"Australian Society: Is there a "Australian Society: Is there a disturbance in the Force?“ disturbance in the Force?“

A Public Health View A Public Health View

Professor Fran BaumProfessor Fran BaumPublic HealthPublic Health

Flinders UniversityFlinders UniversityAdelaideAdelaide

Battle between Good and Evil

What is a healthy What is a healthy community?community?

TransportTransport Education and EmploymentEducation and Employment Peace and securityPeace and security HousingHousing Well plannedWell planned Social and convivialSocial and convivial Equal and non-exploitationEqual and non-exploitation Acceptance of differenceAcceptance of difference Sustainable environmentSustainable environment Absence of diseaseAbsence of disease

Towards Healthy and Sustainable Living

CommunityConvivial

Equitable

Livable

HEALTH

Environment

Viable

Sustainable

Adequatelyprosperous

$$$Economy $$$$

(Hancock, 1994)

So why don’t we have this kind So why don’t we have this kind of balanced society – what is of balanced society – what is

impeding it?impeding it?

Unhealthy SignsUnhealthy Signs

EconomicEconomic Dominance by economic thinkingDominance by economic thinking Some groups doing better than othersSome groups doing better than others

Social – lack of:Social – lack of: TrustTrust ToleranceTolerance EquityEquity

Unsustainable developmentUnsustainable development

Economic rationalism’s march Economic rationalism’s march continues unabatedcontinues unabated

Hallmark of economic Hallmark of economic rationalismrationalism

Private sector values introduced into Private sector values introduced into public sector – outsourcing, contracting public sector – outsourcing, contracting outout

Reduction of size of public sectorReduction of size of public sector Privatisation of public assets: prisons, Privatisation of public assets: prisons,

water, electricity, banks, insurance water, electricity, banks, insurance companies, housingcompanies, housing

Increasingly associated with economic Increasingly associated with economic globalisationglobalisation

GlobalisationGlobalisation Complex set of processesComplex set of processes the evolution of a global financial the evolution of a global financial

trade (key role for WTO)trade (key role for WTO) undermining of the power of undermining of the power of

national governmentsnational governments transformation of traditional transformation of traditional

values including those relating to values including those relating to women and the family and religionwomen and the family and religion

growth in inequities within and growth in inequities within and between countriesbetween countries

What is economic What is economic globalisation?globalisation?

Trade liberalisation, tarriff reduction, Trade liberalisation, tarriff reduction, standards harmonisation and standards harmonisation and deregulationsderegulations

Growth in international trade e.g. 8.6% Growth in international trade e.g. 8.6% per year from 1990-99per year from 1990-99

Greater mobility of capital and increase in Greater mobility of capital and increase in transnational investmenttransnational investment

Global institutions to regulate WTO, GATT, Global institutions to regulate WTO, GATT, GATSGATS

Is globalisation good for Is globalisation good for health?health?

PROPRO Trickle down effectTrickle down effect Will increase Will increase

income of poorincome of poor Cleaning up corrupt Cleaning up corrupt

governments in governments in poor countriespoor countries

More More communicationcommunication

Consumer goods Consumer goods than enrich lives than enrich lives

CONCON Structured unfairness Structured unfairness

of tradeof trade Increases inequitiesIncreases inequities SAPs in poor SAPs in poor

countriescountries Swamping culture Swamping culture

Americanism Americanism McCultureMcCulture

Unhealthy levels of Unhealthy levels of consumptionconsumption

Baum (2002) The New Public Health, p. 109

World Trade Organisation and World Trade Organisation and TNCsTNCs

Cancun, Mexico 10Cancun, Mexico 10thth September 2003 September 2003 Push from EU to expand rights of TNCsPush from EU to expand rights of TNCs Agreement on investmentsAgreement on investments Govts no longer able to prevent a foreign Govts no longer able to prevent a foreign

corporation setting up no matter how bad corporation setting up no matter how bad its environmental or social recordits environmental or social record

Environmental, health or labour standards Environmental, health or labour standards could be seen as a restriction on tradecould be seen as a restriction on trade

Example: Canada and Ethyl Example: Canada and Ethyl CorpCorp

Govt banned a fuel additive in 1996, PM Govt banned a fuel additive in 1996, PM described as “a dangerous neurotoxin”described as “a dangerous neurotoxin”

US-based Ethyl Corp sued for compensation US-based Ethyl Corp sued for compensation arguing ban constituted an “expropriation” arguing ban constituted an “expropriation” of Ethyl’s Canadian investments because of Ethyl’s Canadian investments because global reputation had been harmedglobal reputation had been harmed

Lawyers advised Govt it would lose so it Lawyers advised Govt it would lose so it lifted ban, gave Ethyl $13m and an apologylifted ban, gave Ethyl $13m and an apology

““Canadians breathe in the results of this Canadians breathe in the results of this decision every time they step outside”decision every time they step outside”

Retallack (2003) New Statesman, 25th Aug

Example: MexicoExample: Mexico

Paid US waste disposal company Paid US waste disposal company Metalclad $15.6m because Municipal Metalclad $15.6m because Municipal Govt in Guadalcazar refused to allow Govt in Guadalcazar refused to allow Metalclad to open a new toxic-waste Metalclad to open a new toxic-waste facility on a site that is highly facility on a site that is highly vulnerable to ground water vulnerable to ground water contaminationcontamination

Retallack (2003) New Statesman, 25th Aug

Threats to public healthThreats to public health

WTO agreement on govt WTO agreement on govt procurements could mean govts can procurements could mean govts can not give preference to local companies not give preference to local companies or award contracts on basis of public or award contracts on basis of public health e.g. school canteenshealth e.g. school canteens

Would be illegal to require GM-free Would be illegal to require GM-free food or low fat content – would be food or low fat content – would be seen as a barrier to tradeseen as a barrier to trade

Main beneficiaries from Main beneficiaries from Economic GlobalisationEconomic Globalisation

TNCsTNCs CEOsCEOs Rich peopleRich people Rich countriesRich countries

Walmar, owned by the Walmar, owned by the Walton family in the United Walton family in the United States has an estimated States has an estimated wealth of US$27 billion wealth of US$27 billion which is higher than the which is higher than the GDP of Bangladesh with its GDP of Bangladesh with its population of 120 billionpopulation of 120 billion

Wealthy PeopleWealthy People

The world’s 200 richest people more The world’s 200 richest people more than doubled their net worth in 1993-than doubled their net worth in 1993-77

WHO (1997) note that in 1996 just WHO (1997) note that in 1996 just 358 billionaires had a net worth of 358 billionaires had a net worth of US$760m which equalled the wealth US$760m which equalled the wealth of the poorest 45% of the entire of the poorest 45% of the entire world’s populationworld’s population

Business Review Weekly richest Business Review Weekly richest Australians: 1983 and 2000Australians: 1983 and 2000

Top ten in 1983Top ten in 1983 WorthWorth Top ten in 2000Top ten in 2000WorthWorth

Murdoch familyMurdoch family $250m$250m Kerry PackerKerry Packer$8200m$8200m

Fairfax familyFairfax family $175m$175m Frank Lowy Frank Lowy $2800m$2800m

Smorgon familySmorgon family $150m$150m Richard Pratt Richard Pratt $2700m$2700m

J&R InghamJ&R Ingham $150m$150m David HainsDavid Hains $1400m$1400m

Kerry PackerKerry Packer $100m$100m Boris LibermanBoris Liberman $1300m$1300m

Source: Business Review Weekly web site www.brw.com.auSource: Business Review Weekly web site www.brw.com.au

Rich countries getting richerRich countries getting richer

The UN Human Development Report The UN Human Development Report (1999) compares the size of the (1999) compares the size of the income of the fifth of the world’s income of the fifth of the world’s people living in the richest countries people living in the richest countries and that of the fifth in the poorest. and that of the fifth in the poorest. The ratio had changed from 30 to 1 The ratio had changed from 30 to 1 in 1960, to 60 to 1 in 1990 and to in 1960, to 60 to 1 in 1990 and to 74 to 1 in 199774 to 1 in 1997

About half the world’s About half the world’s population, 3 billion population, 3 billion people, live on less than people, live on less than US$2 a day and of those US$2 a day and of those about 1 billion live in about 1 billion live in extreme poverty of extreme poverty of below US$1 a day.below US$1 a day.

(UNDP, 1998)(UNDP, 1998)

Growing Global InequitiesGrowing Global Inequities

In sub-Saharan Africa 20 countries In sub-Saharan Africa 20 countries have lower incomes per head in real have lower incomes per head in real terms than they had in the late terms than they had in the late 1970s. 1970s.

International comparison of International comparison of health indicators (1999)health indicators (1999)

Country Life expectancy at

birth

Infant mortality rate/1000 live

births

GNP

Low income economies

59.0

77.0

410

Middle income economies

69.0

31.0

2,000

High income economies

78.0

6.0

25,730

Source: World Bank, April 2001

“The global supervisory organisations like the World Bank, the IMF, the WTO, and the United Nations system should be giving the issue of global income inequality much more attention. ……. International public policy to reduce world income inequality must include a basic change in the policy orientation of the World Bank, the IMF, and the WTO so as to allow them to sanction government efforts to impart directional thrust and nourish home grown institutional innovations”

Robert Hunter Wade, Professor of Political Economy London School of Economic and ex World Bank Economist

It is shaking up our existing ways of life, It is shaking up our existing ways of life, no matter where we happen to be. This no matter where we happen to be. This is not - at least at the moment - a global is not - at least at the moment - a global order driven by collective human will. order driven by collective human will. Instead, it is emerging in an anarchic, Instead, it is emerging in an anarchic, haphazard, fashion, carried along by a haphazard, fashion, carried along by a mixture of influences.mixture of influences.

It is not settled or secure, but fraught It is not settled or secure, but fraught with anxieties, as well as scarred by deep with anxieties, as well as scarred by deep divisions. Many of us feel in the grip of divisions. Many of us feel in the grip of forces over which we have no power.forces over which we have no power.

Giddens (1999, p.19)Giddens (1999, p.19)

Unhealthy SocietiesUnhealthy Societies

Economics

$$$

Environment

Social

Inequities within countriesInequities within countries

In all countries where data is In all countries where data is documented there are inequities documented there are inequities between groups based on socio-between groups based on socio-economic statuseconomic status

Evidence inequities are increasingEvidence inequities are increasing Those countries with more equal Those countries with more equal

distributions of income have better distributions of income have better population health statuspopulation health status

Growing inequities in Growing inequities in AustraliaAustralia

Gini coefficient measuring inequity Gini coefficient measuring inequity increasesincreases

Wage income 15.5 %Wage income 15.5 % Market income 7.5%Market income 7.5% Gross income 6.7%Gross income 6.7% Disposable income 7.4%Disposable income 7.4%

Saunders, P (2002) The Ends and Means of Welfare, Cambridge: CUPSaunders, P (2002) The Ends and Means of Welfare, Cambridge: CUP ..

Protests at unfair tradeProtests at unfair tradeEvian, May 2003

When inequities become When inequities become too great the idea of too great the idea of community becomes community becomes impossible (Raymond impossible (Raymond

Arons)Arons)

Trust is decliningTrust is declining

Trust in government and others is Trust in government and others is decliningdeclining

People more likely to be wary of People more likely to be wary of othersothers

Tolerance is decliningTolerance is declining

No apology and reconciliation is making No apology and reconciliation is making shaky progressshaky progress

Political agenda using fear, intolerance Political agenda using fear, intolerance and distrust e.g. Tampa affairand distrust e.g. Tampa affair

Wedge politicsWedge politics Less welcoming and inclusive as a resultLess welcoming and inclusive as a result RefugeesRefugees

“Frontiers, immigration checkpoints and visas form barriers between the wealthier countries and the poorer ones. They are the fortifications that protect privilege and excess, the castle walls behind which global riches are stockpiled for the enjoyment of the few. Removing those barriers would be a revolutionary step towards social justice” Mares (2001, p.187)

Declining social capitalDeclining social capital

Trust reducingTrust reducing Engagement in community & Engagement in community &

voluntary groups is decliningvoluntary groups is declining Less equalityLess equality Yet we know higher levels of social Yet we know higher levels of social

capital appear to be good for healthcapital appear to be good for health

Social Cohesion: Crime and Social Cohesion: Crime and social capitalsocial capital

Elevation in neighbourhood collective Elevation in neighbourhood collective efficacy (social cohesion and trust) was efficacy (social cohesion and trust) was associated with a 39.7% reduction in the associated with a 39.7% reduction in the expected homicide rate (Sampson et al, expected homicide rate (Sampson et al, 1997)1997)

Links at state level between low trust Links at state level between low trust and higher rates of violent and property and higher rates of violent and property crime (Kennedy et al, 1998; Kawachi et crime (Kennedy et al, 1998; Kawachi et al, 1999b)al, 1999b)

Social Capital, health and Social Capital, health and inequalityinequality

In USA States income inequality In USA States income inequality strongly correlated with both per capita strongly correlated with both per capita group membership (r=-.40 P <.01) and group membership (r=-.40 P <.01) and lack of social trust (r=.76, P <.0001)lack of social trust (r=.76, P <.0001)

Social trust and group membership Social trust and group membership associated with total mortality and rates associated with total mortality and rates of death from CHD, Ca, infant mortalityof death from CHD, Ca, infant mortality

(Kawachi et al (1997)Am J PH, 87, 1491-1498)(Kawachi et al (1997)Am J PH, 87, 1491-1498)

SustainabilitySustainability

Are we sustainable?Are we sustainable?

Human development and achieving Human development and achieving human potential require economic human potential require economic activity that is socially and activity that is socially and environmentally sustainable in this environmentally sustainable in this and future generationsand future generations Canadian Public Health Association (1991) Canadian Public Health Association (1991)

Health Implications of the Ecological Crises, Health Implications of the Ecological Crises, Ottawa: CPHAOttawa: CPHA

Threats to sustainabilityThreats to sustainability

Air pollutionAir pollution Water pollutionWater pollution Climate changeClimate change Unsustainable economic activityUnsustainable economic activity Loss of biodiversityLoss of biodiversity Over consumptionOver consumption

We are living beyond our means

Can we restore the good Can we restore the good forces??forces??

First globallyFirst globally Australia and other rich countries Australia and other rich countries

have a responsibility to share wealth have a responsibility to share wealth with poorer countrieswith poorer countries

Could we cope with a small drop in Could we cope with a small drop in standard of living?standard of living?

“….the very right to be human is every day denied to hundreds of millions of people as a result of poverty …. The unavailability of food, jobs, water and shelter, education, health care and a healthy environment” is “not a preordained result of the forces of nature or the product of a curse of the deities”. It is “the consequences of decisions which men and women take or refuse to take, all of whom will not hesitate to pledge their devoted support for the Universal Declarations of Human Rights”. Nelson Mandela quoted in Heywood and Altman, 2000, p.173

Redressing wealth Redressing wealth imbalanceimbalance

The equity challenge is to move The equity challenge is to move some money away from the super some money away from the super rich countries, corporations and rich countries, corporations and individuals and use it effectively to individuals and use it effectively to promote the health and well-being of promote the health and well-being of the world’s poorest citizens.the world’s poorest citizens.

(Annas, 2000, p.185)(Annas, 2000, p.185)

A solution is very possible if A solution is very possible if there is the will……there is the will……

The United Nations has estimated The United Nations has estimated that the cost of universal access to that the cost of universal access to basic education, health care and food basic education, health care and food and clean water is only about $40 and clean water is only about $40 billion a year, less than 4% of the billion a year, less than 4% of the combined wealth of the 225 richest combined wealth of the 225 richest people in the world.people in the world.

Principles to assist in Principles to assist in achieving fair and achieving fair and responsible traderesponsible trade

EquityEquity in trade policies in trade policies Protection of vulnerable groupsProtection of vulnerable groups (eg (eg

family farms, co-operatives, Indigenous family farms, co-operatives, Indigenous peoples)peoples)

SustainabilitySustainability to enhance ecological to enhance ecological systemssystems

Internalisation of costsInternalisation of costs: environmental : environmental costs should be given valuationcosts should be given valuation

Marquez (1999, p.19)Marquez (1999, p.19)

How will we achieve the How will we achieve the balance we need for healthy balance we need for healthy sustainable communities in sustainable communities in

Australia?Australia? Equity as a goal of public policyEquity as a goal of public policy Sustainability as a goal of public Sustainability as a goal of public

policypolicy Strong communities as a goal of Strong communities as a goal of

public policypublic policy

In Australia if we wanted we In Australia if we wanted we could…could…

Dramatically improve Aboriginal healthDramatically improve Aboriginal health Reduce economic inequitiesReduce economic inequities Become more inclusive by welcoming Become more inclusive by welcoming

refugeesrefugees Ensure essential services are in public Ensure essential services are in public

ownershipownership Work to restore trustWork to restore trust Reduce consumptionReduce consumption

All of these things are possible if we have the will

Public stops being a dirty Public stops being a dirty wordword

Restoration of faith in the idea of Restoration of faith in the idea of government as a servant of the government as a servant of the community and guarantor of community and guarantor of personal security and as an entity personal security and as an entity that will modify the market and that will modify the market and ensure equity and redress market ensure equity and redress market inequitiesinequities

State intervention or we State intervention or we sinksinkOur response must be

that we will intervene; we will intervene to retain our right to a say in our future, to temper the market place by action, to provide services and social justice, to retain institutional safeguards and provide needed development in the community interest, for we know that we intervene or we sink