Book contents
2 - Health, development, capital and trade
Published online by Cambridge University Press: 20 January 2024
Summary
By the end of the 1980s, confidence in economic growth as the engine of development – a mechanical process through which developing countries would gradually approximate their rich world counterparts – was in crisis (Singer, 1989; Ghislandi et al, 2019). Developing economies, laden with unmanageable levels of debt, were struggling under an aggressive regime of fiscal retrenchment. GDP growth had stalled. Food production in Africa was in decline and social development in the least developed countries had come to a standstill (Nandi and Shahidullah, 1998; Easterly, 2001).
In 1990, the UN adopted a new framework of metrics, the Human Development Index (HDI), fusing measures of health and education with per capita GDP to create a more nuanced way of estimating country progress (UNDP, 1990). A decade later, 189 countries signed the Millennium Declaration and launched the Millennium Development Goals (MDG), aiming to rid the world of extreme poverty, hunger, ill health, illiteracy and gender inequality, to strengthen environmental protection and build a union of nations. The Declaration proclaimed with customary UN grandiloquence an era of ‘freedom … equality … solidarity … and tolerance’, expanding the development narrative beyond economic growth (Vandemoortele, 2011). On paper, it was transformational. In practice, it was a rather thinner broth.
Goals are excellent as a means of galvanising large groups of people with heterodox views and interests – for example governments – to concentrate on areas of common interest (or at least common enterprise in gaming the data) (Sachs, 2012). They are, in the parlance of management consultancy, SMART. But they are not a particularly effective way of stimulating lasting locally led change in deep-rooted historical, political and institutional arrangements shaping quality of life in the world's multiplicity of countries and cultures.
The MDGs were in many ways a stunning humanitarian accomplishment. Global health improved dramatically. Between 1990 and 2015, maternal mortality fell by over 40 per cent; under-five mortality by 53 per cent. High and rising trends of HIV, tuberculosis and malaria infection were successfully confronted and forced into some degree of retreat – global malaria mortality fell by 58 per cent, new HIV infections by 40 per cent between 2000 and 2013. But if they represent a triumph of collective (albeit Westernised) action, they embody too a failure of concept – indentured to an unreconstructed economic vision of progress.
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- Health in a Post-COVID WorldLessons from the Crisis of Western Liberalism, pp. 41 - 54Publisher: Bristol University PressPrint publication year: 2023