How International Monetary Fund and World Bank policies undermine labor power and rights.

Based on reviews of hundreds of loan and project documents from the International Monetary Fund (IMF) and World Bank, this article provides detailed evidentiary support for critics who have long claimed that the international financial institutions require Third World countries to adopt policies that harm the interests of working people. After reviewing loan documents between the IMF and World Bank and 26 countries, the authors show that the institutions' loan conditionalities include a variety of provisions that undermine labor rights, labor power, and tens of millions of workers' standard of living. These include downsizing of the civil service and privatization of government-owned enterprises; promotion of labor flexibility: the notion that firms should be able to hire and fire workers, or change terms and conditions of work, with minimal regulatory restrictions; mandated wage rate reductions, minimum-wage reductions or containment, and spreading the wage gap between government employees and managers; and pension reforms, including privatization, that cut social security benefits. These labor-related policies take place in the context of broader IMF and World Bank structural adjustment packages that emphasize trade liberalization, with macroeconomic policies that further advance corporate interests at the expense of labor.     

Economic adjustment and the future of health services in the Third World

Hard economic times in the Third World in the 1980s found many countries unable to maintain previous levels of health and social services in the face of the mounting service cost of their external debt and declining export earnings. The economic adjustment policies promoted by the World Bank and International Monetary Fund on the basis of market ideology were not able alone to improve the economic status of the debtor countries and did have deleterious effects on their health services and the health status of their population. Less pressure to privatize health services, more aid from abroad for the public sector, and a reallocation of scarce government resources from military to social purposes would help to rectify the situation, although sustained long-run improvement would still depend on the external factors that determine economic prosperity, and the prognosis in this respect is uncertain.     

The World Bank, pharmaceutical policies, and health reforms in Latin America.

Health care systems spend a relatively high percentage of their resources on the purchase of medicines, and the poor spend a disproportionate amount of their income on pharmaceuticals. There is ample evidence in the literature that drugs are very poorly used. World Bank-led health reforms aim at improving equity, efficiency, quality, and users' satisfaction, and it will be difficult to achieve these goals without making medicines accessible and affordable. The purpose of this article is to examine the adequacy of World Bank pharmaceutical policies, as recommended in various Bank documents, for Latin America and to examine the implementation of the policy recommendations. The authors found that the World Bank identified and recommended a set of pharmaceutical policies that matched the needs of the region. But, as revealed through fieldwork and a review of the literature, the recommended pharmaceutical interventions were left out of the health reforms, and most of the loans that included pharmaceutical interventions allocated funds only to the purchase of drugs. The authors formulate four hypotheses that may explain the lack of congruence between the recommended policies and the strategies financed by World Bank health reform loans to the Latin American region.     

The World Bank and pharmaceuticals

Within less than a decade the World Bank has become the largest single source of finance (loans) for health in low and middle income countries as well as a major player in the field of pharmaceuticals. Often 20-50% of the recurrent government health budget in developing countries is used to procure drugs. Drugs are among the most salient and cost-effective elements of health care and often a key factor for the success of a health sector reform. However, pharmaceuticals are frequently being used irrationally, mainly due to market imperfections in health care, such as information asymmetries, leading to serious health problems and a heavy financial burden on the health system. Lending priorities set by the World Bank could be used to promote public health sector reform, leading to the rational use of affordable and available drugs of good quality in developing countries. This report provides the first analysis of World Bank activity in the pharmaceutical sector worldwide. The analysis of 77 staff appraisal reports, describing the planning phase of World Bank country projects, shows that 16% of the total World Bank health, nutrition and population budget, or approximately US$1.3 billion, has been committed to loans or credits supporting pharmaceutical activities in the programme countries between 1989-95. Roughly US$1.05 billion has been committed to procurement of drugs and medical equipment. Only 5% of the total pharmaceutical sector lending is committed to software components such as drug policy work and rational use of drugs. No more than 45% of the projects were developed in collaboration with pharmaceutical expertise. The World Bank is recommended to improve its pharmaceutical sector involvement by promoting drug policy research and development including national and international dialogue on pharmaceutical issues to ensure rational use of both drugs and loans. In this, the World Bank has an advantage given its experience from working with both the private and the public sector, its in-house expertise in health economics, and lastly its ability to be listened to by governments through its power.     

Human rights, health, and capital accumulation in the Third World.

This article examines the relationship between human rights and the pattern of capital accumulation in the Third World. The repressive authoritarian State increasingly constitutes the means for enforcing the intensive exploitation of labor in Third World industrial enclaves and commercial agriculture. While the development of center capitalism has evolved toward "the Welfare State" and a framework of liberal sociodemocracy, the "peripheral State" is generally characterized by nondemocratic forms of government. This bipolarity in the state structure between center and periphery is functionally related to the international division of labor and the unity of production and circulation on a world level. The programs and policies of the center Welfare State (health, education, social security, etc.) constitute an input of "human capital" into the high-technology center labor process. Moreover, welfare programs in center countries activate the process of circulation by sustaining high levels of consumer demand. In underdeveloped countries, the underlying vacuum in the social sectors and the important allocations to military expenditure support the requirements of the peripheral labor process. Programs in health in the center and periphery are related to the bipolarity (qualification/dequalification) in the international division of labor. The social and economic functions of health programs are intimately related to the organic structure of the State and the mechanics whereby the State allocates its financial surplus in support of both capitalist production and circulation.     

Analysis of the World Bank's pharmaceutical lending

This article analyzes the World Bank's lending activity on pharmaceuticals and medical products (PMP) during the fiscal years (FY) 1999-2001 by regions, borrower and supplier country, and procurement method. Data for the study derived from the World Bank Project and the Business Warehouse databases. The information included all Bank projects approved during the study period. Information for the PMP procurement contracts was extracted for the health sector components of all sector projects awarded. Contract dollar amount was aggregated by borrower and supplier countries. A total of 365 contracts of PMP for a value of US$ 364.5 million (2001 prices) were awarded. International competitive bidding was the most common procurement method used representing 46.0% of the total PMP contracts amount. Domestic providers supplied 52.5% of the PMP contracts managed by the borrower countries. Twenty-two countries accounted for 97.0% of the total PMP purchased during the period of analysis. Only a small fraction of the Bank activity was directed to the pharmaceutical sector. There is a need for more involvement of the World Bank to increase accessibility, affordability and rational use of pharmaceuticals and medical products. An evaluation of the different procurement methods and their implications on drug quality and prices should be performed.     

International Monetary Fund and World Bank policies can hurt poor, study says.

According to a study by a World Bank economist, developing countries that do not follow International Monetary Fund and World Bank economic programs have seen more of their people lifted out of poverty in times of economic growth than have countries that do take the advice of these lenders.     

HIV Infection and AIDS in Africa and the Third World

Acquired immunodeficiency syndrome (AIDS) threatens to undermine the health status and economic development of Third World populations unless there is global cooperation to prevent the further spread of infection. Poor people in developing countries are considered to be at greatest risk of developing AIDS because their immune systems have been compromised by prior infections. The poor are further placed at risk by their lack of accessibility to health care services and information about AIDS. Despite a host of competing health problems (e.g., childhood diarrhea and malnutrition) and scarce funds for mass educational campaigns, some Third World countries have launched government-sponsored prevention programs. Leaders in this area include Zambia, Rwanda, Uganda, and Brazil. The fact the 90% of those with AIDS are in the economically productive age group (10-49 years) has serious implications for the future of Third World countries. In Zaire, for example, it has been projected that premature deaths from AIDS will reduce the gross national product by 8% in 1995. The World Health Organization (WHO) is in the best position to spearhead the global campaign against AIDS and has called for the integration of AIDS prevention activities into family planning programs. The US's withdrawal of financial support from family planning programs that provide abortion and its reduction in recent years in its contributions to the WHO general budget are unfortunate, given the need for massive international assistance to stop the transmission of AIDS in developing countries.     

Tobacco industry attempts to counter the World Bank report Curbing the Epidemic and obstruct the WHO framework convention on tobacco control

In 1999 the World Bank published a landmark study on the economics of tobacco control, Curbing the Epidemic: Governments and the Economics of Tobacco Control (CTE), which concluded that tobacco control brings unprecedented health benefits without harming economies, threatening the transnational tobacco companies' ability to use economic arguments to dissuade governments from enacting tobacco control policies and supporting the WHO Framework Convention on Tobacco Control (FCTC). We used tobacco industry documents to analyze how tobacco companies worked to discredit CTE. They hired public relations firms, had academics critique CTE, hired consultants to produce "independent" estimates of the importance of tobacco to national economies, and worked through front groups, particularly the International Tobacco Growers' Association, to question CTE's findings. These efforts failed, and the report remains an authoritative economic analysis of global tobacco control during the ongoing FCTC negotiations. The industry's failure suggests that the World Bank should continue their analytic work on the economics of tobacco control and make tobacco control part of its development agenda.     

The International Monetary Fund and World Bank in Africa: a "disastrous" record.

In their 60th anniversary year, the International Monetary Fund and World Bank will attempt to highlight their "assistance" to Africa. But in reality, since the 1970s, these institutions have gradually become the chief architects of policies that are responsible for the worst inequalities and the explosion of poverty in the world, especially in Africa. When they began to intervene on that continent in the late 1970s and early 1980s, their stated goal was to "accelerate development." But the actual record is just disastrous, as this article reveals.     

The changing role of the World Bank in global health

The World Bank began operations on June 25, 1946. Although it was established to finance European reconstruction after World War II, the bank today is a considerable force in the health, nutrition, and population (HNP) sector in developing countries. Indeed, it has evolved from having virtually no presence in global health to being the world's largest financial contributor to health-related projects, now committing more than $1 billion annually for new HNP projects. It is also one of the world's largest supporters in the fight against HIV/AIDS, with commitments of more than $1.6 billion over the past several years. I have mapped this transformation in the World Bank's role in global health, illustrating shifts in the bank's mission and financial orientation, as well as the broader changes in development theory and practice. Through a deepened understanding of the complexities of development, the World Bank now regards investments in HNP programs as fundamental to its role in the global economy.     

Excerpts from Joseph Stiglitz's speech to the World Bank, April 1999.

The Journal has published several articles critical of the World Bank and the International Monetary Fund. These articles have shown the damage caused by the neoliberal policies advocated by these agencies to the health and quality of life of the people in countries where such policies are carried out. Published here are excerpts of a speech given by Joseph Stiglitz, senior economist of the World Bank, in which he finally recognizes the damage these policies have caused in Russia, where life expectancy has fallen quite dramatically during the years of neoliberal reform. The question triggered by his speech is why the World Bank continues its neoliberal policies.     

Third World children: promise and problems

Children as they are born into the world are a bundle of human potential. This potential must be nurtured and educated if these children are to make a contribution to the world society. Third World children hold the same promise as other children if they are born to healthy mothers. Societies must contribute both physical resources and human resources for this promise to be fulfilled.

Many Third World children need immunizations, better nutrition, oral rehydration therapy, and educational opportunities if they are to survive and reach their potential.

A proposal is made for international development agencies to help fund child care centers which could become a focus of many services for both the children and their families.     

Community monitoring of integrated pest management versus conventional pesticide use in a World Bank project in Indonesia

Pesticide Action Network North America (PANNA) collaborated with a local Indonesian nongovernmental organization (NGO), Yayasan Duta Awam (YDA), in monitoring impacts of the World Bank-financed Integrated Swamps Development Project (ISDP). This paper reports the results of the community-based investigation, which found wide disparities between the World Bank's policy on pest management and its implementation. Instead of reducing farmers' reliance on pesticides as required, the ISDP led to increased intensity and frequency of pesticide use and adverse health and environmental effects from pesticide exposures. YDA and PANNA presented the findings to the Indonesian government and World Bank officials, and farmers requested training in IPM among other recommendations. After NGOs undertook joint advocacy efforts to reduce pesticide dependence in the project, the World Bank withdrew hazardous pesticides from input packages, IPM training was initiated, and community monitors became local leaders in their villages. The study demonstrates the importance and efficacy of independent community-based monitoring in documenting pesticide problems and replacing pesticides with IPM in World Bank development projects.     

Community Monitoring of Integrated Pest Management versus Conventional Pesticide Use in a World Bank Project in Indonesia

Abstract

Pesticide Action Network North America (PANNA) collaborated with a local Indonesian nongovernmental organization (NCO), Yayasan Duta Awam (YDA), in monitoring impacts of the World Bank-financed Integrated Swamps Development Project (ISDP). This paper reports the results of the community-based investigation, which found wide disparities between the World Bank's policy on pest management and its implementation. Instead of reducing farmers' reliance on pesticides as required, the ISDP led to increased intensity and frequency of pesticide use and adverse health and environmental effects from pesticide exposures. YDA and PANN A presented the findings to the Indonesian government and World Bank officials, and farmers requested training in IPM among other recommendations. After NCOs undertook joint advocacy efforts to reduce pesticide dependence in the project, the World Bank withdrew hazardous pesticides from input packages, IPM training was initiated, and community monitors became local leaders in their villages. The study demonstrates the importance and efficacy of independent community-based monitoring in documenting pesticide problems and replacing pesticides with IPM in World Bank development projects.     

The concern and contribution of the World Bank in population planning

The present efforts to improve standards of living throughout the world would be threatened by high population growth rates. In three different ways the World Bank is trying to do something about this problem: a) increasing awareness of adverse consequences of population growth, b) alerting national leaders to the demographic conditions of their own countries, c) giving aid to countries willing to implement programs for reduction of growth rates. Tables complement the text in summarizing the growth of lending by the Bank and the International Development Association and indicating future planned activities.     

Poverty,policy, and pathogenesis: Economic justice and public health in the US

This paper addresses public health and access to care for the urban poor in the context of US urban, economic, and industrial policy. The pathogenic deterioration of 'inner city' neighbourhoods is a direct result of political and economic strategies to facilitate capital accumulation and consolidation, manifested in geographic patterns of uneven development that mirror the relationship between First and Third World countries. The deleterious public health effects of these trends include reduced access to care; medical indigence in the wake of deindustrialization and the restructuring of the blue-collar workforce; and the spread of social epidemics such as AIDS, violence, and substance abuse. Contemporary health policy and 'reform' debates, however, have virtually ignored the pathogenic role played by economic and social inequality in the etiology and dispersion patterns of disease. To confront the health crisis that currently threatens poor and minority communities in the US, economic justice must be explicitly acknowledged as a public health issue, alongside more traditional concerns such as access to care, immunization, vector control, and behaviour modification. It will be necessary to challenge political and economic policies that shore up corporate power at the expense of community development; spur capital accumulation at the expense of social programs and economic opportunity for the poor and politically disenfranchised; and actively facilitate the continued exploitation of, and withdrawal of resources from, the nation's most vulnerable citizens and their communities.     

Commercial drug compendium information: a First World/Third World comparison

The purpose of this study was to determine what differences exist in the content of commercial drug compendium monographs available in First World and Third World countries. A content model representing First World information was developed from monographs contained in the Physicians' Desk Reference, ABPI Data Sheet Compendium, and the Rote Liste. The content of the three First World compendia was found to be variable, with the Physicians' Desk Reference consistently more comprehensive than either the ABPI or Rote Liste. This result suggests that there is a lack of agreement among industrialized countries regarding what amount of information is necessary or appropriate for inclusion in a commercial drug compendium. A sample of 58 monographs was selected from four Third World compendia and evaluated in terms of comprehensiveness and accuracy. These monographs represented five commonly prescribed drugs from the World Health Organization's Essential Drugs List. The monographs were found to be less comprehensive than any of the three monographs contained in the First World compendia. Approximately 5 percent of the information contained in the sampled monographs was determined to be inaccurate. The sampled monographs for drugs supplied by multi-national pharmaceutical firms were found to contain the same amount of information as those for drugs supplied by domestic firms.     

The role of Third World universities in health development.

The need for a pro-active role for universities in the Third World in health development is identified as one of the important frontiers of international health. The questions of how to combine scientific objectivity with involvement in social problems are examined, using the experience of the Aga Khan University in Karachi, Pakistan as an example. The need for a clear and explicit value base to guide the university in its engagement with the problems of its society is stressed. The Third World university must serve the purposes of both absorbing advances in science and benefiting those who live at the social and geographic periphery of the country.     

Dependency among Third World elderly: a need for new direction in the nineties

The current political economy of aging focuses largely on the conditions of old people in Western industrialized societies. Thus it ignores more than half of the world's elderly--those residing in Third World countries. In the first part of this article the author examines aging trends in developing countries, considering recent approaches to addressing the deteriorating economic and social conditions that shape the lives of the elderly in these countries. In the second part, a feminist perspective is used to assess the implications of these demographic trends and development strategies for women in Third World countries. It is argued that policies that place primary responsibility for care of the elderly within families are as unjust in Third World societies as they are in industrialized nations.