This book explores the history of and current collision between two of the major global phenomena that have characterized the last 30 years: the spread of HIV and AIDS and other diseases of poverty and the ascendancy of neoliberal economic ideas. The book explains not only how International Monetary Fund policies of restrictive spending have exacerbated public health problems in developing countries, in particular the HIV and AIDS crisis, but also how such issues cannot be resolved under these economic policies. It also suggests how mounting global frustration about this inability to adequately address HIV and AIDS will ultimately lead to challenges to the dominant neoliberal ideas, as other more effective economic ideas for increasing public spending are sought. In stark, powerful terms, Rowden offers a unique and in-depth critique of development economics, the political economy dynamics of global foreign aid and health institutions, and how these seemingly abstract factors play out in the real world - from the highest levels of global institutions to African finance and health ministries to rural health outposts in the countryside of developing nations, and back again.
Health equity in economic and trade policies
The EU and the ACP countries aim to conclude the Economic Partnership Agreements (EPAs) by the end of December 2007. All parties agree that these trading arrangements are meant to be first and foremost “development instruments”. However, their positions differ greatly on how the EPAs will impact on the ultimate goal of poverty reduction. In this policy note Marikki
Stocchetti addresses the key issues of this disagreement.
This study reviewed evidence on the impact of reproductive, maternal, newborn, and child health (RMNCH) on economic growth and development. The authors performed a systematic search of the published literature in electronic databases and consulted grey literature such as working papers and reference lists of selected articles. They found that GDP loss attributable to maternal mortality varies from US$0 per year in Botswana to US$504 per year in Ethiopia. If maternal mortality increases by one death, GDP per capita decreases by US$0.36 per year on average in 45 sub-Saharan countries. AIDS was found to have a negative effect on economic growth, especially in sub-Saharan Africa, although the magnitude varies among studies from 0.05% to 1% decline in GDP per capita. The intergenerational effect of HIV and AIDS is much higher, at 30-50% reduction of GDP per capita over four generations at a 15-20% HIV prevalence rate. The review revealed inadequate evidence on the impact of RMNCH on economic growth and development, which may, in part, be due to difficulties in measuring economic impact over extended time periods, and may also be due to the breadth of health states that fall within the RMNCH continuum. The authors argue that future research should focus on identifying the most cost-effective policy, programmes and interventions to prevent, reduce, delay or eliminate the complications of RMNCH.
The ‘brain drain’ has long been a common concern for migrant-sending countries, particularly for small countries where high-skilled emigration rates are highest. However, while economic theory suggests a number of possible benefits, in addition to costs, from skilled emigration, the evidence base on many of these is very limited, according to this review. Moreover, the lessons from case studies of benefits from skilled emigration may not be relevant to much smaller countries. This paper presents the results of innovative surveys which tracked academic high-achievers to wherever they moved in the world in order to directly measure at the micro level the channels through which high-skilled emigration affects the sending country. The results show that there are very high levels of emigration and of return migration among the very highly skilled. The income gains to the best and brightest from migrating are very large, and an order of magnitude or more greater than any other effect. There are large benefits from migration in terms of postgraduate education. Most high-skilled migrants from poorer countries send remittances; but involvement in trade and foreign direct investment is a rare occurrence. There is considerable knowledge flow from both current and return migrants about job and study opportunities abroad, but little net knowledge sharing from current migrants to home country governments or businesses. Finally, the fiscal costs vary considerably across countries, and depend on the extent to which governments rely on progressive income taxation – the greater the reliance on progressive taxation, the higher the fiscal cost of losing health professionals to the economy.
This study’s objective was to assess the effect of food taxes and subsidies on diet, body weight and health through a systematic review of the literature. Researchers searched the English-language published and grey literature for empirical and modelling studies on the effects of monetary subsidies or taxes levied on specific food products on consumption habits, body weight and chronic conditions. Twenty-four studies met the inclusion criteria. The study found that, in general, taxes and subsidies influenced consumption in the desired direction, with larger taxes being associated with more significant changes in consumption, body weight and disease incidence. However, studies that focused on a single target food or nutrient may have overestimated the impact of taxes by failing to take into account shifts in consumption to other foods. The quality of the evidence was generally low. The study concludes that food taxes and subsidies have the potential to contribute to healthy consumption patterns at the population level. However, the empirical evaluation of existing taxes should become a research priority, along with research into the effectiveness and differential impact of food taxes in developing countries.
The health consequences of tobacco use are well known, but less recognised are the significant environmental impacts of tobacco production and use. The environmental impacts of tobacco include tobacco growing and curing; product manufacturing and distribution; product consumption; and post-consumption waste. The World Health Organisation’s Framework Convention on Tobacco Control addresses environmental concerns in Articles 17 and 18, which primarily apply to tobacco agriculture. Article 5.3 calls for protection from policy interference by the tobacco industry regarding the environmental harms of tobacco production and use. The authors detail the environmental impacts of the tobacco life-cycle and suggest policy responses.
The objective of the study was to examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing. Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. The authors interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, the authors used multilevel regression models controlling for potential confounders. Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries. Of the 11 842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries. For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities. Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.
This report traces the trends and patterns in economic and non-economic aspects of inequality and examines their causes and consequences across and within regions and countries. It focuses on the gaps between the formal and informal economies and between skilled and unskilled workers, the growing disparities in health, education and opportunities for social, economic and political participation as well as analysing the impact of structural adjustment, market reforms, globalisation and privatisation on economic and social indicators.
The authors of this paper argue that there is scope to balance current fiscal consolidation efforts in favour of more equity with only limited adverse impact on potential growth. In particular, relatively little weight has been given to reducing tax expenditures and raising taxes on immovable property. A number of consolidation instruments are consistent with equity goals while doing little or no harm to potential growth: increases in the effective retirement age, raising efficiency in the education and health care systems, cutting certain tax expenditures, hiking taxes on immovable property and broadly-based consumption taxes. Increases in capital income taxes would also be equitable but need to be well designed to avoid being distortive. Calculations based on simplifying assumptions indicate that increasing household direct taxes would reduce income inequality, while cutting transfers by the same amount would have a larger and opposite effect on inequality. However, raising progressive labour income taxes could have adverse effects on long-run growth. Cuts in government wages and employment can yield fast consolidation gains but the authors warn that this needs to be accompanied by increases in efficiency of service delivery to avoid that reductions in public services mainly hit poor people.
The Joint Africa-EU Strategy (JAES) launched by European and African leaders at the Lisbon summit of 2007 is argued to have so far failed to deliver on its key promise to fundamentally transform development and political cooperation between the continents. Three years of uncertain implementation reveals just how wide a gap separates the rhetoric and reality of the new strategic partnership. This policy brief shows how the Joint Africa-EU Strategy has struggled to integrate some pre-existing frameworks and transform the logic of elevated partnership. Both sides admit difficulties in the face of unfulfilled expectations of additional European Union (EU) funding. At the same time implementation of the agreement is clouded by dissonant discourses from both sides of the negotiation table. To complicate matters further, institutional complexity in Europe is met by an embryonic process of continental integration in Africa.