Health equity in economic and trade policies

IMF conditionality: still undermining healthcare?
Brunswijck G; Griffiths J: Global Health Check, April 2018

An IMF blog in March 2017 claimed that: “A number of studies have found that IMF support for countries’ reforms, on average, either preserve or increase public health spending.” However, the evidence provided was weak. Of the six studies referenced, one, by Oxford and Cambridge university researchers flatly contradicts this claim. Two were not related to health expenditure: one looked at revenue, not expenditure, and the second had a broader remit and contained no new evidence on the IMF and health. One was over a decade old and did not directly support the claim; while another was a link to an IMF page on the Ebola crisis. In fact the only referenced study that supported the claim was written by the staff who authored the blog. The IMF’s concern not to be seen to be impacting negatively on health expenditure in the poorest countries can be viewed as an improvement. However, the authors suggest that it is clear that IMF conditionality can constrain expenditure on health and other related services, at odds with the SDG commitment to achieve universal health coverage. The next scheduled review of IMF funding to low-income countries is planned for 2018. The authors argue that it is time for a much broader reform of IMF conditionality. Citing Eurodad’s detailed study, in 2014, that found that IMF conditions are often highly controversial and intrusive on key economic policy issues, they suggest that these policies should be the crux of democratic debate in country, not mandated from Washington.

African leaders sign continental free-trade agreement
Al Jazeera News: 21 March 2018

African leaders have signed an agreement to set up a massive free-trade area to improve regional integration and boost economic growth across the continent. The deal to create the African Continental Free Trade Area (AfCFTA) was signed at an extraordinary summit in Kigali, Rwanda by representatives of 44 of the 55 African Union (AU) member states. The agreement commits countries to removing tariffs on 90 percent of goods, with 10 percent of "sensitive items" to be phased in later. It will also liberalise trade in services and might in the future include free movement of people and a single currency. AfCFTA will now have to be ratified by individual countries. Nigeria pulled out of the signing ceremony. The Nigeria Labour Congress (NLC) had warned government against signing the agreement, calling it a "renewed, extremely dangerous and radioactive neo-liberal policy initiative". A further protocol, the Protocol on Free Movement of People has to date been signed by 27 countries.

Listeriosis: One of many food horrors of South Africa’s profit-driven, corporate-controlled food system
COPAC, SAFC: South Africa, March 2018

The South African Food Sovereignty Campaign (SAFSC) and Co-operative and Policy Alternative Centre issued as press statement calling the outbreak of listeriosis in South Africa as a food horror of a profit-driven corporate food system, with limited state regulation. They blame the current corporate controlled food system for compromised health standards in South Africa, which has led to food horrors of not only listeriosis, but also obesity, hunger, malnutrition, child stunting and diabetes. The private sector with profit as its main motive, claims that it has solutions to end food crises, but these organisations say that it is perpetuating the very crises that the poor and vulnerable face on a daily basis, and that the listeriosis outbreak, as well as ongoing hunger, hiking obesity and diabetes rates and contamination of soils with pesticides, tell a story of the failure of the corporate food system to ensure adequate nutrition for all citizens, and the destruction of natural environments. The South African Food Sovereignty Campaign (SAFSC) calls for greater state regulation based on the People’s Food Sovereignty Act. This Act calls for the democratic planning of the food system, increased state regulation on destructive practices of the corporate controlled food system, prioritising local food supply over trade, a ban on advertising of all junk food, and greater reliance on small-scale food producers to feed citizens culturally appropriate and nutritious food.

The institutional context of tobacco production in Zambia
Labonté R; Lencucha R; Drope J: Globalisation and Health 14(5) doi:, 2018

Tobacco production is said to be an important contributor to Zambia’s economy in terms of labour and revenue generation. In light of Zambia’s obligations under the WHO Framework Convention of Tobacco Control (FCTC) the authors examined the institutional actors in Zambia’s tobacco sector to better understand their roles and determine the institutional context that supports tobacco production in Zambia. Findings from 26 qualitative, semi-structured individual or small-group interviews with key informants from governmental, intergovernmental and non-governmental organisations were analysed, along with data and information from published literature. Although Zambia is obligated under the FCTC to take steps to reduce tobacco production, the country’s weak economy and strong tobacco interests make it difficult to achieve this goal. Respondents uniformly acknowledged that growing the country’s economy and ensuring employment for its citizens are the government’s top priorities. Lacklustre coordination and collaboration between the institutional actors, both within and outside government, contributes to an environment that helps sustain tobacco production in the country. A Tobacco Products Control Bill has been under review for a number of years, but with no supply measures included, and with no indication of when or whether it will be passed. As with other low-income countries involved in tobacco production, there is inconsistency between Zambia’s economic policy to strengthen the country’s economy and its FCTC commitment to regulate and control tobacco production. The absence of a whole-of-government approach towards tobacco control has created an institutional context of duelling objectives, with some government ministries working at cross-purposes and tobacco interests left unchecked. With no ultimate coordinating authority, this industry risks being run according to the desire and demands of multinational tobacco companies, with few, if any, checks against them.

The Political Economy of Renewable Energy Investment in Kenya
Osiolo H; Pueyo A; Gachanja J: IDS Bulletin 48(5-6), doi:, 2017

Kenya has been hailed as a successful sub-Saharan African country in attracting private investment for renewable energy. However, this paper observes that energy poverty remains very high, with connectivity rates lower than the average for sub-Saharan Africa and poor quality of supply for those connected. Several constraints persist to achieve universal access to clean and affordable electricity: high system costs, including a deficient transmission and distribution infrastructure; low rural demand and inadequate planning to meet it; and local opposition to large renewable infrastructure. This article considers the political economy of these constraints, explaining how they arose, which policies can address them and which actors back or oppose these policies. The overarching message is that a prominent state role is required to fund the network components of the electricity system and to reach the less profitable segments of society, namely the rural poor. However, the authors find that this clashes with a dominant private sector-led narrative in the international development community.

Alternative Mining Indaba 2018
Economic Justice Network et al.,: Alternative Mining Indaba, Cape Town, February 2018

The Alternative Mining Indaba (AMI) started in 2010 with a small group of approximately 40 participants lead by Faith Based Organisations. It intended to create space for communities living in and around mines affected by and left out of key discussions of extractive industries in Africa. The theme for the 2018 AMI was: “Making Natural Resources Work for the People: Towards Just Legal, Policy and Institutional Reform”. The Thematic issues for discussion included: human rights defenders; the curse of natural resource policies; gender and legal reforms; the independent problem solving mechanism; policies and laws that facilitate the benefit sharing for local people and faith and the extractives sector. The meeting gathered representatives of over 400 members of faith-based organisations, civil society organisations, community-based organisations, pan-African networks and organisations, labour movements, women movements, human rights activists, media, students from African countries and international partners on February 5 – 7, 2018 in Cape Town. The AMI site provides presentations and proceedings from the indaba.

Foresight Africa: Top priorities for the continent in 2018
Kagame P; Coulibaly B; Signé L; et al: Brookings, January 2018

The Foresight Africa, African Growth Initiative invited scholars and experts to delve into six overarching themes that highlight areas in which African countries and their citizens are taking the lead to achieve inclusive growth. In a world where China and other emerging economies are ascendant, where cooperation on global governance is under challenge, and where free trade faces headwinds, Africa is argued to need its own institutions to play a more assertive role in advancing the continent’s agenda. The report emphasizes that Africa’s future lies in its own hands and that it already has the power to reach its goals. The authors describe, and argue for, new and innovative instruments to better mobilize and leverage resources for development financing. They authors explore and offer recommendations on policy interventions to broaden the benefits of future economic growth. Further chapters explore technological innovations and their potential to transform the continent. The final chapter explores a shifting global landscape of diplomacy – what will the impact of reduced engagement from the United States be? How do development, defence, and diplomacy best fit into foreign policies toward the continent?

Monitoring SO2 emission trends and residents’ perceived health risks from PGM smelting at Selous Metallurgical Complex in Zimbabwe
Gwimbi P: International Journal for Equity in Health 16(1) doi: , 2017

This paper examined sulphur dioxide (SO2) emission trends, emission regulations and residents’ perceived health risks from exposures to such emissions at Selous Metallurgical Complex platinum group metal smelting facility in Zimbabwe. SO2 data from roof monitoring sites at the smelter furnace were aggregated into annual, quarterly and monthly emission trends from 2008 to 2015. The regulatory regime’s ability to protect human health from SO2 pollution in communities located around the smelter was examined. Questionnaire responses to perceived health risks from SO2 exposure from 40 purposively sampled residents were assessed. Between 2008 and 2015, annual SO2emissions increased from 7951 to 2500 tonnes. Emissions exceeded the recommended standard limit of 50 mg/Nm3, presenting considerable adverse health risks to local residents. Concerns relating to inefficient environmental impact assessment licensing system, poor monitoring and auditing by the environmental management agency, as well as non-deterring SO2emission exceedance penalties were identified as major drivers of emission increase. Thirty-two of the forty respondents perceived exposure to SO2 emissions as adverse and the cause of their illnesses, with coughing, nasal congestion and shortness of breath the most frequently self-reported symptoms. A set of legally-binding SO2 emission standards supported by stringent environmental impact assessment licensing arrangements for smelting industries are suggested for development and enforcement to reduce the SO2 emission problem. Community participation in SO2 emissions monitoring was also proposed as a core part of sustainable environmental management in communities located around smelters.

New evidence of Africa’s systematic looting, provided by an increasingly schizophrenic World Bank
Bond P: Pambazuka News, February 2018

A recent World Bank report, The Changing Wealth of Nations 2018, offers evidence of how much poorer Africa is becoming thanks to rampant minerals, oil and gas extraction. Yet the author notes that World Bank policies and practices remain oriented to enforcing foreign loan repayments and transnational corporate profit repatriation. Central to its “natural capital accounting,” the Bank uses an “Adjusted Net Savings” (ANS) measure for changes in economic, ecological and educational wealth. The Bank asks, “How does sub-Saharan Africa compare to other regions? Not favourably.” The ANS decline for sub-Saharan Africa was worst from 2001-09 and 2013-15. The author observes that there are two ways to address transnational corporate (TNC) capture of African wealth: bottom-up through direct action blocking extraction, or top-down through reforms. He critiques the latter, such as in the African Union’s 2009 Alternative Mining Vision (AMV) position that foreign resource investors with capital, skills and expertise are critical to development, which ignores these evident trends on the continent.

Honest Accounts 2017: How the world profits from Africa’s wealth
Curtis M; Jones T: Curtis Research, Jubilee Debt Campaign and others, 2017

This report presents the movement of all the main financial resources into and out of Africa, mainly using 2012 figures. It found that $134 billion entered the continent in 2017, mainly in the form of loans, foreign investment and aid. However, some $192 billion was taken out, mainly in profits made by foreign companies, tax dodging and the costs of adapting to climate change. Africa was found to suffer a net deficit of $58 billion a year. This is reported to have has led to reductions in government holdings of international reserves and lower (but still significant) multinational company profits taken out of the continent. They report that there are now more loans to African governments, another in inflow, although this comes at the cost of future debt payments and possibly debt crises.