As this issue goes to press, leaders of the industrialized world and of quasi-rehabilitated Russia are meeting in Genoa, Italy, at the G8 Summit. That's G for group, but in the public mind also G for global clout. Once again they gather at their summit, a political Parnassus from whose heights the voices of protest will be heard faintly, or not at all (see page 69).1
The central concern of the mortals who shake the chain-link fences at the foot of the mountain is that, as the rich nations of the world strive to globalize trade in private goods and services, there is reason to fear that public goods — such as environmental integrity, food security, human rights and health — will be lost in the barter. Paul Samuelson2 defines a public good as one that each person can consume or use without subtracting from the consumption of the same good by others. A lighthouse is an example. All mariners benefit from this good, and their use of it does not prevent others from using it also. Many of the fundamental determinants of health are examples of public goods: a safe environment, economic stability, education, knowledge and, not least, peace. Unlike private goods, public goods “cannot be easily provided by the ‘invisible hand of the market.’”3 They require cooperation. This is most emphatically true of global public goods, that is, benefits that may be enjoyed equitably and without rivalry by all nations. These goods might be described as outcomes, which rely on the intermediary public goods of international organizations (e.g., WHO and the UN), standards and accords.3
In Genoa the G8 nations will vote to increase debt relief for “heavily indebted poor countries” — countries such as Angola, Bolivia and Sierra Leone, whose burden of external debt is crippling.4 Debt reduction is a necessary, rehabilitative step on the road to “development” (which still seems to mean ever-upward growth and consumption). But debt reduction will do more than increase the capacity of poor countries to trade with rich countries (clearly the central motive for globalization) — it should also create an increased capacity to create public goods such as health.
We cannot increase our stock of global public goods without international solidarity. But the protestors below Parnassus are right to persist in their vigilant harassment of the new order of demigods who, unelected, are assuming governance of a corporatized world. The invisible hand of the market has become larger, but not more visible. And insofar as that market is governed by private interests it will be prone to inequity.5 What will the implications be in the marketplace of health?
Globalization could usher in a Golden Age of international cooperation — and, with it, universal standards for work safety, improved infectious disease surveillance and control, more stringent environmental protection, greater equity in education, the freer exchange of expertise and the potential benefits of transnational food and drug regulation.
Funny though, how so few of us are ready to believe it. — CMAJ