1FW2e8F

Recommendations

Info

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
SECTION 1 2 3 WHAT CAN BE DONE Strong IP protection also stifles generic competition – the most effective and sustainable way to cut prices. It was only after Indian generic companies entered the HIV medicine market that prices dropped from $10,000 per patient per year to around $100 – finally making it possible for donors and governments to fund treatment for over 12 million people. 446 Yet developing countries are being pressed to sign new trade and investment deals, like the Trans-Pacific Partnership, which further increase IP protection, putting lives on the line and, in the end, leading to a wider gap between rich and poor. The interests that are served when the public interest is not At both a national and global level, powerful coalitions of interests are making the rules and dictating the terms of the debate. Rich country governments and MNCs use trade and investment agreements to further their own interests, creating monopolies that hike up the prices of medicines and force developing countries to open up their healthcare and education sectors to private commercial interests. In South Africa, private health insurance companies have been accused of lobbying against a new National Health Insurance scheme that promises to provide essential healthcare to all. 447 In 2013, the US-based pharmaceutical company Eli Lilly filed a $500m law suit against the Canadian government for invalidating patents for two of its drugs. 448 The fact that only 10 percent of pharmaceutical R&D expenditure is devoted to diseases that primarily affect the poorest 90 percent of the global population 449 is a stark reminder that big drug companies are dictating priorities to suit their own commercial interests at the expense of public health needs. It is no accident that there is no cure for Ebola, as there has been virtually no investment in finding one for a disease predominantly afflicting poor people in Africa. 450 In Europe, the pharmaceutical industry spends more than €40m each year to influence decision making in the EU, employing an estimated 220 lobbyists. 451 Often their influence is helped by their close connections to power. For example, there is a well-known revolving door between the US Trade Representative office, which sets trade policies and rules, and the powerful Pharmaceutical Research and Manufacturers of America. 452 Margaret Chan, Director General of the World Health Organization (WHO), put it well in 2014: ‘Something is fundamentally wrong in this world when a corporation can challenge government policies introduced to protect the public from a product [tobacco] that kills. If [trade] agreements close access to affordable medicines, we have to ask: Is this really progress at all, especially with the costs of care soaring everywhere’ 453 95
Page 1 and 2:
Even it up TIME TO END EXTREME INEQ
Page 3 and 4:
JEFFREY SACHS Director of the Earth
Page 5 and 6:
ACKNOWLEDGEMENTS The paper was writ
Page 7 and 8:
SECTION 1 2 3 FOREWORD FOREWORD The
Page 9 and 10:
SECTION 1 2 3 FOREWORD Persistent i
Page 11 and 12:
SECTION 1 2 3 EXECUTIVE SUMMARY Nth
Page 13 and 14:
SECTION 1 2 3 EXECUTIVE SUMMARY Bil
Page 15 and 16:
SECTION 1 2 3 EXECUTIVE SUMMARY The
Page 17 and 18:
SECTION 1 2 3 EXECUTIVE SUMMARY pow
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
SECTION 1 2 3 EXECUTIVE SUMMARY Des
Page 25 and 26:
SECTION 1 2 3 EXECUTIVE SUMMARY and
Page 27 and 28:
SECTION 1 2 3 EXECUTIVE SUMMARY gov
Page 29 and 30:
SECTION 1 2 3 INTRODUCTION Nthabise
Page 31 and 32:
A view across Santa Marta favela an
Page 33 and 34:
SECTION 1 2 3 EXTREME INEQUALITY ME
Page 35 and 36:
SECTION 1 2 3 EXTREME INEQUALITY FI
Page 37 and 38:
SECTION 1 2 3 EXTREME INEQUALITY TA
Page 39 and 40:
SECTION 1 2 3 EXTREME INEQUALITY 1.
Page 41 and 42:
SECTION 1 2 3 EXTREME INEQUALITY FI
Page 43 and 44:
SECTION 1 2 3 EXTREME INEQUALITY Th
Page 45 and 46:
SECTION 1 2 3 EXTREME INEQUALITY EX
Page 47 and 48: SECTION 1 2 3 EXTREME INEQUALITY 20
Page 49 and 50: SECTION 1 2 3 EXTREME INEQUALITY in
Page 51 and 52: SECTION 1 2 3 EXTREME INEQUALITY Ca
Page 53 and 54: SECTION 1 2 3 EXTREME INEQUALITY ed
Page 55 and 56: SECTION 1 2 3 EXTREME INEQUALITY (C
Page 57 and 58: SECTION 1 2 3 EXTREME INEQUALITY Si
Page 59 and 60: SECTION 1 2 3 EXTREME INEQUALITY Th
Page 61 and 62: SECTION 1 2 3 EXTREME INEQUALITY CA
Page 63 and 64: SECTION 1 2 3 EXTREME INEQUALITY Id
Page 65 and 66: SECTION 1 2 3 EXTREME INEQUALITY CA
Page 67 and 68: SECTION 1 2 3 EXTREME INEQUALITY On
Page 69 and 70: SECTION 1 2 3 EXTREME INEQUALITY MY
Page 71 and 72: SECTION 1 2 3 EXTREME INEQUALITY ma
Page 73 and 74: SECTION 1 2 3 WHAT CAN BE DONE THE
Page 75 and 76: SECTION 1 2 3 WHAT CAN BE DONE BURK
Page 77 and 78: SECTION 1 2 3 WHAT CAN BE DONE In S
Page 79 and 80: SECTION 1 2 3 WHAT CAN BE DONE wage
Page 81 and 82: SECTION 1 2 3 WHAT CAN BE DONE (CAS
Page 83 and 84: SECTION 1 2 3 WHAT CAN BE DONE Some
Page 85 and 86: SECTION 1 2 3 WHAT CAN BE DONE 2.3
Page 87 and 88: SECTION 1 2 3 WHAT CAN BE DONE Inte
Page 89 and 90: SECTION 1 2 3 WHAT CAN BE DONE appr
Page 91 and 92: SECTION 1 2 3 WHAT CAN BE DONE fisc
Page 97: SECTION 1 2 3 WHAT CAN BE DONE CASE
Page 103 and 104: SECTION 1 2 3 WHAT CAN BE DONE to 5
Page 107 and 108: SECTION 1 2 3 WHAT CAN BE DONE hous
Page 111 and 112: SECTION 1 2 3 WHAT CAN BE DONE CASE
Page 113 and 114: SECTION 1 2 3 WHAT CAN BE DONE The
Page 115 and 116: SECTION 1 2 3 WHAT CAN BE DONE (CAS
Page 117 and 118: SECTION 1 2 3 TIME TO ACT Today’s
Page 119 and 120: SECTION 1 2 3 TIME TO ACT • Imple
Page 121 and 122: SECTION 1 2 3 TIME TO ACT • Commi
Page 123 and 124: SECTION 1 2 3 TIME TO ACT • Ensur
Page 125 and 126: SECTION 1 2 3 NOTES NOTES 1. Based
Page 127 and 128: SECTION 1 2 3 NOTES 51. M. Carney (
Page 129 and 130: SECTION 1 2 3 NOTES 106. S. Limwatt
Page 131 and 132: SECTION 1 2 3 NOTES 168. The Transn
Page 133 and 134: SECTION 1 2 3 NOTES 245. P. Engel,
Page 135 and 136: SECTION 1 2 3 NOTES 324. Oxfam and
Page 137 and 138: SECTION 1 2 3 NOTES 390. In C. Godf
Page 139 and 140: SECTION 1 2 3 NOTES 449. P. Stevens
Page 142: The widening gap between rich and p
show all

1FW2e8F

Create successful ePaper yourself

Delete template?

Save as template?