Health equity in economic and trade policies

The impact of the global financial crisis on the budgets of low-income countries
Development Finance International: 2010

This report, written for Oxfam, examines the impact of the global financial crisis on the budgets of low-income countries, especially their spending to reach the Millennium Development Goals (MDGs). It points out that the current global economic crisis has created a huge budget revenue hole of US$65 billion, of which aid has filled only one-third. As a result, after some fiscal stimulus to combat the crisis in 2009, most low-income countries (LICs) – including those with International Monetary Fund (IMF) programmes – are cutting MDG spending, especially on education and social protection. They have also had to borrow expensive domestic loans, and increase anti-poor sales taxes. The report argues that almost all LICs could absorb much more aid without negative economic consequences (whereas they have much less space to borrow or to raise taxes). It urges the international community to make strong new aid commitments at the Millennium Summit in September 2010, funded by financial transaction taxes or other innovative financing. The IMF should encourage LICs to spend more on MDG goals and on combating climate change and to report regularly on such spending, and LIC governments should increase spending on social protection and education, and bolster efforts to fight tax avoidance.

The impact of transnational ‘Big Food’ companies on the South: A view from Brazil
Monteiro CA and Cannon G: PLoS Medicine 9(7), 3 July 2012

Traditional long-established food systems and dietary patterns are being displaced in Brazil and in other countries in the South (Africa, Asia, and Latin America) by ultra-processed products made by transnational food corporations (‘Big Food’). This displacement, the authors of this paper argue, is increasing the incidence of obesity and of major chronic diseases and affects public health and public goods by undermining culture, meals, the family, community life, local economies, and national identity. In Brazil, the penetration of transnational companies has been rapid, but the tradition of shared and family meals remains strong and is likely to provide protection to national and regional food systems. The Brazilian government, under pressure from civil society organisations, has introduced legislation to protect and improve its traditional food system - by contrast, the governments of many industrialised countries have partly ceded their prime duty to protect public health to transnational companies. The authors recommend that the experiences of countries like Brazil in the South that still retain traditional food systems should be used as a basis for policies that protect public health.

The Implementation Game: The TRIPS Agreement and the Global Politics of Intellectual Property Reform in Developing Countries
Deere C: Oxford University Press, November 2008

This new book provides extensive evidence and data in accessible format for researchers and policymakers in the field of intellectual property rights and gives background information on the origins of the TRIPS Agreement for readers new to the subject. For scholars of international political economy and law, it is the first detailed exploration of the links between global IP politics and the implementation of IP reforms. It exposes how power politics occur not just within global trade talks but afterwards when countries implement agreements. The Implementation Game will be of interest to all those engaged in debates on the global governance of trade and intellectual property.

The institutional context of tobacco production in Zambia
Labonté R; Lencucha R; Drope J: Globalisation and Health 14(5) doi: https://doi.org/10.1186/s12992-018-0328-y, 2018

Tobacco production is said to be an important contributor to Zambia’s economy in terms of labour and revenue generation. In light of Zambia’s obligations under the WHO Framework Convention of Tobacco Control (FCTC) the authors examined the institutional actors in Zambia’s tobacco sector to better understand their roles and determine the institutional context that supports tobacco production in Zambia. Findings from 26 qualitative, semi-structured individual or small-group interviews with key informants from governmental, intergovernmental and non-governmental organisations were analysed, along with data and information from published literature. Although Zambia is obligated under the FCTC to take steps to reduce tobacco production, the country’s weak economy and strong tobacco interests make it difficult to achieve this goal. Respondents uniformly acknowledged that growing the country’s economy and ensuring employment for its citizens are the government’s top priorities. Lacklustre coordination and collaboration between the institutional actors, both within and outside government, contributes to an environment that helps sustain tobacco production in the country. A Tobacco Products Control Bill has been under review for a number of years, but with no supply measures included, and with no indication of when or whether it will be passed. As with other low-income countries involved in tobacco production, there is inconsistency between Zambia’s economic policy to strengthen the country’s economy and its FCTC commitment to regulate and control tobacco production. The absence of a whole-of-government approach towards tobacco control has created an institutional context of duelling objectives, with some government ministries working at cross-purposes and tobacco interests left unchecked. With no ultimate coordinating authority, this industry risks being run according to the desire and demands of multinational tobacco companies, with few, if any, checks against them.

The interim economic partnership agreements between the EU and African States: Contents, challenges and prospects
ECDPM and ODI: July 2009

To date, claims about the likely development effects of economic partnership agreements (EPAs) have been speculative because the final details of the agreements were unknown. The conclusion of a full EPA with the CARIFORUM region and interim EPAs (IEPAs) with some African and Pacific states makes it possible to analyse what has actually been agreed and to assess the potential development effects. This book provides a comprehensive analysis of the African IEPAs as they stand in early 2009. It also establishes the negotiations that remain to be completed and the challenges facing Africa in implementation, some of which require support from Europe. It provides both a summary of the principle features of very complex documents and also the foundations for the many follow-up studies that will be needed to look in more detail at specific country, sectoral and other specific features of the IEPAs.

The International Monetary Fund and the Ebola outbreak
Kentikelenis A, King L, McKee M, Stuckler D: The Lancet, 21 December 2014

In recent months, the International Monetary Fund (IMF) has announced US$430 million of funding to fight Ebola in Sierra Leone, Guinea, and Liberia. By making these funds available, the IMF aims to become part of the solution to the crisis, even if this involves a departure from its usual approach. As IMF Director Christine Lagarde said at a meeting on the outbreak, “It is good to increase the fiscal deficit when it's a matter of curing the people, of taking the precautions to actually try to contain the disease. The IMF doesn't say that very often.” Yet, could it be that the IMF had contributed to the circumstances that enabled the crisis to arise in the first place? A major reason why the outbreak spread so rapidly was the weakness of health systems in the region. There were many reasons for this, including the legacy of conflict and state failure. Since 1990, the IMF has provided support to Guinea, Liberia, and Sierra Leone, for 21, 7, and 19 years, respectively, and at the time that Ebola emerged, all three countries were under IMF programmes. However, IMF lending comes with strings attached—so-called “conditionalities”—that require recipient governments to adopt policies that have been criticised for prioritising short-term economic objectives over investment in health and education. Indeed, it is not even clear that they have strengthened economic performance. Here the authors review the policies advocated by the IMF before the outbreak, and examine their effect on the three health systems.

The International Monetary Fund’s effects on global health: Before and after the 2008 financial crisis
Stuckler D and Basu S: International Journal of Health Services 39(4): 771–781, October 2009

In April 2009, the G20 countries committed US$750 billion to the International Monetary Fund (IMF), which has assumed a central role in global economic management. The IMF loans to financially ailing countries come with loan conditions that have been extremely controversial. In principle, they are designed to help countries balance their books. In practice, they often translate into reductions in social spending, including spending on public health and health care delivery. This article introduces a series in which contributors review the evidence on the relationship between the IMF and public health and discuss potential ways to improve the Fund’s effects on health. While more evidence is needed for some regions, there is sufficient evidence to indicate that IMF programmes have been significantly associated with weakened health care systems, reduced effectiveness of health-focused development aid, and impeded efforts to control tobacco, infectious diseases, and child and maternal mortality. Reforms are urgently needed to ensure progress towards meeting the health Millennium Development Goals.

The Joint Africa-EU Strategy
Faria F and Laporte G: Trade Negotiations Insights 10(9), December 2010-January 2011

This article looks at the main challenges to European Union-Africa relations in light of the EU-Africa summit held in Tripoli, Libya from 29-30 November 2010. The Tripoli meeting marked the third Africa-EU Summit since 2000. In 2007, both parties to the JAES pledged to work together to implement the Africa Health Strategy, the EU Project on Human Resources for Health, the Abuja commitment to dedicate 15% of government financing for health, and the European Programme for Action to Tackle the Shortage of Health Workers in Developing Countries. President Jacob Zuma of South Africa openly expressed his concern that after ten years of the partnership, there was still too little to show in terms of tangible implementation of the undertakings made in previous summits. He cautioned the summit against committing to another action plan when commitments made in the past have not been implemented. The author noted that for example the ongoing Economic Partnership Agreement (EPA) negotiations, have become a contentious issue in EU-Africa relations, with clauses that may negatively impact on the production of affordable generic medicines for developing countries by rigorously protecting patent holders in developed countries.

The Joint Africa-EU Strategy: Quo vadis after Tripoli?
Faria F and Laporte G: Trade Negotiations Insights 10(9), December 2010-January 2011

This article looks at the main challenges to European Union-Africa relations in light of the EU-Africa summit held in Tripoli, Libya from 29-30 November 2010. The Tripoli meeting marked the third Africa-EU Summit since 2000. In 2007, both parties to the JAES pledged to work together to implement the Africa Health Strategy, the EU Project on Human Resources for Health, the Abuja commitment to dedicate 15% of government financing for health, and the European Programme for Action to Tackle the Shortage of Health Workers in Developing Countries. President Jacob Zuma of South Africa openly expressed his concern that after ten years of the partnership, there was still too little to show in terms of tangible implementation of the undertakings made in previous summits. He cautioned the summit against committing to another action plan when commitments made in the past have not been implemented. The author noted that for example the ongoing Economic Partnership Agreement (EPA) negotiations, have become a contentious issue in EU-Africa relations, with clauses for example that may negatively impact on the production of affordable generic medicines for developing countries by rigorously protecting patent holders in developed countries.

The Least Developed Countries Report 2015: Transforming Rural Economies
United Nations Conference on Trade and Development(UNCTAD): New York, November 2015

The United Nations Conference on Trade and Development Least Developed Countries (LDC’s) Report 2015 focuses on the transformation of rural economies. Assessing LDCs’ progress in agricultural productivity, the extent and nature of their rural economic diversification, and gender issues in rural transformation, it shows that agricultural productivity began to increase in LDCs in 2000, following decades of stagnation or decline, but has risen strongly only in Asian LDCs. The report also shows that rural economic diversification varies widely between LDCs, but only a few have passed beyond the stage in which non-farm activities are centred on agriculture, and that urban linkages are limited. Further, the report highlights that women comprise half the rural workforce in LDCs, but face serious constraints on realising their productive potential, slowing rural transformation. The 2030 Agenda both highlights the need and provides the opportunity for a new approach to rural development centred on poverty-oriented structural transformation (POST), to generate higher incomes backed by higher productivity. In rural areas, this means upgrading agriculture, developing viable non-farm activities, and fully exploiting the synergies between the two, through appropriately designed and sequenced efforts to achieve the SDGs. The Report argues that differentiation is needed between peri-urban, intermediate, remote and isolated rural areas and a key priority is to overcome the contradiction between need and opportunity, by which more remote areas and poorer households have the greatest need but also the most limited opportunities for income diversification. Gender-specific measures are needed to overcome disadvantages arising directly from gender norms, and more inclusive gender-sensitive approaches to address their poverty-related consequences. Access to appropriate technologies, inputs, skills and affordable finance needs to be fostered. Effective policy coordination is required nationally, while producers’ associations, cooperatives and women’s networks can play a key role locally. Innovative approaches to trade and cross-border investment could make a substantial contribution. Finally, the report highlights the importance of adequate support from the international community to achieve structural transformation and fulfil the SDGs, based on the principle that “to will the end is to will the means”.

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