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RECENT INTERNATIONAL PUBLICATIONS Code Number: hp04029 State of the World Population: The Cairo Consensus at Ten: Population,
Reproductive Health and the Global Effort to End Poverty
Countries are making real progress in carrying out a bold global action plan that links poverty alleviation to women's rights and universal access to reproductive health. Ten years into the new era opened by the 1994 International Conference on Population and Development (ICPD) in Cairo, the quality and reach of family planning programmes have improved, safe motherhood and HIV prevention efforts are being scaled up, and governments embrace the ICPD Programme of Action as an essential blueprint for realizing development goals. But inadequate resources, gender bias and gaps in serving the poor and adolescents are undermining further progress as challenges mount, according to The state of World Population 2004 report from UNFPA, the United Nations Population Fund. The report, The Cairo Consensus at Ten: Population, Reproductive Health and the Global Effort to End Poverty, reviews countries' achievements and constraints in implementing the Programme of Action, nearly half way to the 2015 completion target date. It examines actions addressing: the links between population and poverty, environmental protection, migration and urbanization; discrimination against women and girls; and key reproductive health issues including access to contraception, maternal health, HIV/AIDS, and the needs of adolescents and people in emergency situations. The plan, adopted by 179 countries in Cairo ten years ago, sought to balance the world's people with its resources, improve women's status, and ensure universal access to reproductive health care, including family planning. The starting point was the premise that population size, growth and distribution are closely linked to development prospects, and that actions in one area reinforce actions in the other. But the Cairo consensus gave priority to investing in people and broadening their opportunities, rather than to reducing population growth. Empowering women and ensuring the rights of individual women, men and young people - including the right to reproductive health and choice in determining when and whether to have children - were seen as key to sustained economic growth and poverty alleviation. Competing Concepts of Inequality in the Globalization Debate
How have the world's poorest fared since the early 1980s?
Ravallion M., The World Bank, 1818 H Street NW, Washington DC, 20433, USA Differences in the value judgments made in measuring inequality underlie the conflict factual claims often heard about how much poor people have shared in the economic gains from globalization. Opponents in the debate differ in the extent to which they care about relative inequality versus absolute inequality, vertical inequalities versus horizontal inequalities and whether or not they are consistently individualistic in assessing the extent of inequality. The value judgments on these issues made by both sides need greater scrutiny if the globalization debate is to move forward. Shaohua Chen and Martin Ravallion Development Research Group, World Bank We present new estimates of the extent of the world's progress against poverty. By the frugal $1 per day standard, we find that there were 390 million fewer people living in poverty in 2001 than 20 years earlier. Over the same period, 400 million fewer people were poor in China; half of this decline was in the early 1980s. Aggregate gains to the poor elsewhere in the world have roughly balanced the losses. A marked bunching up of people between $1 and $2 per day has emerged over time. If the trends over 1981-2001 continue then the aggregate $1 per day poverty rate for 1990 will be almost halved by 2015, though East and South Asia will be the only regions to more than halve their 1990 poverty rates. Sub-Saharan Africa has emerged as the region with the highest incidence of extreme poverty and the greatest depth of poverty. Sometimes More Equal Than Others How Health Inequalities
Depend on the Choice of Welfare Indicator.
The World Bank A large body of empirical work in recent years has focused on measuring and explaining socioeconomic inequalities in health outcomes and health service use. In any effort to address these questions, analysts must confront the issue of how to measure socioeconomic status. In developing countries, socioeconomic status has typically been measured by per capita consumption or an asset index. Currently, there is only limited information on how the choice of welfare indicators affects the analysis of health inequalities and the incidence of public spending. The purpose of this paper is to illustrate the potential sensitivity of the analysis of health-related inequalities to how socioeconomic status is measured. Using data from Mozambique, the paper focuses on five key health service indicators and tests whether measured inequality (concentration index) in the five health service variables is different depending on the choice of welfare indicator. The paper shows that, at least in some contexts, the choice of welfare indicator can have a large and significant impact on measured inequality in utilization of health service and on the perceived incidence of public spending. Consequently, we can reach very different conclusions about the "same" issue depending on how we define socioeconomic status. The results call for more clarity and care in the analysis of health-related inequalities and for explicit recognition of the potential sensitivity of findings to the choice of welfare measure. The results also point to the need for more careful research on how different dimensions of socioeconomic status are related, and on the pathways by which these dimensions affect health-related variables. Statement of the State of the Planet 2004: Mobilizing the
sciences to fight global poverty
The Earth Institute, Columbia University, March 2004 For two days, scientists from around the world gathered at Columbia University to examine the relationship between the human condition and the condition of the Earth. Focusing on four essential determinants of human well being - energy, food, health and water these leading experts assessed how science and technology can best be mobilized to achieve sustainable development. The development challenge is to enable the poor to meet their basic needs for energy, food, health, and water, recognizing that these needs are also human rights under international law and long-standing international commitments of both the rich and poor nations. The Millennium Development Goals, agreed on by all of the world's governments, are critically important poverty reduction targets to be met by the year 2015. The sustainability challenge is to achieve development while protecting the world's ecosystems, ensuring that economic activity does not undermine the biodiversity, climate, and other natural processes on which our security, well-being, and life itself depend. These scientists have identified areas for priority action as well as new research initiatives. The recommendations that follow are based on consensus achieved among a broad cross-section of these experts, and are meant to help policy makers and the public understand the scientific underpinnings in several critical areas of sustainable development. In addressing these issues, the conference participants recognized the stark contrasts of the challenges facing the rich and poor. In the poorest countries, where an estimated 800 million people are chronically hungry and where extreme poverty leads to some 120,000 avoidable deaths per day, meeting basic human needs has first priority. Providing safe energy for cooking, clean water for drinking and sanitation, sufficient food for basic nourishment, and systems for disease control and prevention are paramount and urgent global challenges, in which the high-income countries will need to help the poorest. Environmental degradation in these places is often both a direct cause and consequence of the struggle to meet basic needs on a daily basis, as when poor rural households cut down forests to clear land for farming or to harvest fuel wood for cooking. Women typically face the greatest burdens of this daily struggle for survival, and often suffer the added hardships of legal and social discrimination. In the rich countries, where basic human needs re exceeded by a very wide margin, the pursuit of increasingly affluent lifestyles also has broad and pervasive impacts on Earth. By loading the atmosphere with greenhouse gases, the high-income countries are making a dangerous contribution to long-term climate change, with potentially dire risks for societies both rich and poor in all parts of the world. Maintaining and indeed improving the standard of living in the developed world without irreversibly depleting global resources and altering natural systems is the rich world's sustainability challenge. The world therefore faces multiple and complex challenges: extreme poverty and the environmental degradation causing and resulting from poverty, as well as pervasive environmental consequences of affluence that must be brought under control. Ecosystem resilience and stability, which sustains healthy human communities, must be maintained through environmentally sustainable practices in energy, food, water and health management. The scientists have therefore aimed to identify paths of sustainable development, which will permit the poorest of the poor to improve their lot decisively, while permitting the rich to enjoy improvements in living standards as well, but in both cases in a manner that protects the environment and the vital services of the Earth's ecosystems. These problems are amenable to human solutions, but only under four circumstances which constitute overarching recommendations of the scientists. Over-arching Recommendations
The Arithmetic of Health Care
Janice Mackinnon, Policy Matters, IRPP, July 2004 There is a simple arithmetic to the rising costs of health care, just as there was to the growing deficits and debt of the 1980s and early 1990s. Health care costs re increasing at a faster rate than the revenue of any government, and other critical priorities are being under funded in the scramble to cover those costs. Despite enormous investments of new money, Canada's health care performance lags behind that of other Western countries such as Sweden. Yet, attempts to change the system are constrained by an ideological debate in which new ideas are often branded as taking Canada down the road to Americanization, privatization or two-tiered health care. Canadian governments need to make their health care systems more effective and affordable, and in doing so they should look to models beyond North America. New ways to fund health care are also needed, to prevent costs from continually squeezing out funding for other government priorities like education. The provincial case that there is a fiscal imbalance between the responsibilities of the provinces and the revenue available to the federal government rests upon some debatable assumptions. Also, an analysis of the position of Quebec, the only provincial government to specify the amount of new money it is requesting from Ottawa, shows that the federal government would have to go into deficit to meet the province's funding demands. In determining its level of investment in health care, the federal government should avoid traveling the road taken by the provinces: under funding other priorities and returning to deficit. If Ottawa commits to an escalator - a fixed formula to increase federal funding -then its investment in health care should increase at the same rate as the federal revenue. A federal commitment to pay a fixed share of health care costs would lead to a disproportionate share of federal money being committed to health in terms of other federal priorities. Also, Canada's experience with federalprovincial cost sharing in the 1980s shows that it is bad public policy to have one level of government running a Programme like health care while another level is committed to paying a share of its costs with no power to administer the programmes and ensure their cost-effectiveness. Provinces are already raising taxes, fees or premiums to help cover the costs of health care. The question, then, is what an ideal revenue-raising measure should look like. It must be fair and it should be based on income or ability to pay. A fee should not be charged at the point of service, since this could deter people from seeking needed care, but should be charged annually. The amount charged should be related to the individual's use of the system. People need to take more responsibility for their own health care choices and have a greater sense of the costs of the system. There is also the issue of intergenerational equity. The funding of health care through general tax revenues has led to under funding of education and higher tuition fees and student debt for people who, in addition, have to pay interest on the public debt racked up for programmes they do not benefit from. To expect the same young people to pay higher taxes for health services that they use less than older Canadians is to place a further fiscal burden on their generation. With shortages of educated, skilled workers looming in the next decade, governments will not fare well in the international competition for such people if they burden them with high tax loads for services they little use; hence the need to link revenue measures to pay for health care with use of the health care system. If the original goals of medicare are to be preserved, the current health care system will have to be changed. In addition, new ways to pay for health care will have to be found so that other government priorities can be adequately funded. Health care may be Canadians' highest priority, but it is not their only priority. Does earmarked donor funding make it more or less likely
that developing countries will allocate their resources towards
programmes that yield the greatest health benefits?
Global Governance: The Next Frontier
Catriona Waddington: Bulletin of the World Health Organization 2004; 82:703-708 It should not be assumed that earmarked donor funding automatically increases the allocation of developingcountry resources towards programmes that yield the greatest health benefits. Sometimes it does, sometimes it does not - how the funding is designed can influence this. This is true particularly in the longer term, once the earmarked funding has ended. Even in the short term, total funding does not necessarily increase because of fungibility (i.e. recipient governments adjust their spending to offset donor funding preferences). The author explores six problems with earmarked funding: the multiplicity of earmarked funds confuses the situation for decision-makers; earmarking works against the spirit of the sector wide approach; from the national perspective, it makes sense not to double-fund activities; local ownership of an activity is often compromised; earmarking can lead governments to accept interventions which they cannot afford in the longer term; and earmarking can distort local resource allocation. The dilemma faced by developing countries which are offered the prospect of applying for international aid for a specific intervention such as vaccination, for example, are similar to those that beset a town council planning its budget. Imagine a council meeting in a small poor town: the council considers applying for some earmarked funds - one of 15 such initiatives it has discussed during the past year which, together, are worth US$100,000. Now picture another scenario: at its annual discussion, the council has good news: a consortium of donors has agreed to increase its budget by US$100,000, and papers have already been signed describing in broad terms the processes to be used for deciding how the money will be spent. Which council meeting is more likely to end up with a decision to allocate resources to activities that yield the greatest benefits? Obviously, there is no correct answer, as it depends on a variety of factors. In the short term, it is perhaps likely that spending will rise on the earmarked activity. But even then, it depends: is the application process too complicated to make applying worthwhile? When the money is received, does the council react by moving its own money away from that activity, meaning that overall spending has not increased as much as may initially appear? In the long term, the earmarked funding will cease. What happens then depends on what the council thinks about the activity. Is it a council priority? Does the council" own" the programme? Has the council become accustomed to not funding the earmarked activities itself? Rik Coolsaet When the Cold War ended, it was generally thought that a new international era was about to begin. Emphasis on military security seemed to fade away. International diplomacy turned its efforts and attention to those challenges that were of importance to everybody's daily life. Globalization was to become a source of wealth for all, economic, social, technological and cultural wealth. A series of global conferences laid the groundwork of an ambitious global inclusive agenda aimed at the sustainability of mankind, governed by multilateral cooperation and institutions and binding rules for all. It was now widely recognized that anybody's fate ultimately depended upon everybody's fate. The once clear border between domestic and international had become porous. The nineties witnessed the rise and fall of this sense of a shared global fate. Intractable problems, both economic and political, challenged the prospects of rapid successes in global governance. Member states failed to buttress the institutions intended to deal with global problems with the resources needed to attain the goals that they were expected to pursue. The international community failed to put an early end to human suffering in Somalia, former Yugoslavia or Rwanda. States imploded, especially in Africa, often with the international community as a powerless bystander. Then came September 11, Afghanistan and Iraq. Moreover, globalization turned out to also encompass a dark side. Drugs and human trafficking, organized crime, environmental degradation, infectious diseases and financial turmoil showed how the impact of borderless forces have exploded faster than our ability to cope with them. These issues are like global warming: the consequences are diffuse and only perceptible in the long term. But at a certain point, the resulting strains will have become uncontrollable. Started in an atmosphere of euphoria and a strong belief in the feasibility of the polity, the post-Cold War ended in its mirror image. We are now living in times of global tensions and divisions, where consensus and cooperation have become endangered species. Disillusion, anxiety and uncertainty are now major characteristics all around the world. Worldwide public opinion surveys indicate that people all across the globe views their future in dire terms. Large majorities in many parts of the world, when asked whether they think the children of today in their countries will be better or worse off when they grow up than people now, reply 'worse''. It is vital to regenerate the prospect of an effective and credible rule-based system of cooperative global governance, legitimized by representative institutions and by the rule of law. Global governance needs effective institutions and mechanisms for global action. What makes a society? A general sense of shared fate, a degree of solidarity and a government to secure the provision of public goods - goods to which everybody is entitled and which cannot and should not be denied to anyone, which everybody should be able to consume, including future generations, without diminishing its availability to others. This enables a group of individuals to transform into a community. In order to exist, international society is to be seen in broadly similar terms as a national society. For the international community to exist as such, that what is deemed vital at the national level, is likewise to be seen as vital at the global level. What is deemed unacceptable at the national level must likewise be considered unacceptable at the global level. As in a nation-state, where a government is in charge of securing public goods, the international community too needs governance, an institutionalized framework that secures public goods at the global level. If global governance is made to work, it will gain the legitimacy it needs to be sustainable. As in a nation-state, an international community cannot endlessly endure the strains arising from the growing gap between haves and have-lass's, between haves and have-nots, be it in affluence, in security or in political power. A world divided along zones of peace and zones of turmoil, with islands of security in an ocean of insecurity, will ultimately collapse, as the world experienced in the 1930s. In today's world, anybody's security and well being ultimately depends upon everybody's security and well being. As in a nation-state, where the citizens need to be involved in setting the political agenda and in having their say in the affairs of the state in order for a national government to be legitimate, the aim should be to increase citizens' participation around the globe for global governance to be legitimate. As a nation-state, the international community cannot be but a work in progress. Many strands of cooperation have affirmed themselves over the years. We must now stitch them into a strong fabric of community. Participating in this long-term process of identifying and forging the ties that bind the international community is as important an endeavour as obtaining short-term results. Just like a national government, global governance has to concentrate on an overall linked set of core public goods. Between them there is no hierarchy, since they all are evenly important. International stability and security, for which the greatest powers carry the main responsibility. An international legal order which should ensure the effective equality of all. An open and inclusive economic world system that meets the needs of all, especially the poorest, so as to enable all to participate fully in decision-making. Global welfare as the global equivalent of national human security systems. The shared commitment to combat pockets of lawlessness and settle regional conflicts. Globalization and Cultural Choice Sakiko Fukuda-Parr, Arunabha Ghosh, Stefano Pettinato, HDR 2004 Report Team "I do not want my house to be walled in on all sides and my windows to be stuffed. I want the cultures of all lands to be blown about by house as freely as possible. But I refuse to be blown off my feet by any." -Mahatma Gandhi. When historians write of the world's recent history, they are likely to reflect on two trends: the advance of globalization and the spread of democracy. Overall the advance of globalization has contributed greatly to human progress, However, globalization has been the more contentious, because it has effects both good and bad, and democracy has opened space for people to protest the bad effects. So, controversies rage over the environmental, economic, and social consequences of globalization. But there is another domain of globalization, that of culture and identity, which is just as controversial and even more divisive because it engages ordinary people, not just economists, government officials and political activists. Globalization has increased contacts between people and their values, ideas and ways of life in unprecedented ways. People are traveling more frequently and more widely. Television now reaches families in the deepest rural areas of China. From Brazilian music in Tokyo to African films in Bangkok, to Shakespeare in Croatia, to books on the history of the Arab world in Moscow, to the CNN world news in Amman, people revel in the diversity of the age of globalization. But while for many people this new diversity is exciting, even empowering, for some it is disquieting and disempowering. They fear that their country is becoming fragmented, their values lost as growing numbers of immigrants bring new customs and international trade and modern communications media invade every corner of the world, displacing local culture. Some even foresee a nightmarish scenario of cultural homogenization - with diverse national cultures giving way to a world dominated by English language and the global consumer culture of Nike sneakers, lavish swimming pools and promiscuous lifestyles embodied in the goods sold in modern shopping malls and portrayed in Hollywood movies. The questions go deeper. Do economic growth and social progress have to mean adoption of dominant Western values? Is there only one model for economic policy, political institutions and social values? Complexity and vagueness in the capability approach: strengths
or weaknesses?
Enrica Chiappero Martinetti University of Pavia Enrica.chiappero@unipv.it This paper discusses the meanings of complexity and vagueness in relation to the capability approach and the implications of operationalizing intrinsically complex and vague concepts such as poverty and wellbeing. Special attention is paid to the fuzzy sets methodology, which seems to be well able to capture these concepts, preserving the richness of the theoretical framework behind them. Concepts of poverty and well-being, like many probably most - issues and phenomena relating to the human sciences re intrinsically complex and vague, though no more so than crucial economic concepts such as utility, rationality, or recession.; This is largely due to the fact that they involve a plurality of interrelated variables, dimensions, and spaces with no clear-cut boundaries within and between them. While both common sense and some of the social sciences (sociology and psychology in particular) plainly acknowledge the intrinsically complex and vague nature of poverty and well-being, the same cannot be said for economics. Only infrequently mentioned, rarely acknowledged at the foundational level, almost always feared and avoided from an empirical point of view, complexity and vagueness are often perceived in economic analysis as elements of weakness within a theoretical framework, and potential obstacles to its operationalization. The Evolution of Development Thinking: Theory and Policy
Gustav Ranis Frank Altschul Professor of International Economics Director, Yale Centre for International and Area Studies This paper makes an effort to trace the course of development thinking and associated development policy over the pat six decades. Section I focuses on the early Post-War Consensus, with theory focused largely on a revival and extensions of classical dualism theory and policy concentrating on creating the preconditions for development and severing colonial ties viewed as tied to the market. Section II traces the increasing awareness of the role of prices, the rejection of various types of elasticity pessimism and a diminishing reliance on the developmentalist state as the main actor. This is also the period when the IFI's moved towards increased reliance on structural adjustment lending associated with conditionality and reform at both macro and micro levels of policy, embodied in the Washington Consensus and its extensions. Section III illuminates the search for "silver bullets" over time in both the theory and policy arenas. It demonstrates the never-ending search for dimensions of development in both the theory and policy realms which can be identified as critical or key to the achievement of success. Finally, Section IV presents the author's rather personal assessment of where we are at the moment and where we will, or should be, heading in the effort to achieve the third world's basic development objective of human development fuelled by equitable growth. A message to Ministers of Finance: Health and Health Research
are possibly the best economic investments
The Global Forum Secretariat The costs of bad health and the benefits of better health for individuals: For the average person in a low or middle income country, falling sick for any length of time seriously endangers the economic situation and well-being of both the individual and their family, in the short and long term, for the following reasons: Bad health will have a severe impact on the individual's level of income f(Treatment costs, immediate loss of revenue, longer term loss of revenue due to reduced work opportunities, revenue losses due to premature death. It will decrease the capacity of the individual or other family members to acquire an education. It will also affect the family's productive opportunities as some members of the family will be called upon to help the member who has fallen ill. If ill health persists, the family may fall into absolute poverty (due to loss of income and the "catastrophic payments" needed to regain health). Finally, it will decrease substantially both their own and their family's psychological well-being. Therefore it is not surprising that in a survey commissioned by the United Nations in preparation the Millennium Summit in September 2000, respondents from around the world overwhelmingly ranked health as their "number one" desire. Nor is it a coincidence that "good wishes" cards for the New Year from anywhere in the world normally include health as one of the top wishes. There seems to be a wide consensus among people throughout the world that health is their primary asset. If the United Nations poll had focused exclusively on the poor in these countries, it is likely that the answers would have been even more forceful, since for them and their family, bad health may make the difference between life and death, as a result of the vicious circle of poverty and ill health, in one or more of the following ways: Disease for one member of the family means an increase in malnutrition as a result of additional spending on treatment; Malnutrition increases the risk of unemployment or underemployment, further reducing family revenues; An already poor housing situation risks further deterioration; Both the sick and the family members looking after them miss opportunities for education and training in the formal or informal sector; In the long run, the already low productivity level of the family may further decrease in the competitive environment; Access to health care services, safe drinking water and social services in general may become even more precarious as a result of lower revenues and less education;
In the higher income countries, the effects of bad health on the economic situation of individuals are mitigated; at least in the short run, by public and social insurances and the social system in general. However, even in these countries in the long run, the negative effects are felt by individuals especially those at the lower end of the socio-economic ladder. In summary, bad health will directly and profoundly affect the economic situation and well-being of any individual in any society. This is particularly true in the lower income countries (as their social safety nets are weaker or non-existent) and for the absolute poor, due to the vicious circle of poverty and ill health. Conversely, better health will boost the individual's level of income (lower treatment costs, increased revenue, longer term increase in revenue due to better work opportunities, increase in revenues due to longer life-expectancy); it will increase the individual's capacity to acquire an education; it will increase the family's productive opportunities by freeing the members who would otherwise have been called upon to care for the sick; and it will increase substantially the psychological well-being of both the individual and the family. The benefits of good health will be even greater for the absolute poor, as they may transform the vicious circle of poverty into a virtuous circle, with better nutrition, lower risks of unemployment or underemployment, better housing, better use of training opportunities, higher productivity, and overall, better control over the individual's life situation and that of the family. The Wealth Gap in Health Data on women and children in 53 developing countries Population Reference Bureau, 2004 Despite improvements in public health in the last halfcentury, large disparities in health exist between and within counties. Differences among socioeconomic groups can be pronounced, but are easily masked by national data that are used for monitoring and reporting progress. A recent analysis of data from the Demographic and Health Surveys (DHS) programme provides clear evidence of the gap between the rich and poor in a range of health and population indicators -fertility, infant and child mortality, nutrition, and the use of family planning and other health services. Nearly everywhere, inequalities in health care and health status are persistent and pervasive: The poorest women and their children face greater health risks and are less likely to sue key health services than those who re better off. Poorer women generally have more children than better-off women, and have them earlier in life. The poorest adolescents (ages 15 to 19) are three times more likely on average to give birth than the wealthiest adolescents. The children of the poorest mothers are three times more likely to be stunted (have low height for their age) and twice as likely to die than children of the wealthiest mothers. The wealthiest women are one-half as likely to be malnourished, four times more likely to sue modern contraception, and five times more likely to have a medically trained assistant when giving birth. The poor are disadvantaged in nearly all of the factors that contribute to good health, such as education, knowledge of health matters, nutrition, and use of health services. Education figures prominently among these determinants: The wealthiest women are nine times more likely, on average, to have completed fifth grade than the poorest women. Many governments and international agreements have established health, population, and nutrition goals that are stated as national averages. Tracking these averages doesn't allow for monitoring disparities among specific socioeconomic groups. Unless national goals explicitly call for improving equity, countries can achieve progress in health overall without bringing substantial benefits to the poorest and most vulnerable groups. The development of povertyoriented health goals, therefore, is key for monitoring progress in improving the health of the poor. Collecting socioeconomic data along with health data is also essential. Although basic health services re often designed to be universal, a closer look may reveal that the people served are concentrated among better-off groups. Health programmes thus need to explore alternative ways to allocate resources and direct their efforts so that the benefits accrue to those most in need. Evaluating Economic Change
Joseph E Stiglitz, Professor at Columbia University In recent years there have been enormous changes in our technology, our economy, and our society. But has there been progress? From most economists the first reaction to this question is: Of course there must have been progress! After all, the growth of new technologies expand opportunity sets, what we can do, the amount of output per unit input. We can choose either to have more output, more goods and services, or to work less. However we make the choice, surely we are better off. But what, then, about the sweeping changes we associate with the phenomenon of globalization? For several years I have been actively involved in debates around the world about the costs and benefits of this phenomenon. As a result of globalization, the countries of the world are more closely integrated. Goods and services move more freely from one country to another. This is the result of the lowering of transportation and communication costs through changes in technology, and of the elimination or reduction of many man-made barriers such as tariffs. The countries that have been most successful at both increasing incomes and reducing poverty - the countries of East Asia - have grown largely because of globalization. They took advantage of global markets for their goods; they recognized that what separates developed from less developed countries is a disparity not only in resources but also in knowledge; they tapped into the pool of global knowledge to close that gap; and most even opened themselves up to the flow of international capital. But in the countries that have been less successful, globalization is often viewed with suspicion. As I have argued elsewhere, there is a great deal of validity to the complaints of those who are discontent. In much of the world, there has been in recent years a slowing of growth, an increase in poverty, a degradation of the environment, and a deterioration of national cultures and of a sense of cultural identity. Globalization proves that Change does not invariably produce progress. 2004 Report on the Global AIDS Epidemic
Joint United Nations Programme on HIV/AIDS AIDS is an extraordinary kind of crisis; it is both an emergency and a long-term development issue. Despite increased funding, political commitment and progress in expanding access to HIV treatment, the AIDS epidemic continues to outpace the global response. No region of the world has been spared. The epidemic remains extremely dynamic, growing and changing character as the virus exploits new opportunities for transmission. Rates of infection are still on the rise in many countries in sub-Saharan Africa. In 2003 alone, an estimated 3 million people in the region became newly infected. New epidemics appear to be advancing unchecked in other places, notably Eastern Europe and Asia - regions that are experiencing the fastest-growing epidemics in the world. More than 20 years and 20 million deaths since the first AIDS diagnosis in 1981, almost 38 million people (range 34.6 - 42.3 million) are living with HIV. Even though the cure is elusive, we have learned crucial lessons about what works best in preventing new infections and improving the quality and care for people living with HIV. There have been some major developments, including antiretroviral medicines. Despite these signs of progress, there are still huge challenges to turning the tide of this epidemic. Funding has greatly increased but is still only half of what is needed and is not always effectively utilized. Many national leaders remain in denial about the impact of AIDS on their people and societies. Today we are faced with life and death choices. Without major action, the global epidemic will continue to outstrip the response. But there is an alternative: together we can forge policies grounded in science, not political rhetoric, and embark boldly on the 'Next Agenda' - an agenda for future action based on innovative approaches. What are the major challenges?
The female face of the epidemic. Women are increasingly at great risk of infection. As of December 2003, women accounted for nearly 50% of all people living with HIV worldwide and for 57% in sub-Saharan Africa. Women and girls also bear the brunt of the impact of the epidemic; they are most likely to take care of sick people, to lose jobs, income and schooling as a result of illness, and to face stigma and discrimination. There is an urgent need to address the many factors that contribute to women's vulnerability and risk - gender and cultural inequalities, violence, ignorance. Young people - 15-24 year olds - account for nearly half of all new HIV infections worldwide. They are the largest youth generation in history and need a protective environment - regular schooling, access to health and support services - if they are to play their vital part in combating the epidemic. Scaling up treatment programmes providing lifeprolonging antiretroviral therapy. Only 7% of the people who need antiretroviral treatment in developing countries have access to ARVs - 400000 at the end of 2003. Programmes must be sustainable to prevent the development of drug-resistant strains of the virus. Several countries in southern Africa face a growing crisis in delivering vital public services that are crucial to the AIDS response. Reasons for this range from migration of key staff from public to private sectors, migration abroad, to the deadly impact of the AIDS epidemic itself. Scaling up prevention programmes that currently reach only one in five people at risk of HIV infection. In low and middle income countries in 2003, only one in ten pregnant women was offered services for preventing mother-to-child HIV transmission. In highincome countries, treatment has been a much higher priority than prevention and as a result, there have been rises in HIV transmission for the first time in a decade. Tacking stigma and discrimination. They directly hamper the effectiveness of AIDS responses, stop people being tested for HIV, prevent the use of condoms or HIV-positive women breastfeeding to protect their babies against infection, and prevent marginalized groups such as injecting drug users receiving the care and support they need. Tackling the neglect of orphans. AIDS has killed one or both parents of an estimated 12 million children in sub-Saharan Africa and far too many of these orphans are not properly cared for. Global AIDS Funding
In addition to providing up-to-date global, regional and country data, the report releases new estimates on global resources needed to effectively combat the epidemic in the developing world. For the first time, the revised estimates reflect data obtained from 78 countries, many on the frontlines of the AIDS epidemic. Although global spending on AIDS has increased 15fold from US$300 million in 1996 to just under US$5 billion in 2003, it is les than half of what will be needed by 2005 in developing countries. According to newly revised costing estimates, an estimated US$12 billion (up from US$10 billion) will be needed by 2005 and US$20 billion by 2007 for prevention and care in low and middle income countries. The estimated US$20 billion would provide antiretroviral therapy to just over six million people (over four million in sub-Saharan Africa), support for 22 million orphans, HIV voluntary counseling and testing for 100 million adults, school-based AIDS education for 900 million students and peer counseling services for 60 million young people not in school. About 43% of these resources will be needed in sub-Saharan Africa, 28% in Asia, 17% in Latin American and the Caribbean, 9% in Eastern Europe, and 1% in North Africa and the Near East. Fully funding the response to AIDS will require an extraordinary effort, which cannot be met from currently planned regular domestic and international development budgets. It will require extraordinary leadership and will have to sue currently untapped resources. Fatal Indifference The G8, Africa, and Global Health
Ronald Labonte, Ted Schrecker, David Sanders, and Wilma Meeus University of Cape Town Press/IDRC 2004 Available online at: http://web.idrc.ca/en/ev-45682-201-1-DO TOPIC.html The G8 (the United States, England, France, Germany, Japan, Italy, Russia, the European Union, and Canada) represents the major political driver of contemporary globalization. It is also the most powerful political force behind the multilateral institutions that are shaping global economic practice and governance. The aid, trade, and investment policies and practices of G8 member nations largely shape the development possibilities of poorer countries around the world. This book provides a "report a card" of commitments over the past three G8 summits (1999, 2000,and 2001) with a preliminary assessment of the most recent 2002 summit in Kananaskis, Canada. It presents findings from the G8 Research Centre at the University of Toronto (Canada), which ahs been tracking compliance on G8 commitments for a number of years. Based on research funded by IDRC, the book extends these assessments of compliance to an examination of how adequate G8 commitments re to global development needs. Millennium Development Goals and Monterrey Consensus: From
Vision to Action
Zia Qureshi, The World Bank On current trends, most MDGs will not be met by most developing countries. The income poverty goal is likely to be met at the global level, but Africa will fall well short. For the human development goals, the risks are much more pervasive across the regions. Likely shortfalls are especially serious with respect to the health and environmental goals - child and maternal morality, access to safe drinking water and basic sanitation. Few, if any, regions will achieve the mortality goals. The implication of these prospects is clear. There is an urgent need to scale up action on the part of both developing and developed countries based on the Monterrey partnership; Policies and governance in developing countries re improving but progress needs to be accelerated and deepened to achieve stronger economic growth and improve the delivery of basic human services. Developed country actions to date have fallen well short of the Monterrey commitments. Two highest priorities are to ensure a timely and pro-development outcome to the Doha Round and to increase aid in amounts that are sufficient and in forms that are responsive to needs. Engine of War: Resources, Greed, and the Predatory State
By Arvind Ganesan and Alex Vines, The World Bank Internal armed conflict in resource-rich countries is a major cause of human rights violations around the world. An influential World Bank thesis states that the availability of portable, high-value resources is an important reason that rebel groups form and civil wars break out, and that to end the abuses one needs to target rebel group financing. The focus is on rebel groups, and the thesis is that greed, rather than grievance alone, impels peoples toward internal armed conflict. Although examination of the nexus between resources, revenues, and civil war is critically important, the picture as presented in the just-described "greed vs. grievance" theory is distorted by an overemphasis on the impact of resources on rebel group behaviour and insufficient attention to how government mismanagement of resources and revenues fuels conflict and human rights abuses. As argued here, if the international community is serious about curbing conflict and related rights abuses in resource-rich countries, it should insist on greater transparency in government revenues and expenditures and more rigorous enforcement of punitive measures against governments that seek to profit from conflict. Civil wars and conflict have taken a horrific roll on civilians throughout the world. Killings maiming, forced conscription, the use of child soldiers, sexual abuse, and other atrocities characterize numerous past and ongoing conflicts. The level of violence has promoted increased scrutiny of the causes of such wars. In this context, the financing of conflict through natural resource exploitation has received increased scrutiny over the last few years. One theory influential in World Bank circles is that countries with abundant natural resources re more prone to violent conflict than those without, and that insurgent groups re more likely motivated by control over resources than by actual political differences with government authorities, ethnic divisions, or other factors typically viewed as root causes of civil war. The greed vs. grievance theory is provocative and compelling to a point. Even on its own terms, however, there are weaknesses. There is evidence that greed is often not the determinative motive for rebel group behaviour. El Salvador and Sri Lanka, for example, have endured brutal civil wars where resources were not a factor. Cynical exploitation of ethnicity has been a driving force behind conflicts in Rwanda and Cote d'Ivoire. Colombia's civil war existed long before the cocaine boom in the late 1970s and kidnapping in the 1990s, and even the civil war in resource-rich Angola began some twenty years before. A missing element in this greed vs. grievance theory, however, is the role that governments of resource-rich states play. Too often, government control of important resources and the revenues that flow from those resources goes hand-in-hand with endemic corruption, a culture of impunity, weak rule of law, and inequitable distribution of public resources. These factors often lead to governments with unaccountable power that routinely commit human rights abuses; they can also make prolonged armed conflict more likely. The remainder of this essay examines three different aspects of this dynamic. First, control over resources gives such governments a strong incentive to maintain power, even at the expense of public welfare and the rights of the population. In many resource-rich countries, governments re abusive, unaccountable, and corrupt, and they grossly mismanage the economy. Rather than representing the citizenry, the government becomes predatory, committing abuses to maintain power and controlling the resources of the state for the benefit of a few. Researchers at the World Bank sometimes refer to these governments as "Predatory Autocracies." Second, unaccountable governments with large revenue streams at their disposal have multiple opportunities to divert funds for illegal purposes. When such a government is involved in armed conflict, the resulting rights abuses can be horrific. The example of the Liberian government under Charles Taylor, as explained below, is a case in po8int. Relying on offbudget accounts, the Taylor government funded both illegal arms purchases and illegal supplies of arms to rebels in neighbouring Sierra Leone, who at the time were subject to a UN arms embargo. It took stringent international enforcement of the embargo to put an end to the Liberian government's illegal activities. Third, armed conflict can be exacerbated by the actions of third-party governments seeking to profit from resource-rich neighbours. A prime example, detailed below, is the way in which both Ugandan and Rwandan governments have intervened in the conflict in DRC, a conflict that itself has been impelled by competition for lucrative resources. (The involvement of Charles Taylor's forces in Sierra Leone's conflict and in western Cote d'Ivoire from September 2002 to mid-2003 was also driven in part by a desire to obtain control of such resources. The incursion into Cote d'Ivoire also fostered individual greed: Taylor's forces resorted to looting in lieu of pay.) The international community has an important role to play in combating such abuse. Because the problem of abusive, resource-rich states has both economic and political dimensions, a solution requires action by international financial institutions, governments, and corporations to ensure greater transparency and accountability, and, during active conflict, to strengthen enforcement of arms embargoes and sanctions regimes that target known abusers governments and non-state actors alike. Copyright 2004 - Department of Health Sciences of Uganda Martyrs University |
