest actors in accountability relations, they need to be empowered in order to hold duty bearers to account. This will not be possible without deliberate policies for doing so. So, ultimately, the hammer of justice carries no force other than its moral power that rests entirely on the political mobilization of the worst off.
- Bottom line: An unfaltering support of free markets and a credible fight against poverty and HR violations (the right to health included) cannot co-exist; justifiably so, we have lost faith in the old recipes for how the rich might help the poor: at the end of the day, the former always win. What one ends-up with are poverty reduction actions that are overwhelmingly limited to providing public services in a top-down manner; and that is what we mainly still see today.
- There are few examples of countries becoming strong by an economic laissez-faire and the unbridled opening of markets. The formula of economic liberalism may be suitable for increasing the wealth of the few, but not for escaping poverty with its trampled rights.
Claudio Schuftan, Ho Chi Minh City