How wealth and greed are destroying our health and environment and what’s to be done? Fran Baum People’s Health Movement Southgate Institute for Health Society & Equity Flinders University Adelaide, Australia

Richest woman in the world –accumulating as much in a second as many Africans earn in a year

Global oligarchy of wealthy – across borders Avoiding tax Making profit without accounting for health, social & environmental impact

My Argument There is lots of evidence on inequities and health inequities – shows things are growing much more unequal in last decades Commission on Social Determinants of Health summarised evidence and areas for action Why doesn’t action happen? –Distractions – behaviour, trickle down, need for growth –Corporate power and capitalist system that underpins inequities –Manufacturing consent What’s to be done

Per capita income in low-, middle- and high-income countries: GNI per capita and PPP income per capita (GNI) ($US equivalent): Source: World Bank - World Development Reports Gaps Widening

Global wealth distribution 2000 (Baum 2008: 418 quoting Davies et al 2006:47) RegionPop ShareWealth per adult Wealth Share North America , Europe14.967, Africa10.23, World10033,893100

Life expectancy at birth by World and UN region: World Bank 2006: Disease and Mortality in Sub-Saharan Africa. 2nd edition Gap Widening

Under 5 mortality rates/1000 live births; low-, middle- and high-income countries: Source: World Bank - World Development Reports

Percentage reduction in rates of infant mortality (under 1 year) per 1000 live births by region from 1955 to 2005 Clark, R. (2011) World health inequality: Convergence, divergence, and development. Social Science & Medicine 72:

Commission on the Social Determinants of Health Launched 28 th August 2008 by Dr. Margaret Chan, Director General, WHO in Geneva "Health inequity really is a matter of life and death" Margaret Chan

Equity from the start Healthy places- healthy people Fair employment –decent work Social protection across the life course Universal health care Health Equity in All Policies Fair financing Market responsibility Political empowerment – inclusion and voice Good global governance Monitoring, research, training Building a global movement Full report downloadable at Daily Living Conditions Power, Money and Resources Knowledge, Monitoring and Skills CSDH – Action Areas

How is it that inequities are tolerated and there has been little follow through on CSDH and other health equity reports?

Distractions – behaviour, trickle down, need for growth Corporate power and capitalist system that underpins inequities Manufacturing consent – inequities seen as part of natural order

Distractions Trickle down – eventually everyone will benefit and true there has been progress in extending life expectancy Myth of the need for growth – so excesses of capitalism are necessary because economic growth is crucial at all costs Behaviours explain inequities – especially evident in terms of health inequities

Do we need growth for health?

US compared to Costa Rica Indicator (2005)USCosta Rica Life expectancy at birth 7779 Infant MR 711 Happy Planet Index (Life satisfaction, LE, Ecological footprint) (NEF) (rank 150th) 66.0 (rank 3 rd ) Gross National Income per capita (US$) 41,4404,470 Health expenditure per capita (US$) 5, Source: Baum (2007) based on World Bank, 2007

Lessons from low income high health countries: Not what you spend but how you spend it Universal provision of services (not targeted at poor) Strong public sector Education especially for girls Distribution of resources crucial Strong PHC Support for Indigenous agriculture Werner and Sanders, 1997; UNICEF, 1988

Distraction: focus on behaviour “the tendency for policy to start off recognizing the need for action on upstream social determinants of health inequalities only to drift downstream to focus largely on individual lifestyle factors”. Popay, Whitehead and Hunter, 2010 Most health policies based on behaviouralism – with focus on individual and blaming victim for their health status This approach is very compatible with neo-liberalism