PHA-Exchange> PHA background paper 2 - electronic version

[Claudio Schuftan]

Equity and inequity today: some contributing social factors

Nadine Gasman and Maxine Hart

INTRODUCTION

The 1999 United Nations Human Development report begins: 'The real wealth of
a nation is its people. And the purpose of development is to create an
enabling environment for people to enjoy long, healthy and creative lives.
This simple but powerful truth is too often forgotten in the pursuit of
material and financial wealth.'

The current trend of globalisation has contradictory implications. While the
last 50 years have witnessed developments that augur better for the future
of humanity-child death rates have fallen by half since 1965, and a child
born today can expect to live a decade longer than a child born 20 years
ago; the combined primary and secondary school enrolment ratio in developing
countries has more than doubled-the world faces huge amounts of deprivation
and inequality. Poverty is everywhere. Measured on the human poverty
index-more than a quarter of the 4.5 billion people in developing countries
still do not enjoy some of life's basic rights-survival beyond the age of
40, access to knowledge and adequate private and public services.

The quickening pace of globalisation has generated enormous social tensions
that development policies have failed to tackle. The underlying assumption
has been that once economic fundamentals are corrected, social issues will
resolve themselves of their own accord, and that well-functioning markets
will not just create wealth, but will also resolve problems of human
welfare.

Current events reveal with awful clarity the depth of this fallacy. Millions
of people are poorer than ever before, with growing indices of  inequality
between countries and within countries. Most countries report erosion of
their social fabric, with social unrest, more crime, and more violence in
the home.

Neoliberal advisors in the 1980s developed a vision of the ideal country:
its economy would be largely self-regulating through open competition
between private firms; its public sector would be relatively
passive-providing the minimum services necessary to conduct private business
efficiently and to protect society's weakest members.

This dogmatic economic prescription, concludes the United Nations Research
Institute in Social Development (UNRISD), has not only had limited value,
but has been dangerous. Even those countries that have been held up as
economic success stories have been social failures. Most people in highly
indebted African and Latin American countries have suffered a sharp drop in
living standards.

Between 1980 and 1990 the per capita income declined markedly in developing
countries. An International Labour Organization study of 28 African
countries showed that the real minimum wage fell by 20% and more than half
of Africa's people now live in absolute poverty.  In most Latin American
countries the real minimum wage fell by 50% or more. Coupled with this,
people have suffered from severe cuts in public services-affecting
nutrition, health, education and transport.

The UN Human Development Report of 1999 goes further: a comparison between
the size of income of the fifth of the world's people living in the richest
countries and that of the fifth in the poorest showed a ratio of 74 to 1 in
1997, up from 60 to 1 in 1990 and 30 to 1 in 1960.

The advocates of adjustment had hoped for a trade-off: long-term economic
gain in return for short-term social cost. What they did not foresee was
that the social impact could itself frustrate the desired economic effect.
This temporary sacrifice for the poor is beginning to look like a permanent
intensification of poverty.

UNRISD explains: 'When the market goes too far in dominating social and
political outcomes, the opportunities for and rewards of globalisation
spread unequally and inequitably-concentrating power and wealth in a select
group of people, nations and corporations, marginalising others.
Globalisation in this era seeks to promote economic efficiency, generate
growth and yield profits. But it fails on the goals of equity, poverty
eradication and enhanced human security.'

Economic growth, an important input for human development, can only
translate into human development if the expansion of private income is
equitable, and only if growth generates public provisioning that is invested
in human development-in schools and health centres rather than arms. Reduced
public spending weakens institutions of redistribution-leading to
inequalities.

FACTORS SHAPING INEQUALITY

Below are some of the major factors shaping inequality in a globalised
environment:

Institutions

Institutions matter for development. In 1997, the World Bank warned:
'Without adequate institutions, the potential benefits of globalisation in
terms of higher growth and investment rates will either not happen, or be
too concentrated, thereby increasing, rather than decreasing inequalities
and social tensions'. It adds further that 'good institutions are critical
for macroeconomic stability in today's world of global financial integration
'.

UNRISD states: 'Social institutions have not just been ignored but they have
been considered obstacles to progress and have been ruthlessly dismantled.
This has happened at every level. At national level, many state institutions
have been eroded and eliminated. And at local level, the imperatives of
market forces have been undermining communities and families.'

The formal or semi-formal ties between states and society are increasingly
unravelling, and being replaced by more diffuse arrangements. States are
growing weaker, and state institutions are less able to fulfil basic
responsibilities in areas that encourage personal development such as
education, health, nutrition, land redistribution and welfare.

As states weaken, power is being transferred to institutions that ignore the
social implications of their actions, while at the same time responsibility
for absorbing the damage is being passed to non-governmental agencies or to
communities and families that have themselves been so weakened that they are
in no position to respond.

Political parties have become more diffuse and fragmented, particularly in
the former Eastern Bloc countries where institutional chaos is common.

Trade Unions are being eroded-suffering from changes in working patterns. In
countries with high unemployment, employers are finding it easier to avoid
dealing with trade unions and are dealing directly with individual workers.

NGOs are increasing their influence and have been used to deliver services
in many developing countries where governments are incapable of providing
services. Accountability is thus undermined.

While many national institutions are being weakened, forcing communities and
families to take on added burdens, other institutions are enjoying much
greater freedom-without any commensurate increase in responsibility. This is
especially true for Transnational corporations  (TNCs), which now control
33% of the world's productive assets, but only employ directly or indirectly
5% of the global workforce. TNCs are accused of exploiting cheap labour in
developing countries, marketing dangerous products, avoiding taxation and
causing serious environmental damage. Despite this, they remain untouched by
any form of international regulation. In cases where national governments
try to exert pressure on them, the companies move elsewhere.

Education

Persistent inequality and low quality characterise basic education systems
in developing countries. Education inequalities in access to school,
attendance, quality of teaching and learning outcomes-perpetuates income and
social inequalities. Poor children attend poor schools, have less
opportunity to complete their basic education, and perform below their
counterparts in private schools.

Misallocation of resources, inefficiencies and lack of accountability are
prominent attributes of the organisational structure of education in most
countries. According to the report by the UNHDP, one in seven children of
primary school age is out of school.

Corruption

Corruption seriously weakens the ability of nations to ensure wealth is
distributed fairly. Corrupt officials siphon off wealth from public and
private sources, and discourage investment by those who fear profits will be
stolen.

Weak governments allow tax evasion to flourish, undermining one of the key
government tools for wealth redistribution by denying governments adequate
resources to alleviate poverty and assist development.

Underground or informal economies have grown, further reducing national tax
bases and feeding criminal organisations that grow up around the informal
economies.

Employment and unemployment

Expansion of trade does not always mean more employment and better wages. In
the OECD countries, employment creation has lagged behind GDP growth and the
expansion of trade and investment. More than 35 million people are
unemployed, and another 10 million are not taken into account in the
statistics since they have given up looking for a job. Among youth, one in
five is unemployed.

In both poor and rich countries, dislocations from economic and corporate
restructuring and dismantled social protection have meant heavy job losses
and worsening employment conditions. Jobs and incomes have become more
precarious. The pressures of global competition have led countries and
employers to adopt more flexible labour policies and work arrangements with
no long-term commitment between employer and employee.

Dislocation of populations

Migration is now a major global preoccupation, although it represents
nothing new. In today's globalising world, migration is marked by uneven
human opportunities and uneven human impacts. Whilst global employment
opportunities are opening for some, they are closing for most others. For
high-skilled labour, the market is more integrated, but the market for
unskilled labour is highly restricted by national barriers.

While most migrants have some choice over when and how to leave, millions of
others become refugees-driven from their homes and countries by famine,
drought, floods, war, civil conflict, mass persecution, environmental
degradation or misguided development programmes.

Dislocation of populations through wars and economic crises prevents stable
growth in the sending countries and leaves them dependent on uncertain
remittances from migrants. In Lesotho, 60% of households send labourers to
work in South African mines, leaving females to cope with managing families.
People who leave are often the youngest and most enterprising-predominantly
male-leaving communities with high proportions of elderly people, women and
young children.

An alarming outbreak of national conflicts based on race, religion or ethnic
identity has fed social tensions and conflicts-especially when there are
extremes of inequality between the marginal and the powerful. Inequalities
are reflected in incomes, political participation,  economic assets and
social conditions-education, housing and employment. Apart from killing or
maiming millions of people, these wars weaken or destroy societies,
devastate infrastructure and the environment, and bring public services to a
standstill-undoing decades of development.

Global crime

Crime is a growth industry that is likely to intensify as a result of
globalisation. Modern means of transportation, advanced communications and
relaxed border controls have created opportunities for transnational crime.
Organised crime is now estimated to gross US$1.5 trillion a year. Illicit
trade in drugs, women, weapons and laundered money is contributing to the
violence and crime that threaten neighbourhoods around the world.

A high proportion of modern-day criminal activity is associated with
narcotic drugs. Illicit drugs have a corrosive effect in both consuming and
producing countries. Drug syndicates, gangs and smugglers use any means
necessary to protect their trade-whether it be murder, or bribery and
corruption-undermining institutions and social systems such as traditional
agricultural communities. The illegal drug trade in 1995 was estimated at
about 8% of world trade.

All these factors have a direct effect on families, but especially on women
and children. Around the world one in every three women has experienced
violence in an intimate relationships, and about 1.2 million women and girls
under 18 are trafficked for prostitution each year. About 300 000 children
were soldiers in the 1990s, and 6 million were injured in armed conflicts .

Families and women

The weakening of families: The family has always offered the most basic form
of security. When all else fails, people have assumed that they can rely on
their family members for support. This has become especially important
during the current era of economic restructuring that has seriously weakened
the capacity of the state to provide for those in greatest need.
Unfortunately, this is happening at a time when the family itself is coming
under the greatest pressure it has known. In industrialised countries,
around one third of marriages end in divorce, and 20% of children are born
outside marriage. Many of the current social ills are blamed on the
family-from high crime to teenage pregnancies, to drug taking.

One of the most widely discussed changes in the structure of the family is
the rising proportion of single-parent families-generally women.
Female-headed households are disadvantaged, not because women lacking a
sense of responsibility towards their families, but rather because social
and economic factors are stacked against them-women face discrimination in
property, land, income and credit. Social and economic changes in recent
years have made family life even harder for women. Many more women are
working outside the home-in industrial countries women make up 40% of the
official labour force. The economic crisis in many countries has increased
women's workload in other ways. It has been found that women suffer more
from cuts in public services-health cuts mean that women take care of sick
relatives, and cuts in education mean that women spend more time supervising
children, which UNRISD calls 'invisible adjustment'. Further, women spend
more time growing their own food-and this has been transferred to their
daughters at the expense of attending school.

A current problem, which is reaching unprecedented proportions, is the
number of orphans as a result of the AIDS epidemic. Since the beginning of
the epidemic there have been 13.2 million orphan in the world, most of them
are in Sub-Saharan Africa. These children are taken care by their extended
families or emerging institutions that have not only to ensure their
survival but address the psychological, health and social needs. This
increasing problem can only be expected to get worse in the future.

Children

The same pressures that have taken their toll of parents have also taken
their toll of children. In the industrialised countries, the period
1950-1975 saw remarkable progress for children-whether measured by health,
growth rates or education. These rates of progress are being brought to a
halt. There is a steady rise in school drop-out rates, more cases of
physical and sexual abuse, and rises in teenage violence and suicide.
Children in developing countries come under even greater pressure. Whilst
child survival rates have improved enormously over the last 30 years-infant
and under-five mortality rates more than halved-those who survive live under
greater stress.

In developing countries there are some 250 million child labourers -140
million are boys and 110 million girls4. Poverty and low wages are the
underlying reasons for child labour: parents earn so little that their
children have to work and employers are happy to take children as they will
work for even lower wages. (children's wages may pay for their own schooling
as well as keep the family together as a unit)

 THE FUTURE

We face the challenge of setting up rules and institutions for stronger
governance-local, national, regional and global-that put the health and
well-being of each individual, community and nation at the centre. We need
to create enough space for human, community and environmental resources to
ensure that development works for people and not just for profit.

Globalisation expands the opportunities for unprecedented human advance for
some, but shrinks those opportunities for others and erodes human security.
It is integrating economies, culture and governance, but is fragmenting
societies and ignoring the goals of equity, poverty eradication and human
development.

Overcoming poverty must be seen as the main ethical and political challenge.
Experience shows that the most appropriate programmes are long-term
initiatives of a comprehensive/ multi-dimensional and multi-sectoral nature,
aimed at breaking down the mechanisms that perpetuate poverty from one
generation to another.

Development patterns need to be oriented to make equity-that is, the
reduction of social inequality-the central pillar. This should be the basic
yardstick against which we measure development. Education and employment
present two master keys for development. Education has an impact on equity,
development and citizenship, and therefore needs to be assigned top priority
in terms of social policy and public spending, especially important is
education of girls. Latin American studies have indicated that 11-12 years
of schooling (completed secondary education) are required if people are to
have a chance of escaping poverty. At the same time, a high-quality job-
creation process needs to be put in place.

Some questions?

? What are the social factors that influence the health situation in your
community or countries?
? Is violence a problem in your community?
? What is the status of Women and children?
? Is government responding to the people's needs? Why?


Nadine Gasman is a physician and Doctor in Public health from Mexico. She
has worked as a consultant for different government and non-governmental
organizations especially in the area of health and pharmaceutical policies.
She is the coordinator of the analytical drafting group of the PHA.

Maxine Hart is a social worker from South Africa with experience in human
development policies. She worked as a consultant in human development
policies and restructuring of organisation after apartheid was abolished in
South Africa.