Health equity in economic and trade policies

A paradigm shift for socioeconomic justice and health: from focusing on inequalities to aiming at sustainable equity
Garay J; Chiriboga D: Public Health 149, doi:, 2017

This study measured the ‘best possible health for all’, incorporating sustainability, to establish the magnitude of global health inequity. The authors identified countries with three criteria: firstly, a healthy population—life expectancy above world average; secondly, living conditions feasible to replicate worldwide—per-capita gross domestic product (GDP-pc) below the world average; and thirdly, sustainability—per-capita carbon dioxide emissions lower than the planetary pollution boundary. Using these healthy, feasible, and sustainable (HFS) countries as the gold standard, the authors estimated the burden of global health inequity (BGHiE) in terms of excess deaths, analysing time-trends (1950–2012) by age, sex, and geographic location. Finally, the authors defined a global income ‘equity zone’ and quantified the economic gap needed to achieve global sustainable health equity. A total of 14 countries worldwide met the HFS criteria. Since 1970, there has been a BGHiE of about 17 million avoidable deaths per year (about 40% of all deaths), with 36 life-years-lost per excess death. Young children and women bore a higher BGHiE, and, in recent years, the highest proportion of avoidable deaths occurred in Africa, India, and the Russian Federation. By 2012, the most efficient HFS countries had a GDP-per capita/ year of US$2165, which the authors proposed as the lower equity zone threshold. The estimated US$2.58 trillion economic gap represents 3.6% of the world's GDP—twenty times larger than current total global foreign aid. Sustainable health equity metrics provide a benchmark tool to guide efforts toward transforming overall living conditions, as a means to achieve the ‘best possible health for all.’

A Primer to the Emerging Extractive Sector in Kenya: Resource Bliss, Dilemma or Curse
Oiro Omolo MW, Mwabu G: Institute of Economic Affairs, November 2014

In any economy, the extractive sector consists mainly of oil, gas and mining activities. Experience in countries such as Norway, Canada, Botswana and Ghana suggests that extractives can be effectively managed to contribute to sustainable economic growth. Experience, however, in other parts of the world including Nigeria, the Democratic Republic of Congo, South Sudan, and the Central African Republic suggest that extractives if not well managed can lead to conflict. Extractives in Kenya contribute approximately one per cent to gross domestic product. The sector is however emerging. In the recent past, there have been oil and more mining discoveries in Kenya. For instance, oil has been discovered in Turkana County, and there are new discoveries in the mining sectors for minerals such as titanium in Kilifi County and coal in Kitui County. In addition, Kenya is actively undertaking off shore explorations with the aim of making gas discoveries. The growing extractive sector in Kenya means that there is need to give more attention to the social and economic dynamics of the sector. For instance, when Kenya discovered oil in Turkana County in March 2012, the Government was faced with emergent issues such as environmental implications, community obligations and rights, a suitable governance framework, and effective utilisation of resources generated from the sector.

A Recovery for All: Rethinking Socio-Economic Policies for Children and Poor Households
Ortiz I and Cummins M (Editors): UNRISD, October 2012

The world’s financial and economic crisis has taken a toll on children and poor households. High food and commodity prices, unemployment and austerity measures have aggravated persistent inequalities and contributed to a substantial rise in hunger and social tensions. Now, more than ever, investments for the world’s poor are needed to recover lost ground in pursuit of development objectives. People everywhere are demanding change. This book describes the social impacts of the crisis, policy responses to date and United Nations alternative proposals for ‘A Recovery for All.' The book guides us through the effects of the multiple crises on the poor, but it also demonstrates convincingly that the fiscal space for a basic floor of social protection that would provide effective protection from the worst social fall-out of such crises can be found. The book reminds that fiscal space is not a question of economic performance or state of development, it is first and foremost a question of political will. It is the lack of political will, i.e., cruel indifference vis-à-vis avoidable ill health, hunger, destitution and deaths, that prevents us from reducing vulnerability of those who have no means to fend for themselves.

A rethink is needed on Africa’s EPAs with the EU
Khor M: South Bulletin 52, 25 November 2010

African countries have stalled on signing economic partnership agreements (EPAs) with the European Commission because they fear negative consequences for their smaller economies, this article reports. To avoid the pitfalls of signing the EPAs in their current form, the article suggests African countries should negotiate trade preferences. The author notes that the 33 least-developed countries (LDCs) in the African Union do not have to sign the EPAs since their trade preferences will continue under the ‘Everything But Arms’ scheme. They should not have to sign EPAs in order to maintain the common external tariffs they have or would like to have with the non-LDCs in their regional economic groupings. Instead, the 14 non-LDCs can request that the EU provide them also with the ‘Everything But Arms’ scheme, without their having to give preferences to the EU in return. He argues that there is a good case for this, as these 14 countries are also poor and vulnerable, and have similar characteristics as the LDCs. Moreover, they belong to regional economic groupings in which LDCs are the majority of the membership, and there is thus also a good case that they be given a similar status as the LDCs so that these groupings can continue with their common tariffs, without the LDCs having to be sacrificed. There are a number of cases in the WTO in which waivers have been given for non-reciprocal agreements between a developed country member and a developing country or region. The article concludes that the best option to resolve the EPA impasse is for Europe to give a non-reciprocal preferential package for Africa as a region, or for the 14 African non-LDCs, in a treatment similar to ‘Everything But Arms’.

A review of co-morbidity between infectious and chronic disease in sub-Saharan Africa: TB and diabetes mellitus, HIV and metabolic syndrome, and the impact of globalization
Young F, Critchley JA, Johnstone LK and Unwin NC: Globalization and Health 5(9), 14 September 2009

This review found that globalisation was clearly related to an increased risk of diabetes and cardiovascular disease in sub-Saharan Africa. It may be exerting other negative and positive impacts upon infectious and chronic non-communicable disease associations but current reporting on these is sparse. The predicted impact of these co-morbidities in the region is likely to be large. An increasing prevalence of diabetes may hinder efforts at tuberculosis control, increasing the number of susceptible individuals in populations where tuberculosis is endemic, and making successful treatment harder. Roll out of anti-retroviral treatment within sub-Saharan Africa is an essential response to the HIV epidemic however it is likely to lead to a growing number of individuals suffering adverse metabolic consequences. One of the impacts of globalisation is to create environments that increase both diabetes and cardiovascular risk but further work is needed to elucidate other potential impacts. Research is also needed to develop effective approaches to reducing the frequency and health impact of the co-morbidities described here.

A Row to Hoe: The Gender Impact of Trade Liberalization on our Food System, Agricultural Markets and Women‘s Human Rights
Spieldoch A: IATP and the International Gender and Trade Network, 2007

This research paper draws together analysis of recent trends in food and agriculture from a gender perspective within an analysis of how trade and investment have affected food security and agricultural development. Although a number of case studies exist exploring how women have been affected by changes in global and local food systems, few have situated these case studies and their findings in the more global context of international trade and investment. This paper explores these linkages, pointing to the connections as well as to the need for further research to deepen our understanding of why women, who aremore than half the world’s population and overwhelmingly responsible for child nutrition, must be involved in policy decisions that affect agriculture and food security.

A tale of two worlds – Vedanta AGM 2016
Whitmore A: London Mining Network, August 2016

Vedanta Ltd is a mining company which various subsidiaries has operations in India, Zambia, Namibia, South Africa, Liberia, Ireland and Australia in copper, zinc, silver, aluminium, oil, gas, iron ore and power segments. This article reports on Vedanta’s annual general meeting in London and some of the debates that took place at the meeting, including in relation to the report back by shareholders who visited mine sites and reported on what they had seen on working and environmental conditions. The author comments that in part a promise of “zero harm” by large extractive corporations is illusory and can lead to real problems being hidden. The author argues for reports to rather be clearer about the real conditions and situation on the ground to include and allow debate on the improvements intended to manage them.

A WHO/UNICEF global code of practice on the marketing of unhealthy food and beverages to children
Taylor AL, Dhillon IS and Hwenda L: Global Health Governance V(2): Spring, June 2012

The lack of a global legal framework to guide national action and international cooperation to reduce risk factors related to alcohol abuse and unhealthy diet significantly hinders the capacity of nations worldwide to unilaterally and collectively curb the expanding epidemics of non-communicable diseases (NCDs), according to this paper. A number of commentators have suggested the adoption of comprehensive treaties or framework conventions on obesity, or alcohol or both. Given the legal, political, budgetary, and time-related limitations to the development and adoption of all-encompassing treaty regimes to address obesity and alcohol abuse, the authors recommend an alternative legal strategy to counter these rising NCD epidemics. In particular, they call for the prompt adoption of a WHO/UNICEF global code of practice on the marketing of unhealthy foods and beverages to children. Such a non-binding international legal instrument has significant advantages over a treaty approach at the present time. It would provide a much-needed step towards advancing meaningful engagement with and holding to account all relevant actors, including national governments, private industry, and UN agencies, in protecting children everywhere from harm. The WHO Framework Convention on Tobacco Control (“FCTC”) addresses one of the major risk factors contributing to NCDs by establishing a global legal framework to counter the tobacco pandemic: in response, the authors call on the global community to act collectively to establish a legal architecture to regulate a central component of these two other major risk factors.

A2K and the WIPO development agenda: Time to list the public domain
Suthersanan U: UNCTAD-ICTSD Policy Brief 1, December 2008

In this policy brief, the author argues that the world Intellectual Property Organisation (WIPO) development agenda is a valuable opportunity to place the notion of the 'public domain' at the centre of the intellectual property debate. In this regard, she proposes the creation of an international register for public domain matters that countries, particularly developing countries and least developed countries (LDCs), should be able to rely on in order to boost their local innovation and creativity. The author recommends that governments and other stakeholders preserve the public domain and support norm-setting processes that promote a robust public domain, initiate discussions on how to further facilitate access to knowledge for developing countries and LDCs in order to foster creativity and innovation, and establish a forum for exchange of experiences on open collaborative projects such as the Human Genome Project.

Abrupt end to ministerial leaves questions on future of intellectual property issues at WTO
New W: Intellectual Property Watch, 31 July 2008

The World Trade Organisation Doha Round talks ended bitterly on 31 July, but negotiators left town with the general consensus that hard-earned work to date should not be lost and that there might be resumption of talks sometime in the future. The fate of intellectual property (IP) issues at the WTO remains vague and may not come clear for weeks or months, according to some sources, while others said it will be business as usual for international trade rules on IP.