Today

1. Today • World system theory • Global health principles • Case study on war: Iraq • Case study on gender: China • Myths and solutions for world poverty

2. World Hunger, 1970-1990 942 786 Source: Lappe et al, p. 61.

3. Better health through wealth Source: World Bank, UNICEF

4. World-system theory • Theory of global capitalism • Immanuel Wallerstein, adapting Marx • Core (Switzerland to New Zealand) • Diversified economy, strong and stable states, high-wage workers, corporate HQs • Semi-periphery (Greece to Panama) • Partly industrialized, natural resources, small middle class, international debt • Periphery (Colombia to Sierra Leone) • Dependent, extractive economies, unstable states, production for export, very poor

5. World population Countries in the world-system Core (23 countries) Income: $14,000+ Life expectancy: 78 Under 5 mortality: 6 Semi-periphery (26 countries) Income: $2,500-$12,000 Life expectancy: 71 Under 5 mortality: 22 Periphery (112 countries) Income: $100-$2,500 Life expectancy: 60 Under 5 mortality: 99 Source: World Bank, UNICEF

6. Global health principles • Living conditions are most important -- Nutrition, water, housing, medical care • People in rich countries are healthier -- Live longer, with less disease at all stages -- Across time or between countries now • Initial gains are cheaper (epidemiological transition)

7. Wealth and health: countries Life expectancy by country average income Source: WB 2000. 127 countries, by per capita GNP.

8. Resource priorities • Education / Literacy • Improves health behaviors • Promotes empowerment / self-determination • Universal preventive health care • Public health infrastructure • Immunizations • Basic health resources (accessible clinics)

9. Resource priorities • Access to clean water and sanitation Source: WHO Global Water Supply and Sanitation Assessment 2000 Report

10. Resource priorities: what to buy? Sources: WHO; Statistical Abstract; NYTimes 4/7/02.

11. Countries getting worse in the 90s

12. Case study: Iraq Source: UNICEF (www.childinfo.org)

13. Rumsfeld, special envoy for Reagan, 1983 1990: Schwarzkopf, Cheney, Bush, Powell Iraq history 1979: Anti-American Islamic revolution in Iran 1980-88: Iraq war with Iran, U.S. supports Iraq 1990-91: Iraq invades Kuwait; U.S.-led Gulf War

14. President George Bush I ‘Our mission is about protecting national security … because energy security is national security for us and, indeed, for every country … We're not talking simply about the price of gas. We are talking about the price of liberty.’ – Thanksgiving, 1990

15. Bush I on Iraq sanctions We must keep the United Nations sanctions in place as long as [Saddam] remains in power … we cannot compromise for a moment in seeing that Iraq destroys all of its weapons of mass destruction and the means to deliver them… This is not to say – and let me be clear on this one – that we should punish the Iraqi people. … Our argument has never been with the people of Iraq. It was and is with a brutal dictator whose arrogance dishonors the Iraqi people. –Sept 23, 1991

16. Iraq: War, sanctions and health • Iraq making progress before 1991 • Oil exports paid for food and medicine • 1991 war destroyed infrastructure • Electricity, water purification, sewage • Sanctions prevented reconstruction • Plants not rebuilt • Food and medicine imports cut • Oil-for-food program not enough (and corrupt)

17. Simulation: Iraq without war Difference in total number of Infant deaths: 432,935 527,912 Source: UNICEF (www.childinfo.org), World Bank, CIA, and Cohen’s calculations

18. Iraqi mortality: Lancet study • How to measure war-related deaths? • Extrapolating from population sample • Interviewed 33 clusters of 30 households • Close as possible to random selection • Interviews by bilingual doctors, covering 1/2002 through 9/2004 • Household composition, births and deaths http://www.socsci.uci.edu/~cohenp/strat/lancetiraq.pdf

19. 98,000 estimated “excess” deaths after the invasion (Excluding Falluja)

20. Gender: mortality and inequality Source: United Nations Human Development Reports (http://hdr.undp.org/), accessed 1/24/05.

21. Gender and health: Poor countries • Women (and children) benefit from employment, education • Lower fertility follows improvements for women • Boys have an advantage when • Families use boys’ labor • Women live with their husbands’ families

22. China versus India Under-5 mortality (per 100,000 live births) India China

23. Women’s empowerment: Education, employment, birth control available Communist Revolution, 1949 China’s transition Female life expectancy (change in years) One-child policy, Capitalist development Fertility (percent change) Sources: Lee & Wang, 1999; World Bank.

24. China’s barefoot doctors (1960s-70s) • Thousands of peasants trained in basic health care • Health workers from cities sent to the countryside

25. Female mortality in China Source: Demography 1994 (vol 31, no 3)

26. Solutions • Myths • The free market • Foreign aid • Some principles and ideals • Questions of social organization • Resource priorities • Confronting global inequality

27. Let the market work? • Unchecked markets concentrate wealth • Marx was right • Rich countries want free trade • Markets don’t serve the poor • Poor people don’t create ‘demand’ • Competition between unequals • Foreign investment • Profits are exported • Production for export instead of subsistence • Elites align with foreign powers

28. Debt problems, health problems Source: UNICEF, World Bank (2000, table 4.19)

29. Let the market work? • Markets can help • An efficient way to set priorities and prices • Efficiency benefits the poor only when spending power is distributed

30. What about foreign aid? • Rich (usually) don’t aid – they invest • Creating markets for U.S. products • Subsidizing U.S. corporations • Donations lead to later sales • Aid is determined by politics • Top aid recipients are key allies • Aid comes with strings attached • Undermines local production • Flooding markets, driving down prices

31. Social organization • Women’s independence • Education • Employment • State policy oriented toward the poor • Social insurance • Reduce inequality Education in Kerala

32. Social organization • Grassroots movements • Better at determining priorities; motivated by collective needs • E.g., Self-employed women’s association • E.g., Socialist revolutions (e.g., China, Cuba) Protest in the Philippines

33. Cuba versus Uruguay Under-5 mortality (per 100,000 live births) Uruguay Cuba

34. Costa Rica versus Mexico Under-5 mortality (per 100,000 live births) Mexico Costa Rica

35. Confronting global inequality • Self-determination • When people control their own destinies, health improves • Between nations • ‘Neocolonialism’ undermines political and economic independence • Within nations, communities, families

36. Confronting global inequality • Self-reliance • Interdependence is inevitable • But making it yourself is more secure • Provides a basis for cooperation

37. Confronting global inequality • Cooperation, not dependence • Rich and poor countries, on equal terms