The Global Health Watch: A global health report with a difference

Abstract

With impressive advances in science and technology, the unprecedented wealth generated over the past century, and the widespread ratification of the Universal Declaration of Human Rights, health professionals and advocates should feel embarrassed that so many people live in a state of poor health. Last year, a new global initiative was launched to help clarify the causes of this situation and offer alternatives: Global Health Watch 2005–2006: An Alternative World Health Report [1]. What makes this publication ‘‘alternative’’? First, it has an equity orientation, and one that looks at disparities and interrelationships between the poor, powerless, and unhealthy, and the wealthy, powerful, and healthy. Second, the report is explicitly political in its analysis, highlighting the socially constructed barriers to better and fairer health outcomes. Third, the report acknowledges the importance of a multi-sectoral approach to health, with chapters on climate change, food security, conflict and the arms trade, and access to water, a perspective sadly underemphasized in current health discourse and policy. Finally, the Global Health Watch is alternative in the sense that it tries to draw together civil society’s perspective on health as a counterpoint to the views put out by the international institutions whose decisions affect people’s health and livelihoods around the world, and who are themselves the subject of scrutiny in the report. Many of these themes are brought together in the opening chapter of the Watch, which describes the effects on health of the current process of globalization. It questions the success story painted by uncritical proponents of this process, pointing to increases in poverty in Africa, Eastern Europe, central Asia, and Latin America, and a rise in income inequalities in many countries (including wealthy ones) in recent years. These trends are underpinned by a profoundly unfair global trading system. For example, in Mexico, the liberalization of the corn sector under the North American Free Trade Agreement led to a flood of imports from the United States, where agribusiness is massively subsidized. Mexican corn production stagnated whilst prices declined. Small farmers became poorer and 700,000 agricultural jobs disappeared. Rural poverty rates rose to over 70%, the minimum wage lost over 75% of its purchasing power, and infant mortality rates amongst the poor increased [2,3]. Such damage highlights the need for sophisticated national management of global economic change – a daunting challenge for developing countries with run-down or underdeveloped public sectors. Furthermore, whilst many – especially richer – economies have social contracts, progressive taxation systems, and laws and regulations to manage the human consequences of market failures at the national level, there is no ‘global social contract’ to manage the failures of globalization for the world’s majority poor. Those global mechanisms that do exist often reinforce unequal power relations or aggravate problems. World Trade Organization agreements that liberalize trade in goods and services are biased towards protecting and promoting the interests of multinational corporations, whilst decreasing the space for governments and health agencies to