• Third World Health: Hostage to First World Wealth,
Theodore H MacDonald,
Radcliffe Publishing 2005, 312pp, £35.00
One quarter of the world’s population lives on less than $1 per day, with 80% of people not having adequate access to clean water.
These are the facts Theodore MacDonald uses to introduce his book, to make the point that these factors manifest themselves as health issues and therefore health is ‘a good barometer of equity/inequity worldwide’.
Throughout, MacDonald focuses on the division in the world between oppressed and oppressor nations. He demonstrates how capitalism and imperialism satisfy the rich in the wealthy countries and their corporations at the expense of the poor. He explains the origins of the words ‘first world’ and ‘third world’ and the terms developed and developing countries, showing how since the the 1970s ‘developing nations’ has been a misnomer: these nations are in fact going backwards.
The poor fund the rich
The examples he uses are stark: Ghana for instance, in the late 1990s, due to previous IMF and WB loans, was paying off accumulated compound interest which amounted per year to eight times what they spent on health and education. In Uganda, for every dollar spent on health per person, $8 is spent on debt repayment. Between 1995 and 1998, the poorest African countries paid $13billion to creditors while UNICEF estimated that health and nutrition for the whole of Africa would cost $9 billion. In 1996, debtor nations paid $1.8billion more in debt servicing to the IMF than they received in new loans.
MacDonald explains compound interest and provides appendices so that the reader understands all the arguments. He shows how poor countries are forced to adjust their domestic programmes to sustain foreign aid. The Structural Adjustment Policies (SAP) imposed on nations by the WB and IMF are the conditions that the debtor nations must fulfil by making changes to their spending policies before a loan will be granted: these always involve cuts in public spending.
Health of the poor marginalised
80% of the world’s population receive only 11% of global spending on health. In the 1990s, communicable, perinatal and nutritional conditions accounted for 42% of the deaths in third world countries, compared to 6% in the rich nations. Life expectancy is 37.5 years in Sierra Leone, compared to 80 years in Japan. 99% of the 500,000 annual maternal deaths occur in the third world.
45% of Cambodian peasants who are now landless were forced to sell their acreage because of illness – mainly malaria, dengue fever, TB and typhoid, all of which are preventable or curable.
Common diseases which almost exclusively affect the poorest countries attract much less research funding and professional interest compared to high profile diseases in the rich countries. For instance annual global research on malaria in 1990 came to $65 per fatality compared to $789 per asthma fatality.
MacDonald shows how the global financial control exercised by the first world leads to health threatening phenomena such as pollution, deforestation, illegal drug trade, war, global warming and the battle for control of resources such as water. Milk, tobacco and HIV/AIDS, each have a chapter devoted to exposing the killer actions of the imperialists through their multinational corporations such as Nestle (powdered milk promotion), British American Tobacco and the pharmaceutical industry.
Socialist Cuba – an inspiring example
One of the most dramatic tables in the book is the World Development Chart for 2004 which charts the relationship between GNP and the number of children who die in the first five years of life per 1,000 live births. There is a strong positive correlation between being rich and healthy. Notable exceptions include the US – one of the wealthiest nations, yet relatively low on child health indices – and Cuba, a poor country with health indices similar to the richest.
MacDonald dedicates a whole chapter to socialist Cuba and its achievements since the Revolution in 1959. MacDonald, who lived and taught in Cuba, puts Cuba’s achievement in context: blockaded by the US and under siege from imperialism. As a teacher of health promotion, MacDonald recognises that while in 1975 the issue of health promotion was an academic issue, not yet identified as a WHO objective, in Cuba it was already happening. Cuba dedicates 40% of its GNP to health and education – the highest proportion in the world. MacDonald describes how ‘human dignity and social response to one another’s needs are now deeply entrenched in the thinking of ordinary Cubans’. This is reflected in every aspect of their society and their dedication to internationalist missions.
MacDonald points out how Fidel Castro and the Cuban government recognise that young people need to have their cultural needs met and that this has health promotion implications. He cites the work of the Revolutionary Communist Group and Rock around the Blockade and the sound systems they have given as material aid to the Union of Young Communists and quotes Plato: ‘Music reflects the soul of a people and any government which does not support it cannot sustain the loyalty of the people.’
MacDonald concludes that civilisation is being threatened by capitalism and that it is imperative that we all raise awareness about and make information available on an alternative – ‘the health and human dignity of millions of people is the price’.
Read this book, arm yourself, knowledge is power, action must be taken.
Hannah Caller
FRFI 190 April / May 2006
