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Dear Barbara: PAHO's figure for the US share of the world health care market in 2000 is 36%, as you can see in the 2002 issue of Health in the Americas, volume I, page 160. http://ernesto.ingentaselect.com/vl=9043265/cl=113/nw=1/rpsv/bk/paho/9275115 877/contp1.htm Saludos, Cesar -----Original Message----- From: Barbara Krimgold [mailto:[log in to unmask]] Sent: Tuesday, November 19, 2002 8:35 AM To: [log in to unmask] Subject: Re: How much of global GDP for health is spent by US??? 45% or 5 0%??? Hi all, I have put in an inquiry to the World Bank officials who organized the symposium where the $2.6 trillion and $1.3 trillion figures were used. I get a figure of 45% using the 2002 WB indicators below. Checking in the 2002 World Development Indicators, world GDP is $31,492,776, and the percent spent on health, 1995-99, is 9%. Thus, health expenditures would be about $2.8 tillion. Using the same tables, US GDP in 2000 is $9,837,406. The percent spent on health, 1995-99, is pegged at 12.9%, resulting in a figure of $1.26 tillion. This would make the US % of global GDP expenditure for health about 44-45%. Still, the US figures, both dollars and percent spent on health, look a bit low to me, so perhaps the US is approaching the 50% share of global GDP spent on health by now. Does anyone else have newer figures? I am checking with other experts. Barbara Krimgold -----Original Message----- From: Barbara Krimgold To: Barbara Krimgold; ''alex scott-samuel' '; [log in to unmask] ' Sent: 11/18/02 9:19 PM Subject: How much of global GDP for health is spent by US??? 42% or 50%??? A colleague suggested to me that, according to their calculations based on WHO stats, the US spends only 42% of the total world expenditures for health, not 50%, as was stated in the World BAnk symposium. I will try to track down the disparity between the World BAnk and WHO figures. Barbara Krimgold -----Original Message----- From: Barbara Krimgold To: 'alex scott-samuel'; [log in to unmask] Sent: 11/18/02 9:30 AM Subject: RE: Ending world poverty (includes UK!)(a response from DC in US) Re: World Bank: a few responses, a Book and Paper 1. The WB -- Branko Milanovic, head of the inequality group at the Bank, in particular -- has come to the same conclusion, that current economic development policies have resulted in increasing poverty and inequality, if China is pulled out of equation. Check the WB website for Milanovic paper. 2. Also, at a recent symposium cosponsored by the Bank and the International Labour Office, about their new book, "Social ReInsurance: A New Approach to Sustainable Community Health Financing" editors David Dror and Alexander Preker et al explore use of micro-insurance and social reinsurance to help provide some health insurance to uninsured populations. The book is available online at www.worldbank.org/publications and can also be accessed at www.ilo.org/socialre or www.worldbank.org/hnp/hsd/SocialRe.asp. While the emphasis of this symposium was inadequate health funding for the 1.3 billion poor people, it was noted that income/money is a powerful determinant of health -- and that of the $2.6 trillion, or 8% of global GDP spent on health, 50% of that -- $1.3 trillion -- is spent in the US. It was noted that it is easy to design an insurance scheme that doesnt cover the poor, but difficult to design one that tilts to favor the poor; this was an effort to reach the world's poor. 3. An another recent meeting of the thematic group on poverty, nutrition and population health, Davidson Gwatkin presented his recent paper comparing "top down" and "bottom up" approaches to desirable health outcomes. I can attach that paper, if this listserve allows an attachment. David or Adam? If I cant attach on listserve, I would be happy to send to interested individuals. Barbara Krimgold Barbara Krimgold Center for the Advancement of Health 2000 Florida Ave. NW, Suite 210 Washington, DC 20009 Tel: 202-387-2829 ext. 109 Fax: 202-387-2857 [log in to unmask] <mailto:[log in to unmask]> -----Original Message----- From: alex scott-samuel [mailto:[log in to unmask]] Sent: Sunday, November 17, 2002 4:37 PM To: [log in to unmask] Subject: Ending world poverty (includes UK!) "World Poverty - New Policies to Defeat an Old Enemy" edited and partly written by Peter Townsend and David Gordon (Policy Press, Bristol) World Bankand IMF policies are increasing world poverty and must be changed, says new study by leading academics Policies pursued by the World Bank, IMF and other international institutions are demonstrably wrong and must be changed if targets to reduce world poverty are to be met, finds a major new study published today. World poverty: New policies to defeat an old enemy shows how policies pursued by the World Bank, IMF, World Trade Organisation and national governments - particularly of the G8 nations - have not only failed to reduce poverty but have exacerbated the problem. It also puts forward a radical Manifesto for international action against poverty - an 18 point plan to be adopted by governments internationally to meet targets set by the United Nations and at the 2002 World Summit.1 Co-editor of the study, Peter Townsend, Professor of International Social Policy at the London School of Economics and Political Science said: "Despite decades of national and international policy making, mass poverty persists and is set to increase. Policies that are more directly effective have to be devised for rich and poor countries alike. Economic growth without redistribution - the central assumption of World Bank strategy - is found not to reduce poverty. A new international strategy must be devised." Policies that meet with particular criticism include: " Policies designed to bring about economic growth without redistribution The World Bank, IMF and many national governments continue to pursue policies that rest on the assumption that if the GDP of a country increases, the poor will be lifted out of poverty. In fact, policies based on this assumption are simply giving rise to growing and dramatic inequalities both within and between countries. " Policies based on a belief that conditional (or targeted) forms of welfare are more effective in tackling poverty than universal welfare This includes policies such as means-testing for benefits and 'workfare policies', i.e. benefit conditional upon participation in work, favoured by countries like the USA and Britain. Means-tested benefits in particular are found not always to reach those in need, to be costly and complex to administer, and to generate social divisions. The IMF's efforts to force developing countries to move from universal welfare programmes to targeted ones (by lending money on condition that recipient governments cut public spending) has resulted, by their own admission, in devastating social and economic consequences for the countries involved. " World trade policies, particularly terms of trade between rich and poor countries Developing countries who export to markets in the richest countries face tariff barriers in the reverse direction. This costs them $100 billion per year - twice as much as they receive in aid. The World Trade Organisation and powerful Transnational Corporations are accused of operating unfair policies, which result in a concentration of wealth in developed countries and in the accounts of global business giants. Fifty one of the world's largest economies are now corporations. " Policies that rely on the World Bank's $1-a-day threshold as a measurement of poverty This threshold is found to be arbitrary, based on out of date information and ineffective as a means of comparing poverty across countries. In particular, it does not help when assessing relative poverty between countries and does not allow for analysis of other factors which may give rise to a poor standard of living. For example, access to basic services such as water, sanitation, health and education is not taken into account. World Bank figures therefore underestimate the number of poor in the world. The study's Manifesto for international action against poverty2 puts forward an alternative strategy for tackling poverty worldwide. In particular, it argues for increased redistribution of wealth, a system of international universal welfare, and giving legal force to human rights declarations on entitlements to social security and an adequate standard of living. Policy recommendations include: " All developed countries to commit to 1% GDP overseas development assistance - to be introduced first by the EU and subsequently extended to all OECD countries. This is affordable and would have a major impact on poverty in developing countries; " Introduce an international financial transactions tax to be administered by the UN - payable on all currency exchanges at banks and currency exchange offices. Half of the gross revenue would be administered by the UN to subsidise the establishment of child benefit in developing countries; " Introduce or strengthen the legal right to child benefit - provision to be made for every child of a monthly cash benefit, or the equivalent in value of goods and services, which is adequate to surmount material and social deprivation; " Introduce and develop schemes to fulfil a fundamental and legal right to social security - involving legislation that defines minimum adequate benefit and minimum adequate wages in all countries; " Establish, in practice, the universal human right of access to basic social services such as sanitation, water, healthcare and education.3 Co-editor, David Gordon, Director of the Townsend Centre for International Poverty Research said: "Ending poverty is largely a matter of lack of political will. It is not a problem of lack of money or scientific knowledge of how to eradicate poverty. The United Nations Development Program (UNDP) has estimated the cost of providing basic health and nutrition for every person in the world at $13 billion per year for 10 years. This seems like a large figure, but, to put it in perspective, in 2000 the US population spent $11.6 billion on dog and cat food." 1 The United Nations Millennium target on poverty is to halve, by 2015, the proportion of the world's people (currently 22 per cent) whose income is less than one dollar a day (see http://www.un.org/millennium/sg/report/key.htm). The target of halving the number of people without access to basic sanitation by 2015 was set at the recent Earth Summit in Johannesburg. 2 Appendix A (attached) gives full details of the Manifesto for international action to defeat poverty, as published in the study. 3 The study develops the link between human rights and the eradication of poverty more substantially than elsewhere. NOTES 1. World poverty: New policies to defeat an old enemy, edited by Peter Townsend and David Gordon, is published by The Policy Press. www.policypress.org.uk. The study describes anti-poverty policies in both rich and poor countries, including the United States, European Union countries, the Czech Republic, Ghana, Sub-Saharan Africa, India, and China. It includes major contributions from leading economists and sociologists with UN and European expertise. 2. The book is available from: Marston Book Services, PO Box 269, Abingdon, Oxon OX14 4YN. Tel: 01235 465500 Fax: 01235 465556 Email: [log in to unmask] Price £25.00 (plus £2.75 p&p).