Letter in response to BMJ article, "Globalization is Good for Your Health, Mostly"

The September 1, 2001 issue of the British Medical Journal (BMJ) published an article by Richard Feacham, Director of the Institute for Global Health, University of California. This article, Globalization is Good for Your Health, Mostly, features the following summary points: 1) Notwithstanding the angry protests at the recent G8 summit in Genoa, globalization continues to bring benefits to the incomes and health of the poor; 2) Globalization also brings a variety of social and political benefits, especially to oppressed peoples; 3) The risks and adverse consequences of globalization must be confronted, but they must not be allowed to obscure its overall positive impact on health and development.

Since our experience in developing countries sharply contradicts the conclusions of this article, DGH felt compelled to write a letter to the editor. Below is our response:

Dear Sir,

In his recent article praising the positive health effects of globalization, Richard Feacham [1] espouses a view shared by few researchers concerned about the negative effects of "globalization-as-we-know-it" on the health of poor countries. There are demonstrated harmful effects of the debt crises, structural adjustment, and privatization of health services on the overall health of poor countries, yet Feacham does not address these. [2]

Feacham follows the lead of other proponents of undemocratic, corporate-controlled globalization. He does not answer the critics’ charges, but rather creates straw-man arguments and then knocks them down. Opponents of "globalization" are not isolationists. Who in the world, save for a few dictatorial countries, is not open to greater communication between peoples and cultural exchange? He conveniently sidesteps addressing the documented damaging effects of what globalization is known as around the world, namely neoliberal economics: privatization, cuts in government social spending, imposition of user fees, export promotion over the promotion of domestic production, higher interest rates, and currency devaluation.

Feachem claims that countries who have increased trade and reduced tariffs have grown much faster than other developing countries. One might question how that growth is measured and how well it correlates with improved health measures and human rights standards. [3] In fact, inequality within and between countries has actually worsened over the past 20 years. [4] Even using the imperfect measure of per capita income, globalization’s effects are mixed. From 1960 to 1980, per-capita income in Latin America grew by 73%, whereas from 1980 to 2000 growth was only 6%. In Africa incomes rose 34% between 1960 and 1980 and fell 23% between 1980 and 2000. [5] Growth was no greater in countries that followed World Bank/IMF policy than those who did not.

We agree that globalization of previously codified human rights standards is good for global health. However, to assume that one must put up with if not welcome "the eyesore of the McDonald’s outlet in Hyderabad," in order to achieve equity and parity in human rights and health stretches credibility. Many countries have made advances in health and human rights standards without inviting in Western corporate fast food chains.

Feacham acts as if no one calling attention to the abuses of globalization has put forth a viable alternative. No thoughtful health professional is opposed to economic growth and the advancement of human development as long as those two goals are considered equally. Human development is all too often considered secondary in global economic policy decisions. Our viable alternative is a democratic development strategy that is both equitable and beneficial to the poorest sectors of the global economy, that takes into consideration the full spectrum of human rights, including health, environment and labor rights. Proposals that continue to ignore the health of the poorest sectors will be doomed to perpetuate economic inequality and poor health for us all.

Timothy H. Holtz, MD, MPH
Vice President

Wendy Johnson, MD

Doctors for Global Health
PO Box 1761
Decatur, GA 30031

1. Feacham RGA. Globalisation is good for your health, mostly. British Medical Journal 2001;323:504-6.

2. Kim JY, Millen JV, Irwin A, Gershman J, editors. Dying for Growth: Global Inequality and the Health of the Poor. Monroe, Maine: Common Courage Press, 2000.

3. Sen A. Health in development. Bulletin of the World Health Organization 1999;77(8):619-623.
UNDP. Human Development Report 1998. New York, NY: United Nations Development Program, 1998.

4. Weisbrot M, Baker D, Kraev E, Chen J. The Scorecard on Globalization, 1980-2000: Twenty Years of Diminished Progress. Washington, D.C.: Center for Economic and Policy Research, 2001.