Friday, April 10, 2009

Economic downturn and global health

Economic crises and economic recovery plans are dominating the news. There is news about macroeconomic indicators (such as unemployment rates) as well as how the economic downturn/recession is affecting the lives of ordinary people. Or at least, the macro- and micro effects of the crisis in America, Europe and better-off nations in Asia. With rare exceptions, there is little talk or concern about how the breakdown of the world's dominant economies is playing out in the world's poorer countries, despite estimates that the numbers of persons living on less than $2 per day will soon swell by the tens of millions.

Last week, the New York Times published an editorial about the situation that many developing countries find themselves. Currency rates are falling as is demand for whatever products those countries export in the global market. Unlike the United States and Europe, these countries don't have a few trillion dollars on hand to stimulate their own economies; they are struggling to pay back the loans taken out in years past to ... stimulate their economies. The NYT editorial claims that affluent nations should give more money to the International Monetary Fund, who in turn can extend more lines of credit to developing countries. The assumption seems to be: we need to maintain the longstanding debt and dependency relationship between developed and developing countries, i.e. prop it up with more cash injections. The editorial is silent about the very spotted history of IMF loan practices and developing countries, and about who is responsible for the culture of toxic financial products that created the global financial crisis in the first place. It has a real 'rearranging deskchairs on the Titanic' feel to it.

Another publication, quite another angle: the British Medical Journal has published a thoughtful piece on the potential effects of the financial crisis on health in developing countries, and how the crisis could be an opportunity to positively change the global financial landscape. Although there is no firm data yet, the consequences of the financial crisis on health in developing countries look very dire: if you take the 'social determinants of health' model, and reasonably assume that the economy (in terms of income) partly determines health, then people in already resource-poor countries are going to get sicker, and more are going to die of preventable and treatable conditions than before. The way out, according to the authors, is not to refill the coffers of the IMF. It would be better to first ditch the idea that the more unregulated a market is, the better off the economy will be, and the better off the health of nations will be. The de-regulation of markets seems to have faciliated the growing inequalities between the health and wealth of nations over the last decades. Moreover, at crucial points where the global market was regulated -- through trade laws and regulations -- the conditions of trade were largely set by and to the advantage of more affluent nations. We therefore need to draw radical lessons from our current predicament, by reflecting on just how we got here. As the authors write, "The financial crisis gives us the opportunity to bring social justice and environmental concerns to bear on the kind of new global economic order that must be put in place." Amazing that health professionals in the BMJ are now giving voice to these views, once the mainstay of activists at global economic forums.

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