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"Chiapas Today" Bulletin No. 323

CIEPAC; CHIAPAS, ME'XICO 22 de November de 2002

WARNING: GLOBALIZATION CAN BE DANGEROUS TO YOUR HEALTH

Recent studies in several countries confirm that corporate globalization can cause damage to our health. This idea comes from comparisons made by Dr. Stephen Bezruchka, School of Medicine of the University of Washington, of levels of inequality (the gap between the rich and the poor) in certain countries, and overall health, as measured by life expectancy. Dr. Bezruchka and other researchers have come to the surprising conclusion that what's important in determining a country's state of heath is its degree of equality. The greater the inequality between rich and poor, the worse the population's health is. In countries with a more equal distribution of national wealth, the population enjoys better health.

Dr. Bezruchka recalls that since beginning to study medicine he wondered about the relatively poor state of health in the United States. He was shaken by the fact that Americans, with 5% of the world's population, spend 42% of worldwide expenditures on health, and yet suffered poor health as compared to other industrialized nations. Another disquieting fact is that over time Americans' health continues deteriorating in relation to other countries with a similar level of development. (1) Dr. Bezruchka drew up a list, which he called the "Health Olympics", that ranks countries' life expectancy, from best to worse. The winner of these "Olympics" is Japan, with a life expectancy of 81 years. Runners up are Sweden (79.6 years), Hong Kong (79.5), Iceland (79.2), Australia (78.9), Switzerland (78.9) and Canada (78.8). The United States, with a life expectancy of 77 years, is in 25th place, behind other countries with an inferior level of development such as Italy and Spain (78.5), Greece (78.2), Cyprus and Malta (78.0). The US is barely ahead of countries such as Costa Rica (76.5) and Kuwait (76.2). In fact, life expectancy of Costa Rican males is greater than that of US males. (2)

Even more surprising is the fact that the Japanese smoke on average four times as much as Americans. What's more, the Japanese, together with the Chinese, smoke more than any other nationality. How, then, to explain this apparent contradiction of a country whose inhabitants also win the "smoking olympics" and yet live longer than anyone? How do we explain a further contradiction of a country, the United States, that spends far more than any other on health, and yet has a comparatively low life expectancy? These contradictions led Dr. Bezruchka to investigate further.

And he found that the general health of a population has not so much to do with the degree of sophistication in heath care (medical attention in the US is among the most advanced and expensive). What appears to explain these contradictions is the prevailing degree of equality (or inequality). Looking again at the "Health Olympics", we see that countries that enjoy the longest life expectancy are also the most equal, either for cultural reasons (such as Japan), or due to public policy and tax rates that tend to level everyone's income (Sweden, Norway, Switzerland, Island), and which in addition have state-run health services with universal coverage (Canada). Dr. Bezruchka concludes then that if the United States is the richest and most powerful country on earth, but has the worse life expectancy among the industrialized nations, the reason lies with the growing inequality in the country, in addition to a health-care system controlled by large corporations and thus subject to the profit motive.

Since the present phase of capitalism began, which some call neoliberalism, and others corporate globalization, it has become commonplace to say that the rich are getting richer and the poor poorer. And the United States is no exception but, in addition, the widening gap between the middle class and the very rich has now reached scandalous proportions. And that's not even counting the poor, who are worse off. Paul Krugman, economist at the University of Princeton, found that between 1979 and 1997, the income of the US's super rich, the 1% richest people, grew 157%, while the income of the middle class in the same period grew only 10%. Krugman adds that the gap has not closed since 1997, but rather continues to widen, concentrating the country's wealth, not only among the 1% richest, but principally among the 0.1% richest. In other words the 13,000 Americans that make up the 0.1% richest sector, with an average annual income of US$17 million, are becoming even wealthier, and quicker, than the other 99.9%. (3) Krugman points out another tendency, that surely will jolt most Americans: their government is making decisions that favor wealthier folks, at the expense of the middle class and the poor. Of course Krugman says that it wasn't always so.

There was a long period in which the government seemed to be working for the "common good", particularly during and after Franklin D. Roosevelt's New Deal, and up to the arrival of Ronald Reagan's neoliberal presidency, when the tendency began to shift in the other direction. Compare these tendencies to Japan. After World War II, the Japanese restructured their society to make it more horizontal than vertical, i.e., they made it more equitable. This can be seen, on the one hand, in the small difference between the highest and lowest salaries. For example, the Prime Minister of Japan earns hardly four times that of an average worker.

In Japanese corporations, the CEO commonly makes 10 times an entry-level worker. On the other hand, in the US, CEOs make 475 times what a blue-collar worker makes. (4) Japanese culture also demands greater equity. It is not uncommon to read that in Japan high-level executives at firms in financial difficulties take salary cuts rather than lay off their workers. We have seen in recent months the shabby behavior of CEOs in financially-strapped companies in the US: executives continue to channel through sleight-of hand schemes millions of dollars to their accounts, while employees are left unemployed and their retirement funds collapse due to bankruptcy. The cultural ambience is just different. Furthermore, in Japan the gap between the rich and poor is the narrowest of any country.

And Japanese society has also been characterized by its cohesiveness (unity), with a place, and respect for all (well, at least among Japanese. Non-Japanese minorities are discriminated). In other words, when citizens feel a sense of unity amongst each other, when they do not observe great differences, the health of the population is better. And there are now many studies that confirm this psychosocial relationship. When people experience economic insecurity, when they have no control over their lives and their jobs, chronic stress and anxiety weaken their immune system, as Richard G. Wilkinson, researcher at the University of Sussex, England, has shown. (5) Canada offers more evidence in this regard. Although the income gap has widened in Canada since the mid-80s, income distribution undertaken by the federal government through taxation has helped to level differences.

Redistribution takes the form of unemployment insurance, social assistance, universal access to education and health, and this gives Canadians security, stability, confidence in the future and a greater sense of control over their lives. Which in turn in reflected in Canada by one of the highest life expectancies in the world. (6) Doctor Bezruchka asks, "What kind of a country will have a smaller gap between the rich and the poor? One in which people see one another as equals. The norms of behavior are those of friendship, support, cooperation, trust, sociability, and community.

Those are healthy-sounding words. In societies where there is a big gap between the rich and poor, the way to get things done is through power, coercion and domination. People with no power feel resignation, submission and resentment. These aren't healthy feelings. The quality of the psychosocial environment determines a population's health." (7) Doctor Dennis Raphael, of the University of York in Toronto confirms this, but specifically for heart-related illnesses. He states that both conceptual and empirical studies identify conditions such as poverty, social exclusion, and the growing economic gap as fundamental factors in determining the incidence of cardiovascular diseases in individuals and communities. (8). Although the majority of these studies have been done in industrialized countries, the same relationship between economic equality and health holds in poor countries.

For example, a study undertaken by Dr. Simon Hales of the Dept. of Public Health of Wellington, New Zealand, using national income data from 23 poor countries (GNP per head < US$1,000/year) and 15 "richer" countries (GNP per head > US$1,000), found that the average health of the population in these countries has to do with the distribution of income within the society. His investigations suggest that "in poor countries (GNP per head < US$1,000) a substantial reduction in [the] infant mortality rate may be possible by decreasing income inequality or increasing GNP per head. In [richer] countries, reduction of income inequality is likely to be more effective in lowering infant mortality rates than further increases in GNP per head would be." (9) For countries such as Mexico, conclusions from these studies have obvious implications for public policy. The most apparent is that it doesn't make much sense to dismantle or privatize the state institutions that, for better or worse, have given millions of Mexicans access to health, education, housing and food.

It is undeniable that these structures need profound changes. But the weakening, privatization or disappearance of institutions such as the IMSS, ISSSTE, etc., and their subsequent transfer to the private sector, would in no way improve the general health of the population,. On the contrary, evidence in this and other countries indicates that the general health of Mexicans would plummet. And not just because the poor could not afford it, but also due to the psychosocial factors mentioned above, with the onset of chronic stress, when no health alternative would be available for the general population in times of need. The need for greater equality in income distribution also becomes apparent. If we compare rich to poor, Mexico is one of the most unequitable countries in the world, and a profound revamping of the tax code, with greater taxes on high incomes, and not on consumption, as in now the case with the VAT (value added tax), would help to redistribute the nation's wealth.

In taking similar steps to lessen structural injustice, we could also assure a future of more and better health for all Mexicans. In conclusion, present tendencies dictated by corporate globalization, that increase the gap between rich and poor, must be reversed and defeated.

Notes in the text: (1) Stephen Bezruchka, "Societal hierarchy and the health Olympics", Canadian Medical Association Journal, June 12, 2001, p.1701. (2) Data compiled for 2000 by S. Bezruchka, using the Human Development Report, UNDP (United Nations Development Program), New York, 2002, Oxford University Press. (3) Paul Krugman, "For Richer", Sunday magazine of the New York Times, October, 20, 2002. (4) Stephen Bezruchka, "Sick of it all: Economic Equality: Good for What Ails You", 2001, available on the internet at http://projects.is.asu.edu/pipermail/hpn/2001-January/002363.html (5) Quoted in: Crawford Kilian, "Nation's Health Depends on Equality, Not Wealth", Georgia Straight, Vancouver, Canada, June 8, 2000. (6) Kilian, ibid. (7) Bezruchka, "Sick of it all", ibid. (8) Dennis Raphael, "Social Justice is Good for Our Hearts: Why societal factorsnot lifestylesare major causes of heart disease in Canada and elsewhere", Centre for Social JusticeFoundation for Research and Education, Toronto, 2002. (9) Simon Hales, et. al., "National infant mortality rates in relation to gross national product and distribution of income", The Lancet, Vol. 354, December 11, 1999, p. 2047. Miguel Pickard The Center for Economic and Political Investigations of Community Action, A.C. CIEPAC, CIEPAC is a member of the Movement for Democracy and Life (MDV) of Chiapas, the Mexican Network of Action Against Free Trade (RMALC) www.rmalc.org.mx, Convergence of Movements of the Peoples of the Americas (COMPA ) www.sitiocompa.org, Network for Peace in Chiapas, Week for Biological and Cultural Diversity www.laneta.apc.org/biodiversidad, the International Forum "The People Before Globalization", Alternatives to the PPP http://usuarios.tripod.es/xelaju/xela.htm, and of the Mexican Alliance for Self-Determination (AMAP) that is the Mexican network against the Puebla Panama Plan. CIEPAC is a member of the Board of Directors of the Center for Economic Justice http://www.econjustice.net and the Ecumenical Program on Central America and the Caribbean (EPICA) http://www.epica.org. Note: If you use this information, cite the source and our email address. We are grateful to the persons and institutions who have given us their comments on these Bulletins. CIEPAC, A.C. is a non-government and non-profit organization, and your support is necessary for us to be able to continue offering you this news and analysis service. If you would like to contribute, in any amount, we would infinitely appreciate your remittance to the bank account in the name of: CIEPAC, A.C Bank: Banamex Account number: 7049672 Sucursal 386 San Cristo'bal de las Casas, Chiapas, Me'xico. You will also need to use an ABA number: BNMXMXMM Thank you! CIEPAC Note: If you wish to be placed on a list to receive this English version of the Bulletin, or the Spanish, or both, please direct a request to the e-mail address shown below. Indicate whether you wish to receive the email or the "attached file" (Word 7 for Windows 95) version.

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