THE MACROECONOMIC DETERMINANTS OF HEALTH

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THE MACROECONOMIC DETERMINANTS OF HEALTH

• Emee Vida Estacio
• David F Marks
• Department of Psychology
• City University, London

Paper presented at The 4th International
Conference of the International Society of
Critical Health Psychologists 29 March 1 April
2005Sheffield, UK
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When one individual inflicts bodily injury upon
another, such injury that death results, we call
the deed manslaughter when the assailant knew
in advance that the injury would be fatal, we
call his deed murder But when society places
hundreds of proletarians which is quite as much
a death by violence as that by the sword or
bullet when it deprives thousands of the
necessities of life, places them under
conditions in which they cannot live forces
them, with the strong arm of the law, to remain
in such conditions until that death ensues which
is the inevitable consequence knows that these
thousands of victims must perish, and yet
permits these conditions to remain, its deed is
murder just as surely we the deed of the single
individualdisguised, malicious murder, murder
against which none can defend himself, which
does not seem what it is, because no man sees the
murderer,because the death of the victim seems a
natural one, since the offence is more one of
omission than of commission. But murder it
remains - Frederick Engels, 1845
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The Determinants of Health1

• The core Age, sex and genetics
• Layer 1 Individual lifestyle factors
• Layer 2 Social and community influences
• Layer 3 Living and working conditions
• Layer 4 General socioeconomic, cultural and
  environmental conditions

1 Whitehead, M. (1995). Tackling inequalities
A review of policy initiatives. In M. Benzeval,
K. Judge, M. Whitehead (eds). Tackling
inequalities in health, 22-52. London King's
Fund.
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Phases of Research

• Phase 1 Review of the Literature
• - The Macroeconomic Determinants of Health
• Phase 2 Statistical Study
• - GDP, Income distribution and Quality of Life
• Phase 3 Empirical Research
• - Health in the midst of poverty and social
  inequality
• Experiencing health through the eyes of the
• dispossessed

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OVERVIEW

• What is macroeconomics?
• Structures of Trade
• Monetary policy
• Fiscal policy
• Implications for action
• The role of critical health psychology

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What is Macroeconomics?

• Macroeconomics The Big Picture
• a branch of economics that focuses on the overall
  level of prices, outputs and employment in an
  economy
• i.e. economic growth, unemployment, inflation,
  balance of payments, and exchange rates

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What is Macroeconomics?

• Structures of Trade
• Monetary Policy
• Fiscal Policy

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STRUCTURES OF TRADE

• Trade is the commercial exchange or the buying
  and selling on domestic or international markets
  of goods and services
• i.e. terms of trade, imports/exports, opportunity
  costs, and gains from trade
• FOCUS THE TOBACCO TRADE

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The Tobacco Trade

• Current trends show that about 1.1 billion people
  smoke worldwide 1.
• Consumption in low and middle income economies is
  on the rise 1.
• The burden of tobacco-related diseases is now
  being borne by developing countries 2.

1 World Bank (1999). Curbing the epidemic
Governments and economics of tobacco control. 2
WHO (1999). Confronting the epidemic A global
agenda for tobacco control research.
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The Tobacco Trade

• At the national level, tobacco worsens poverty
  1
• Increasing healthcare costs
• Losses in productivity due to illness and
  premature death
• Losses in foreign exchange
• Losses in government revenue

1 WHO (2004). Tobacco and poverty A vicious
circle. IAG, France WHO.
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The Tobacco Trade

• At the household level, tobacco perpetuates
  poverty and ill-health 1
• The familys scarce resources are being spent on
  tobacco instead on their basic needs
• Poor families are more vulnerable to increasing
  healthcare costs
• Loss of income due to illness or death

1 WHO (2004). Tobacco and poverty A vicious
circle. IAG, France WHO.
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The Tobacco Trade
SOURCE Saloojee, Y. Dagli, E. (2000). Tobacco
industry tactics for resisting public policy on
health. Bulletin of the World Health
Organisation, 78(7), 902-910.
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The Tobacco Trade Implications for action

• REDUCE DEMAND
• Taxation
• Advertising bans
• Smoking restrictions in public places
• Information measures
• Smoking cessation therapies

• REDUCE SUPPLY
• Crop substitution
• Trade restrictions
• Anti-smuggling actions
• Prominent tax stamps
• Local language warnings
• Aggressive enforcement
• Tough penalties

SOURCE World Bank (1999). Curbing the epidemic
Governments and economics of tobacco control.
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MONETARY POLICY

• Monetary policy is the policy used to influence
  the economy by controlling the supply and demand
  for money
• i.e. interest and exchange rates, flows of
  capital and debt
• FOCUS THE DEBT CRISIS

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The Debt Crisis

• The severe economic deprivation in poor countries
  today can be rooted to the debt crisis.
• we, the poor, pay from our poverty, not from
  abundance the high and often floating
  interest rates are a form of taxation without
  representation taxation of the poor for the
  benefit of the rich- Julius K.
  NyererePresident of Tanzania, 1985

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The Debt Crisis

• 1960s US Government overspending
• Print more dollars
• Worlds stock of dollars fell in value
• 1973 OIL PRICE HIKE
• Revenues deposited in Western banks
• Banks lent lavishly to the Third World

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The Debt Crisis

• Mid-1970s Cash crops
• Increasing supplies ?falling prices
• 1979 US adopts a new monetary policy
• Rising interest rates
• 1980s - ??? THE DEBT CRISIS

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The Debt Crisis

• The poor are the worst hit in this crisis.
• The resources are being spent on debt repayment
  instead on healthcare, education or social
  welfare.
• Debt relief from the IMF and the World Bank is
  contingent upon the countries adaptation of
  structural adjustment programmes.

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The Debt Crisis

• Structural adjustment programmes (SAPs)
• Free trade
• Privatization
• Deregulation
• Less public spending
• SAPs have done developing countries more harm
  than good.

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The Debt Crisis Implications for action

• Debt cancellation is the only way.
• To achieve the Millennium Development Goal
  (No.1), heavily indebted poor countries will
  require
• 100 debt cancellation
• plus an additional 15bn-46bn 1

1 Greenhill, R. (2002). The unbreakable link -
debt relief and the millenium development goals.
A report from Jubilee Research at the New
Economics Foundation.
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FISCAL POLICY

• Fiscal policy is the policy used to influence the
  economy by altering the balance between
  government expenditure and taxation
• i.e. central government deficits and surpluses,
  priorities in public spending
• FOCUS WAR ON TERRORISM

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The War on Terrorism

• While the rest of the world is cutting down on
  military expenditure, the US Government is
  increasing billions every year -
• 343bn ?396bn ?400bn ?420bn ?500bn2002
  2003 2004 2005 2010
• Source Center for Defence Information

IS IT WORTH IT?
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The War on Terrorism

• 100,000 DEATHS

SOURCE Roberts, L., et al. (2004). Motality
before and after the 2003 invasion of Iraq
Cluster sample survey. Lancet, 364 1857-64.
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The War on Terrorism

• Abuse

Broken homes
Disease
GRIEF
FEAR
H A T E
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The War on TerrorismImplications for Action

• END THE OCCUPATION NOW
• Re-allocation of military budget 1
• If the military expenditure of the 23 richest
  countries was cut by half, there will be enough
  capital to supply clean water to every person on
  this planet, and leave 20bn extra for improved
  health and education.

1 Marks, D.F., Murray, M., Evans, B., Willig,
C., Woodall, C. Sykes, C.M. (2005). Health
Psychology Theory, Research and Practice (2nd
ed). London Sage.
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SUMMARY

• Macroeconomic forces impact on the lives of
  ordinary people.
• Many of these factors are far beyond the control
  of individuals.
• Policies have been proposed and implemented to
  promote peace, health and better quality of
  life.
• And yet, health inequalities continue to
  persist.
• W H Y ?

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The Role of Critical Health Psychologists

• We, as critical health psychologists, can
• Provide critical evaluations
• Generate frameworks
• Provide data for evidence-based policy
• Case studies
• Surveys
• Data analysis
• Become more actively involved in translating
  research into practice

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THE MACROECONOMIC DETERMINANTS OF HEALTH

• Emee Vida Estacio
• David F Marks
• Department of Psychology
• City University, London

For more related papers, see http//www.student.
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