The world has more than enough resources to realise the vision of the People’s Charter for Health. Yet for the last 40 years, international financial institutions and many governments have largely pursued an approach that has often undermined people’s health and well-being. This approach – based on an ideology commonly known as neoliberalism, but perhaps better described as “market fundamentalism” – promotes the notion that the best way to organise society is through an economic model that combines privatisation, fiscal austerity, deregulation, reductions in government spending and a reduced the role of the state. Its results have often driven us headlong into poor heath, poverty, insecurity, and vast inequality.
Market fundamentalism is so firmly embedded in many cultures that alternative voices often do not even feature in debates about tackling poverty and inequality. But there is hope. In many places around the world there is evidence of a different track, where people are pursuing alternative policies that improve people’s health, strengthen public health systems, reduce inequality and improve people’s lives. Health Poverty Action’s new report, The Alternatives – policies towards a Life in Full, takes an in-depth look at some of these alternative approaches from a range of countries which have – to varying extents – successfully promoted inclusive development or indeed, alternatives to Western ideas of development itself. For example:
Ecuador has recently seen gains in welfare and reductions in poverty and inequality, and achieved the world’s most “inclusive” growth. The Correa government of 2007 – 2017 explicitly rejected market fundamentalism and enshrined the right to a good life in the Constitution. Other policies that contributed to this include large increases in direct taxes (mainly corporation taxes), bringing the central bank under political control; a variety of tariffs on imports, renegotiating oil contracts with multinationals to raise state profits from oil revenues; investments in renewable energy, education, health and poverty reduction and a refusal to pay illegitimate debt.
Mauritius has increased, on average, its people’s income more than threefold from the early 1970s to the late 1990s and is the only country in Sub-Saharan Africa where average household expenditures increased significantly between 1990 and 2008. It has eliminated malaria and achieved (alongside the Seychelles) the lowest under-five child mortality rate in Sub-Saharan Africa. The government of Mauritius has pursued strong intervention in the economy, including high levels of trade protection and promotion of domestic business, combined with business-friendly policies and sequenced, gradual liberalisation.
In just over half a century, South Korea has journeyed from chronic poverty to aid donor. It has achieved an astronomical rise in gross national income per capita while its citizens enjoy a life expectancy of 82 and low maternal, child and infant mortality rates. Key to these achievements has been strong government intervention in the economy, with key policies being: gradual and carefully sequenced opening of markets; nurturing of domestic firms (especially to promote exports); restrictions on foreign investment; government ownership of banks; and the state’s promotion of technology and research and development.
Our research also examined two countries that are often cited as success stories of the market fundamentalism approach: Botswana and Chile. We found that – in sharp contrast to the “received wisdom” about their experience – the progress that they have made in addressing poverty and improving health cannot in fact be attributed to their pursuit of market fundamentalism.
It is important to recognise that none of the countries that have rejected market fundamentalism have been successful on all fronts, and there remain deep problems in some. In Ecuador, government policies have often oppressed or ignored indigenous peoples, failed to tackle labour abuses and continued some market fundamentalist policies, for example by promoting private health care. Mauritius has achieved success while offering itself as a tax haven to global investors. And whilst South Korea has achieved massive reductions in poverty, its people report low levels of wellbeing – although this has been attributed to a recent shift to more market fundamentalist approaches.
But the underlying message is clear: there are alternatives to market fundamentalism which can provide inspiration for those of us concerned with improving people’s health and well-being.
Recommendations to reach a Life in Full
On the basis of our research into what has worked to improve people’s health, Health Poverty Action has formulated the following recommendations to reach a Life in Full:
The World Bank must stop undermining health through its ideologically driven promotion of market fundamentalism and stop promoting private care through public private partnerships.
Donor governments must end aid that promotes market fundamentalism such as opening up markets or supporting private healthcare in their own ideological interests.
All governments should explore alternative measures of health and wellbeing, rejecting GDP as the main indicator of progress.
Governments and NGOs should give greater recognition to, and learn from alternative approaches such as indigenous concepts of health and wellbeing.
NGOs must:
Ensure that aid projects are not simply part of broader market fundamentalist approaches on the part of donors.
In all public communications about our work providing services, articulate the political and economic climate driving the need for it.
Refuse to take part in projects or events which deny space to alternative voices.
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Contribution by Health Poverty Action to the Annual Report 2017 of the MMI Network
The Alternatives report and related video clips: https://www.healthpovertyaction.org/speaking-out/the-alternatives-global-perspectives-for-healthier-lives/