Desmond McNeill

The political origins of health inequity: prospects for change

Ole Petter Ottersen, Jashodhara Dasgupta, Chantal Blouin, Paulo Buss, Virasakdi Chongsuvivatwong, Julio Frenk, Sakiko Fukuda-Parr, Bience P Gawanas, Rita Giacaman, John Gyapong, Jennifer Leaning, Michael Marmot, Desmond McNeill, Gertrude I Mongella, Nkosana Moyo, Sigrun Møgedal, Ayanda Ntsaluba, Gorik Ooms, Espen Bjertness, Ann Louise Lie, Suerie Moon, Sidsel Roalkvam, Kristin I Sandberg, Inger B Scheel

On Interdisciplinary Research: with particular reference to the field of environment and development

Interdisciplinary research is fashionable, but also controversial; yet it is far from agreed what is meant by the term. This paper analyses some central issues concerning interdisciplinary research, both in general and with particular reference to the field of environment and development. It draws on earlier literature, especially Becher (1989) and on experience from universities in Norway, Sweden, Denmark, U.S.A and Britain. The paper includes an analysis of how disciplines interact, focussing on economics, ecology and anthropology. It also addresses two ‘great divides’. The first is that between the ‘two cultures’: a gap which is indeed important, although it does not lie precisely between the natural sciences on the one hand and the social sciences and humanities on the other. The second is the gap between research and application; research that is usable by policy-makers, it is argued, is typically, and necessarily, not of high quality judged in academic terms.

The Diffusion of Ideas in Development Theory and Policy

The article uses quantitative bibliographic data from 1972 to 2002 to trace how three selected ideas–‘the informal sector’, ‘sustainable development’ and ‘social capital’–took off and spread throughout the academic, policy and popular realms during this period. It analyses data from electronic databases–of academic journals, dissertations, newspapers, magazines, and World Bank and United Nations publications–and also draws on insights from the CANDID-project (an acronym for the ‘Creation, Adoption, Negation and Distortion of Ideas in Development’). It appears that the rate of diffusion of ideas is increasing over time; and that the rate, and extent, of diffusion is more rapid when the idea is initiated/promoted in the policy or popular realms than in the academic realm. The most successful ideas are not those that are most analytically rigorous but those that are most malleable, achieving consensus by conveying different meanings to different audiences.

'Human Development': The Power of the Idea

The idea of human development, and the related index, has been developed and promoted by the United Nations Development Programme (UNDP) largely through its annual Human Development Reports. In recent years it has become more closely associated with the work of Amartya Sen. Initially, the concept formed an important part of the counter‐discourse against the dominant perspective associated with the Bretton Woods Institutions. Since then, the policies and perspectives of both the UNDP and the World Bank have to some extent changed, and much has been built on the foundations of this concept — both by bureaucrats and academics. The aim of this paper is to critically assess this process. The paper draws a comparison with findings from the authors earlier research on a number of other influential ideas in development policy, such as ‘social capital’, and suggests that ‘human development’ has generally fared rather better.

Post 2015: a new era of accountability?

The Millennium Development Goals (MDGs) were criticised for failing to address the issue of governance, and the associated notions of responsibility and accountability. The Sustainable Development Goals, we argue, need to recognise the structural constraints facing poor countries – the power imbalances in the global economic system that limit their ability to promote the prosperity and well-being of their people, as was clearly brought out by the Commission on Global Governance for Health, of which we were both members [Ottersen, O. P., J. Dasgupta, C. Blouin, Paulo Buss, Virasakdi Chongsuvivatwong, Julio Frenk, Sakiko Fukuda-Parr, et al. 2014. “The Political Origins of Health Inequality: Prospects for Change.” Lancet 383: 630–667]. This article is divided into three parts. We begin by making the case for a global justice perspective which emphasises the responsibility – and hence also accountability – of international organisations and rule-making bodies. We next demonstrate the limitations of accountability mechanisms of the type adopted in the MDGs. We conclude by arguing for a new approach to accountability that may be better suited to the post-2015 era.

Local Conflicts and International Compromises: The Sustainable Use of Vicuña in Argentina

The vicuña Vicugna vicugna is a wild South American camelid with a fiber so highly valued that the species was hunted almost to extinction. Strict conservation regulations and international treaties have been successful in causing vicuña populations to recover to a level where it is now possible to develop “sustainable use” programs. In Chile, Bolivia, Peru, Ecuador, and Argentina, vicuña management plans have been developed, with differing biological and socioeconomic implications. The major issue is whether vicuña are managed in the wild or in captivity. The aim of this paper is to examine the forces that have, in recent years, shaped policies concerning vicuña management, and especially the underlying conflict between economic growth and conservation. The analysis draws largely on primary data from Argentina and a report written by the U.S. Department of the Interior, Fish and Wildlife Service concerning the reclassification of vicuña from endangered to threatened. This report is important both directly (because FWS is the key advisory body to the U.S. government and the United States is a major potential market for the fiber), and indirectly, because the views of the United States and its advisers will in turn have a major influence on other actors.

Political origins of health inequities: trade and investment agreements

The Trans-Pacifi c Partnership (TPP) agreement, signed on Feb 4, 2016, and the Transatlantic Trade and Investment Partnership (TTIP) currently under negotiation, have generated a groundswell of opposition from politicians, civil society, and academics. Growing evidence suggests that they will have major, and largely negative, consequences for health that go far beyond those of earlier trade agreements. This situation is particularly disturbing since the agreements have created blueprints for future bilateral and regional trade agreements: a rewriting of the rules that govern the global economy, promoting corporate interests at the expense of public health priorities. Until the 1990s, multilateral negotiations under the General Agreement on Tariff s and Trade concentrated on reducing or eliminating tariff s and quotas on imports. Following the North American Free Trade Agreement (NAFTA) in 1993, and the World Trade Organization (WTO) regime in 1995, trade policy and law acquired binding dispute resolution processes, and began to have signifi cant eff ects on a variety of domestic policies. Several agreements comprising the WTO regime have been identifi ed with substantial potential eff ects on health. Harmonisation of intellectual property protection under TRIPS and its consequences for access to medicines are perhaps the most familiar; eff ects on various social determinants of health—the conditions in which people live, work, and die—are probably more important, yet indirect and harder to assess. Nowadays, bilateral and regional trade and investment agreements (TIAs) are largely overshadowing the deadlocked WTO negotiating process. This applies most notably to so-called mega regional agreements such as TPP and TTIP, as well as Economic Partnership Agreements between the European Union and African, Caribbean, and Pacifi c countries and regions. The TIAs intrude still further on the policy space of signatory countries: “the freedom, scope, and mechanisms that governments have to choose, design, and implement public policies to fulfi ll their aims”. Many of these agreements are more about investment than trade. They provide legal infrastructure for a global reorganisation of production in which cross-border trade of inputs and outputs takes place within the networks of affi liates, contractual partners, and suppliers of transnational corporations, which coordinate as much as 80% of world trade. Recent agreements not only go beyond the WTO agreements in domains such as intellectual property, food safety, and trade in services, but they also extend to areas such as public procurement, disputes between corporations and states, and more. Their broad scope leads to correspondingly broad consequences for economies and societies; they are infl uential in shaping employment, access to technologies, environmental pollution and sustainability, and many other social determinants of health. There is growing evidence that they widen inequalities in multiple ways, as the rules disproportionately aff ect the poorest countries and low-income, vulnerable, and marginalised populations within countries. For example, the 1994 WTO TRIPS agreement recognised the potential confl ict of intellectual property on health priorities and included provisions—so-called fl exibilities—to resolve contradictions, such as to allow governments to use compulsory licensing in times of public health emergencies to oblige companies to allow generic manufacture for a suitable royalty. The 2001 WTO Doha Declaration reaffi rmed these fl exibilities and articulated the primacy of human health, but the new TIAs weaken this resolve and put up new barriers. The TPP is a case in point. The chapter on intellectual property is particularly intrusive to health and restricts access to the latest advances in medicines, diagnostic tools, and other life-saving medical technologies. This agreement contains many of the provisions in previous bilateral and regional free trade agreements that strengthen patent protection that provides monopolies and inevitably leads to high prices. For example, provisions include extensions of patent terms beyond 20 years required under TRIPS; lowering patentability criteria to include modifi cations of existing medicines; and data exclusivity provisions that eff ectively put up barriers to generic manufactures entering markets after expiry of patents. Whereas some trade agreements are between neighbouring countries at relatively equal levels of economic development (such as Argentina, Brazil, Paraguay, Uruguay, and Venezuela, which together form the Mercosur subregional bloc), trade negotiations between countries are very often asymmetrical, as are disputes about the implementation of agreements. Countries with small populations and economies might have to grant major concessions—even beyond the requirements of WTO agreements—to larger, richer trading partners to secure even modest improvements in market access. On top of the well known asymmetry of economic and political power and capacity between states, new negotiations are skewed by asymmetry of power between corporations and states, especially small states. The situation is complicated by the fact that, at least according to some, transnational corporations can fi nd common interest with national bureaucratic-political elites who Published Online November 7, 2016 http://dx.doi.org/10.1016/ S0140-6736(16)31013-3

What Counts as Progress? The Contradictions of Global Health Initiatives

Global initiatives to finance maternal and child health have saved millions of lives and protected millions more against the ravages of crippling and debilitating disease; for this they are to be highly commended. Such technological and vertical programmes are appealing to policy-makers at the global level; but these health interventions take place within complex social and economic structures, and pertinent questions have been raised both about some negative consequences of these programmes and the implications for governance at local, national and global levels. Based on recent and ongoing research, and especially on a case study from India, this article critically assesses these related concerns. Is it the case that these programmes may actually weaken local health systems, which are crucial both in themselves and for ensuring health improvements? Do they change the direction of accountability, with national governments becoming accountable upwards to donors (for achieving specified numerical targets) rather than downwards to their citizens? And do such programmes also serve to de-politicize the field of global public health, diverting attention from the responsibilities of powerful nations to rectify the shortcomings of the global political economy and global governance which impact negatively on peoples health?

Social Capital or Sociality? Methodological Contrasts between Economics and Other Social Sciences

This book is based on the premise that mainstream economics has become excessively specialized and formalized, entering a state of de facto withdrawal from the study of the economy in favour of exercises in applied mathematics. The editors believe that there is much scope for synergies by engaging in an encounter with economics and the other social sciences. The chapters in this book offer important new contributions to such a development.

Institutional Context for Sustainable Development

With the presentation of the Brundtland UN commission report ‘Our common future’ in 1987 (WCED, 1987) the issue of sustainable develop-ment was put on the political agenda. It was defined as ‘a development that meets the needs of the present without compromising the ability of future generations to meet their own needs’. The concept has been much debated and criticized (Redclift, 1992) and numerous alternative definitions have been proposed (such as Robinson, 2002). (And it has been noted that this was not the first use of the term.)No consensus has been – or is likely to be – reached on any other defi-nition; in part because for most people the concept is normative. What is clear is that the central issue is the potential, or actual, conflict between development and the environment, and hence between the interests of present and future generations (see Weaver and Rotmans, 2006). Ewert et al. (2006) have argued, with respect to the sustainability of agricul-tural systems, that the appropriate definition will depend on the specific problem to be analysed.Our particular concern in this book is the impact on sustainable devel-opment of alternative land use policies in developing countries. While we do not see it as necessary to propose an alternative to the WCED defini-tion of SD, it is appropriate to clarify how we interpret it, as a basis for the analysis that follows.In the literature the term ‘sustainable’ is sometimes used to mean simply ‘capable of lasting over time’; as for example in the expression ‘sustain-able institutions’. To avoid confusion, we will use the term ‘sustainable’ in a more restricted sense: relating specifically to the environment. Thus, in the expression ‘sustainable development’, ‘sustainable’ will refer only to the environmental dimension, and we will avoid referring to a system