Transcript 'Australian Society: Is there a disturbance in the Force

"Australian Society: Is there a
disturbance in the Force?“
A Public Health View
Professor Fran Baum
Public Health
Flinders University
Adelaide
Battle between
Good and Evil
What is a healthy community?
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Transport
Education and Employment
Peace and security
Housing
Well planned
Social and convivial
Equal and non-exploitation
Acceptance of difference
Sustainable environment
Absence of disease
Towards Healthy and
Sustainable Living
Community
Environment
Livable
Convivial
Viable
HEALTH
Equitable
Sustainable
Adequately
prosperous
$$$Economy $$$$
(Hancock, 1994)
So why don’t we have this kind of
balanced society – what is
impeding it?
Unhealthy Signs
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Economic
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Social – lack of:
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Dominance by economic thinking
Some groups doing better than others
Trust
Tolerance
Equity
Unsustainable development
Economic rationalism’s march continues
unabated
Hallmark of economic rationalism
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Private sector values introduced into public
sector – outsourcing, contracting out
Reduction of size of public sector
Privatisation of public assets: prisons, water,
electricity, banks, insurance companies, housing
Increasingly associated with economic
globalisation
Globalisation
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Complex set of processes
the evolution of a global financial
trade (key role for WTO)
undermining of the power of
national governments
transformation of traditional
values including those relating to
women and the family and religion
growth in inequities within and
between countries
What is economic globalisation?
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Trade liberalisation, tarriff reduction,
standards harmonisation and
deregulations
Growth in international trade e.g. 8.6%
per year from 1990-99
Greater mobility of capital and increase in
transnational investment
Global institutions to regulate WTO, GATT,
GATS
Is globalisation good for health?
PRO
 Trickle down effect
 Will increase income
of poor
 Cleaning up corrupt
governments in poor
countries
 More communication
 Consumer goods than
enrich lives
Baum (2002) The New Public Health, p. 109
CON
 Structured unfairness
of trade
 Increases inequities
 SAPs in poor
countries
 Swamping culture
Americanism
McCulture
 Unhealthy levels of
consumption
World Trade Organisation and TNCs
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Cancun, Mexico 10th September 2003
Push from EU to expand rights of TNCs
Agreement on investments
Govts no longer able to prevent a foreign
corporation setting up no matter how bad
its environmental or social record
Environmental, health or labour standards
could be seen as a restriction on trade
Example: Canada and Ethyl Corp
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Govt banned a fuel additive in 1996, PM
described as “a dangerous neurotoxin”
US-based Ethyl Corp sued for compensation
arguing ban constituted an “expropriation” of
Ethyl’s Canadian investments because global
reputation had been harmed
Lawyers advised Govt it would lose so it lifted
ban, gave Ethyl $13m and an apology
“Canadians breathe in the results of this decision
every time they step outside”
Retallack (2003) New Statesman, 25th Aug
Example: Mexico
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Paid US waste disposal company Metalclad
$15.6m because Municipal Govt in
Guadalcazar refused to allow Metalclad to
open a new toxic-waste facility on a site
that is highly vulnerable to ground water
contamination
Retallack (2003) New Statesman, 25th Aug
Threats to public health
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WTO agreement on govt procurements
could mean govts can not give preference
to local companies or award contracts on
basis of public health e.g. school canteens
Would be illegal to require GM-free food or
low fat content – would be seen as a
barrier to trade
Main beneficiaries from Economic
Globalisation
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TNCs
CEOs
Rich people
Rich countries
 Walmar,
owned by the Walton
family in the United States has
an estimated wealth of US$27
billion which is higher than the
GDP of Bangladesh with its
population of 120 billion
Wealthy People
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The world’s 200 richest people more than
doubled their net worth in 1993-7
WHO (1997) note that in 1996 just 358
billionaires had a net worth of US$760m
which equalled the wealth of the poorest
45% of the entire world’s population
Business Review Weekly richest
Australians: 1983 and 2000
Top ten in 1983 Worth
Top ten in 2000 Worth
Murdoch family $250m
Kerry Packer
$8200m
Fairfax family
Frank Lowy
$2800m
Smorgon family $150m
Richard Pratt
$2700m
J&R Ingham
$150m
David Hains
$1400m
Kerry Packer
$100m
Boris Liberman
$1300m
$175m
Source: Business Review Weekly web site www.brw.com.au
Rich countries getting richer
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The UN Human Development Report
(1999) compares the size of the
income of the fifth of the world’s
people living in the richest countries
and that of the fifth in the poorest.
The ratio had changed from 30 to 1 in
1960, to 60 to 1 in 1990 and to 74 to
1 in 1997
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half the world’s
population, 3 billion
people, live on less than
US$2 a day and of those
about 1 billion live in
extreme poverty of below
US$1 a day.
(UNDP, 1998)
Growing Global Inequities
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In sub-Saharan Africa 20 countries have
lower incomes per head in real terms than
they had in the late 1970s.
International comparison of health
indicators (1999)
Country
Life
expectancy at
birth
Infant mortality
rate/1000 live
births
59.0
77.0
410
Middle income
economies
69.0
31.0
2,000
High income
economies
78.0
6.0
25,730
Low income
economies
Source: World Bank, April 2001
GNP
“The global supervisory organisations like the
World Bank, the IMF, the WTO, and the
United Nations system should be giving the
issue of global income inequality much more
attention. ……. International public policy to
reduce world income inequality must include
a basic change in the policy orientation of the
World Bank, the IMF, and the WTO so as to
allow them to sanction government efforts to
impart directional thrust and nourish home
grown institutional innovations”
Robert Hunter Wade, Professor of Political Economy London School of
Economic and ex World Bank Economist
It is shaking up our existing ways of life,
no matter where we happen to be. This
is not - at least at the moment - a global
order driven by collective human will.
Instead, it is emerging in an anarchic,
haphazard, fashion, carried along by a
mixture of influences.
It is not settled or secure, but fraught
with anxieties, as well as scarred by deep
divisions. Many of us feel in the grip of
forces over which we have no power.
Giddens (1999, p.19)
Unhealthy Societies
Economics
$$$
Environment
Social
Inequities within countries
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In all countries where data is documented
there are inequities between groups based
on socio-economic status
Evidence inequities are increasing
Those countries with more equal
distributions of income have better
population health status
Growing inequities in Australia
Gini coefficient measuring inequity increases
 Wage income 15.5 %
 Market income
7.5%
 Gross income 6.7%
 Disposable income 7.4%
Saunders, P (2002) The Ends and Means of Welfare, Cambridge: CUP.
Protests at unfair trade
Evian, May 2003
When inequities become too
great the idea of community
becomes impossible (Raymond
Arons)
Trust is declining
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Trust in government and others is
declining
People more likely to be wary of others
Tolerance is declining
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No apology and reconciliation is making
shaky progress
Political agenda using fear, intolerance and
distrust e.g. Tampa affair
Wedge politics
Less welcoming and inclusive as a result
Refugees
“Frontiers, immigration checkpoints and visas
form barriers between the wealthier countries
and the poorer ones. They are the fortifications
that protect privilege and excess, the castle walls
behind which global riches are stockpiled for the
enjoyment of the few. Removing those barriers
would be a revolutionary step towards social
justice” Mares (2001, p.187)
Declining social capital
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Trust reducing
Engagement in community & voluntary
groups is declining
Less equality
Yet we know higher levels of social capital
appear to be good for health
Social Cohesion: Crime and social
capital
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Elevation in neighbourhood collective
efficacy (social cohesion and trust) was
associated with a 39.7% reduction in the
expected homicide rate (Sampson et al,
1997)
Links at state level between low trust and
higher rates of violent and property crime
(Kennedy et al, 1998; Kawachi et al,
1999b)
Social Capital, health and inequality
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In USA States income inequality strongly
correlated with both per capita group
membership (r=-.40 P <.01) and lack of
social trust (r=.76, P <.0001)
Social trust and group membership
associated with total mortality and rates of
death from CHD, Ca, infant mortality
(Kawachi et al (1997)Am J PH, 87, 1491-1498)
Sustainability
Are we sustainable?
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Human development and achieving human
potential require economic activity that is
socially and environmentally sustainable in
this and future generations
Canadian Public Health Association (1991) Health
Implications of the Ecological Crises, Ottawa: CPHA
Threats to sustainability
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Air pollution
Water pollution
Climate change
Unsustainable economic activity
Loss of biodiversity
Over consumption
We are living beyond our means
Can we restore the good forces??
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First globally
Australia and other rich countries have a
responsibility to share wealth with poorer
countries
Could we cope with a small drop in
standard of living?
“….the very right to be human is every day
denied to hundreds of millions of people as a
result of poverty …. The unavailability of food,
jobs, water and shelter, education, health care
and a healthy environment” is “not a
preordained result of the forces of nature or
the product of a curse of the deities”. It is “the
consequences of decisions which men and
women take or refuse to take, all of whom will
not hesitate to pledge their devoted support
for the Universal Declarations of Human
Rights”.
Nelson Mandela quoted in Heywood and Altman, 2000, p.173
Redressing wealth imbalance
The equity challenge is to move some
money away from the super rich
countries, corporations and individuals and
use it effectively to promote the health
and well-being of the world’s poorest
citizens.
(Annas, 2000, p.185)
A solution is very possible if there is
the will……
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The United Nations has estimated that the
cost of universal access to basic
education, health care and food and clean
water is only about $40 billion a year, less
than 4% of the combined wealth of the
225 richest people in the world.
Principles to assist in achieving
fair and responsible trade
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Equity in trade policies
Protection of vulnerable groups (eg
family farms, co-operatives,
Indigenous peoples)
Sustainability to enhance ecological
systems
Internalisation of costs:
environmental costs should be given
valuation
Marquez (1999, p.19)
How will we achieve the balance
we need for healthy sustainable
communities in Australia?
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Equity as a goal of public policy
Sustainability as a goal of public policy
Strong communities as a goal of public
policy
In Australia if we wanted we
could…
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Dramatically improve Aboriginal health
Reduce economic inequities
Become more inclusive by welcoming
refugees
Ensure essential services are in public
ownership
Work to restore trust
Reduce consumption
All of these things are possible if we have the will
Public stops being a dirty word
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Restoration of faith in the idea of
government as a servant of the
community and guarantor of personal
security and as an entity that will modify
the market and ensure equity and redress
market inequities
State intervention or we sink
Our response must be that
we will intervene; we will
intervene to retain our
right to a say in our
future, to temper the
market place by action, to
provide services and social
justice, to retain
institutional safeguards
and provide needed
development in the
community interest, for we
know that we intervene or
we sink