Health equity in economic and trade policies

Climate costs South Africa 10% of its GDP
Kings S: Mail and Guardian, South Africa, April 2019

Research suggests that poor countries in the south would have 24% larger economies if it wasn’t for global warming. This is because the world is 1°C hotter than it was a century ago. That warming means crops fail, economic productivity goes down and people get sick or die because of the heat. South Africa is argued to be between 10% and 20% poorer than it would have been without that warming in the last six decades. Nigeria is 29% poorer and India is 30% poorer. The research, titled “Global warming has increased global inequality' reports that rich countries have benefited from this warming. By calculating temperature and economic growth between 1961 and 2010, the researchers found that already rich countries, mostly in colder climates, have growth spurts during an unusually hot year. This is because hotter weather moves them closer to what is known as the “empirical optimum” — the closer a country’s average temperature is to 13°C, the more its economy thrives. South Africa’s average is around 17°C and is only increasing with global warming. The researchers concluded that global warming has meant countries are also more unequal. Richer people can insulate themselves from extreme events — by buying food when the price goes up or by being able to claim from insurance — and keep functioning. Those with few resources to start with do not have such a buffer. This local and global inequality in the impact of global warming is the topic of fierce international negotiation. While China and India are massively growing their emissions, the authors note that they still represent a fraction of total emissions in the last two centuries, with China has emitted half of what the United States has and India a seventh.

'You often get sick': the deadly toll of illegal gold mining in South Africa
Clark C: The Guardian, April 2019

According to a 2015 report by the South African Human Rights Commission, South Africa’s burgeoning illicit gold trade has been fuelled by the formal mining industry’s decline combined with the failure of government to regulate the informal mining sector. The report estimated 30,000 illegal miners were operating across South Africa; about 75% are believed to be undocumented migrants, primarily from Zimbabwe, Mozambique and Lesotho. The authors indicate that hundreds have died due to collapsing mine shafts, gas explosions and turf wars between the criminal syndicates that have seized control of the illegal industry. On Johannesburg’s outskirts, cut off from support networks and services, women are bearing the brunt of the violence and lawlessness associated with illicit mining. With the vast majority of people in the area living off the proceeds of illicit mining, fear of arrest or deportation prevents many women from going to the police or seeking help at overstretched local medical clinics.

Commercial determinants of health: advertising of alcohol and unhealthy foods during sporting events
Ireland R; Bunn C; Reith G; Philpott M; et al: Bulletin of the World Health Organisation 97(4), 290-295, 2019

Tobacco, alcohol and foods that are high in fat, salt and sugar generate much of the global burden of noncommunicable diseases. A better understanding is needed of how these products are promoted. The promotion of tobacco products through sporting events has largely disappeared over the last two decades, but advertising and sponsorship continues by companies selling alcohol, unhealthy food and sugar-sweetened beverage. The sponsorship of sporting events such as the Olympic Games, the men’s FIFA World Cup and the men’s European Football Championships in 2016, has received some attention in recent years in the public health literature, as have global football events with which transnational companies are keen to be associated, to promote their brands to international markets. Despite this the marketing and sponsorship portfolio of these events have received very little scrutiny from public health advocates. The authors call for policy-makers and the public health community to formulate an approach to the sponsorship of sporting events, one that accounts for public health concerns.

Local solutions can boost healthier food choices in South Africa
Ndlovu N: The Conversation, March 2019

In this article, Ndlovu asks, how should countries like South Africa go about making sure that people – particularly poor people where the burden of non-communicable diseases is highest – have access to healthy food? Recent research from the Wits School of Public Health, the Health Systems Trust and the University of KwaZulu-Natal sheds fresh light on the problem, showing a proliferation of unhealthy food, particularly in poorer communities. The research set out to assess differences in food environment based on socio-economic status. It focused on grocery stores and fast-food restaurants only, with full service restaurants excluded. The analysis used a tool called the “modified retail food environment index” and show the proportion of food retailers in Gauteng that were “healthy” and what proportion were “unhealthy”. The results showed how fast-food outlets and the unhealthy foods they serve, vastly outnumbered formal grocery stores. In November 2016, there were 1559 unhealthy food outlets in Gauteng compared to only 709 healthy food outlets. Strikingly, the distribution of these outlets are income-based. Most of the poorer wards had only fast-food retailers with no healthy food outlets. Conversely, grocery stores are concentrated in wealthy areas. The research shows that many wards in Gauteng have high concentrations of unhealthy food – in other words, they have “obesogenic” food environments. This means the type of food available in this environment promote obesity, leaving their residents little choice. Local as well as national government structures have the authority to license and control food retailers. Alternatively, national level policies can better guide implementation at a local level. This would require governments to adapt existing business licensing and planning frameworks to take into account the lack of healthy food retailers in a particular area. Additionally, municipalities could streamline the process for licensing healthy food retailers, making it easier and faster for them to open in areas most in need. The authors indicate that there is a plethora of options to select from if municipalities want to improve their food environments and can facilitate the right to access to healthy foods for the poorest and most vulnerable.

The health impacts of extractive industry transnational corporations: a study of Rio Tinto in Australia and Southern Africa
Anaf J; Baum F; Fisher M; London L: Globalization and Health 15(13) 1-20, 2019

This research on extractive industries examined Rio Tinto in Australia and Southern Africa to test methods for assessing the health impacts of corporates in high and middle income jurisdictions with different regulatory frameworks. The authors adapted existing Health Impact Assessment methods. Data identifying potential impacts were sourced through media analysis, document analysis, company literature and semi-structured interviews. The data were mapped against a corporate health impact assessment framework which included Rio Tinto’s political and business practices, productions and workforce, social, environmental and economic conditions. Both positive and detrimental aspects of Rio Tinto’s operations were identified. Positive impacts include provision of direct employment under decent working conditions, but countered by an increase in precariousness of employment. Commitments to upholding sustainable development principles are undermined by limited site remediation and other environmental impacts. Positive contributions are made to national and local economies but then undermined by business strategies that include tax minimisation. This study confirmed that it is possible to undertake a corporate health impact assessment on an extractive industry transnational corporation. The different methods provided sufficient information to understand the need to strengthen regulations that are conducive to health; the opportunity for Rio Tinto to extend corporate responsibility initiatives and support their social licence to operate; and for civil society actors to inform their advocacy towards improving health and equity outcomes from transnational corporations operations.

Reflections of an Engaged Economist: An Interview with Thandika Mkandawire
Meagher K: Development and Change 0(0), doi:, 2019

This article reports an interview with Professor Thandika Mkandawire, a leading development economist of Malawian origin specializing in the comparative study of Africa. The interview explores how growing up under colonialism in Zimbabwe meant that huge decisions were being made that had profound effect on one's life, that he saw in the experience of his father as a unionised worker on a mine and a tailor at home. He recounts the conversations on politics and working conditions on the mines that took place while people waited for their garments, as people tried to make sense of policies they had no contribution to. As a school student in Malawi doing is 'O levels' at a time of anti-colonial struggles, he was involved in demonstrations that exposed the brutality of the police. After school and working on a weekly paper his experience of being arrested exposed the facade of rule of law in a trial that he called a farce. His study of economics was initially to be a better journalist. Studying in Latin America he saw the hostility of Latin Americans to the USA as a 'more naked' form of the 'new imperialist order'. The interview traces him to his life in exile from Malawi, living in Sweden, where the thinking of Amartya Sen and others exposed the deeply social and political nature of economics, while the writing of African nationalists exposed the tension between class and nation as the overriding concern, a debate he posits as continuing until today. Living in Sweden at that time provided an experience of a democratic state that could "tame the structural power of capital", reinforcing but also moderating his "leftist inclinations". The interview continues to track how his life experiences and work at institutions such as CODESRIA and UNRISD influenced his thinking on developmental states, his views on strategic responses to the structural adjustment programmes in Africa, of the role of intelligent, capable and democratic states as the only viable instrument for development, and of social investment as a developmental tool. The interview explores his views on the implications for the current African political economy and for African scholarship.

The Global Commission on the Future of Work calls for fundamental changes in health at work
Osseiran N: World Health Organisation, Geneva, Switzerland, 2019

The ILO Global Commission on the Future of Work called for fundamental changes in the way people work in the wave of globalisation, rapid technological development, demographic transition and climate change, according to its report Work for a Brighter Future published in January 2019. The report examines how to achieve a better future of work for all at a time of un­precedented change and exceptional challenges in the world of work. These changes require placing health higher on the agenda of the world of work. Everybody has the right to health, which is defined by WHO as a state of complete physical and mental wellbeing and not only the absence of disease and infirmity. Working people have the right to health and to health care as close as possible to where they live and work. In 2018, WHO and ILO established a global coalition on occupational safety and health as multi-partner initiative of international and national agencies to create common solutions for the challenges for health and safety at work and to stimulate joint actions by health and labour sectors in countries. WHO welcomed the attention given by the Global Commission on the care economy and healthcare is a major part of it. WHO is also working with ILO and OECD to implement a five-year ‘Working for Health’ global action plan to create new and decent job opportunities in health care, to ensure the necessary workforce for universal health coverage and at the same time for stimulating economic growth.

Courts deliver big wins for environment
Sipho Kings: SangoNet Pulse, 2018

South Africa’s environment law has a strange loophole. In theory, every activity that would harm the environment falls under the National Environmental Management Act (Nema) and the Acts linked to it. This allows the government to uphold everyone’s constitutionally guaranteed right to a healthy environment. Nema is what should give the environment department teeth. But mining is exempt because of a 2014 takeover by the mineral resources department of most environmental oversight for mining. Now, far-reaching court decisions are pulling apart the way in which the mining department discharges its job of looking after the environment, and questioning how positive a development this has been. In a stinging rebuke last week, the high court ruled in defence of a wetland in Mpumalanga. This has created a precedent that rights groups say they will use to challenge other cases when mines threaten the environment. This decision follows a judgment earlier this month by the Constitutional Court in a case between residents of villages that fall under the Bakgatla Ba Kgafela tribal administration, near Rustenberg in the North West, and a would-be mining company. Read together, the environmental and land rights judgments are argued by the author to be a serious blow to the carte blanche attitude of the minerals department and its mandate to expand mining. Mining companies will now have to consult all residents. The minerals department will also have to do more than tick boxes based on information given by mines when it comes to looking after the environment.

Trade, investment and public health: compiling the evidence, assembling the arguments
Labonté B: Globalisation and Health 15(1), doi:, 2019

Trade has long been an axiomatic characteristic of globalization, although international rules governing trade are of more recent vintage. In the post-World War II period, an increasing number of countries began negotiating treaties to reduce, first, tariff barriers and, later, non-tariff barriers (government measures of any sort) that could impede the cross-border flow of goods. The rationale, in part, was that countries that became more entwined economically would be less likely to go to war with each other. It wouldn’t be in their own economic interests to do so, or at least that of the firms based within their borders but engaged in transnational trade and dependent upon global supply chains. At first primarily an undertaking in high-income countries, low and middle-income countries slowly enjoined in what, in 1995, became the World Trade Organization. The WTO locked in scheduled declines in tariffs (border taxes), albeit with lesser obligations on low income country members. Importantly, a slew of new agreements that coincided with the establishment of the WTO also sought to liberalize trade in services and not just goods in the General Agreement on Trade in Services, with new rules for agricultural trade, expanded intellectual property rights protections and other agreements ensuring that government food, health, or environmental regulations would not pose an unnecessary barrier to trade. Outside of the WTO system, bilateral or regional investment treaties grant special rights to foreign investors to sue governments for actions perceived to affect the value of their investment similarly exploded in number, dispute frequency, and the size of monetary claims. The breadth and depth of these post-1995 Agreements meant that few areas of general public health concern are potentially untouched. Given mounting evidence that trade and investment liberalization was creating and globally diffusing new health risks, public health researchers began focusing on the specific measures in trade and investment treaties that created such risks, primarily but not exclusively through constraining the ‘policy space’ for new public health regulations. Globalization processes affect health through multiple pathways and not simply through those more directly linked via changes in health systems. This issue explores the methods and issues that this poses for research on globalisation and health.

Transforming the workplace environment to prevent non-communicable chronic diseases: participatory action research in a South African power plant
Schouw D, Mash R, Kolbe-Alexander T: Global Health Action, 11:1, DOI: 10.1080/16549716.2018.1544336, 2018

The workplace is an important setting for the prevention of non-communicable diseases (NCDs). Policies for transformation of the workplace environment for occupational health and safety in South Africa have focused more on what to do and less on how to do it. There are no guidelines and little evidence on workplace-based interventions for NCDs. This study aimed to learn how to transform the workplace environment in order to prevent and control cardio-metabolic risk factors for NCDs amongst the workforce at a commercial power plant in Cape Town, South Africa. The study used participatory action research in the format of a cooperative inquiry group (CIG). The researcher and participants engaged in a cyclical process of planning, action, observation and reflection over a two-year period. The group used outcome mapping to define the vision, mission, boundary partners, outcomes and strategies required. At the end of the inquiry the CIG reached a consensus on their key learning. Substantial change was observed in the boundary partners: catering services (78% of progress markers achieved), sport and physical activities (75%), health and wellness services (66%) and managerial support (65%). Highlights from a 10-point consensus on key learning included the need for: authentic leadership; diverse composition and functioning of the CIG; value of outcome mapping; importance of managerial engagement in personal and organizational change; and making healthy lifestyle an easy choice. Transformation included a multifaceted approach and an engagement with the organization as a living system.