Health equity colleagues,

OK, with apologies for posting three blurbs, here is what I have been able
to find out so far to justify the 50% figure the World Bank cited:
Using the WD Indicators for 2002, the US spent 45% of the global GDP spent
on health.  However, these WD Indicators used 12.9% as the % of GDP US spent
on health, while the US actually spent 13.3% of GDP on health in 2000 and
14.1% of GDP on health in 2001.  Using the 13.3% and 14.1%, the US spent
about $1.3 trillion in 2000 & $1.4 trillion in 2001 on health.  The WB
indicators, which are for 2000, show world spent 9% of $31.5 trillion or
$2.8 trillion on health. The global percentage spent on health might also
need to be updated, but given current US spending on health as & of GDP, I
think the US is spending close to 50% of all global health expenditures in
2000-01. It seems to me that the closer we get to current economic & health
expenditure projections, the closer the US comes to spending half of global
health expenditures. I welcome WHO/ World Bank/LSE/other economists to
comment on or update these figures,
which I find quite stunning. 

Best regards, 

Barbara Krimgold
Center for the Advancement of Health
Washington, DC, USA
 
-----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).