1FW2e8F

SECTION 1 2 3
WHAT CAN BE DONE
In education, there is a growing enthusiasm for so-called ‘Low-Fee Private
Schools’ (LFPS). However, these schools are prohibitively expensive for the
poorest families and are widening the gap between rich and poor. In Ghana,
sending one child to the Omega chain of low-fee schools would take up 40
percent of household income for the poorest. 433 For the poorest 20 percent
of families in Pakistan, sending all children to LFPS would cost approximately
127 percent of each household’s income. 434 The trends are similar in Malawi 435
and rural India. 436 Poor families will also often ‘hedge their bets’ by prioritizing
one or two children 437 and it is usually girls who lose out. A study in India
found that 51 percent of boys attended LFPS, compared with just 34 percent
of girls. 438
The wealthiest are able to opt-out and buy healthcare and education outside
of the public system. This undermines the social contract between citizen and
state, and is damaging for democracy. When only the poorest people are left
in public systems, the largely urban upper-middle class (i.e. those with greater
economic and political influence) have no self-interest in defending spending
on public services and fewer incentives to pay taxes. This sets in motion
a downward spiral of deteriorating quality, and a risk that structural inequalities
will be made worse, as the rich become even more divorced from the reality
of a suffering ‘underclass’. 439
The Argentinean education system offers a cautionary tale of this two-tiered
future. A gradual increase in income inequality has gone hand-in-hand with
increased segregation in education. 440 Evidence from Chile also showed that
the introduction of an opt-out option damaged the efficiency and equity of
the entire healthcare system. 441
International rules threaten public services
As with taxation, international rules can undermine domestic policy.
International education and health service corporations have long lobbied
at the World Trade Organization for international rules that require countries
to open up their health and education sectors to private commercial interests,
and recently Wikileaks exposed plans for 50 countries to introduce a Trades
in Services Agreement that would lock in the privatization of public services. 442
More immediately, the intellectual property (IP) clauses of current trade and
investment agreements, which oblige governments to extend patents on lifesaving
medicines, are squeezing government health budgets in developing
countries, rendering them unable to provide many much-needed treatments.
For example, the majority of the 180 million people who are infected with
Hepatitis C cannot benefit from effective new medicines because they live
in the global south where neither patients nor governments can afford the
$1,000 per day medical bill. 443 In Asia, medicines comprise up to 80 percent
of out-of-pocket healthcare costs. 444 And while poor countries are hit hardest
by high medicine prices, rich countries are not immune. In Europe, government
pharmaceutical spending increased by 76 percent between 2000 and 2009, 445
with some countries now refusing to offer new cancer medicines to patients
due to high prices.
94