Third, it focuses on eliminating current barriers and constraints rather than on opportunities associated with the potential emergence of new forms and institutions of global governance. Those opportunities represent an important area for building research collaborations and communities of practice that link development policy, clinical disciplines, population health and social science fields such as international relations and political economy.
Health care and health systems are among the SDH, and an immediate imperative is to make more resources available to deliver key interventions. The Commission on Macroeconomics and Health and, more recently, the Commission for Africa and the UN Millennium Project all argued strongly for a several-fold increase in the value of development assistance for health, focused on basic interventions.
The Commission for Africa [ 12 ] p. The need for such commitments underscores the fact that many low-income countries will require substantial development assistance for many years, probably for decades, if their health systems are to be financed at the minimum level identified by the Commission on Macroeconomics and Health [ 25 , 26 ].
The urgency of providing such additional resources is clear and should not require further elaboration, but one argument is worth citing. Foreign aid is therefore not a luxury for African health. It is a life-and-death necessity. However, rich countries have so far not even lived up to the rhetoric associated with their highest profile initiative to increase support for health in the developing world. This creates serious constraints on what activities the Fund can support even after scientific merit has been demonstrated, since the Fund "can only approve grants if the full amount required for the first two years is covered by pledges from donors in the calendar year of the approval" [ 28 ] p.
Provision of public goods related to health presents distinctive problems. In common usage, the phrase "public good" is often associated with the common welfare, or with such values as equity and social justice. Its definition in economic theory is more precise: a private good either a service or a good in the physical sense is one whose individual consumption is both excludable my use of the good is not dependent on others' use and rivalrous my use of the good could preclude use by another. Conversely, a public good is one that is non-excludable classic illustrations are the order created by traffic lights and, from the days before GPS, the safety benefits of lighthouses and, in pure form, is non-rivalrous my use of the traffic light, lighthouse or GPS signal in no way impairs your use of it.
Few pure public goods exist and public policy choices, which may vary over time, often determine the balance between private and public characteristics of a good [ 30 , 31 ]. Although health itself is not a public good, numerous public goods for health exist, including scientific knowledge and communicable disease control. The terminology of global public goods for health GPGH is now in widespread use, but a recent WHO research initiative [ 32 ] concluded that many public goods for health are in fact regional, rather than global.
Malaria control is a case in point [ 33 ] p.
Whether global or regional, many public goods for health, such as communicable disease control including vaccination and control of antibiotic resistance, are conspicuously undersupplied in the marketplace, reflecting the "dramatic decay in local and global public health capacity" identified by the United Nations High Level Panel on Threats, Challenges and Change [ 35 ].
In theory scientific knowledge is a quintessential public good, yet in practice it is often ring-fenced by mechanisms such as intellectual property rights. A further complication arises from the fact that potential for commercialization is an increasingly important consideration for at least some national, publicly financed health research granting agencies. Commercially oriented research priorities are likely entirely to ignore interventions both within and outside the health sector that address disparities in SDH, since such interventions are intrinsically not amenable to commercialization.
Thus, it is imperative to develop new mechanisms for financing health research that do not rely on the anticipation of profit and avoid the resulting skewing of priorities; reform of national and international intellectual property regimes is arguably a part of such necessary reforms [ 37 - 39 ], but just a part see e. The need for more resources for health systems and to support provision of health-related public goods is just one argument among many for increasing the value of official development assistance ODA.
ODA is the most visible and conspicuous transfer of resources from rich to poor countries, although it is far from being the single largest contributor to international financial flows. The UN Millennium Project and the UK Commission for Africa each concluded that an approximate doubling of current ODA spending is necessary, although not sufficient, if much of the developing world is to have a chance of achieving the MDGs [ 12 , 13 ].
The Millennium Project report was also noteworthy for recommending major changes in how ODA spending is directed in order to increase its relevance to the MDGs, thereby lending support to long-standing criticisms of aid agencies for providing assistance for specific projects rather than as general budget support and for the multiple reporting requirements they demand of recipients [ 13 ] p. It remains to be seen how effectively the G8 will live up to the Gleneagles aid commitments, and whether the increase will come at the expense of aid flows to other regions of the world, where national-level statistical indicators may be less bleak but poverty and other deficiencies in access to SDH are nevertheless widespread.
Some commentators were and are sceptical about the value of these commitments for a different reason. They argue that domestic governance failures, capacity limitations, and the tendency of African countries in particular toward "neopatrimonial systems of rule" [ 41 ] will render such inflows ineffective if not destructive [ 42 , 43 ].
The Commission for Africa and the Millennium Project each examined the evidence and made numerous recommendations for improving the effectiveness with which aid is used to achieve the MDGs and similar objectives, which cannot be reviewed in this series. More importantly though, each initiative directly challenged fashionable scepticism about the value of development assistance, crucially emphasizing donor policies and practices as constraints on aid effectiveness. The Millennium Project report further pointed out the irony that "the notion of taking the [Millennium Development] Goals seriously remains highly unorthodox among development practitioners" because of a lack of financial support from the industrialized world [ 13 ] p.
In a direct rejection of received wisdom that weak governance or "absorptive capacity" constraints seriously limit the potential benefits from short-term increases in development assistance, its discussion of Africa concluded that the quality of governance in African countries is comparable to that in other regions with similarly low incomes, noting that "good governance requires resources for wages, training, information systems, and so forth" [ 13 ] p.
Important changes in delivery mechanisms and funding criteria to improve the effectiveness of aid in contributing to health equity can and should be made see e. However, it is to be hoped that the Millennium Project and the Commission for Africa have decisively shifted the burden of proof to those resisting substantial new ODA commitments to show how meaningful improvements in health equity and access to SDH can be achieved in the absence of such commitments, and to the rich countries to demonstrate mechanisms for making the necessary resources available without compromising their effectiveness through ties to their own economic and strategic interests.
External debt remains perhaps the most serious constraint on aid's effectiveness: " [D]ozens of heavily indebted poor and middle-income countries are forced by creditor governments to spend large parts of their limited tax receipts on debt service, undermining their ability to finance investments in human capital and infrastructure. In a pointless and debilitating churning of resources, the creditors provide development assistance with one hand and then withdraw it in debt servicing with the other" [ 13 ] p.
Over the last ten years, the rich countries have offered gradually increasing levels of debt cancellation to a limited number of the world's poorest countries through the Heavily Indebted Poor Countries HIPC initiative. Although debt cancellation for HIPCs has made possible increases in public spending on such basic needs as health and education in several recipient countries [ 45 ], many HIPCs have seen only modest decreases in their debt service obligations, and three have actually seen increases [ 46 ] p. In addition, the eligible countries are not those where a majority of the world's poor people live: many other countries are not statistically desperate enough to qualify, despite high levels of poverty and high external debt burden [ 47 , 48 ].
Both limitations arise from the fact that a "sustainable" debt load has been defined for purposes of the HIPC initiative with reference to a ratio of debt service to annual export revenues, based on what have often turned out to be optimistic projections of export earnings and commodity prices. Debt service and development assistance, by region, — This debt sustainability criterion was adopted at the insistence of the G7, "balancing the need to include strategic G7 allies and the desire to help keep costs down" [ 49 ] p.
Various refinements of this criterion are now under consideration [ 46 ] p. The Millennium Project echoed many earlier critiques in recommending that: "'Debt sustainability' should be redefined as 'the level of debt consistent with achieving the Millennium Development Goals,' arriving in without a new debt overhang. For many heavily indebted poor countries this will require percent debt cancellation.
For many heavily indebted middle-income countries this will require more debt relief than has been on offer" [ 13 ] p. Thus, expanding both the availability of debt relief and its value must be a priority from the standpoint of health equity and SDH. However, the reliability of the MDRI commitment is called into question by the fact that as of mid, existing i.
Confronting the root causes of forced labour: globalisation and the rise of supply chains
Indeed, because development assistance spending for includes major one-off debt cancellations for Iraq and Nigeria, without further new commitments which have not yet been forthcoming , overall ODA spending may actually decline in , for which data are not yet available, and [ 57 ]. Although the process offers great potential benefit, in practice direct parallels exist between the PRSP process of qualifying for debt relief and earlier forms of conditionality [ 58 , 59 ]; recent studies confirm the continuity of the macroeconomic principles embodied in PRSPs with the earlier era of structural adjustment [ 60 - 62 ].
For example, PRSPs may include "trade-related conditions that are more stringent, in terms of requiring more, or faster, or deeper liberalization, than WTO provisions to which the respective country has agreed" [ 63 ] p. Even if one rejects the position that PRSPs are being used quite cynically as a vehicle to pry open developing country markets, it appears that the lending institutions that demand and assess PRSPs continue to operate on the uncritical presumption that development is best achieved through rapid integration into the global economy, without consideration of economic distribution or health equity impacts.
Further questions about the architecture of development assistance and debt relief involve effects on public health and education budgets of the expenditure ceilings on which the IMF, in particular, is reported to insist as elements of PRSPs and macroeconomic management plans, even when the necessary resources have been committed by external donors. The economic rationale involves limiting inflation and currency appreciation, with the latter viewed with special concern because it could reduce the competitiveness of a country's exports and hence its ability to repay external debts. A article based on previous research and the field experience of one of the authors identified this constraint as operating in a number of countries including Mozambique, Tanzania and Uganda [ 64 , 65 ].
In response, World Bank and IMF officials argued that Medium-Term Expenditure Frameworks MTEFs incorporating public sector expenditure ceilings "are not a reflection of some malign intent," but rather "state what money is available and what programmes are possible within the context of that resource envelope" [ 66 ]. They provided no country-specific evidence to counter the argument that such expenditure ceilings are compromising national governments' ability to meet basic needs. Subsequent analyses [ 65 , 67 ] have strengthened the case against expenditure ceilings. A full assessment is difficult given the lack of transparency and the asymmetrical nature of relations between the IMF and national governments.
Nevertheless, it is clear that the IMF approach does not reflect a willingness to revisit past policy choices and address present-day asymmetries in resources and bargaining power that together determine "what money is available" to a particular society or national government: say, one in sub-Saharan Africa trying to deal simultaneously with declining commodity prices, the impact of the HIV-AIDS epidemic, and the legacy of capital flight facilitated by hospitable financial centres in the developed world. Finally, it is important to challenge the legitimacy of external creditors' financial claims when they involve repayment of funds lent to governments that systematically looted the public treasury or used public funds including those supplied by external borrowers for domestic repression in order to maintain power.
Pogge [ 68 ] questions the legitimacy of these debts on ethical grounds, since the international community need not have permitted violently repressive or larcenous rulers to borrow against the assets and future earnings of their subjects, which is what they did in many cases. Other commentators have similarly questioned whether "odious debts" are collectible as a matter of international law [ 69 , 70 ]. The international community remains obstinate in its failure to confront this question, which needs to be explored with special urgency in cases where the imperative of repaying external creditors threatens to conflict with domestic public expenditure priorities related to health equity and SDH.
In our view, and that of other commentators on debt issues [ 47 , 52 , 71 , 72 ], the latter must always take priority, and the onus is now on the industrialized countries individually and collectively to develop concrete policy responses. Something close to a new conventional wisdom has grown up around the relation between trade and development.
Organizations otherwise as divergent in their perspectives as Oxfam and the World Bank apparently agree on the value to developing economies, especially the world's poorest countries, of access to industrialized world markets — sometimes citing figures to the effect that annual gains from complete liberalization of trade would amount to several times the value of development assistance [ 73 , 74 ].
Because markets for agricultural commodities are economically critical for many developing countries agricultural subsidies, which simultaneously lower prices within the borders of the producing country and enable producers to export at artificially low prices, are a special concern.
So, too, is the continuing use of tariff escalation on high value-added or manufactured exports from poorer nations by industrialized countries, in contrast to low or zero tariffs on raw commodity exports. Improved access to developed country markets for manufactured products could yield very substantial income gains for the developing world [ 75 , 76 ], although estimating the value of potential markets lost to developing country producers as a result of subsidies and trade restrictions is fraught with difficulty [ 77 ].
Birdsall and colleagues [ 78 ] question the new conventional wisdom. They argue, unfortunately without supporting documentation, that the effects of agricultural subsidies on international prices of commodities such as cotton are far too small to affect the competitiveness of developing country producers in their own or export markets. While reserving judgment on this argument, it must be acknowledged that the relations between agricultural subsidies as defined and prospects for development are more complicated than acknowledged by many participants in the debates [ 77 , 79 , 80 ].
Although improved market access may increase the incomes of developing country agricultural producers who are already part of the cash economy, it is likely to have little benefit for larger numbers of producers who are primarily oriented toward subsistence, with occasional local market sales — the problem of "two agricultures" [ 80 ]; see also [ 81 ].
The entire issue of agricultural trade and SDH requires "a more fine-grained approach, which would differentiate among crops and countries" [ 82 ] p. In the aftermath of the collapse of WTO negotiations in July, because of failure to make progress on agricultural subsidies, that prospect is perhaps more remote than ever. Apart from the specifics of agricultural trade, multiple ironies surround the relation between contemporary trade policy priorities and the ability of developing countries to meet basic needs related to SDH.
At a theoretical level, "the arguments advanced in favour of trade liberalization as a way of facilitating learning and productivity growth call for support and protection in the early stages of large scale, specialized enterprises, not full exposure of them to foreign competition" [ 75 ] p. This strategy was adopted, with variations, by countries such as China, Korea and Vietnam that are now held up as exemplars of the benefits of globalization: they opened up their markets to imports selectively as their previously protected industries matured, and adopted intellectual property regimes that favoured domestic producers, just as European and North American countries had done a century earlier [ 78 , 83 , 84 ].
Not only current bilateral and multilateral trade agreements but also informal pressure from the industrialized world may now preclude similar development strategies by later industrializers [ 85 , 86 ]: the reason economist Ha-Joon Chang refers to the trade policy stance adopted by the industrialized countries as "kicking away the ladder.
Two examples suffice to show the importance of this dynamic for development — and thus, by implication, for SDH. First, as noted earlier PRSPs have been used as a source of leverage for import liberalization, without considering impact on countries' ability to meet basic needs related to health.
1. The Study of Global Political Economy - Politics Trove
Second, provisions for Special and Differential Treatment SDT have been a feature of the world trading regime since the early postwar years; they embody recognition of the distinctive needs of countries at vastly different stages of economic development. Intense lobbying by African and Asian countries led to a commitment by WTO members in to review "all Special and Differential provisions But what should count as strengthening?
The fundamental question is whether SDT provisions should be considered temporary measures to facilitate the integration of developing economies into today's trade policy regime, or whether "the bottom-line question for the WTO should be what it can do to facilitate development, not what it is willing to allow to ease adjustment" [ 88 ] p. This issue remains unresolved, and arises even more acutely with respect to the proliferation of bilateral and regional trade negotiations and agreements [ 89 ] pp. In such negotiations and relationships, disparities in bargaining power and resources may be even more glaring than at the WTO.
As a result, "WTO-plus" provisions emerging from these settings may vitiate whatever gains in terms of market access and domestic policy flexibility that developing countries are able to secure within the WTO framework [ 90 ].
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- Governing Cotton - Globalization and Poverty in Africa | A. Sneyd | Palgrave Macmillan.
- Governing cotton : globalization and poverty in Africa / Adam Sneyd. - Version details - Trove.
This is a special concern given the likelihood that bilateral and regional negotiations will become even more important following the events of July The international body of human rights law, starting with the Universal Declaration of Human Rights, includes various provisions related to health and SDH. Most notably, Article 12 of the International Covenant on Economic, Social and Cultural Rights proclaims "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health," and obligates States Parties to ensure "provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; the improvement of all aspects of environmental and industrial hygiene; the prevention, treatment and control of epidemic, endemic, occupational and other diseases; and the creation of conditions which would assure to all medical service and medical attention in the event of sickness.
Although state obligations are limited to the progressive realization of the human right to health in the context of their "available resources" Article 2 , all states must show measurable progress towards its full realization. Assessing the extent of such progress requires evidence of effort to reach health goals, and of empirically grounded links between social and economic policy and health status trends within and between states. In the UN Committee on Economic, Social and Cultural Rights issued General Comment 14 on Article 12, which both clarified the scope of the right to health and identified the obligations of states parties to respect, protect and fulfil the right [ 91 ].
For explication of Article 12 and General Comment 14, see [ 92 - 98 ]. What would public policies that recognize health as a human right look like, and what might they mean for SDH? The question can usefully be considered in terms of potential impacts of trade policy on access to SDH. A more extensive inquiry was conducted by the Special Rapporteur on the Article 12 right to health appointed in , reappointed for a second term in , whose first report adopted an expansive approach that links poverty reduction and the right to health [ 93 ].
The cases studied did not involve the provisions of trade agreements, although the intellectual property provisions of the Agreement on Trade-Related Aspects of Intellectual Property TRIPs remain central to debates about access to essential medicines despite a WTO interpretation that apparently offers flexibility with respect to compulsory licensing and parallel imports [ - ]. Neither did they address the more challenging question of how the right to health can be used to secure more equitable and widespread access to SDH such as adequate nutrition or safe water, which is specifically addressed in one of the MDG targets.
Indeed, the availability of safe water has often been reduced for the poor or otherwise vulnerable when costs rose as a consequence of privatization or the implementation of cost recovery measures [ - ]. Because it is essential to health, " [t]here are compelling arguments for viewing access to water as a human right," and water as a good whose commodification and commercialization should be limited [ ] p. On the other hand, this position is far from universally accepted; "the struggle persists because of reluctance among powerful players to acknowledge that principles of social and economic justice must not be sacrificed for reasons related to wider political economy" [ ] p.
In another example with potentially far-reaching policy relevance, Hammonds and Ooms [ 97 ] have argued that many policies pursued by the World Bank, including expenditure ceilings and some aspects of loan conditionalities, lead to violations of member countries' obligations related to the right to health. How would this claim be adjudicated, and how would conclusions be implemented? These questions underscore the importance of a lack of implementation mechanisms — an issue that is unlikely soon to be resolved.
Thus, the right to health as a counterweight to the priorities of the global marketplace offers important opportunities, but also formidable conceptual and practical challenges. The concept is most often invoked with respect to how trade agreements constrain economic policy choices [ , - ]. However, the effects of trade policy commitments on national policy space are not limited to those associated with the actual texts of trade agreements. For example, once such agreements have facilitated the reorganization of production across multiple national borders, governments' policy space is subsequently limited by the ability of a parent or lead firm to play off subsidiaries or independent contractors in multiple national jurisdictions against one another in order to minimize costs and maximize productivity.
The effect of US retail giant Wal-Mart's procurement practices on suppliers in the developing world is sometimes cited as a case in point [ ], but this is arguably just an especially conspicuous example of a dynamic and a concentration of power that is intrinsic to buyer-driven commodity chains [ - ]. Liberalization of financial markets enhances the power of the owners of financial assets relative to governments because of the often implicit threat of disinvestment.
This process is familiar from the role of bond markets and credit rating agencies in defining the risks to investors, not necessarily to residents of the country in question associated with a particular government's policies, and therefore determining the interest rates bondholders will demand [ - ]. Fiscal discipline is also exercised in other ways; the implications for policies related to SDH can be understood starting from the premise that even when sustained economic growth is achieved, it cannot be assumed that gains from growth will be widely shared in ways that reduce poverty and other forms of vulnerability.
Explicitly redistributive policies may be necessary. As an illustration of this point, a recent study constructed alternative scenarios of progress by 18 Latin American and Caribbean countries — a region of the world where inequality is among the highest, on a variety of dimensions [ ] — toward the MDG of reducing extreme poverty by 50 percent between and The study found "that even very small reductions in inequality can have very large positive impacts in terms of poverty reduction.
For most countries considered, a one- or two-point reduction in the Gini coefficient," which is a standard measure of income inequality across an entire society, "would achieve the same reduction in the incidence of poverty as many years of positive economic growth" [ ] p. This represents an application at the country level of the New Economics Foundation's insight about the relative ineffectiveness of growth in reducing poverty worldwide, discussed in the second article of the series. In other words: even a little economic redistribution could go a long way toward reducing inequalities in access to SDH, especially if redistributive policies were combined with carefully designed publicly financed health system and educational interventions.
The nature of redistributive policies is that someone within the borders of the nation-state in question has to pay for them. The constraint on policy space that arises from the need to raise tax revenues to finance such measures, once again in the Latin American context, is succinctly described by Williamson, codifier of the "Washington consensus" on development policy [ ] which throughout the s focused on domestic deregulation and rapid integration of national economies into the global marketplace.
The operation of this constraint is not limited to Latin America: financial deregulation and the increased mobility of financial assets have enabled the propertied worldwide to join "a sort of global, cross-border economic electorate, where the right to vote is predicated on the possibility of registering capital" [ ] p. Evidence that interjurisdictional competition has already reduced fiscal capacity and constrained the ability of governments to increase the progressivity of taxation and improve the effectiveness of tax collection is inconclusive [ - ].
The former Chief of the IMF's Public Finance Division has predicted that this constraint will clearly arise in the future [ ]; he has identified several "fiscal termites" including inability to tax financial capital, accounting flexibilities associated with intrafirm trade across national borders, the proliferation of derivatives and hedge funds, and the cross-border mobility of high income earners [ ] that will limit fiscal capacity and start chewing on the foundations of tax systems in countries rich and poor alike see also [ , ].
For some observers, the ideal remedy would be multilateral agreement on the creation of a system for global taxation and redistribution of resources across national borders, such as the long-standing proposal for a tax on currency transactions — the "Tobin tax" — or more recent proposals for taxes on carbon emissions or air travel [ - ]. France has now adopted a tax on air tickets, the progressivity of which is maintained by a much higher tax on business class tickets, with proceeds dedicated to supporting purchase of drugs to treat AIDS, tuberculosis and malaria in developing countries [ ]; 13 other countries have signed on to this proposal [ ].
It remains to be seen whether the existence of this levy will create a political obstacle to increasing development assistance from general revenues in the industrialized world, and such purpose-specific funds are no substitute for the larger scale global redistribution that some would argue is ethically imperative. This necessarily brief discussion suggests a rather bleak conclusion. Redistributive policies of various kinds are likely to be needed to reduce health inequities within and between countries.
This book traces the historic relationships between cotton production, the international cotton trade and poverty south of the Sahara, and assesses various approaches to corporate social responsibility and nongovernmental policy advocacy in this area. He has published on the relevance of the North-South debate in the present era of globalization, and his current research focuses on tropical timber and poverty in the Central Africa region.
Sneyd belongs to an innovative and gifted generation of young scholars who are forcing us to rethink the basics of international political economy. His important book deserves high praise. The book's discussion of new governance initiatives such as corporate social responsibility efforts is both rich in detail and highly engaging.
Related Governing Cotton: Globalization and Poverty in Africa (International Political Economy)
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