[Ip-health] New book on neoliberalism and health (One Chapter Courtesy Lancet)

[Riaz K. Tayob]

Neoliberalism, Globalization, and Inequalities: Consequences for Health
and Quality of Life Edited by Vicente Navarro

Policy, Politics, Health and Medicine Series, Vicente Navarro, Series
Editor http://www.baywood.com/books/previewbook.asp?id=3D978-0-89503-338-3

"An impressive and comprehensive set of insights into the current state
of globalization. This is an essential book for anyone who wants to know
how and why neoliberalism has failed to deliver on its promises." =97Jeff
Faux, Founder and Distinguished Fellow, Economic Policy Institute,
Washington, DC, Author, The Global Class War

"Vicente Navarro has assembled a comprehensive, tightly argued, and
powerfully supported set of contributions that demonstrate the links
between neoliberalism, economic inequality, and health outcomes in a
convincing and very timely fashion." =97Andrew Glyn, Professor of
Economics, Oxford University

"These incisive essays dissecting neoliberal globalization provide
highly significant information along with careful and penetrating
analysis, subjecting claims of advocates and critics to the test of
judiciously assembled empirical evidence. Moreover, they develop
neglected perspectives that should prove invaluable to those seeking to
dismantle illusions and deceptive presentations, and to discover the
real human consequences of the dominant intellectual and policy
paradigms of the past several decades. They are a very welcome
contribution to the understanding of some of the most critical issues of
the contemporary era. It is an outstanding work and a remarkably
important book." =97Noam Chomsky, Institute Professor, Retired, MIT

"This book provides essential reading for scholars, practitioners, and
policymakers wanting to understand the rapid social, health, and
economic changes in today's world. It offers an excellent base for
reflection on forces driving these changes as well as critical analyses
of now widespread interpretations of their causes and consequences."
=97Walter Korpi, Professor of Social Policy, Swedish Institute for Social
Research, Stockholm University

"Never in our history have human beings enjoyed such good health; but
never have so many persons suffered or died prematurely because of
hunger, poverty, and avoidable diseases, and never have inequities in
health been so deep and so evident. Vicente Navarro, internationally
known as a champion of social justice, has assembled the best
contributions from all over the world. This book appears at a time when
health for all is being recognized as a fundamental human right and a
touchstone of the civilization of any country. All those who work in
this field may enjoy reading these essays and find a new stimulus for
their activity." =97Giovanni Berlinguer, Professor Emeritus, Sciences
Faculty, University of Rome Member of the WHO Commission on Social
Determinants of Health

ABOUT THE BOOK Since U.S. President Reagan and U.K. Prime Minister
Thatcher, a major ideology (under the name of economic science) has been
expanded worldwide that claims that the best policies to stimulate human
development are those that reduce the role of the state in economic and
social lives: privatizing public services and public enterprises,
deregulating the mobility of capital and labor, eliminating
protectionism, and reducing public social protection. This ideology,
called "neoliberalism," has guided the globalization of economic
activity and become the conventional wisdom in international agencies
and institutions (such as the IMF, World Bank, World Trade Organization,
and the technical agencies of the United Nations, including the WHO).
Reproduced in the "Washington consensus" in the United States and the
"Brussels consensus" in the European Union, this ideology has guided
policies widely accepted as the only ones possible and advisable.

This book assembles a series of articles that challenge that ideology.
Written by well-known scholars, these articles question each of the
tenets of neoliberal doctrine, showing how the policies guided by this
ideology have adversely affected human development in the countries
where they have been implemented.

ABOUT THE EDITOR Vicente Navarro is Professor of Health and Public
Policy, Sociology, and Policy Studies at The Johns Hopkins University,
USA, and Professor of Political and Social Sciences at the Pompeu Fabra
University, Spain. He has also been Professor of Economics at Barcelona
University, Spain. Dr. Navarro has served as consultant to the United
Nations and to many of its agencies, such as the WHO and UNICEF, and
been a member of many international commissions dealing with human
development areas. He has written extensively on political economy,
public policy, and human development and his books have been translated
into many different languages. His most recent volumes include The
Political Economy of Social Inequalities: Consequences for Health and
Quality of Life and The Politics of Health Policy.

***

Neoliberalism, Globalization, and Inequalities: Consequences for Health
and Quality of Life

Table of Contents

Introduction Vicente Navarro

PART I What Is Neoliberalism?

Neoliberalism as a Class Ideology; Or, the Political Causes of the
Growth of Inequalities Vicente Navarro

PART II Neoliberalism, Globalization, and the Welfare State

Is Globalization Undermining the Welfare State? The Evolution of the
Welfare State in Developed Capitalist Countries during the 1990's
Vicente Navarro, John Schmitt, and Javier Astudillo

The Future of the Welfare State: Crisis Myths and Crisis Realities
Francis G. Castles

PART III The Growth of Inequalities

Should We Worry about Inequality? Robert Hunter Wade

The Causes of Increasing World Poverty and Inequality; Or, Why the
Matthew Effect Prevails Robert Hunter Wade

Is Globalization Reducing Poverty and Inequality? Robert Hunter Wade

PART IV Consequences of Neoliberalism and Globalization for Health and
Quality of Life

The Scorecard on Development: 25 Years of Diminished Progress Mark
Weisbrot, Dean Baker, and David Rosnick

The World Health Situation Vicente Navarro

PART V European Integration and Its Consequences for Health and Quality
of Life

Economic Efficiency versus Social Equality? The U.S. Liberal Model
versus the European Social Model Vicente Navarro and John Schmitt

Is the United States a Good Model for Reducing Social Exclusion in
Europe? John Schmitt and Ben Zipperer

PART VI The Liberal Model in the United States and Its Social Consequences

Labor Markets and Economic Inequality in the United States Since the End
of the 1970s John Schmitt

The Politics of Health Inequalities Research in the United States
Vicente Navarro

PART VII The Situation in Latin America: Alternatives to Neoliberalism

An Alternative to the Neoliberal Model in Health: The Case of Venezuela
Oscar Feo and Carlos Eduardo Siqueira

Venezuela's Barrio Adentro: An Alternative to Neoliberalism in Health
Care Carles Muntaner, Ren M. Guerra Salazar, Joan Benach, and Francisco
Armada

PART VIII The Consequences of Neoliberalism in Africa

The Dispossession of African Wealth at the Cost of Africa's Health
Patrick Bond

Uneven Health Outcomes and Political Resistance under Residual
Neoliberalism in Africa Patrick Bond and George Dor

The International Monetary Fund and World Bank in Africa: A "Disastrous"
Record Demba Moussa Dembele

PART IX Analysis of Proposed Solutions to Current Health and Social
Problems

A. Critiques of WHO Commissions The Sachs Report: Investing in Health
for Economic Development-Or Increasing the Size of the Crumbs from the
Rich Man's Table? Alison Katz

Report of the WHO Commission on Macroeconomics and Health: A Critique
Debabar Banerji

Assessment of the World Health Report 2000 Vicente Navarro

Serious Crisis in the Practice of International Health by the World
Health Organization: The Commission on Social Determinants of Health
Debabar Banerji

B. Critique of Neoliberal Solutions to World Poverty A Critique of
Jeffrey D. Sachs's The End of Poverty Doug Henwood

Contributors

Index


***

Introduction Vicente Navarro At the end of the 1970s and beginning of
the 1980s, an ideology originating in the United States (first with a
Democratic president, Jimmy Carter, then with a Republican president,
Ronald Reagan) and the United Kingdom (with Prime Minister Margaret
Thatcher) spread worldwide. According to this ideology, the role of the
state in all dimensions of economic and social life should be reduced in
order to free up the enormous potential of market forces (usually
referred to as =93free=94 market forces), by deregulating world trade,
increasing the mobility of capital and labor, and eliminating social
arrangements (such as social pacts and protectionism) that stood in the
way of the full development and expansion of capitalism. Capitalism
without borders became the name of the game in world affairs,
reproducing a narrative that became known as neoliberalism=97adding the
neo prefix to indicate that this was indeed a new, broader, more
advanced form of the old liberalism. Such ideology became the guiding
force behind international economic relations, a process facilitated by
the collapse of the Soviet Union, which until then had been the other
pole in a bipolar world. From that point there was only one pole, and
only one alternative. The application of neoliberal policies to the
international economic order became known as globalization. Neoliberal
globalization has now been around for more than 30 years. Indeed, its
hegemony is evident not only in the international institutions that
manage the globalization process (such as the International Monetary
Fund, World Bank, World Trade Organization, and United Nations=97including
its technical agencies such as the World Health Organization, UNICEF,
UNESCO, and others), but also in the majority of governments of both the
developed and the developing countries. Such hegemonic ideology has been
promoted as the Washington consensus, supported by all U.S.
administrations (Carter, Reagan, Bush senior, Clinton, and Bush junior),
and on the other side of the Atlantic (in the European Union) as the
Brussels consensus=97and, indeed, it has guided the establishment of the
European Union. The defenders of neoliberal policies (i.e., most
academic and mainstream media, both in North America and in Europe) have
presented these policies as a great success: they have given rise, it is
said, to an unprecedented increase in economic development and social
well-being. These perceptions are uncritically presented as obvious
facts and realities in the major economic and political forums and in
the establishment media. An exception to this choir of complacency is
the International Journal of Health Services (IJHS), established in 1970
and remaining loyal to its critical vocation. Despite its name (kept for
historical reasons), the IJHS covers a much broader range of topics than
health services. As indicated by its subtitle, the IJHS covers health
and social policy, political economy and sociology, history and
philosophy, and ethics and law. In summary, it covers any subject
related to population=92s health and quality of life. And neoliberalism
and globalization do indeed affect the health and quality of life of our
populations, as is the theme of this volume. This book (with the
exception of one chapter) is a collection of articles published in the
IJHS. The book opens, in Part I, with a chapter by Vicente Navarro
(Professor of Health and Public Policy at the Johns Hopkins University
and Professor of Political and Social Sciences at the Pompeu Fabra
University, Spain), which explains the origins and nature of
neoliberalism and globalization=97two sides of the same coin. Chapter 1
challenges the widely held assumption among liberal authors (reproduced
on occasion by sectors of the anti-globalization movement, such as Susan
George and Ignacio Ramonet of Le Monde Diplomatique) that in the new
globalized order, nation-states have lost their importance and have been
replaced by multinational corporations, which are now the main motors of
economic activity. Navarro questions the disappearance of the state and
shows how states (heavily influenced by the classes and economic groups
dominant in each nation-state) play a critical role in the international
order=97 or, better, disorder. Moreover, he postulates that neoliberalism
is the ideology of the dominant classes of both developed countries (the
North) and developing countries (the South). These dominant classes have
established an alliance that governs today=92s world, and neoliberalism is
the ideology of this class alliance. Part II shows how states (and thus
politics) play a critical role in defining what happens in each country.
Chapter 2, by Vicente Navarro, John Schmitt
(Visiting Professor in the Public and Social Policy Program of the
Pompeu Fabra University and economist at the Center for Economic and
Policy Research in Washington, D.C.) and Javier Astudillo (Professor of
Political Science at the Pompeu Fabra University), shows there is no
convergence toward a uniform, reduced set of welfare state interventions
(such as social security, labor market interventions, health and medical
care, education, social services, housing, prevention of social
exclusion and immigration), as neoliberal authors claim. Rather, there
continue to be different types of welfare states (with different levels
of public social expenditures), depending on the political traditions
that have governed in each country and the class interests those
traditions represent. Chapter 3, by Francis G. Castles (Professor in the
Department of Social Policy of the University of Edinburgh, Scotland),
further expands on the continuing centrality of political factors in the
configuration of social policies. There is no economic determinism
(globalization) that forces all governments to do the same thing (i.e.,
to carry out neoliberal policies). The relations of power, including
class power, continue to have a critical role. Many of the heralded
crises of the welfare state are overblown by governments that have used
=93globalization=94 as a way of justifying and carrying out unpopular,
class-oriented policies. Part III consists of three chapters by Robert
Hunter Wade (Professor at the London School of Economics) that analyze
the adverse effects of neoliberalism and globalization on economic
efficiency, social cohesion, and inequality. Chapter 4 challenges the
basic economic assumptions of neoliberalism and globalization,
presenting empirical information that invalidates the intellectual
arguments used to sustain the theoretical framework on which
neoliberalism is based. Chapter 5 challenges the argument that free
trade in goods and services
(including financial services) makes for better overall economic
performance at the level of the world economy or national economies. It
shows that neoliberal policies have increased inequalities and poverty,
a position further documented in Chapter 6, in which Wade also
challenges the neoliberal position that inequalities are desirable
because of their beneficial effects on incentives and innovation. This
chapter presents empirical evidence that falsifies the liberal position
and emphasizes that redistribution within each nation-state is a
critical condition for economic efficiency. Part IV presents the
consequences of neoliberalism and globalization for the quality of life
of the world=92s populations. Chapter 7, by Mark Weisbrot, Dean Baker, and
David Rosnick (economists at the Center for Economic and Policy
Research, Washington, D.C.), documents the enormous human costs of
neoliberalism and globalization for health, education, and other
indicators of social well-being and quality of life. The authors
demonstrate these costs by comparing the evolution of social indicators
in the period 1980=962005 with the period
1960=961980, stressing that improvement in economic and social indicators
for countries at equal levels of development at the beginning of each
period was much lower (and even, on occasions, negative) in the later
than in the earlier period. Chapter 8, by Vicente Navarro, critically
analyzes the consequences of neoliberalism for health around the world.
This also includes a critique of the =93humanism=94 of many initiatives
coming from neoliberal establishments (such as the AIDS campaigns),
which reproduce a =93technological bullet=94 approach to solving enormous
health problems=97problems that are rooted in the unequal power relations
(class power as well as gender power) supported by the liberal
establishments. The chapter also includes a critique of the WHO for its
reproduction of neoliberal policies (a point elaborated on in Part IX).
In Part V, the authors analyze the situation of monetary and economic
integration in the European Union. Chapter 9, by Vicente Navarro and
John Schmitt, challenges the widely held view in neoliberal discourse
that there is a necessary trade-off between higher efficiency and lower
reduction of inequalities. The chapter empirically shows that the
liberal U.S. model has been less efficient economically (slower economic
growth, higher unemployment) than the social model existing in the
European Union and in most of its member states. Based on the data
presented, Navarro and Schmitt criticize the adoption of features of the
neoliberal model (such as deregulation of labor markets and reduction of
public social expenditures) by some European governments. They go on to
analyze the causes for the slowdown of economic growth and increased
unemployment in the European Union=97the application of monetarist and
neoliberal policies in the institutional frame of the European Union,
including the Stability Pact, the objectives and modus operandi of the
European Central Bank, and the very limited resources available to the
European Commission for stimulatory and distributive functions. Finally,
the authors detail the reasons for these developments, including
(besides historical considerations) the strong influence of financial
capital in the E.U. institutions and the very limited democracy.
Proposals for change are included. Chapter 10, by John Schmitt and Ben
Zipperer (economist at the Center for Economic and Policy Research,
Washington, D.C.) gives a detailed analysis of the neoliberal model,
presented by its advocates as the model the European Union should
follow, and highlights the huge deficiencies of that model. In Part VI,
the discussion focuses on the social and economic situation of the
United States, the point of reference in the neoliberal narrative.
Chapter 11, by John Schmitt, analyzes the most unequal of the world=92s
advanced capitalist economies, the United States, showing how inequality
has increased substantially over the past 30 years. Schmitt also
documents trends in the inequality of three key economic
distributions=97hourly earnings, annual incomes, and net wealth=97 and
relates these developments to changes in economic and social policy over
the past three decades. The primary cause of high and rising inequality
is the systematic erosion of the bargaining power of lower- and
middle-income workers relative to their employers, reflected in the
erosion of the real value of the minimum wage, the decline in unions,
wide-scale deregulation of industries such as airlines and trucking,
privatization and outsourcing of many state and local government
activities, increasing international competition, and periods of
restrictive macroeconomic policy. Chapter 12, by Vicente Navarro,
discusses the political context in which health inequalities research
has historically operated in the United States. The discussion focuses
on the limitations of research that uses income, consumption, and status
as the primary categories of research practice. Navarro concludes that
it is essential to use categories of analysis that focus on class
relations, as well as race and gender relations, and their reproduction
through international and national institutions, in order to study their
impact on the health and well-being of populations. In fact, a major
weakness of most health inequalities research in the United States is
its profound apoliticism. The actual causes of inequalities
(in class, gender, and race power relations) are systematically ignored
or downplayed. Even the term inequalities has disappeared from the
narrative, replaced by the term disparities. Part VII describes one of
the most interesting alternatives to neoliberalism that has appeared in
the developing world. Venezuela=92s health policies are based on an active
public intervention with active mobilization of the population. Several
scholars from the United States, Europe, and Venezuela present and
analyze these experiences: in Chapter 13, Oscar Feo (Professor at the
University of Carabobo, Venezuela) and Carlos Eduardo Siqueira
(Professor at the University of Massachusetts, Lowell); and in Chapter
14, Carles Muntaner (Professor at the University of Toronto), Ren=E9 M.
Guerra Salazar (Professor at the University of Toronto), Joan Benach
(Professor at the Pompeu Fabra University, Spain), and Francisco Armada
(Minister of Health of Venezuela). The focus of Part VIII is the
experience of neoliberalism and its negative effects on the African
continent. In Chapter 15, Patrick Bond (Professor at the University of
KwaZulu-Natal, South Africa) describes the dispossession of Africa=92s
resources at the cost of its populations=92 health. The international
establishments, including the International Monetary Fund and the World
Bank are hypocritical=97as Demba Moussa Dembele (from the African Forum on
Alternatives) clearly shows in Chapter 17=97in having pushed and imposed
neoliberal policies on African countries and now lamenting the
widespread crises and calling for more aid to these countries. It is
neoliberalism itself that has worsened the health of African
populations, as is further documented by Patrick Bond and George Dor
(activist with Jubilee South Africa and the African Social Forum) in
Chapter 16. Part IX, Section A, critically analyzes proposals put
forward by the WHO to resolve health crises at the world level. Indeed,
three major commissions established by the WHO have had an major
influence on the configuration of health policies. And, as the chapters
here show, two of these commissions, heavily influenced by
neoliberalism, are wrong, and the third is clearly insufficient. In
Chapter 18, Alison Katz (former consultant to the WHO) critically
analyzes the Sachs report Investing in Health for Economic Development.
This report, the product of the WHO Commission on Macroeconomics and
Health, reproduces a set of highly dubious assumptions, one of which is
that the primary cause of poverty in countries is a lack of resources.
Thus, the report calls for aid to developing countries. Completely
absent is any analysis of the class power relations existing within each
country, as well as globally, as causes of underdevelopment. This lack
of attention to the political factor accompanies a lack of questioning
of the basic assumptions of the neoliberal project (perhaps because of
Jeffrey Sachs=92s leadership in imposing neoliberal policies on the Soviet
Union, policies that resulted in half a million deaths in just two
years). It is an indication of the enormous hegemony of the neoliberal
discourse that Sachs was asked to chair the WHO commission. Debabar
Banerji (Emeritus Professor, Jawaharlal Nehru University, India) also
criticizes the WHO Commission on Macroeconomics and Health (Chapter 19),
as well as the WHO Commission on Social Determinants of Health (Chapter
21), from the viewpoint of a long-time public health professional
working in a developing country. Chapter 20 presents a critique by
Vicente Navarro (first published in the Lancet) of the WHO report Health
Systems: Improving Performance, a document that, again, reproduced the
neoliberal ideology of the WHO. The critique of neoliberal policies ends
with Section B of Part IX, a critical analysis of Jeffrey Sachs=92s
manifesto The End of Poverty, by Doug Henwood
(of the Left Business Observer). These, then, are the contents of the
volume. As indicated at the beginning of the introduction, the objective
of this collection is to critically analyze the conventional wisdom in
the political, economic, and academic establishments of the Western
world. The chapters in this volume differ from and frequently are in
conflict with mainstream explanations that present neoliberalism and
globalization as good for people's health and quality of life. The data
presented here challenge such assumptions. We hope that this
contribution stimulates a much needed debate on the impact of economic,
social, and political determinants on health and quality of life,
focusing on how two major developments=97neoliberalism and
globalization=97are adversely affecting the human development of our
population. Finally, we wish to thank the many persons who have labored
in the preparation of this volume, starting with Linda Strange and Jean
McMahon, copy editor and managing editor, respectively, of the
International Journal of Health Services. Their work has been essential.
Special thanks are also owed to Bobbi Olszewski and the staff of Baywood
Publishing, who have been crucial to the editing, production, indexing,
and promotion of the book. And, of course, out thanks to the President
of Baywood, Stuart Cohen, who has always been a strong supporter of the
International Journal of Health Services, the major forum for the topics
discussed in this volume. We are grateful to Sule Calikoglu, a doctoral
candidate at Johns Hopkins University, for her assistance in the
collection and preparation of the articles. We thank the Lancet for
allowing us to publish one of their articles as a chapter in this book.