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Past Orations 2002 – Dr David Legge 1st Annual Eberhard Wenzel Memorial
Oration – Sydney
2003 – Dr Adrian Reynolds 2nd Annual Eberhard Wenzel Memorial Oration – Canberra
2004 – Dr Papaarangi Reid 3rd Annual Eberhard Wenzel Memorial Oration –
Melbourne
2005 – Professor Ron Labonte 4th Annual Eberhard Wenzel Memorial Oration –
Canberra
2006 – Associate Professor Boni Robertson 5th Annual Eberhard Wenzel Memorial
Oration – Alice Springs
2007 - Professor Fran Baum 6th Annual Eberhard Wenzel Memorial Oration –
Adelaide
2005 Eberhard Wenzel Memorial Oration
Presented at the Australian Health Promotion Association’s
15th National Health Promotion Conference Dinner,
15 March 2005
Ronald Labonte
Canada Research Chair, Globalization/Health Equity
Institute of Population Heath, University of Ottawa
It is a privilege to be asked to honour Eberhard’s legacy this evening.
I met Eberhard in 1982, when Hobart hosted the conference for the International
Union for Health Education, as the IUHPE was then known. It was my first of
many trips to Australia. Eberhard and I bonded at once, sharing the same
passions for a better world, for playful theorizing and for the fine wines and
whiskeys that we earnestly believed should be available to all without regard to
race, gender, financial standing or accident of birth. His influence on my own
work was pivotal, and especially the tack it has taken in the past decade.
For after 20 years of working to radicalize first health education and then health
promotion, developing hopefully useful models and approaches for local
empowerment and health advocacy, Eberhard taught me that more was needed.
We were entering a new era where the global could no longer simply be thought
about while we acted only on the local. The global increasingly demanded its
own actions. So it is fitting that I honour him tonight in the country where we first
met, by speaking to what this new passion has so far taught me.
I will do so by invoking an aphorism attributed to Victor Sidel, an American public
health leader:
Statistics are people with the tears washed off.
Or, as a wise Master once said, “The shortest distance between truth and a
human being is often a story.” Eberhard embraced that belief, powerfully
affirmed in the oral traditions of indigenous peoples he so profoundly respected.
And so to cherish Eberhard’s legacy, I begin my oration with four short stories.
In rural China, high school student Zheng Qingming kills himself by jumping in
front of a train. Friends say it was because he couldn’t afford the last $80 of
school tuition fees, which meant he could not take the college admission test and
so educate his way out of rural poverty. The annual school tuition is more than
the average village family in his region earns in a year. Health care, like
education, has become scarce and expensive since China embraced the market
economy, and his grandfather had already spent the entire family savings on
treating a lung disease.
In Zambia, Chileshe waits painfully to die from AIDS. The global funds and
antiretroviral programmes are too little and too late for her. She was infected by
her now dead husband, who once worked in a textile plant along with thousands
of others but lost his job when Zambia opened its borders to cheap, second-hand
clothing. He moved to the city as a street vendor, selling cast-offs or donations
from wealthier countries. He would get drunk and trade money for sex – often
with women whose own husbands were somewhere else working, or dead, and
who themselves desperately needed money for their children. Desperation, she
thought, is what makes this disease move so swiftly; she recalls that a woman
from the former Zaire passing through her village once said that the true meaning
of SIDA, the French acronym for AIDS, was “Salaire Insuffisant Depuis des
Années” – too little money for too many years.
In northern Mexico, a young girl named Antonia is suffering from severe asthma.
She is falling far behind in school. Her parents don’t have enough money to pay
for specialists or medicines, and wonder whether her problems are connected to
the industrial haze and foul-smelling water that come from the nearby factory.
They can’t afford to move. All their savings were used up when corn prices
plunged after the border opened to imports from the US, and it is not clear how
they would make a living. How could so much corn grow so cheaply, her father
Miguel used to wonder.
In a Canadian suburb, two people die when a delivery van swerves into
oncoming traffic and slams into their car. The van driver, Tom, survives. He
either fell asleep at the wheel or suffered a mild heart attack. No one knows, and
he cannot remember. It was his 15th day of work without a rest. When the
assembly plant where he once worked relocated to Mexico, driving the van
became one of his three part-time jobs, at just over minimum wage and with no
benefits. He alternated afternoon shifts at two fast food outlets, did early night
shifts at a gas station and drove the van late nights as often as the company
needed him. With the recession over, they had needed him a lot lately.
These four stories from different parts of the world, at different levels of what we
euphemistically call ‘development,’ illuminate the toxic underbelly of our current
wave of globalization. Modern globalization is not without some health benefits –
the more rapid diffusion of health technologies, a digitally linked if still divided
world engendering a greater sense of global connectedness and obligation. But
the past twenty years have witnessed a marked slowdown in the global health
gains we experienced in the thirty ‘Golden Years’ of progressive welfare reforms
and de-colonization following the end of World War Two. Global inequalities in
income also declined over the same Golden Years period, but are now rising
rapidly. So, too, are health inequalities. There is convergence in health status,
but it is occurring around two distinct global poles. Most of us in wealthy
countries can expect to live to 80; those in poor countries will frequently be dead
before 45.
This about-face in global health equity has many causes, but there is one that
trumps all others: The triumphal dominance of market neo-liberalism, and its
gospel of privatization, de-regulation, open borders and state minimalism. The
champions of this elite religion argue that these policies are necessary to create
economic growth. Such growth is invariably good (despite the environmental
damage it causes) because it creates wealth. Wealth reduces poverty, provides
money for investing in health and education, and makes people environmentally
more conscious (presumably so they can begin rectifying the ecological damage
required to create this consciousness). Healthier, smarter people lead to more
economic growth and the rising tide lifts all boats, even if most of the world’s
boats remain leaky dinghies at best.
But this Panglossian story ignores more than it reveals. Apart from China and
India, growth rates were much higher before neo-liberal policies came to
dominate in the 1980s. Both of these populous countries began their growth
before adopting market reforms. Ad since adopting neoliberal policies the rate of
increase in their growth has slowed while inequalities in both income and health
have skyrocketed. Consider China: Once an egalitarian nation and the health
world’s envy for its low-cost, barefoot public health system through which it
achieved startling health improvements, it is now one of the world’s most unequal
countries, with an increasingly privatized health system that plunged 27 million of
its citizens into ‘medical poverty’ in 1998. Indirectly, but no less causally, these
market reforms are why Qingming last year chose a premature and preventable
death.
Had Qingming lived and gained his college entrance, his success would have
made him one of the Chinese millions who migrate each year to the coastal
industrial centres that have become the factories of the world. Apart from the
communist legacy of a healthy, literate workforce, the source of China’s
industrial-led growth has been three-fold:
- Liberalization in trade and financial markets, allowing Western companies
to move their labour intensive-production into special ‘Export Processing
Zones’ – the source of work for 40 million Chinese, a figure expected to
grow by 10 million each year for at least the next several.
- The Chinese government’s reluctance to accept such basic human rights
as independent trade unions or individual civil liberties, and Western
capitalism’s indifference to this denial as long as there is money to be
made.
- Occupational and environmental standards sufficiently low or unenforced
that guolaosi, or ‘death by overworking’ from continuous 12 – 18 hour
days, has become a commonly used term. Workplace accidents
reportedly killed 140,000 labourers in 2003, an annual death toll of one in
every 250 Chinese workers and the highest recorded since the
disposable workers of Europe’s industrial revolution of nearly two
centuries ago.
I am not joining the chorus of Western elites bashing China simply because it is
becoming one of the world’s dominating economic powers, busily buying up
Canadian energy and other resource companies to feed its still rapacious diet for
growth. Many have commented that Chinese leaders mean well for their people,
but are now caught between the rock of sustaining high growth and the hard
place of mitigating the inequalities and environmental degradation it creates.
In time, China may reach a point where internal unrest – sparked partly by the
inequalities of its economic success – forces a return to, if not state-centralism,
an Asian form of Keynesian welfare-ism, in which green is good and
redistribution an ethical imperative.
This optimism, however, is simply a variation of the neo-liberalism’s infamous
trickle-down theory, for which there is so far no historical precedent. And it
forces all of us in this room to confront the moral question: How long must we
ask those displaced by globalization’s asymmetries of growth and wealth to wait
for their dinghies to be patched, so they might take their place bobbing amongst
the luxury yachts of the few?
This question has particular poignancy for Chileshe, the Zambian woman of my
second story. Nowhere has a part of the world suffered as much from neoliberalism’s
egregious prescriptions, and the plagues of HIV and other infectious
diseases that flooded its wake, as has sub-Saharan Africa. The causal pathways
that link globalization with the illness of A particular individual are not linear or
straightforward. But it is plausible and defensible to link Chileshe’s HIV infection
to the rise of free markets in Zambia, a policy shift actively promoted by
international agencies dominated by the world’s rich nations.
In 1992, as part of a structural adjustment program that was one of the conditions
attached to loans from the International Monetary Fund, Zambia opened its
borders to second-hand clothing. Its domestic, state-run clothing manufacturers,
inefficient in both technology and management by wealthier nation standards,
could not compete, especially since used clothing had no production costs.
Within eight years, 132 of 140 clothing and textile mills closed operations and
30,000 jobs disappeared, which the World Bank acknowledges as “unintended
and regrettable consequences” of the adjustment process. Ironically, many of
the second-hand clothes that flooded Zambia and other African countries began
as donations to charities in Europe, the US and Canada. Surpluses not needed
for their own poor were sold to wholesalers who exported them in bulk to Africa,
earning up to 300 per cent or more on their investments. In 2001, Canadian
exports of salaula (“rummaging through the pile,” as used clothing is called in
Zambia) were worth $25 million – not much in terms of Canada’s overall
economy, but substantial relative to Zambia’s.
For conventional economists, this is a textbook example of how and why trade
liberalization works: Consumers get better and cheaper goods and inefficient
producers are driven out of business. But Chileshe’s husband, and then
Chileshe herself, paid a heavy price for that presumed inefficiency, one that
cascaded throughout other sectors of Zambia’s limited manufacturing base.
Large numbers of previously employed Zambian workers came to rely on the
informal, ill-paid and untaxed underground economy. The privatization of state
enterprises eliminated a further source of revenues that might have been used to
support social programmes, such as education and health care. Instead, and
again at the request of the international financial institutions, Zambia imposed
user fees, cut health staff and reduced the salaries of those who remained – just
at a time when the AIDS pandemic was surging out of control.
The Zambian government is now trying to undo some of this damage. But it is
hampered by two other aspects of contemporary globalization: The rich world’s
failure to cancel its crippling debt or to provide it with the resources it needs to
sustain its peoples’ health.
Worldwide, the money returned to the rich world in debt payments dwarfs what it
gives as aid. The causes of the ongoing debt crisis are many, but owe as much
to the lending and macroeconomic policies of the lending nations as to the
corruption and inefficiencies of the borrowing ones. As journalist Ken Wiwa, son
of Ken Saro-Wiwa, the activist hanged for opposing Shell Oil’s destruction of
Nigerian homelands, noted:
“You’d need the mathematical dexterity of a forensic accountant to explain
why Nigeria borrowed $5 billion, paid back $16 billion, and still owes $32
billion.”
Not until 1996 did the rich world respond collectively with the so-called Heavily
Indebted Poor Countries or HIPC initiative. Debt relief under this initiative has
freed up more money for health and education. But half of HIPC countries’ debt
will remain unpaid and uncancelled at the conclusion of the initiative. Despite
recent promises of greater debt relief over the next 5 to 10 years, adequate debt
cancellation for the world’s poorest countries, while rising, is still firmly on the
global political agenda.
And to get what debt relief they do, countries must also agree to the neo-liberal
nostrums of privatization, de-regulation, open borders and state minimalism –
now neatly dressed up in the phrases ‘pro-poor growth’ and ‘poverty reduction
strategies.’ Who gets debt relief also remains more a matter of rich world
interest than poor world need. Why else would Canada agree to cancel $570
million in Iraqi debt over the next 3 years, but forgive only $172 million in African
debt over the next 5 – a 100-fold difference in per capita generosity?
Finally, debt relief gains for poor countries like Zambia usually come at the
expense of declining amounts of other forms of development assistance.
Development assistance is not a panacea for the problems that underpin
Chileshe’s HIV infection. It is not without its problems, some of which are slowly
being addressed. But what is most striking is the rich world remarkably
stinginess with its overseas generosity.
To reach the Millennium Development Goals, an unambitious set of quantified
targets all nations agreed to reach by 2015, and all of which health or healthrelated
targets, would require an additional $60 – $120 billion a year in aid. This
is double what donor countries presently give, but less than our repeatedly
promised 0.7% of gross national income on which all but a handful of European
countries have repeatedly failed to deliver. It’s also a fraction of what the US
spends on its military, or what Canada, the US and other wealthy nations have
spent on tax breaks for their rich over the past five years.
Chileshe’s plight is a line in the sand for humanity. If our nascent global society
cannot respond with the aid, debt and trade obligations that will end the poverty
that fuels the pandemic in southern Africa, we will have demonstrated our
inabilities to govern ourselves into any hopeful future.
That future must also rectify the wrongs in our global trading system that now
imperils Antonia and her father, Miguel. Miguel’s story actually begins a century
ago with Mexican land reforms that created subsistence and smallholding
production plots. These plots were big enough to feed a family and earn some
capital by selling to local markets, but were never intended to provide economies
of scale comparable to those of modern corporate farming practices.
In the run-up to the North American Free Trade Agreement (NAFTA), the
Mexican government ended its subsidies to small-scale producers of basic crops,
including corn, the main ingredient of tortillas, Mexico’s staple food. When
NAFTA opened the Mexico-US border, corn from the US, where it is so heavily
subsidized it sells for less than its production costs, flooded the Mexican market.
Currency crises due to liberalization of financial markets also played a role.
Following the collapse of the peso in 1995, the IMF bail-out organized by the
Clinton administration included a $1 billion export credit that obliged Mexico to
purchase US corn. Mexican imports of US corn rose by 120% in a single year.
Mexican corn production stagnated while prices declined. Small farmers were
hardest hit, becoming much poorer than they were in the early 1990s. 700,000
agricultural jobs disappeared, depressing wages to less than half of what they
were 20 years earlier. Rural poverty rates rose to over 70%; the minimum wage
lost over 75% of its purchasing power; infant mortality rates of the poor
increased; and wage inequalities became the worst in Latin America. Adding
insult to injury, as corn prices fell the price of commercially marketed tortillas
almost tripled, because two companies grew to monopolize nearly all the corn
products in Mexico. Wal-Mart, the US-based fiercely anti-union retailer that is
now the world’s largest corporation, moved in to become Mexico’s single biggest
employer.
But let us return to Antonia: Her worsening asthma is unlikely to be treated
because Mexico’s fragmented health care sector, while now improving, still
leaves half its population without access to insured services. Her asthma almost
certainly results from exposure to air pollution from the nearby factory and the
exhaust emissions from trucks taking the factory’s products north to the US.
Even with the recent loss of more than 300 manufacturing plants to China,
northern Mexico remains home to over 3000 manufacturing plants producing
goods ranging from furniture and car parts to electronic components and textiles.
As the cost of pollution control and health and safety standards rose in the US,
and with the establishment of the NAFTA, many of the more hazardous and
polluting links in the industrial production chain moved to the maquiladoras
(Mexican export processing zones). The environmental and occupational
hazards associated with the maquiladoras include increased ground water and
air pollution and the often illegal discharge of highly toxic chemicals. Despite a
higher than average income level, northern Mexico has higher than average
infant and age-adjusted mortality and increased mortality and morbidity for
infectious disease.
A final danger for Antonia is the possibility that she might be tricked or kidnapped
into the sex trade. Some 50,000 people annually, a third of them from Latin
America, are sexually trafficked to the US by pimps and criminal gangs. Sex
businesses are the largest employment sector for women who have lost jobs as
a result of globalization. The international sex trade is one of the more invidious
elements of today’s globalization.
Antonia’s and Miguel’s story relates to a regional trade agreement. Such
agreements are proliferating, especially as developing country organization is
now preventing the rich world from getting its previously singular way at the
World Trade Organization. The WTO, however, remains the archetypal institute
enforcing our neo-liberal form of global market integration. I won’t recount all that
is wrong with the WTO, or what is potentially right with it since, unlike other critics
of globalization’s present architecture, I believe something like the WTO needs to
exist. But its growing alphabet soup of agreements all contain health risks:
TRIPS, which ironically prevents free trade by extending patent protection
limiting poor countries’ access to essential medicines.
GATS, which locks in health care privatization to the benefit of elites and
private companies and to the determinant of those unable to pay the
costs.
TRIMS, which forbids governments from imposing equity requirements on
foreign investors or companies, good for shareholders but bad for the
socially excluded.
AGP, which requires signatory governments to contract their services to
the lowest bidder, regardless of where it is located. Canada’s next census
may be undertaken by US-based Lockheed-Martin, the largest supplier of
weapons of mass destruction to the US government and, under the US
Patriot Act, obliged to reveal all that it might collect on Canadian citizens
to US authorities if the American government deems it to be of national
security interest.
AoA, the agriculture agreement that allows Japanese, European and
American cows to be paid twice as much in subsidies each year than the
amount of development assistance required to allow all countries in the
world to achieve the Millennium Development Goals.
I could rant on with my Sesame Street incantation. The key point here is a
simple one: Equal rules for unequal players will only produce increasingly
unequal results. A fair trading system is one that handicaps the rich while
discriminating in favour of the poor. That was the principal that guided world
trade before the WTO, and still guides how we play golf or race horses. It is a
principal that needs re-enacting. And a fair trading system is one where
liberalization is seen as a means to health and development, and not as an end
in itself. Whenever there is conflict between the two – and there increasingly is –
health and human rights trumps trade.
Most of the world’s nations have already agreed to this under international law.
But we haven’t agreed yet on how to punish ourselves when we break it.
This brings me to Tom’s story, and the realization that the transgressions we
often read or write about in other countries are now occurring in our own. Our
accidental births of good fortune mean increasingly less as we allow our nations
to surrender more of their regulatory power – and hence our political rights to
influence or determine it – to global economic entities with no accountability
except to their overpaid executives and, as they wistfully claim, their
shareholders.
Tom’s story is a simple one. As globalization frees capital, it immobilizes labour
and destroys the awkward counter-balancing of productive forces that led to most
of our progressive welfare reforms of the 20th century. Open borders create
downward wage competition, particularly for the less qualified. The state
response is to increase ‘labour market flexibility,’ resulting in the ‘just-in-time’
worker with no benefits, no security, few labour rights and lower wages. In
tandem, and with the mantra of ‘deficit and debt reduction,’ social spending
declined in almost all high-income countries: between the mid-80s and 90s, a
stunning 28 percent in Ireland; 21 percent in The Netherlands; and 19 percent in
Canada. Some of the biggest declines occurred in areas most important to
health: health care, cash transfers to low-income families, supports to
unemployed workers and programs to increase labour market opportunities.
Even as labour income stagnated or declined for many workers, their hours,
workloads and work speed rose rapidly. Workplace stress, work-related mental
health problems and physical illness are climbing in parallel, as is the number of
workers experiencing difficulty in managing both work and family life –
particularly since many public services have been cut back or privatized.
It is not a great leap from what the data tell us about the physical and mental
health risks of part-time, insecure and precarious employment to Tom’s deadly
car accident that one fateful night.
I acknowledge:
These stories and their explication are not the light stuff that makes digesting
one’s dinner easy. I apologize for any gastrointestinal distress I may be causing
any of you in the room. But it would dishonour my memory of Eberhard not to
have us hear the stories of those whose lives permit us the very act of dining
together in such salubrious spirit, however indirect the link between our privilege
and their penury. Even more dishonourable would be our failure to act on the
knowledge of what can be done to change these stories from despair, to hope, to
change.
For we have that knowledge.
And we have legally binding covenants, one of which empowers each of us in
this room to ensure that our countries meet their obligations to respect, protect
and fulfill the universal right to health, which includes access for all to health care
and to such underlying health determinants as potable water, food, shelter,
education and safe working and physical environments.
We also have well-developed policy options with budget forecasts that detail
exactly how our countries can fulfil these healthful obligations:
- From enhanced and untied aid for which the only condition is that money
gets to those in need and makes a difference in their lives;
- to debt cancellation so that the rich stop obtaining their wealth and health
from the poverty and disease of the poor;
- to fair trade that discriminates on the basis of right rather than might;
- to novel and workable systems of global taxation that might begin on a
planetary scale to create a welfare state – a well and fair state – to which
all the world enjoys citizenship.
Meeting the challenge of global health equity – of creating a world in which
Qingming would have no financial reason to kill himself, Chileshe would have a
husband rather than a fatal disease, Miguel and Antonia would not be pushed by
poverty into illness or something worse, and Tom would still enjoy the triple 8s
that Australia vanguarded for the rest of world when its laws declared 8 hours
work a day was enough so that one could also enjoy 8 hours rest and 8 hours
pleasure – meeting this challenge requires more than just incremental increases
to existing commitments and policy ideas. It demands that we fundamentally
challenge the individualistic and market-based priorities and values that presently
guide political and economic decision-making on an international scale.
We can seek guidance in this challenge from the proliferation of our new global
justice movements, one of which – the Peoples Health Movement – links activists
from grassroots, government, academia and NGOs in every part of the world.
Indeed, we can and should become loud-mouthed fellow travellers in these
movements. It is our democratic right, and our moral responsibility.
History suggests that such changes demand radical and not always non-violent
forms of political mobilization and action. History has not yet encountered such a
demand on a global scale. But it is worth recalling that the political difficulties of
abolishing slavery or implementing universal suffrage were also once thought to
be insurmountable. Overcoming the seemingly insurmountable requires a
passion that is indignant of our globalizing wrongs, even as it is tempered by
intellectual discipline and ethical generosity.
Eberhard would understand that. Eberhard would swell large with passion, and
with indignation. But he would do so without sacrificing either discipline or
generosity. Nor would he consider it appropriate to be passionate or indignant or
disciplined or generous without first a lugubrious salute to the idealism he always
brought to his work. By lugubrious salute, of course, I mean a drink.
So for those who, like Eberhard and me, believe that the fermented or distilled
grape offers at least as much health as it sometimes risks, and for those for
whom aqua naturale is the preferred beverage, please rise and join me in
recalling the spirit of a man whose leadership for the challenges I have portrayed
tonight is sorely missed, but whose mentorship ensures it is not lacking.
Eberhard: Your laughter is missed, but not your presence. For you continue to
live as long as those who knew you continue to gather in your name to honour
the causes that you championed.
Prosit!
* * * * * * * *
The content of this oration is drawn from a short book written by Ronald Labonte
and Ted Schrecker, with Amit Sen Gupta, titled: Health for Some? Death,
disease and disparity in a globalizing era.
This book will be available free as a
downloadable PDF from the Canadian Centre for Social Justice’s website:
www.socialjustice.org, sometime near the end of March, 2005.
A bound copy of
the book can also be ordered at a cost of $20 (Canadian), which includes
shipping costs. Bulk orders are welcome.
For further information, e-mail:
justice@socialjustice.org |
