Re: global health vs. welfare

Dr. Barendse,

There is also a serious bottleneck with respect to pharmaceutical
companies and patent rights. One of the issues sure to be raised at the
WTO meetings is strengthing controls over drug patents. AIDS and other
diseases concentrate in the periphery where people haven't the resources
to buy the outrageously expensive medications the major pharmaceuticals
monopolize (medications subsidized by the tax dollars of citizens in the
core countries). Pharmaceutical industry spokespersons offer all sorts of
excuses, such as that Third World people haven't the sophistication to
participate in the complex drug therapy regimes that people in the core
can manage, if they can afford it. Drug companies claim their profits
would be damaged, but estimates show that local generics produced at cost
would have minimal impact on the industry. Neither of these excuses are
good excuses. The emphasis on profits is all wrong, anyway. Peripheral
physicians and many doctors in the core are tired of having to send their
patients home to die when there are drugs available that could either cure
their ailment or greatly ameliorate their suffering.

Andy Austin

On Thu, 2 Dec 1999, Dr. R.J. Barendse wrote:

>On John R. Groves' posting:
>>
>>>dear WSNers: Chase-Dunn's point on global social security echoes my own 
>on
>>>global health care.
>>
>assuming these questions are addressed to me rather than to Chase Dunn,
>since
>Chase Dunn did not drop that term and I did.
>>
>>I would argue that health care might be easier to start with
>>>since we can identify a minimal state of health to aim at in the
>beginning.
>>I
>think it would also be a smaller investment. It could increase over time.
>>
>    Precisely - let's start combating malaria for a start; a program which
>on the point of nearly eradicating malaria was stopped by the WHO because 
>it
>was short of 200 million and the US didn't want to contribute. (And all 
>this
>while the US is investing 2 billion + in a missile-defense system against
>attacks from God only knows who ...). So that malaria-mosquitoes resistant
>to any known remedy have now re-emerged and are already threatening 300
>million people in West Africa, with these malignant new forms of malaria
>already spreading to the Middle East, South Asia and in the very near 
>future
>Southern Europe, Latin America and hence the southern United States.
>
>    We have NOT won the war on viruses (never will really) and if humanity
>as a whole does not continue to heavily invest in combating this threat -
>sparing neither rich nor poor - the combination of global poverty and 
>global
>communication is going to insure the spread of epidemics comparable to the
>bubonic plague. A vastly more concrete and immediate thread to the US than
>some missile-attack in the God knows how distant future - Malaria is one
>immediate candidate, new more deadly forms of AIDS - which already appear 
>to
>be emerging in Africa - being another.
>
>    N. B. lest I be accused of racism - Africa is the main fulcrum of
>epidemic infections on the moment not because it's black, but because both
>its states and its people are poor - and thus also poorly able to prevent
>the spread of epidemics - And as it is undergoing a transport-revolution on
>the moment, in which so far isolated `disease pockets' are brought in
>contact with the rest of the continent and hence, ultimately, the world.
>Epidemic disease spreads together with trucks and minibuses on the
>continent.
>>>
>>>I am wondering what sort of program of global social security or welfare
>>system
>>>(it wouldn't only be for the elderly, right?--I may be misunderstanding,
>so
>>>forgive me if I am) would be at all acceptable to core states.
>>
>    That's a major problem but let's begin with the beginning, as you say 
>in
>Dutch - the big problem on the moment in the Third World is youth - not -
>yet - the elderly.
>
>    But that's surely going to come: each family on the moment in the
>Ghaza-strip, for example,  has ON AVERAGE 8 children now. I see utterly no
>way the economy of a future independent Palestine state is ever going to
>afford to pay the pensions for all these people in fifty years; meaning 
>that
>the Palestine state is going to depend on alms from the `internal 
>community'
>and on remittances of its workers abroad for at least the next century.
>
>    But even a 4.000 miles journey starts with the first mile. So, let's 
>say
>that programs to combat child-labor,  - I mean LABOR here for the market
>not merely helping on the farm - which are generally being discussed and
>evoke a lot of popular attention should be accompanied by a program to
>ensure general, obligatory, primary schooling for children. With the
>government promising to compensate for lost incomes to the parents during
>the schooling of the children - otherwise the parents are still going to
>send their children off to work no matter what noble intentions of the
>government. If, say, Third World governments undertake to promise this,
>they'll be permitted to participate in a global UNESCO-led program to
>ensure primary education to all children before, say, 2040 through funding
>of schools and teachers, which is mainly going to be paid by the first
>world.
>
>    The second big problem on the moment in the Third World is unemployment
>and, coupled to this, low wages and abysmal working-conditions, 
>particularly
>among very young people - 12 to 16, really children to a US-citizen -.
>
>    Therefore - and I understand that's being discussed in Seattle on the
>moment - we should come to a global labor-code, ensuring minimum wages,
>health and safety at work and - but that's not (yet) being discussed - the
>global introduction of labor-inspections to implement this. (- As was
>pointed out for Brasil but that's equally true for the so-called
>`fundamental rights' in the Constitution of India - the point is  NOT that
>many Third World countries lack declarations of intent on social
>legislation - the point is they have no way to implement these noble
>intentions.)
>
>    What the WTO should arrive at is that the `first world' should 
>guarantee
>that this will not lead to job-losses in the Third World through
>trans-national corporations withdrawing investments from the Third World
>countries, if
>they raise wages. Therefore, the WTO should ultimately come to a code of
>conduct for TNC's - to be reinforced with fines if they offend against 
>this.
>
>    All this is very much music for the future for now - but just keep up
>the
>pressure on the WTO ! They'll be forced to come with some result now - if
>only to silence all the negative publicity!
>>
>>Should the people
>>>of the U.S. agree to contribute to a minimum income for a billion 
>Indians?
>>A
>>>billion Chinese? What is the extent of the core's responsibility to the
>>>periphery?
>
>    Do I hear something of good old US-isolationist sentiments here ? In
>spite of all avowed internationalism of this list. Well - you can't escape
>your culture can't you ? But for a start - if the US is serious about
>wanting
>to be the leader of the global community - let it really pay the
>contribution it's
>still due to the United Nations.
>
>    As to the extent of the core's responsibility to the periphery, that's
>simple - either the core takes responsibility for the periphery, or the
>entire periphery is going to come to the core. For the periphery is
>motorized by now - every villager in El Salvador can nowadays take a bus to
>the USA - when I was in a provincial town in Ghana four months ago I
>practically everyday met people who had lived for years in Amsterdam three
>or four blocks away from my home here. In a `globalized' world the Center
>can not simply shift responsibility to the periphery anymore.
>
>>    What if India's population keeps growing? Are Americans also
>>>committed to a minimum income to the people of a country that has lost
>>control
>>>of its population growth?
>>>
>    Actually percentage-wise Indian population growth is not much higher
>than that of the US. But that's really putting the question upside down. It
>may be a truism but it's still useful to remind you that children are an
>old-age insurance in the Third World. The best way to combat global
>population growth and therewith the global thread to the environment is
>insuring a minimum income, a pension, schooling for women AND insure
>children of a decent education until the minimum-age of, say, 16. For if
>parents have to wait many years for their `initial investment' in a child 
>to
>pay-off, they're going to take less children. Note, again, that the
>European experience tends to indicate these are global, 
>culture-independent,
>mechanisms. Believe it or not - the country with the lowest
>population-growth in western Europe on the moment is Italy, in spite of its
>Roman-catholic religion and a culture which values nothing more than having
>children.
>
>    Well, since I don't want to be accused of cloaking people's mail-boxes 
>I
>better cease here - I apologize in advance for posting.
>
>Best wishes
>R.J. Barendse
>
>
>
>