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which have been redefined since the mid-1990s as commodities

so as to encompass private rights over body parts, life

forms and as the output of life science corporations, including

ownership of patents over seeds or even parts of the human

genetic structure (this has also been reinforced by contract

law) (Correa 1999; Drahos and Mayne 2002; Kimbrell 1995;

Richards 2005; Sahai 1999). All of the above require as a

condition of their existence a particular liberal structure of

the Rule of Law and the strong institutionalization of private

property rights – elements central to new constitutionalism.

3. A third set of measures connects to the growing contestation

over disciplinary neo-liberalism as reflected in the

emergence of the World Social Forum and other organizations

concerned to constrain and challenge globalization from above.

Privatized forms of development generate global contradictions.

Perhaps the most central is the way that the discipline

of capital intensifies a general crisis of social reproduction and

the depletion and destruction of nature – this is why activists

throughout the world are calling for greater political, social

and ecological democracy.

Thus a third set of measures include those that have been

devised to attempt to deal with dislocations and contradictions

associated with for example the growing frequency and

depth of financial and economic crises, widespread impoverishment

of populations, unsustainable ecological damage

and the generalized social crisis. Neo-liberal accumulation

requires dismantling certain types of protection for industry,

agriculture, and for workers; as such it is resisted, as people

seek to protect the basic means of their livelihood and the

conditions of their existence. Dominant forces seek to constrain

and co-opt such resistance by means of compensatory

measures and crisis management to deal with the wide range

of dislocations noted above. The World Bank supports the idea

of „social safety nets“ and „poverty alleviation“.

A wide range of measures are designed to try to make

neo-liberalism politically sustainable whilst it engages in

the restructuring of state forms and the enlargement of the

world market for capital. Whether this can succeed is an open

question, one that will be crucial for global politics in the

foreseeable future.

New constitutionalism and caring institutions

The shift towards more market oriented, privatized governance

arrangements prioritized by neo-liberals has enormous

impact on caring institutions that have been traditionally

mainly associated with socialized public provision – e.g. in

health and education. For example, the WTO is now one of

the principal organizations of economic governance at the

global level, and it is an institution that is premised upon the

primacy of private property rights, e.g. the rights of those who

hold capital to freely move it across jurisdictions in order to

maximize profit and promote economic growth, enshrined in

the principles of non-discrimination between foreign and domestic

rights-holders that the WTO institutionalizes in trade

in goods, investment and services.

Caring institutions once governed by enabling professions

with some degree of public accountability, geared to universal

care, are now determined increasingly by market values and

private forces, driven directly by the profit motive. A good

example of this is the General Agreement on Trade in Services

(GATS) in the WTO which seeks to „progressively liberalize“

provision of services, including public services in health

and education (and in agriculture, including water supplies,

finance, tourism and in other fields) (OECD 2001; Scherrer


In so far as GATS influences the regulation of public services,

it will widen the operation of the profit motive, for

example in healthcare, worsening what can be called an increasingly

antagonistic and globalizing contradiction between

(a) the structures of accumulation focused on the development

of knowledge about health, which is enshrined as proprietary

knowledge and increasingly provided through private competitive

provision systems; and (b) the ability of society as

a whole to meet the need for accessible, appropriate and affordable

health care (Sinclair 2000) (Woodward 2005).

After World War II in many countries socialized provision

was made widely available to care for the sick, infirm and

the elderly, and although not fully observed in practice, the

regulative principle was equal rights of all to equal treatment

for all when and if it was needed. Disciplinary neo-liberalism

has ushered in pay-as-you-go systems, involving user fees

and other forms of self-provisioning, a part of a shift towards

a self help society as opposed to one based on collective provisioning.

These changes narrow the framework of access and entitlements

according to income or ability to pay – so that a

new hybrid between public and private health care institutions

has emerged, increasingly regulated by market practices

and principles. The much more unequal structure of access to

healthcare that results in turn may contribute to a decline in

social solidarity and other social ills, although the effects of

restructuring of caring institutions are matters of deep controversy

and continuing debate.

The move towards the re-privatization of medical research,

health education and the provision of care and the intensification

of exploitation is operative at various levels. At the

macro-level, although US$2.2 trillion is spent globally on

health care each year, about 87% of this is spent on 16% of the

world’s population. This disparity is echoed in the allocation

of global research expenditures, with 90% of $70 billion spent

annually on research being devoted to diseases responsible for

only 10% of the global burden of disease. Further, of 1,393

new drugs to reach the market between 1975 and 1999 only 16

were developed for treatment of tropical diseases or tuberculosis.

The US alone accounts for around 50% of global health

care spending and 45% of global drug expenditures.

This trend is associated with the re-orientation of key social

institutions as we have recounted above. It involves (a) a shift

of resources away from the provision of broad-based health

care towards specialization and the emergence of „boutique

medicine“ available to those with private insurance or resources;

and (b) a new categorical imperative as key institutions

are forced to rely on private funding for research and health

education. Knowledge about disease, sickness and health is

accumulated in the form of privately controlled medical capital,

produced and distributed according to the dictates of

competitive markets and profitability.

The governance of public health care systems is being

transformed, and there is evidence that they are gravitating

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