Mexico's Health and Inequality: a view from Chiapas

[Stephen Bezruchka]

This person from Chiapas attended a conference on FTAA in Seattle earlier
this month, and wrote this for a local paper there.  STephen

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Chiapas al Da, No. 323
CIEPAC (Centro de Investigaciones Economicas y Politicas de Accion
Comunitaria) Chiapas, Mexico
22 de November de 2002
http://www.ciepac.org/bulletins/ingles/ing323.htm

WARNING: GLOBALIZATION CAN BE DANGEROUS TO YOUR HEALTH

Recent studies in several countries confirm that corporate globalization
can cause damage to our health. This idea comes from comparisons made by
Dr. Stephen Bezruchka, School of Medicine of the University of Washington,
of levels of inequality (the gap between the rich and the poor) in certain
countries, and overall health, as measured by life expectancy.

Dr. Bezruchka and other researchers have come to the surprising conclusion
that whats important in determining a country's state of heath is its
degree of equality. The greater the inequality between rich and poor, the
worse the population's health is. In countries with a more equal
distribution of national wealth, the population enjoys better health.

Dr. Bezruchka recalls that since beginning to study medicine he wondered
about the relatively poor state of health in the United States. He was
shaken by the fact that Americans, with 5% of the worlds population, spend
42% of worldwide expenditures on health, and yet suffered poor health as
compared to other industrialized nations. Another disquieting fact is that
over time Americans health continues deteriorating in relation to other
countries with a similar level of development. (1)

Dr. Bezruchka drew up a list, which he called the Health Olympics, that
ranks countries life expectancy, from best to worse. The winner of these
Olympics is Japan, with a life expectancy of 81 years. Runners up are
Sweden (79.6 years), Hong Kong (79.5), Iceland (79.2), Australia (78.9),
Switzerland (78.9) and Canada (78.8). The United States, with a life
expectancy of 77 years, is in 25th place, behind other countries with an
inferior level of development such as Italy and Spain (78.5), Greece
(78.2), Cyprus and Malta (78.0). The US is barely ahead of countries such
as Costa Rica (76.5) and Kuwait (76.2). In fact, life expectancy of Costa
Rican males is greater than that of US males. (2)

Even more surprising is the fact that the Japanese smoke on average four
times as much as Americans. Whats more, the Japanese, together with the
Chinese, smoke more than any other nationality. How, then, to explain this
apparent contradiction of a country whose inhabitants also win the smoking
olympics and yet live longer than anyone? How do we explain a further
contradiction of a country, the United States, that spends far more than
any other on health, and yet has a comparatively low life expectancy?

These contradictions led Dr. Bezruchka to investigate further. And he
found that the general health of a population has not so much to do with
the degree of sophistication in heath care (medical attention in the US is
among the most advanced and expensive). What appears to explain these
contradictions is the prevailing degree of equality (or inequality).

Looking again at the Health Olympics, we see that countries that enjoy the
longest life expectancy are also the most equal, either for cultural
reasons (such as Japan), or due to public policy and tax rates that tend
to level everyones income (Sweden, Norway, Switzerland, Iceland), and
which in addition have state-run health services with universal coverage
(Canada).

Dr. Bezruchka concludes then that if the United States is the richest and
most powerful country on earth, but has the worse life expectancy among
the industrialized nations, the reason lies with the growing inequality in
the country, in addition to a health-care system controlled by large
corporations and thus subject to the profit motive.

Since the present phase of capitalism began, which some call
neoliberalism, and others corporate globalization, it has become
commonplace to say that the rich are getting richer and the poor poorer.
And the United States is no exception but, in addition, the widening gap
between the middle class and the very rich has now reached scandalous
proportions. And thats not even counting the poor, who are worse off.

Paul Krugman, economist at the University of Princeton, found that between
1979 and 1997, the income of the US's super rich, the 1% richest people,
grew 157%, while the income of the middle class in the same period grew
only 10%. Krugman adds that the gap has not closed since 1997, but rather
continues to widen, concentrating the countrys wealth, not only among the
1% richest, but principally among the 0.1% richest. In other words the
13,000 Americans who make up the 0.1% richest sector, with an average
annual income of US$17 million, are becoming even wealthier, and quicker,
than the other 99.9%. (3)

Krugman points out another tendency, that surely will jolt most Americans:
their government is making decisions that favor wealthier folks, at the
expense of the middle class and the poor. Of course Krugman says that it
wasnt always so. There was a long period in which the government seemed to
be working for the common good, particularly during and after Franklin D.
Roosevelts New Deal, and up to the arrival of Ronald Reagan's neoliberal
presidency, when the tendency began to shift in the other direction.

Compare these tendencies to Japan. After World War II, the Japanese
restructured their society to make it more horizontal than vertical, i.e.,
they made it more equitable. This can be seen, on the one hand, in the
small difference between the highest and lowest salaries. For example, the
Prime Minister of Japan earns hardly four times that of an average worker.
In Japanese corporations, the CEO commonly makes 10 times an entry-level
worker. On the other hand, in the US, CEOs make 475 times what a
blue-collar worker makes. (4)

Japanese culture also demands greater equity. It is not uncommon to read
that in Japan high-level executives at firms in financial difficulties
take salary cuts rather than lay off their workers. We have seen in recent
months the shabby behavior of CEOs in financially-strapped companies in
the US: executives continue to channel through sleight-of hand schemes
millions of dollars to their accounts, while employees are left unemployed
and their retirement funds collapse due to bankruptcy. The cultural
ambience is just different.

Furthermore, in Japan the gap between the rich and poor is the narrowest
of any country. And Japanese society has also been characterized by its
cohesiveness (unity), with a place, and respect for all (well, at least
among Japanese. Non-Japanese minorities are discriminated).

In other words, when citizens feel a sense of unity amongst each other,
when they do not observe great differences, the health of the population
is better. And there are now many studies that confirm this psychosocial
relationship. When people experience economic insecurity, when they have
no control over their lives and their jobs, chronic stress and anxiety
weaken their immune system, as Richard G. Wilkinson, researcher at the
University of Sussex, England, has shown. (5)

Canada offers more evidence in this regard. Although the income gap has
widened in Canada since the mid-80s, income distribution undertaken by the
federal government through taxation has helped to level differences.
Redistribution takes the form of unemployment insurance, social
assistance, universal access to education and health, and this gives
Canadians security, stability, confidence in the future and a greater
sense of control over their lives. Which in turn in reflected in Canada by
one of the highest life expectancies in the world. (6)

Doctor Bezruchka asks, What kind of a country will have a smaller gap
between the rich and the poor? One in which people see one another as
equals. The norms of behavior are those of friendship, support,
cooperation, trust, sociability, and community. Those are healthy-sounding
words. In societies where there is a big gap between the rich and poor,
the way to get things done is through power, coercion and domination.
People with no power feel resignation, submission and resentment. These
arent healthy feelings. The quality of the psychosocial environment
determines a populations health. (7)

Doctor Dennis Raphael, of the University of York in Toronto confirms this,
but specifically for heart-related illnesses. He states that both
conceptual and empirical studies identify conditions such as poverty,
social exclusion, and the growing economic gap as fundamental factors in
determining the incidence of cardiovascular diseases in individuals and
communities. (8).

Although the majority of these studies have been done in industrialized
countries, the same relationship between economic equality and health
holds in poor countries. For example, a study undertaken by Dr. Simon
Hales of the Dept. of Public Health of Wellington, New Zealand, using
national income data from 23 poor countries (GNP per head < US$1,000/year)
and 15 richer countries (GNP per head > US$1,000), found that the average
health of the population in these countries has to do with the
distribution of income within the society. His investigations suggest that
in poor countries (GNP per head < US$1,000) a substantial reduction in
[the] infant mortality rate may be possible by decreasing income
inequality or increasing GNP per head. In [richer] countries, reduction of
income inequality is likely to be more effective in lowering infant
mortality rates than further increases in GNP per head would be. (9)

For countries such as Mexico, conclusions from these studies have obvious
implications for public policy. The most apparent is that it doesn't make
much sense to dismantle or privatize the state institutions that, for
better or worse, have given millions of Mexicans access to health,
education, housing and food. It is undeniable that these structures need
profound changes. But the weakening, privatization or disappearance of
institutions such as the IMSS, ISSSTE, etc., and their subsequent transfer
to the private sector, would in no way improve the general health of the
population,. On the contrary, evidence in this and other countries
indicates that the general health of Mexicans would plummet. And not just
because the poor could not afford it, but also due to the psychosocial
factors mentioned above, with the onset of chronic stress, when no health
alternative would be available for the general population in times of
need.

The need for greater equality in income distribution also becomes
apparent. If we compare rich to poor, Mexico is one of the most
unequitable countries in the world, and a profound revamping of the tax
code, with greater taxes on high incomes, and not on consumption, as in
now the case with the VAT (value added tax), would help to redistribute
the nations wealth. In taking similar steps to lessen structural
injustice, we could also assure a future of more and better health for all
Mexicans.

In conclusion, present tendencies dictated by corporate globalization,
that increase the gap between rich and poor, must be reversed and
defeated.

Notes in the text:

(1) Stephen Bezruchka, Societal hierarchy and the health Olympics,
Canadian Medical Association Journal, June 12, 2001, p.1701.

(2) Data compiled for 2000 by S. Bezruchka, using the Human Development
Report, UNDP (United Nations Development Program), New York, 2002, Oxford
University Press.

(3) Paul Krugman, For Richer, Sunday magazine of the New York Times,
October, 20, 2002.

(4) Stephen Bezruchka, Sick of it all: Economic Equality: Good for What
Ails You, 2001, available on the internet at
http://projects.is.asu.edu/pipermail/hpn/2001-January/002363.html

(5) Quoted in: Crawford Kilian, Nations Health Depends on Equality, Not
Wealth, Georgia Straight, Vancouver, Canada, June 8, 2000.

(6) Kilian, ibid.

(7) Bezruchka, Sick of it all, ibid.

(8) Dennis Raphael, Social Justice is Good for Our Hearts: Why societal
factors--not lifestyles--are major causes of heart disease in Canada and
elsewhere, Centre for Social Justice--Foundation for Research and
Education, Toronto, 2002.

(9) Simon Hales, et. al., National infant mortality rates in relation to
gross national product and distribution of income, The Lancet, Vol. 354,
December 11, 1999, p. 2047.

Miguel Pickard
Center for Economic and Political Investigations of Community Action, A.C.
CIEPAC is a member of the, Mexican Network of Action Against Free Trade
(RMALC) www.rmalc.org.mx, Convergence of Movements of the Peoples of the
Americas (COMPA ) www.sitiocompa.org, Network for Peace in Chiapas, Week
for Biological and Cultural Diversity www.laneta.apc.org/biodiversidad,
the International Forum "The People Before Globalization", Alternatives to
the PPP http://usuarios.tripod.es/xelaju/xela.htm, and of the Mexican
Alliance for Self-Determination (AMAP) that is the Mexican network against
the Puebla Panama Plan. CIEPAC is a member of the Board of Directors of
the Center for Economic Justice http://www.econjustice.net and the
Ecumenical Program on Central America and the Caribbean (EPICA)
http://www.epica.org.