1. "Australian Society: Is there a disturbance in the Force?“ A Public Health View Professor Fran Baum Public Health Flinders University Adelaide

2. Battle between Good and Evil

3. What is a healthy community? Transport Transport Education and Employment Education and Employment Peace and security Peace and security Housing Housing Well planned Well planned Social and convivial Social and convivial Equal and non-exploitation Equal and non-exploitation Acceptance of difference Acceptance of difference Sustainable environment Sustainable environment Absence of disease Absence of disease

4. Towards Healthy and Sustainable Living Community Convivial Equitable Livable HEALTH Environment Viable Sustainable Adequately prosperous $$$Economy $$$$ (Hancock, 1994)

5. So why don’t we have this kind of balanced society – what is impeding it?

6. Unhealthy Signs Economic Economic Dominance by economic thinking Dominance by economic thinking Some groups doing better than others Some groups doing better than others Social – lack of: Social – lack of: Trust Trust Tolerance Tolerance Equity Equity Unsustainable development Unsustainable development

7. Economic rationalism’s march continues unabated

8. Hallmark of economic rationalism Private sector values introduced into public sector – outsourcing, contracting out Private sector values introduced into public sector – outsourcing, contracting out Reduction of size of public sector Reduction of size of public sector Privatisation of public assets: prisons, water, electricity, banks, insurance companies, housing Privatisation of public assets: prisons, water, electricity, banks, insurance companies, housing Increasingly associated with economic globalisation Increasingly associated with economic globalisation

9. Globalisation Complex set of processes Complex set of processes the evolution of a global financial trade (key role for WTO) the evolution of a global financial trade (key role for WTO) undermining of the power of national governments undermining of the power of national governments transformation of traditional values including those relating to women and the family and religion transformation of traditional values including those relating to women and the family and religion growth in inequities within and between countries growth in inequities within and between countries

10. What is economic globalisation? Trade liberalisation, tarriff reduction, standards harmonisation and deregulations Trade liberalisation, tarriff reduction, standards harmonisation and deregulations Growth in international trade e.g. 8.6% per year from 1990-99 Growth in international trade e.g. 8.6% per year from 1990-99 Greater mobility of capital and increase in transnational investment Greater mobility of capital and increase in transnational investment Global institutions to regulate WTO, GATT, GATS Global institutions to regulate WTO, GATT, GATS

11. Is globalisation good for health? PRO Trickle down effect Trickle down effect Will increase income of poor Will increase income of poor Cleaning up corrupt governments in poor countries Cleaning up corrupt governments in poor countries More communication More communication Consumer goods than enrich lives Consumer goods than enrich livesCON Structured unfairness of trade Structured unfairness of trade Increases inequities Increases inequities SAPs in poor countries SAPs in poor countries Swamping culture Americanism McCulture Swamping culture Americanism McCulture Unhealthy levels of consumption Unhealthy levels of consumption Baum (2002) The New Public Health, p. 109

12. World Trade Organisation and TNCs Cancun, Mexico 10 th September 2003 Cancun, Mexico 10 th September 2003 Push from EU to expand rights of TNCs Push from EU to expand rights of TNCs Agreement on investments Agreement on investments Govts no longer able to prevent a foreign corporation setting up no matter how bad its environmental or social record Govts no longer able to prevent a foreign corporation setting up no matter how bad its environmental or social record Environmental, health or labour standards could be seen as a restriction on trade Environmental, health or labour standards could be seen as a restriction on trade

13. Example: Canada and Ethyl Corp Govt banned a fuel additive in 1996, PM described as “a dangerous neurotoxin” Govt banned a fuel additive in 1996, PM described as “a dangerous neurotoxin” US-based Ethyl Corp sued for compensation arguing ban constituted an “expropriation” of Ethyl’s Canadian investments because global reputation had been harmed US-based Ethyl Corp sued for compensation arguing ban constituted an “expropriation” of Ethyl’s Canadian investments because global reputation had been harmed Lawyers advised Govt it would lose so it lifted ban, gave Ethyl $13m and an apology Lawyers advised Govt it would lose so it lifted ban, gave Ethyl $13m and an apology “Canadians breathe in the results of this decision every time they step outside” “Canadians breathe in the results of this decision every time they step outside” Retallack (2003) New Statesman, 25 th Aug

14. Example: Mexico Paid US waste disposal company Metalclad $15.6m because Municipal Govt in Guadalcazar refused to allow Metalclad to open a new toxic-waste facility on a site that is highly vulnerable to ground water contamination Paid US waste disposal company Metalclad $15.6m because Municipal Govt in Guadalcazar refused to allow Metalclad to open a new toxic-waste facility on a site that is highly vulnerable to ground water contamination Retallack (2003) New Statesman, 25th Aug

15. Threats to public health WTO agreement on govt procurements could mean govts can not give preference to local companies or award contracts on basis of public health e.g. school canteens WTO agreement on govt procurements could mean govts can not give preference to local companies or award contracts on basis of public health e.g. school canteens Would be illegal to require GM-free food or low fat content – would be seen as a barrier to trade Would be illegal to require GM-free food or low fat content – would be seen as a barrier to trade

17. Main beneficiaries from Economic Globalisation TNCs TNCs CEOs CEOs Rich people Rich people Rich countries Rich countries

18. Walmar, owned by the Walton family in the United States has an estimated wealth of US$27 billion which is higher than the GDP of Bangladesh with its population of 120 billion Walmar, owned by the Walton family in the United States has an estimated wealth of US$27 billion which is higher than the GDP of Bangladesh with its population of 120 billion

19. Wealthy People The world’s 200 richest people more than doubled their net worth in 1993-7 The world’s 200 richest people more than doubled their net worth in 1993-7 WHO (1997) note that in 1996 just 358 billionaires had a net worth of US$760m which equalled the wealth of the poorest 45% of the entire world’s population WHO (1997) note that in 1996 just 358 billionaires had a net worth of US$760m which equalled the wealth of the poorest 45% of the entire world’s population

20. Business Review Weekly richest Australians: 1983 and 2000 Top ten in 1983WorthTop ten in 2000Worth Murdoch family$250mKerry Packer$8200m Fairfax family$175m Frank Lowy $2800m Smorgon family$150m Richard Pratt $2700m J&R Ingham$150mDavid Hains$1400m Kerry Packer$100mBoris Liberman$1300m Source: Business Review Weekly web site www.brw.com.au

22. Rich countries getting richer The UN Human Development Report (1999) compares the size of the income of the fifth of the world’s people living in the richest countries and that of the fifth in the poorest. The ratio had changed from 30 to 1 in 1960, to 60 to 1 in 1990 and to 74 to 1 in 1997 The UN Human Development Report (1999) compares the size of the income of the fifth of the world’s people living in the richest countries and that of the fifth in the poorest. The ratio had changed from 30 to 1 in 1960, to 60 to 1 in 1990 and to 74 to 1 in 1997

23. About half the world’s population, 3 billion people, live on less than US$2 a day and of those about 1 billion live in extreme poverty of below US$1 a day. About half the world’s population, 3 billion people, live on less than US$2 a day and of those about 1 billion live in extreme poverty of below US$1 a day. (UNDP, 1998)

24. Growing Global Inequities In sub-Saharan Africa 20 countries have lower incomes per head in real terms than they had in the late 1970s. In sub-Saharan Africa 20 countries have lower incomes per head in real terms than they had in the late 1970s.

25. International comparison of health indicators (1999)

26. “The global supervisory organisations like the World Bank, the IMF, the WTO, and the United Nations system should be giving the issue of global income inequality much more attention. ……. International public policy to reduce world income inequality must include a basic change in the policy orientation of the World Bank, the IMF, and the WTO so as to allow them to sanction government efforts to impart directional thrust and nourish home grown institutional innovations” Robert Hunter Wade, Professor of Political Economy London School of Economic and ex World Bank Economist

27. It is shaking up our existing ways of life, no matter where we happen to be. This is not - at least at the moment - a global order driven by collective human will. Instead, it is emerging in an anarchic, haphazard, fashion, carried along by a mixture of influences. It is not settled or secure, but fraught with anxieties, as well as scarred by deep divisions. Many of us feel in the grip of forces over which we have no power. Giddens (1999, p.19)

28. Unhealthy Societies Economics $$$ Environment Social

29. Inequities within countries In all countries where data is documented there are inequities between groups based on socio-economic status In all countries where data is documented there are inequities between groups based on socio-economic status Evidence inequities are increasing Evidence inequities are increasing Those countries with more equal distributions of income have better population health status Those countries with more equal distributions of income have better population health status

30. Growing inequities in Australia Gini coefficient measuring inequity increases Wage income 15.5 % Wage income 15.5 % Market income 7.5% Market income 7.5% Gross income 6.7% Gross income 6.7% Disposable income 7.4% Disposable income 7.4% Saunders, P (2002) The Ends and Means of Welfare, Cambridge: CUP.

35. Protests at unfair trade Evian, May 2003

36. When inequities become too great the idea of community becomes impossible (Raymond Arons)

37. Trust is declining Trust in government and others is declining Trust in government and others is declining People more likely to be wary of others People more likely to be wary of others

38. Tolerance is declining No apology and reconciliation is making shaky progress No apology and reconciliation is making shaky progress Political agenda using fear, intolerance and distrust e.g. Tampa affair Political agenda using fear, intolerance and distrust e.g. Tampa affair Wedge politics Wedge politics Less welcoming and inclusive as a result Less welcoming and inclusive as a result Refugees Refugees

39. “Frontiers, immigration checkpoints and visas form barriers between the wealthier countries and the poorer ones. They are the fortifications that protect privilege and excess, the castle walls behind which global riches are stockpiled for the enjoyment of the few. Removing those barriers would be a revolutionary step towards social justice” Mares (2001, p.187)

40. Declining social capital Trust reducing Trust reducing Engagement in community & voluntary groups is declining Engagement in community & voluntary groups is declining Less equality Less equality Yet we know higher levels of social capital appear to be good for health Yet we know higher levels of social capital appear to be good for health

41. Social Cohesion: Crime and social capital Elevation in neighbourhood collective efficacy (social cohesion and trust) was associated with a 39.7% reduction in the expected homicide rate (Sampson et al, 1997) Elevation in neighbourhood collective efficacy (social cohesion and trust) was associated with a 39.7% reduction in the expected homicide rate (Sampson et al, 1997) Links at state level between low trust and higher rates of violent and property crime (Kennedy et al, 1998; Kawachi et al, 1999b) Links at state level between low trust and higher rates of violent and property crime (Kennedy et al, 1998; Kawachi et al, 1999b)

42. Social Capital, health and inequality In USA States income inequality strongly correlated with both per capita group membership (r=-.40 P <.01) and lack of social trust (r=.76, P <.0001) In USA States income inequality strongly correlated with both per capita group membership (r=-.40 P <.01) and lack of social trust (r=.76, P <.0001) Social trust and group membership associated with total mortality and rates of death from CHD, Ca, infant mortality Social trust and group membership associated with total mortality and rates of death from CHD, Ca, infant mortality (Kawachi et al (1997)Am J PH, 87, 1491-1498)

43. Sustainability

44. Are we sustainable? Human development and achieving human potential require economic activity that is socially and environmentally sustainable in this and future generations Human development and achieving human potential require economic activity that is socially and environmentally sustainable in this and future generations Canadian Public Health Association (1991) Health Implications of the Ecological Crises, Ottawa: CPHA Canadian Public Health Association (1991) Health Implications of the Ecological Crises, Ottawa: CPHA

45. Threats to sustainability Air pollution Air pollution Water pollution Water pollution Climate change Climate change Unsustainable economic activity Unsustainable economic activity Loss of biodiversity Loss of biodiversity Over consumption Over consumption We are living beyond our means

46. Can we restore the good forces?? First globally First globally Australia and other rich countries have a responsibility to share wealth with poorer countries Australia and other rich countries have a responsibility to share wealth with poorer countries Could we cope with a small drop in standard of living? Could we cope with a small drop in standard of living?

47. “….the very right to be human is every day denied to hundreds of millions of people as a result of poverty …. The unavailability of food, jobs, water and shelter, education, health care and a healthy environment” is “not a preordained result of the forces of nature or the product of a curse of the deities”. It is “the consequences of decisions which men and women take or refuse to take, all of whom will not hesitate to pledge their devoted support for the Universal Declarations of Human Rights”. Nelson Mandela quoted in Heywood and Altman, 2000, p.173

48. Redressing wealth imbalance The equity challenge is to move some money away from the super rich countries, corporations and individuals and use it effectively to promote the health and well-being of the world’s poorest citizens. (Annas, 2000, p.185)

49. A solution is very possible if there is the will…… The United Nations has estimated that the cost of universal access to basic education, health care and food and clean water is only about $40 billion a year, less than 4% of the combined wealth of the 225 richest people in the world. The United Nations has estimated that the cost of universal access to basic education, health care and food and clean water is only about $40 billion a year, less than 4% of the combined wealth of the 225 richest people in the world.

50. Principles to assist in achieving fair and responsible trade Equity in trade policies Equity in trade policies Protection of vulnerable groups (eg family farms, co-operatives, Indigenous peoples) Protection of vulnerable groups (eg family farms, co-operatives, Indigenous peoples) Sustainability to enhance ecological systems Sustainability to enhance ecological systems Internalisation of costs: environmental costs should be given valuation Internalisation of costs: environmental costs should be given valuation Marquez (1999, p.19)

51. How will we achieve the balance we need for healthy sustainable communities in Australia? Equity as a goal of public policy Equity as a goal of public policy Sustainability as a goal of public policy Sustainability as a goal of public policy Strong communities as a goal of public policy Strong communities as a goal of public policy

52. In Australia if we wanted we could… Dramatically improve Aboriginal health Dramatically improve Aboriginal health Reduce economic inequities Reduce economic inequities Become more inclusive by welcoming refugees Become more inclusive by welcoming refugees Ensure essential services are in public ownership Ensure essential services are in public ownership Work to restore trust Work to restore trust Reduce consumption Reduce consumption All of these things are possible if we have the will

53. Public stops being a dirty word Restoration of faith in the idea of government as a servant of the community and guarantor of personal security and as an entity that will modify the market and ensure equity and redress market inequities Restoration of faith in the idea of government as a servant of the community and guarantor of personal security and as an entity that will modify the market and ensure equity and redress market inequities

54. State intervention or we sink Our response must be that we will intervene; we will intervene to retain our right to a say in our future, to temper the market place by action, to provide services and social justice, to retain institutional safeguards and provide needed development in the community interest, for we know that we intervene or we sink