Globalization and its Negative Consequences
The peculiar current form of Capitalism rechristened as 'free market economics' goes
by the motto of "trade, not aid", no matter how uneven the former may be, and despite
the fact that equal relations between unequals simply reinforce inequality. In line
with the above, Globalization – Capitalism's corresponding new flagship – is creating
wealth for the few and depressing local wages and conditions of employment for the
many. It has also brought about a shift in power: the nation state has weakened and
has markedly reduced its social accountability. In the Globalization context, the
privatization called-for often ends up meaning denationalization and an acceleration
of poverty, of disparities, of exclusion, of unemployment, of alienation, of environmental
degradation, of exploitation, of corruption and often brings about violence and conflict.
All these add up to marginalization on a massive scale. The effects of Globalization
are thus producing big winners and losers. [2-4]
Further, Globalization limits the ability of union workers to bargain, as well as
making it more difficult for governments to implement equitable policies. Governments
that need to adopt proven pro-poor strategies are simply not doing so. [4,5] As a
result, sovereign states now 'row' rather than 'steer' in the process of development.
Ergo, the very right to development of poor countries is threatened by Globalization.
[2,6] The 'corporocracy' in command of the flagship consistently ignores the social
problems they see as patently as everyone else; they rather only pay lip service to
change and seldom change their acquisitive practices (or only change them in very
marginal ways). [7] And what is more worrisome, in the dealings of Globalization,
the deceptions are so brilliantly woven into its processes that falling for those
deceptions is deemed as both fashionable and progressive. [3,8]
Because of these negative consequences of Globalization, communities in many Third
World countries are no longer able to cope – their previously successful coping strategies
diminishing daily. [9] Moreover, because of Globalization, governments in the Third
World are simply incapable of assuming minimum levels of welfare for their citizen.
It is then implied that it is necessary to look for alternatives in the private sector
or to directly privatize services. Often such privatization strategies lower the access
and quality of services for the poor and end up widening the gap between the rich
and poor.
A quick review of the hard facts documenting the negative effects of Globalization
shows that:
-Under Globalization, the annual losses to developing countries run at an estimated
$500 billion – an amount much higher than what they receive in foreign aid.
-As a consequence, developing countries have had a series of years of consecutive
negative financial flows; this is equivalent to at least seven years of an economic
hemorrhage.
-From 1960–99, there was a 60% fall in the prices of commodities other than oil! This
resulted in a reduction of two thirds in the buying power of developing countries.
[10]
-As a result, the number of hungry people around the world keeps rising every year
and poverty is becoming increasingly feminized (70% of all the poor are women). 'Free
trade has been free for business and industry, but not for women and the poor'. New
technologies have not shown to have intrinsic pro-poor or pro-women positive effects
either, although they have such a potential (which unless we help steer in that direction
will invariably continue favoring the already wealthy and male). Therefore, any genuinely
poverty-redressing policy is bound to be a gender-oriented policy.
Our Need to Change
Our work in development is about change. And change brings conflict, pain, confusion.
Only out of this emerges a new understanding. For us, this means we have to start
deconstructing the whole existing development delusion which has led us to the unwarranted
situation in which people have come to accept scarcity and poverty as inextricable
facts of life. But the universe does not have unmovable laws that lead to poverty!
It has habits – and habits can be broken. [11-13] The greatest risk for us in this
is to be deluded into thinking that palliative approaches and socioeconomic tinkering
can bring about the long term stability needed for sustainable economic take-off.
If poverty is a function of powerlessness, how can extreme poverty at the base of
so much of the ill-health and malnutrition we find around the world be reversed? Whatever
the response, one thing is clear: One does not have to wait until big changes are
in place; otherwise, the process would never start. The poor can begin to empower
themselves even while their respective governments are still saying 'no' to political
changes...and this is where we can play a catalyst role. Existing grassroots organized
groups we come across in our work do matter: their voices matter, especially if their
raised voices lead them to influence key events. Unions matter; self-help projects
matter, women's and youth organizations matter. When they speak out, they do have
the legitimacy to do so. Working with and through them increases our legitimacy and
their power.
Real empowerment requires understanding the larger social forces that shape individual
situations to then learn how to join with others in taking, not individual, but collective
responsibility and action for reshaping situations of oppression and exploitation.
What is most people-empowering is a shared vision of collective responsibility, i.e.
that only by working together on an intolerable social reality can individual lives
ultimately be improved. The role of progressive forces is to help develop such a rational
understanding of the underlying forces at play. Only if we speak the truth will people
have grounds to trust us. But, in all honesty, we have simply been too narrow in the
focus of our own thinking when interacting with communities and their leaders and
have failed to address the foundations of the problems of underdevelopment we posit
to be addressing. It is high time for us to repair the damage inflicted by our Western-biased
social order and by our lack of outspokenness about that order not having laid the
foundations for a sustainable development. To do so now, calls for a serious rethinking
on our part of the fundamentals of what we do and how this contributes (or not) to
sustainable development. [14]
Let us not forget that we are more irrational than rational; our emotions control
us more than our 'ratio'. Therefore, appealing to reason only is inefficient: To fully
empower people, we have to appeal to their reason and to their emotions. Society is
said to evolve as a (bloody) pendulum: a conservative cycle/a liberal cycle; always
taking a toll of death. As long as we are trapped in these cycles and do not actively
try to break their passive succession, we cannot expect much in the way of liberation.
[13]
A Dearth of Workable Solutions?
Redressing Poverty Through Empowerment
The battle against poverty, ill-health and malnutrition calls for liberation, empowerment,
self-reliance and partnership instead of heeding calls for integrity, operational
effectiveness and administrative accountability – the latter three being an often
touted Northern recipe for development success. To combat the ongoing process of immiseration,
in part brought about by Globalization, welfare states choose to transfer payments
and handouts. But what is needed is a transfer of assets and power (for example, few
of us get involved in lobbying for more deliberate direct measures related to greater
fairness in the tax system). And for this to happen, the poor will have to fight for
it by themselves (!). The welfare ethics does not provide for this transfer. Moreover,
in real welfare terms, numbers matter more than percentages or rates (!). The analysis
of poverty should thus, by necessity, focus on numbers, not on rates – but not to
make this analysis into a 'numbers game' as is too often being done by academicians,
bureaucrats and politicians. [15]
Because we normally look at the effects of underdevelopment on just two broad income
groups – the poor and the non-poor – a more operationally relevant poverty line needs
to be defined, not as a mere cut-off point, but specifically to set measurable Poverty-Redressal
Objectives over time. Here is a point where we can concretely contribute by helping
define a Critical Consumption Level that will sustain at least good health and nutrition.
Such an indicator needs then to be expressed as a fraction of the per capita income.
Persons below this Critical Consumption Level will be potentially eligible for consumption
subsidies, and persons above this line, potentially eligible for higher, progressive
taxes. Such poverty redressal measures can still promote economic growth and need
not be administered as welfare measures. [16]
As part of this new focus, Northern non-governmental organizations (NGOs) should more
decisively support local efforts to address these larger structural issues in an open
way letting people's movements, not elites, define the partners they want to work
with and the causes they want to actively tackle. [17] In such an effort, multiple
social objectives have to be taken into account: true. But distributional concerns
must take center stage. It is up to us to bring these concerns more into the heart
of what we stand for and what we do. The alleviation of poverty through empowerment
must be kept at the center of what we do professionally – beyond mere lip service
(the latter a place where it mostly still is). [16] In our example, current changing
circumstances require that we more-than-think about new approaches to the role health
and nutrition should play in fostering a sustainable development. At this juncture,
then, we need people who can rescue themselves from their own modest objectives; we
need development thinkers and doers of consequence. [13,18,19]
Reversing the Negative Effects of Globalization
With Globalization, the slogan "Might is Right" has come back with a vengeance. And
in a defeatist stance, we have so far accepted this fact and have bowed to the forces
we think we cannot effectively oppose. But while not denying that the giant tentacles
of Globalization reach into every corner of the world, this should not be equated
with omnipotence. (President Mahatir Mohamad, Kuala Lumpur, 9/2/1998) The bottom line
here is that there is no single universal solution in sight that will promote just
the benefits of Globalization to all people: giving the same advice to everyone simply
has not and will not work. Unfortunately, a balanced and realistic value-free response
to the negative effects of Globalization is difficult. [20] On the one hand, the transnational
corporations cannot be allowed to continue to hide, invest in smoke screens, espouse
gradualist solutions and attempt to derive maximum publicity from piecemeal changes.
They must be persuaded, cajoled or even forced to change (some initial success has
been had in facing transnational pharmaceutical houses). On the other hand, new insights
are emerging as to the appropriate mix of market and government activities needed
to complement each other. [9] The extraordinary and more equitable growth of Vietnam
and China contradicts the view that a state control of the economy and the market
is inimical to growth.
The Equity/equality Approach
As we had said already, equal relations between unequals reinforces inequality. Period!
[6] To illustrate this, think for a while that equity under Globalization is a bit
like the fight of the Mongoose and the Snake: Both are of about the same strength,
but invariably the mongoose wins – it is more resourceful and it organizes its strategy
better to strike. The First World is like the mongoose; the Third World is like the
snake.
The lesson of this fable is that an asymmetry in the use of market power aggravates
inequality. The affluent always end up having more political clout (and more wealth).
Therefore, promoting self-interest (the soul of the market) is simply not enough.
(Quoted from R Ricupero, UNCTAD)
To achieve greater equity, a set of "equity modifiers" have been proposed. These include:
-targeting interventions (geographically and/or to vulnerable groups or individuals),
-land reform,
-pro-poor educational/water and sanitation/health/nutrition and family planning interventions,
-employment generation,
-grassroots participation in the setting of priorities,
-development of the non-farm rural economy,
-aid to rural women, and the
-levying of taxes on environmental polluters and degraders. [2]
As pertains to gender, gender equality is (finally) considered compatible with the
basic tenets of the neo-liberal credo. But economic equality, not! (Quoted from S
Maxwell, IDS, Univ. of Sussex)
Some of the remedies proposed to specifically increase equity and access to basic
services have thus included:
-the targeting of subsidies (i.e. selective subsidies of goods and services disproportionately
consumed by the poor),
-prepayment plans (e.g. community-based health insurance),
-exemptions and the selective dropping of some fees (e.g. health and education fees).
-an emphasis on prevention and on improvements of the quality of care (in health),
as well as on
-a fairer urban/rural distribution of resources.
In health, some consensus exists that government expenditures have to increase, but
to be equitable, they have to be concentrated on preventive activities in rural areas
and should be targeted to the lower income quintile. [5]
[Note that Social Marketing – one of the sweetheart companions of Globalization attempting
to give it a human (equitable) face – focuses on high-powered "Madison Avenue-type"
messages and communication strategies that pursue behavior modification and not informed
choices. It is quite obvious that we should rather be trying to understand better
what motivates people to change and why, and then letting them decide by themselves
what steps to take to get there].
The bottom line here is: We need not apologize to act with a more resolute equity
bias beyond lip service since such a bias is an important corrective to the other
more dominant inequitable value biases out there in the heartless market place. Valid
arguments have been raised against the targeting of interventions though. The example
of health and nutrition is again used here to explain why.
Equity and Targeting in Health and Nutrition
The best way to improve the health and nutrition of the poor still is to have them
move out of poverty. For equity to be achieved, economic growth in the development
process needs to be deliberately geared towards the needs of the poor. Focusing on
sustainable poverty alleviation is inseparable from bringing about greater equity.
A focus on both tasks is necessary to achieve the indispensable reduction in the existing
rich-poor gap. Focusing on poverty alleviation alone can end up as charity in disguise.
Focusing on equity is a step towards social justice. Equity and social justice in
health and nutrition are one and the same thing: in health and nutrition, social inequities
are always unfair.
Greater equity will only be achieved by raising the disposable income of the least
privileged 20% of the population at a faster pace than that of the upper income quintile.
And this will only happen through the combination of more income redistribution measures
and government funds being deliberately directed to achieve this goal. The absence
thus far of a serious and concerted fight for greater equity in health and nutrition
is not a historical accident. It has suited the pro-status-quo Establishment. In the
process, it has convinced all health and nutrition professionals to keep trying ever
new technical fixes to the many problems experienced by the poor. [Note that not until
the late 1970s did WHO recognize poverty as a distinct determinant of disease; until
then, they still talked about "tropical diseases" being the major killers).
Acknowledging the importance of equity is simply not enough; it is like a new toy:
"batteries not included". Well thought out, concerted effective actions is what is
needed. There is a dearth of basic information so far that shows convincing epidemiological
morbi-mortality differences by income quintiles. There is an element of selective
blindness here that hardly justifies having been kept in the dark (or having chosen
to stay in the dark). This is part of the so-called 'exclusion fallacy' in which what
we choose not to discuss is assumed to have no bearing on the issue. This dearth of
epidemiological data on rich-poor health differences is actually not a surprise or
a coincidence either; rather, we have to accept it as a deliberate omission. Furthermore,
making such equity-relevant data available is no solution in and by itself either;
it is a necessary, but not sufficient step in a process. What is important is what
we commit ourselves to do with those data, how we use them proactively to correct
inequities, starting when. [Note that (growth) stunting of under three year olds may
actually be a quite excellent indicator of poverty, inequity and of violations of
the rights of children. Therefore, many of us are echoing the growing calls for using
stunting trends as one of the good indicators of trends in overall equity in society].
So now – with discussions on poverty and equity gaining momentum – there seems to
be a new opportunity. Powerful alternative approaches are being brought to the fore
that can be put in place to start making a difference on equity. Differences in perspectives
are still significant, no doubt, both on conceptual and practical matters. Most of
these differences are ideological. They are, therefore, not easy to overcome. A more
suitable paradigm for sustainable improvements is called for. Unfortunately, the renewed
interest in poverty alleviation and equity in our international community still is
top-down; it ignores the contributions the poor themselves need to make to the debate.
One can see here a set-up for yet another failure.
Equity and health for all
The claim that Health for All is not attainable in the era of Globalization is a value
judgement, as is the lack of confidence in the public sector approach to primary heath
care (PHC). It all depends on how decisively and quick a shift to greater control
by the beneficiaries occurs at the grassroots. The core question here is what type
of PHC we should support more aggressively now. Going back to Alma Ata is a good start.
Then, decisively fixing PHC's well-known deficiencies (mostly the non-technical ones)
can be the basis to get going – the sooner the better. We need to make PHC what it
should have been from the outset, namely, a public sector driven vehicle fostering
true equity in health. Privatization is simply never going to lead us to such a path.
Who are the poor and how do we find them?
We (professionals) have to move away from defining who the poor population groups
are. Especially inappropriate are arbitrary absolute poverty income cut-off points.
Communities themselves are the best qualified to identify the poor amongst them in
each locality. International agencies ought to insist on it.
Equity and the public/private allocation of resources
Concrete actions to allocate government funds according to real needs are necessary.
Most central government budgets do not compensate for inequities.
Current government health services expenditures tend, in many countries and in many
different ways, to benefit the rich more than the poor. Private for-profit health
care discriminates against the poor and often is of poorer quality than government
services although, not infrequently, it receives unwarranted government subsidies.
Avenues and dead-end streets to equity
Other than privatization, many currently proposed approaches to resolve the problems
of health and nutrition still only favor and select actions covering, for the most
part, four strategies:
-targeting of services (the No. 1 choice),
-participatory approaches (a distant second),
-social health insurance schemes, and
-expansion of social security schemes linked to health/nutrition benefits. [21]
These strategic approaches – purportedly leading to equity – depart from one question:
If not PHC, then what?
Rather, we repeat that what is needed is to mobilize a strong political popular support
for a comprehensive truly equity-oriented health and nutrition policy, using an improved
PHC approach that, at its core, resurrects the Alma Ata spirit.
Equity and Targetry
Many of us also think it is a fallacy to propose targeting as an alternative to PHC.
In a way, individual targeting is a new variant of a selective PHC approach: "Go for
the worst cases, fix them, and improve the statistics". But where are the sustainable
changes to avoid the ongoing recurrence of the same problems being addressed? Unfortunately,
individual targeting is seen as central among the alternatives being proposed by the
World Bank and other major funding agencies (together with geographical and other
types of targeting). In an era of fee for services, service delivery systems promoted
by free-market proponents, one of the key issues for individual targeting to keep
a semblance of equity seems to be the exemption from user fees for the poor. Unfortunately,
these waiver schemes have proven to be mostly catastrophes.
Individual targeting can simply not be made to work equitably and effectively. Targeting
cannot be a full substitute for redistributive public policy! Moreover, targeting
can and does stigmatize people by creating a clientele of 'second-class citizens'
who can be easily manipulated by those in power. [22] Geographical targeting has probably
more potential; it can make sense in terms of equity. But keep in mind that poor areas
or districts have little political clout to fight for their share and are also usually
administratively weak to implement the needed changes. Starting with targeting interventions
as the central thrust to achieve equity (no matter how carefully designed) thus seems
the wrong approach. It pursues what rather is a 'mirage of equity' that basically
leaves the perennial determinants of the rich-poor gap untouched. It tacitly blames
the most vulnerable for being where they are and then tends them a rescuing hand.
Local communities are not on the driver's seat when it comes to steer targeted (or
other) project activities.
Furthermore, one can genuinely be skeptical when one sees calls for participatory
approaches in projects that have not taken the poverty reduction and the promotion
of greater equity as their central thrust. Most often, communities are not being empowered
to implement measures that directly aim at having them gain growing control over the
assets and resources they need to improve their own lives.
The Human Rights Approach
A human rights framework is the emerging UN response to foster development in the
new millennium. Globalization may be inevitable, but what it does to people is not
– there are forces that can shape it, and human rights must be one of those forces.
As someone said, human rights can set limits to the sways of the market. [23,24] Human
Rights are universal and indivisible: they do not apply some yes and some no, some
today and some tomorrow, some to us and some to them, some to the Western countries
and some to the other countries, some to the rich and some to the poor, some to women
and some to men. We are therefore compelled to operationalize civil, political, economic,
social and cultural rights in our daily work.
We have to be on the lookout, though. One can easily 'preach human rights' and have
little concrete to offer. To make the human rights approach concrete and giving it
substance is a political task. Soft approaches will not do. [25] Western intellectuals
have simply abandoned their commitment to challenge the exploitation and oppression
of the poor as they continue being brought about by Globalization. Concerted campaigns
and struggles against poverty, tyranny any exploitation will form the only sustainable
basis of an intellectual renaissance of ourselves. On human rights, a first step in
the right direction, in an initial phase, will be the establishment of National Human
Rights Committees. But bolder steps will have to follow thereafter.
Furthermore, we have to fight the indifference of our youth to the present human rights
situation. Our young remain largely indifferent to the negative effects of Globalization.
We simply have to enroll the youth before they resign themselves to the fact that
they can do little or nothing. Our youth seems more interested in the information
superhighway. We have thus to use the same medium to give them more appropriate direction
and guidance on options to counter Globalization and more aggressively foster human
rights. [26] In sum, an effective challenge against Globalization and its negative
effects on human rights is possible, but probably demands the same kind of intellectual
commitment and vigor that characterized anti-colonial or independence struggles.
Bolder Steps are Needed
The obvious ensuing set of questions to be asked at this point is:
a) Is this more resolute equity bias a radical proposition? Yes, it is.
b) Is it necessary? Absolutely.
c) Is it impossible? No, it is possible.
d) Is it likely? Not very likely, based on my latest dispassionate reality check.
The inertia is so great and our collective virtual view of reality so distorted and
entrenched, in part due to Globalization, that the likelihood of us changing that
reality remains dim. Neither greater individual responsibility nor containment strategies
will do.
What, then, are the alternatives to choose from that could start doing the job before
it is too late? [8] Taking a minimalist stand towards Globalization will do no harm,
but neither will it do much good. Inertia in history (has) and will always work(ed)
against the more visionary and radical changes deemed necessary when the same fall
outside the ruling paradigm. [26] Development cooperation must thus become more political,
because only structural reforms will deliver equitable and sustainable development.
Solutions must be geared to control that which fuels the problem at its roots. The
solutions to the consequences of Globalization on the health and nutrition sector,
for example, cannot be medicalized any longer. Technical assistance focused on health/nutrition
matters only is not enough to uproot the structural inequities underlying the pervasive
and unrelenting ill-health and malnutrition we find in the world. We need to give
a larger intellectual and political scope to our discussions on Globalization and
come up with a focused common agenda with overt political interventions. What the
people's movements around the world expect is simply "More", from life, from history
and from us.
When economics has ceased to strengthen social bonds and its prescriptions are actually
further pauperizing millions, it is time to start thinking in political terms again.
Stereotyping Globalization risks to emotionalize the issue rather than objectively
analyzing and diagnosing it. We have to give up our quick prescriptive impulses (saying
what should have been done) and become more empirico-analytical (describing and dialectically
interpreting what is actually happening). [27] One can set morally desirable goals
so high (or set goals without following them with sincere, workable policies) that
they remain out of all realistic reach and lose all power to determine the direction
of action. Keep in mind that rules can be set or imposed more as a source of comfort
than as an effective way to achieve veritable results. [28]
So Where Do We Go from Here?
We should not 'leave it up to the Joneses' again and miss the opportunity the current
momentum offers. The sense of urgency is high. Breaking down health, nutrition, education
and other related data by income quintiles is a welcome first step to consolidate
a credible international database that can be used to track equity issues in each
respective field. Every year, a publication should rank countries according to their
respective equity performance; the publication should further analyze existing gaps,
and targets should be set for individual countries' improvements for the following
year. But actually using these data to tackle the inequities at national, sub-national
and especially the local level is where the real challenge lies. Donor agencies and
civil society will have to more forcefully advocate for equity-promoting, participatory,
bottom-centered interventions, as well as being more responsive to low income countries'
government-initiated requests for funding to prepare and execute policies specifically
addressing the central equity issue.
Governments and donors will have to enter into binding commitments to move in the
direction of poverty alleviation and greater equity including the close monitoring
of progress. These binding commitments will be needed as a precondition for continued
support. Funds would then be released in tranches based on the achievement of negotiated
verifiable indicators of progress along the line of project implementation. A donor-NGO/civil
society link and funding window should be developed concomitantly along the same lines.
In the case of non-responsive or non-performing governments, donor funding earmarked
for use by the latter should be progressively reallocated to the NGO/civil society
sector. Non-performing NGOs should be dropped under the same guise. [See Schuftan.
C., "Foreign aid: Giving conditionalities a good name (A development ethics with a
South perspective)", D+C Development and Cooperation, No.4/1988].
All this may only add up to a start – and from the top at that. But it is a start
in the right direction. The road ahead will, for sure, require our greatest boldness
ever. Let the more creative inputs on ways out of the dead-end street of non-inequity-redressing
schemes come from the more directly affected themselves. Devoting most of our energies
to facilitate just that process, will, by itself, be a big leap forward.
In Closing
These seemingly abstract issues about which we write papers are matters determining
the lives of millions of people. When all is said and done, a lot more is said than
done. The facts discussed here are more than enough to allow us to go negotiate (or
struggle) for new more radical equitable/pro-poor/pro-women/human rights-based strategies
on the highest of moral grounds. [6] Those whose interests we claim to serve expect
it from us.