Global Health Watch 1 in one file

Health and globalization | A1
economy. The privatization of state enterprises eliminated a further source of
revenues that might have been used to support social programmes such as
education and health care.
Other causes for the public revenue decline included a continuous slide
in world prices for copper, Zambia’s main export; Japan’s 1990s recession
(it was Zambia’s main importer of copper); high debt service costs; declining
development assistance; and capital flight (WTO 1996, Lindsey 2002). Faced
with public revenue declines and a donor preoccupation with ‘cost recovery’,
Zambia began to impose user charges for schools and health services in the
1990s. Not surprisingly, this was followed by a rapid rise in school dropout
and illiteracy rates, projected to double by 2015 (UN-Habitat 2003b), and costs
became the main reason people failed to seek health care or did not follow up
medical treatment (Atkinson et al. 1999).
The Zambian government is now seeking to undo many of these policies,
to reimpose tariffs on salaula, and to reorient its development inwards. ‘In a
sense,’ two officials recently wrote, ‘Zambia is now a victim of its own honest
policies. Trade in goods and services is now one of the mainstays of the economy,
to the detriment of more productive activities and thereby employment
opportunities’ (Mtonga and Chikoti 2002). Or, as one of the Zambians interviewed
by Jeter (2002) commented, ‘The young people really love the [salaula]
clothes they see … but is this the way to develop your economy?’
Globalization played an important part in Chileshe’s HIV infection. The
web of connection between globalization and the HIV pandemic in Africa has
many strands. Two of these include the debt crisis and the donors’ response,
particularly by the wealthy G7 countries (Canada, Germany, Italy, Japan, the
UK and the USA).
Debt and aid
The long-standing debt crisis is a major factor in the inability of low-income
countries to sustain or benefit from economic growth (UNCTAD 1999), or to
invest in health-sustaining infrastructures. Worldwide, the amount of money
returned to high-income countries dwarfs the amount received in development
assistance: donor countries receive back many times over in debt repayments
what they give in aid. Journalist Ken Wiwa, son of Ken Saro-Wiwa, the activist
hanged for opposing Shell Oil’s destruction of Nigerian homelands, noted:
‘You’d need the mathematical dexterity of a forensic accountant to explain why
Nigeria borrowed $5 billion, paid back $16 billion, and still owes $32 billion’
(Wiwa 2004). The specific causes of debt crises vary from country to country
and over time but the major contributors are as follows:
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