Global Health Watch 1 in one file

its benefits and its risks, it works less well for the currently poor countries
and for poor households within developing countries. Because markets at
the national level are asymmetric, modern capitalist economies have social
contracts, progressive tax systems, and laws and regulations to manage asymmetries
and market failures. At the global level, there is no real equivalent
to national governments to manage global markets, though they are bigger,
deeper and if anything more asymmetric. They work better for the rich; and
their risks and failures hurt the poor more’ (Birdsall 2002).
The national and global are linked. Globalization’s present form limits the
macroeconomic, development and health policy space in rich and poor nations
alike. Liberalized capital markets ‘sanction deviations from orthodoxy’
(WCSDG 2004), that is, anything that limits the potential for profit, and have
‘added to the speed at which, and the drama with which, financial markets
bring retribution on governments whose policies are not “credible”’ (Glyn
1995). Between nations, liberalized trade still benefits high- more than lowincome
countries; and its rules-based system is frequently ignored or undermined
by countries such as the US when its outcomes are not in their interests.
Developing world debt is ‘perhaps the most efficient form of neocolonialism’
(Bullard 2004). And the wealthy world’s responses to disease crises sweeping
many parts of the low-income world, while belatedly improving, are woefully
inadequate and eclipsed by huge expenditures on attempts to make the world
safer for the rich through increased militarization and decreased civil rights
(Oloka-Onyango and Udugama 2003).
The discussion of whether globalization and openness is good or bad for the
poor should move on to a discussion of ‘the appropriate global social contract
and appropriate global arrangements for minimising the asymmetric risks and
costs of global market failure’ (Birdsall 2002). What should the contents of
such a global social contract look like? In somewhat idealist tones, the World
Commission on the Social Dimensions of Globalization urged a rights-based
approach in which the eradication of poverty and the attainment of the MDGs
should be seen as the first steps towards a socioeconomic ‘floor’ for the global
economy, requiring in part a more democratic governance of globalization
(WCSDG 2004). Its recommended reforms to move the global political economy
in this direction resemble those that have been proffered for at least the
past 20 years, as follows:
• Increases in untied development assistance to the long-standing, albeit
non-binding UN target of 0.7% of rich countries’ gross national income,
along with efforts to mobilize additional sources of funding.
Health for all in a ‘borderless world’?
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