Globalisation and neoliberalism as structural drivers of health inequities

Abstract

In this paper, we draw upon and build on three presentations which were part of the plenary session on ‘Structural Drivers of Health Inequities’ at the National Conference on Health Inequities in India: Transformative Research for Action, organised by the Achutha Menon Centre for Health Science Studies in Trivandrum, India. The three presentations discussed the influential role played by globalisation and neoliberalism in shaping economic, social and political relationships across developed and developing countries. The paper further argues that the twin process of globalisation and liberalisation have been important drivers of health inequities. The first segment of the paper attempts a broader conceptualisation of neoliberalism beyond the economic realm. Using Stephanie Lee Mudge’s conceptualisation (Soc Econ Rev 6:703–3, 2008) we have analysed how the political, bureaucratic and intellectual domains of neoliberalism have intersected and redefined the role of state and commercialised health services leading to inequities. Neoliberal ideas have reconfigured the role and changed the priorities of non-governmental organisations resulting in a fracture within this movement. n the second segment, we focus on the rise of American philanthro-capitalism, and how the two major foundations, the Rockefeller Foundation (early twentieth century) and the Bill and Melinda Gates Foundation (twenty-first century), have shaped the ideology of institutions engaged in international health and influenced the global health agenda. We discuss how the activities of philanthro-capitalists have transformed the architecture of health governance through their top-down organisational culture and deficit of structures to ensure accountability. The third and final segment of the paper focuses on how neoliberalism as a political project and cultural movement has forged alliances with conservative politics and religious fundamentalisms, resulting in negative consequences for women and other marginalised groups. These alliances have resulted in the control of women’s bodies and contributed to the reversal of hard-won rights for health and gender justice in many parts of the world.

Linking political exposures to child and maternal health outcomes: a realist review

“…In theory two, relating to political tradition, the focus is on child mortality and low birth weight, thereby taking a child health perspective. In theory six, relating to globalisation, a child health perspective is again taken, with a broader range of key outcomes, including child and infant mortality, as well as youth smoking rates (age [11][12][13][14][15][16][17].…”

“…A dominant force in western politics since the 1980s, this theoretical perspective has featured widely in scholarly discourse linking politics and population health. For example, an analysis of the health consequences of Thatcherism in the United Kingdom was conducted by Scott-Samuel et al [ 15 ], a conceptualisation of neoliberalism – along with economic globalisation – as a key driver of health inequity [ 16 ], and a book on ‘neoliberal epidemics’ has been published [ 17 ]. A qualitative case study by Garnham [ 18 ] offers further insight into how the effects of neoliberalism may operate, although this study is limited to post-industrial west central Scotland, and context may be important in terms of how political exposures have their impact.…”

A World of False Promises: International Labour Organization, World Health Organization, and the Plea of Workers Under Neoliberalism

“…32 American foundations have shaped the ideology of institutions engaged in international health and influenced the global health agenda. 33 The WHO's top 20 contributors provide nearly 80% of the total financing-among them, the Bill and Melinda Gates Foundation, Rotary International, and the Bloomberg Family Foundation. They do so with independence from government agencies and with little or no public accounting of their activities and conflicts of interest.…”

Poverty, Reproductive Health and Public Health Policies in Chile

“…The scientific literature has given a fund of evidence about the influence that the social determinants have on the individual and familiar health, as the substratum of diverse illnesses that manifest regardless the universal access that people may have to health systems [5,6]. The social inequality is the result of the accumulation and concentration of incomes, wealth and property coming from the prevailing neoliberal model in the Chilean economy [7][8][9][10]. Under this model have raised public, economic, political and social policies [9], which have set a new generation of inequalities expressed in persistent gaps in the basic living standards, the precariousness of assets, negatively affected emotional ties and solidarity, health disparities and inequalities regarding well-being, jobs, treatment and security of people in their communities [8,[11][12][13][14][15].…”