Galveston.qxd 4/19/00 12:29 PM Page i Health & Human Development in the New Global Economy: The Contributions and Perspectives of Civil Society in the Americas Editors Division of Health and Human Development Pan American Health Organization Regional Office of the Americas Alexandra Bambas World Health Organization Juan Antonio Casas Harold A. Drayton University of Texas Medical Branch América Valdés Washington, D.C., U.S.A., © 2000 Galveston.qxd 4/19/00 12:29 PM Page ii Reference Bambas, Alexandra; Casas, Juan Antonio; Drayton, Harold A.; and Valdés, America. (Eds.) (2000). Health and Human Development in the New Global Economy: The Contributions and Perspectives of Civil Society in the Americas. Washington, DC: Pan American Health Organization (PAHO/WHO). This publication derives from presentations and discussions at the Seminar/Workshop co- sponsored by the University of Texas Medical Branch, the Pan American Health Organization, and the World Health Organization, which was held in Galveston, Texas, USA, October 26-28, 1998. Materials in this publication may be freely quoted or reprinted, but acknowledgement is requested together with a reference to the title and the ISBN number. A copy of the publication containing a quote or reprint should be sent to the Division of Health and Human Development of the Pan American Health Organization/WHO, 525 Twenty-Third Street NW,Washington,DC 20037, and another to the UTMB/WHO Collaborating Center for International Health, 301 University Blvd., Galveston, Texas 77555. Copyright 2000 by the Pan American Health Organization, unless otherwise noted. Library of Congress Catalog Card Number: ISBN In order to disseminate this information broadly, at the time of publication, this document is available in full text on the World Wide Web in English at www.paho.org/english/hdp/hdp.htm and in Spanish at www.paho.org/spanish/hdp/hdp.htm. This site may include additional information or perspectives developed since the publication of this book. The views expressed in this publication are those of the authors and do not necessarily reflect the views of the institutions these individuals represent. Galveston.qxd 4/19/00 12:29 PM Page iii TABLE OF CONTENTS FOREWORD . vii ACKNOWLEDGEMENTS . xi EDITORS AND CONTRIBUTORS . xiii SETTING THE STAGE FOR THE WORKSHOP. xv Opening Remarks to the Workshop Harold A. Drayton . 1 Introduction to the Workshop: Health and Human Development in the Global Economy Sir George A.O. Alleyne. 3 INTERNATIONAL AND REGIONAL INTEGRATION PROCESSES IN THE NEW GLOBAL ECONOMY. 13 Globalisation and Health Policy: A Review of the Literature and Proposed Research and Policy Agenda Kelley Lee. 15 The International Dimensions of Economic Development Clive Thomas . 43 NAFTA and the Persistence of Poor Labor Conditions in Chile Fernando Leiva Letelier . 61 The FTAA: Reality and Expectations Manuela Tortora. 71 Towards a Caribbean-American Strategic Alliance Norman Girvan . 77 Social Policy and the FTAA Manuela Tortora. 97 Healthy Public Policy and the World Trade Organization: A Proposal for an International Health Presence in Future World Trade/Investment Talks Ronald Labonte . 105 Globalisation, International Health, and A New International Relations Framework Alberto J.F. Cardelle . 121 Galveston.qxd 4/19/00 12:29 PM Page iv iv HEALTH & HUMAN DEVELOPMENT IN THE NEW GLOBAL ECONOMY CASE STUDIES ON THE EFFECT OF ECONOMIC REFORM POLICIES ON HEALTH. 127 Market Failures and Moral Failures: The Privatization of Health in Peru Jim Kim, Aaron Shakow, and Jaime Bayona . 129 The Impact of Structural Adjustment Policies on Health and Health Services in the Caribbean Elsie Le Franc. 146 Malaria Control in Nicaragua: Political and Social Influences in Disease Transmission and Control Activities Richard Garfield. 161 THE POTENTIAL CONTRIBUTION OF CIVIL SOCIETY. 171 The Potential Role of Transnational Civil Society in Health Development in the Americas: Lessons from the NGO Revolution in International Law and International Relations David P. Fidler . 173 Civil Society Participation Dev K. Ray . 195 Democratization, Health Care Reform, and NGO-Government Collaboration: Catalyst or Constraint? Alberto J. F. Cardelle . 203 Governability and Governance: Toward Health and Human Development Juan Antonio Casas, Rita Delia Casco, Cristina Torres-Parodi . 231 OPPORTUNITIES AND RISKS PRESENTED BY GLOBALIZATION: COUNTRY CASE STUDIES FROM THE PERSPECTIVE OF CIVIL SOCIETY GROUPS. 257 Notes on Globalisation and the Environment for Women’s Reproductive Health in the English-Speaking Caribbean: The Guyana Example Jocelyn Dow and Andaiye. 257 Three Responses to the Comprehensive Health System Reform by Civil Society in Guatemala Hugo Icú . 265 The Risks Involved in Health Sector Reform and the Role of Civil Society in Guatemala: Moving from a War-time Economy to a Market Economy Juan Carlos Verdugo . 277 Nicaragua: The Struggle for Health María Hamlin Zúniga . 297 Galveston.qxd 4/19/00 12:29 PM Page v TABLE OF CONTENTS v A Response by Women to the Rapid Diminution of Health and Other Social Services as a Result of the Application of Neoliberal Economic Policies in Nicaragua Dorothy Granada . 305 The Effect of the Neoliberal Economy on El Salvador Jose Danilo Ramírez Martínez . 309 Health, Basic Sanitation and the Generation of Employment and Income: Paths to Sustainable Development Vicky Schreiber . 313 CONCLUSION. 323 Final Remarks Alexandra Bambas . 325 Galveston Declaration on Health and Human Development in the Americas . 329 Galveston.qxd 4/19/00 12:29 PM Page vi Galveston.qxd 4/19/00 12:29 PM Page vii FOREWORD ne World, Two Fates,” accurately describes the global future foretold in a recent article published in the British journal The “OEconomist.1 The article reports that 98% of deaths in children under five years of age occur in developing countries and makes a plea for strengthening global structures that promote health and nutrition, such as the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO). The author suggests that the growing economic surpluses generated by financial speculation and world trade should be reinvested in the human development of the less fortunate. This concern for and attention to the human and social effects of globalization is growing. The United Nations has just published its Human Development Report 1999, which also addresses the positive and negative effects of globalization, and many other international health & development organizations have focused their efforts on understanding and influencing this phenomenon for social benefit. Without a doubt, “globalization” has become the leitmotiv of our times. In this new world of dramatic polarization in the distribution of wealth and opportunities, the poorest 20% of humankind benefits from less than the 1% of the wealth, trade, and direct external investment, while the richest 20% of the global population takes 86% of the global economic product. In terms of access to and use of the information and communications media, the growing disparity is even more flagrant: the poorest sector utilizes just 1.5% of telephone lines and constitutes only 1 Jeffrey Sachs, “Helping the Poorest”, The Economist. 14 August 1999. Galveston.qxd 4/19/00 12:29 PM Page viii viii HEALTH & HUMAN DEVELOPMENT IN THE NEW GLOBAL ECONOMY 0.2% of Internet traffic. It is estimated that half of the inhabitants of our planet have never received a telephone call, an indication of just how far we are from creating a equitable a world society that provides fair opportunities for all.2 So where will all this disparity and polarization lead? Some of the foremost ideologues of the New World Order, such as George Soros, Paul Krugman, and Jeffrey Sachs, have anxiously called on those in government to establish new regulatory structures for the market, with a view to reducing economic and social instability in the most vulnerable countries. It is apparent that failing to protect populations at risk for the negative effects of globalization on a worldwide scale is indefensible, as ever-growing numbers of human beings become marginalized from the global economy. The course that we chart for the new century, then, will depend on our ability to find new and just modalities of governance at the national and global levels. Shaping the specific process of globalization is a core priority for the Strategic and Programmatic Orientation of the Pan American Health Organization (PAHO) in health and human development. Accordingly, PAHO’s Division of Health and Human Development, together with support from the University of Texas Medical Branch-WHO Collaborating Center for International Health (UTMB), is interested in disclosing and publicizing the presentations of experts made at the meeting “Health and Human Development in the New Global Economy: Experiences, Opportunities, and Risks in the Americas,” held in Galveston from 26-28 October 1998. The objective of this forum was to examine the impact of the economic globalization process and technological change on health trends in the Region of the Americas. More specifically,the meeting sought to explore how civil society groups can influence the formulation of healthy public policies and monitor equity, in terms of both the health situation and the distribution of health care resources. One of the recommendations that emerged from the meeting was to establish mechanisms within the context of Panamericanism that will facilitate the continuity of a broad partnership between state and non-state actors to promote the adoption of healthy public policies in every country in the Americas, expressed through the “Galveston Declaration,” included in this publication. PAHO hopes that this publication will be of use to decision-makers, experts in the field of health and development, and emerging civil society groups in the Latin American and Caribbean countries, and will help them to better address the enormous risks facing the different sectors of society as a result of globalization and to take advantage of the tremendous potential this process affords, creating a solid foundation for investing in health.