WEBVTT 1 00:00:00.000 --> 00:00:05.740 I'm Chris Burrell. My role this afternoon is to introduce to you Professor Fran Baum, 2 00:00:05.940 --> 00:00:13.140 who will be talking to us on capitalism and health and extensions beyond that. 3 00:00:14.040 --> 00:00:19.540 Now, I do medical research and I guess we expect that when we get an important result, 4 00:00:19.800 --> 00:00:25.020 there's a system that will translate this into delivery of improved health care 5 00:00:26.180 --> 00:00:29.880 that should work and that's supposed to function well. 6 00:00:30.360 --> 00:00:35.160 Now, we've heard yesterday in a number of talks about problems in health delivery, 7 00:00:36.300 --> 00:00:41.440 self-seeking interests and networks that impinge, cause problems in health delivery, 8 00:00:42.440 --> 00:00:45.980 the lack of goals, lack of coordination, lack of prioritisation, 9 00:00:46.100 --> 00:00:52.180 all these things going on that complicate the delivery of health, of improved health. 10 00:00:53.380 --> 00:00:55.000 Fran, I think, is going to take this. 11 00:00:55.020 --> 00:00:56.680 I think we need to take this one step further this afternoon 12 00:00:56.680 --> 00:01:02.760 and look at the capitalist system itself and how this affects how health is delivered. 13 00:01:05.000 --> 00:01:08.720 I guess we all know extreme instances of a direct conflict 14 00:01:08.720 --> 00:01:12.420 between the rights of the individual and health benefits to the community. 15 00:01:13.600 --> 00:01:17.540 Quarantining infective individuals with HIV, with swine flu, 16 00:01:18.800 --> 00:01:23.680 prioritising costs and grappling with whether to provide expensive treatments or not, 17 00:01:23.860 --> 00:01:25.000 all of this... 18 00:01:26.400 --> 00:01:31.460 the hard decisions that have to be made between the rights of the individual and the community as a whole. 19 00:01:31.680 --> 00:01:34.120 How about the capitalist system? How does this fit? 20 00:01:34.800 --> 00:01:39.200 Is there something intrinsic in the capitalist system that undermines our goal? 21 00:01:39.360 --> 00:01:44.880 And how does this translate into other parts of the world and other societies? 22 00:01:45.700 --> 00:01:48.800 Well, Fran, talking about this, 23 00:01:48.880 --> 00:01:52.020 she's the Professor of Public Health at Flinders University in Adelaide. 24 00:01:52.340 --> 00:01:54.060 She's very active nationally. 25 00:01:55.020 --> 00:01:56.400 And with WHO internationally. 26 00:01:58.000 --> 00:02:00.240 She's heavily involved in health promotion, 27 00:02:01.320 --> 00:02:03.400 the measures for improved health, 28 00:02:03.520 --> 00:02:07.020 but also the motivation behind societies and communities, 29 00:02:07.520 --> 00:02:09.580 how to get them to adopt these measures, 30 00:02:09.740 --> 00:02:12.980 and also looking at the systems that lie behind it. 31 00:02:13.180 --> 00:02:15.520 And I think we'll be hearing about this from you, Fran. 32 00:02:16.620 --> 00:02:17.480 Thanks very much. 33 00:02:18.920 --> 00:02:20.740 Well, thanks very much, Chris. 34 00:02:20.980 --> 00:02:22.980 And good afternoon to everybody. 35 00:02:23.000 --> 00:02:24.780 And it's great that you're here on a... 36 00:02:25.020 --> 00:02:27.740 a wet and windy Adelaide afternoon. 37 00:02:28.520 --> 00:02:31.700 I'd like to start by paying my respects to the Kaurna people 38 00:02:31.700 --> 00:02:33.580 on whose land we meet, 39 00:02:33.700 --> 00:02:35.360 and discuss all these ideas, 40 00:02:35.600 --> 00:02:38.660 and pay respects to their elders past and present, 41 00:02:38.800 --> 00:02:42.100 and respect their ongoing deep connection to the land. 42 00:02:43.180 --> 00:02:46.120 So the question I'm addressing is, 43 00:02:46.260 --> 00:02:48.000 is capitalism good for our health? 44 00:02:48.400 --> 00:02:51.940 And I guess I would say the short answer is 45 00:02:51.940 --> 00:02:53.140 it does depend who you are, 46 00:02:53.240 --> 00:02:54.780 but I think for most people in the world, 47 00:02:54.780 --> 00:02:56.000 the answer is probably no, 48 00:02:56.100 --> 00:02:59.360 at least the form of capitalism we've had in the last 30 years. 49 00:02:59.560 --> 00:03:03.060 And I'm going to argue that markets can deliver some goods and services, 50 00:03:03.320 --> 00:03:05.620 but they don't really aid fair distribution. 51 00:03:06.060 --> 00:03:08.540 They're often exploitative of people and the environment, 52 00:03:08.800 --> 00:03:11.120 and they're concerned with profits above all else. 53 00:03:11.400 --> 00:03:12.620 And I think our challenge, 54 00:03:12.920 --> 00:03:15.740 and I'll, in the second half of my talk, talk about this, 55 00:03:17.380 --> 00:03:20.040 assuming an absence of revolutionary political will 56 00:03:20.040 --> 00:03:22.860 to establish a completely new economic order, 57 00:03:22.940 --> 00:03:24.700 although I'm happy to talk about that in discussion, 58 00:03:24.780 --> 00:03:27.900 is to regulate and progressively move to a system 59 00:03:27.900 --> 00:03:30.200 that is ecologically sustainable, equitable, 60 00:03:30.300 --> 00:03:31.900 and which promotes health and well-being. 61 00:03:32.060 --> 00:03:34.680 And I'm glad to see that these ideas have really been 62 00:03:34.680 --> 00:03:38.000 very much tossed around so far in the festival of ideas. 63 00:03:38.740 --> 00:03:43.680 So I think what's happened in the past few months 64 00:03:43.680 --> 00:03:45.960 is that the elephant of capitalism, 65 00:03:46.140 --> 00:03:49.020 which has been standing there in the room and we've taken for granted, 66 00:03:49.260 --> 00:03:51.780 has really sort of come out into the open. 67 00:03:52.960 --> 00:03:54.760 And one commentator, 68 00:03:54.780 --> 00:04:00.460 William Tabb, has said of globalisation of capital 69 00:04:00.460 --> 00:04:02.240 that our vision of it remains imperfect. 70 00:04:02.780 --> 00:04:04.340 Our task is made more difficult 71 00:04:04.340 --> 00:04:07.520 because our great elephant seems constantly to change its shape, 72 00:04:07.700 --> 00:04:11.220 even as the basic elements of its nature remain or remain constant 73 00:04:11.220 --> 00:04:12.680 through these dramatic transformations. 74 00:04:13.480 --> 00:04:16.480 The central discourse of the early 20th, 1st century 75 00:04:16.480 --> 00:04:18.860 is making sense of the same old elephant, 76 00:04:19.000 --> 00:04:23.120 and note that it hasn't really changed its spots or wallpaper that much, 77 00:04:23.240 --> 00:04:24.760 and it's now seen in individuals, 78 00:04:24.780 --> 00:04:25.780 new and different guys. 79 00:04:26.400 --> 00:04:29.140 Now, of course, there's a long tradition of people commenting 80 00:04:29.140 --> 00:04:31.420 on the impacts of capitalism on health. 81 00:04:31.640 --> 00:04:33.300 Anyone who's read Engels, 82 00:04:33.380 --> 00:04:35.580 he did some wonderful work in the 19th century 83 00:04:35.580 --> 00:04:38.020 looking at the impact of work on workers' health. 84 00:04:38.200 --> 00:04:39.280 And at Flinders University, 85 00:04:39.280 --> 00:04:41.540 we're still continuing that tradition, I have to say. 86 00:04:42.140 --> 00:04:45.240 And, of course, that thought continued from the 19th century 87 00:04:45.240 --> 00:04:46.520 through the 20th century. 88 00:04:46.620 --> 00:04:48.860 I think the 60s saw a flowering of questioning 89 00:04:48.860 --> 00:04:52.460 of the benefits of capitalism, student protests, music, 90 00:04:53.300 --> 00:04:53.980 and a sort of... 91 00:04:54.780 --> 00:04:56.640 questioning of the way we organise ourselves. 92 00:04:57.160 --> 00:05:00.240 But, of course, from the 1980s and the rise of neoliberalism 93 00:05:00.240 --> 00:05:01.980 and the subsequent fall of the Soviet Union 94 00:05:01.980 --> 00:05:04.520 meant that that kind of critique of capitalism 95 00:05:04.520 --> 00:05:06.360 was increasingly out of vogue, 96 00:05:06.500 --> 00:05:08.260 and many of us who were engaged in it 97 00:05:08.260 --> 00:05:10.340 were accused of being stuck in the 60s, 98 00:05:10.340 --> 00:05:12.160 or even worse, being an ageing hippie. 99 00:05:12.620 --> 00:05:14.180 So I don't know how many people here 100 00:05:14.180 --> 00:05:16.040 would consider themselves an ageing hippie. 101 00:05:17.380 --> 00:05:18.880 Not many are willing... 102 00:05:18.880 --> 00:05:21.180 Oh, yes, a few more are willing to admit to it. 103 00:05:21.520 --> 00:05:24.100 OK, so the sort of capitalism I'm talking about 104 00:05:24.100 --> 00:05:26.840 are that that really evolved from the late 70s onwards. 105 00:05:27.040 --> 00:05:29.800 Large corporations, especially financial sectors, 106 00:05:29.940 --> 00:05:33.200 making profit out of speculation with money. 107 00:05:33.560 --> 00:05:35.660 Much greater deregulation, 108 00:05:35.900 --> 00:05:37.440 cutbacks to public services 109 00:05:37.440 --> 00:05:39.820 and privatisation of many essential services, 110 00:05:40.200 --> 00:05:42.020 less environmental safeguards 111 00:05:42.020 --> 00:05:45.840 and social safety nets dismantled, 112 00:05:45.840 --> 00:05:49.080 and really a propensity to capture 113 00:05:49.080 --> 00:05:51.140 the total benefit of productivity gains 114 00:05:51.140 --> 00:05:52.320 for owners and managers. 115 00:05:53.020 --> 00:05:53.780 The... 116 00:05:54.100 --> 00:05:55.760 The tax burden really shifting 117 00:05:55.760 --> 00:05:58.220 from financial speculation to working people, 118 00:05:58.360 --> 00:06:00.880 and I'll produce some evidence for some of these claims later, 119 00:06:01.040 --> 00:06:03.900 and very little or no sign of ecological responsibility 120 00:06:03.900 --> 00:06:06.580 in the face of the hunt for profit maximisation, 121 00:06:06.700 --> 00:06:09.220 and a strong focus on consumerism. 122 00:06:09.440 --> 00:06:10.060 Those who... 123 00:06:10.060 --> 00:06:12.420 You were at the previous session in this room 124 00:06:12.420 --> 00:06:15.300 where Peter Shergold, much of what he said I didn't agree with, 125 00:06:15.360 --> 00:06:17.300 but I think one of the things he said that was very good 126 00:06:17.300 --> 00:06:19.920 was that we need to shift to a greater focus on citizens. 127 00:06:21.020 --> 00:06:23.620 And, of course, the size of transnational corporations, 128 00:06:23.620 --> 00:06:24.780 has become huge. 129 00:06:25.060 --> 00:06:27.520 Here's just some listed, such as ExxonMobil, 130 00:06:27.760 --> 00:06:29.460 Walmart, Ford and so on, 131 00:06:29.500 --> 00:06:32.740 just comparing their annual revenue 132 00:06:32.740 --> 00:06:37.020 with GDP of a range of countries, including Australia. 133 00:06:37.340 --> 00:06:39.380 But you can see that they're up there as a player, 134 00:06:39.400 --> 00:06:40.340 as big as a country. 135 00:06:40.580 --> 00:06:43.440 And this has been something that has been new. 136 00:06:43.680 --> 00:06:46.000 Now, David Corton, who has written extensively, 137 00:06:46.240 --> 00:06:48.100 and if you're interested in reading more about this, 138 00:06:48.140 --> 00:06:49.460 I'd really recommend his work, 139 00:06:49.600 --> 00:06:50.140 he said, 140 00:06:50.200 --> 00:06:53.500 these forces have transformed once beneficial corporations 141 00:06:53.620 --> 00:06:54.880 and financial institutions 142 00:06:54.880 --> 00:06:57.300 into instruments of a market tyranny 143 00:06:57.300 --> 00:07:00.260 that is extending its reach across the planet like a cancer, 144 00:07:00.420 --> 00:07:03.060 colonising ever more of the planet's living spaces, 145 00:07:03.240 --> 00:07:05.560 destroying livelihoods, displacing people, 146 00:07:05.820 --> 00:07:08.420 rendering democratic institutions impotent 147 00:07:08.420 --> 00:07:11.620 and feeding on life in an insatiable quest for money. 148 00:07:11.880 --> 00:07:14.460 The problem is not business or the market per se, 149 00:07:15.340 --> 00:07:17.020 but a badly corrupted global system 150 00:07:17.020 --> 00:07:19.020 that is gyrating far beyond control. 151 00:07:19.260 --> 00:07:22.120 The dynamics of the system have become so powerful and perverse 152 00:07:22.120 --> 00:07:23.600 that it's becoming increasingly... 153 00:07:23.620 --> 00:07:25.300 increasingly difficult for corporate managers 154 00:07:25.300 --> 00:07:26.880 to manage in the public interest, 155 00:07:27.100 --> 00:07:29.700 no matter how strong their moral values and commitment. 156 00:07:30.120 --> 00:07:33.140 And I think David put that extremely well. 157 00:07:34.080 --> 00:07:35.680 One of the things, as I've said, 158 00:07:35.720 --> 00:07:38.380 that's happened in the past few years 159 00:07:38.380 --> 00:07:39.840 is a massive privatisation 160 00:07:39.840 --> 00:07:42.760 that I think has been very bad for our collective health. 161 00:07:43.400 --> 00:07:45.900 It's been of public goods that I would consider essential, 162 00:07:46.100 --> 00:07:49.180 such as gas, the way we heat prisons, etc., 163 00:07:49.180 --> 00:07:50.220 in the past 30 years. 164 00:07:50.400 --> 00:07:52.600 In Adelaide, every time we turn on the tap, 165 00:07:52.700 --> 00:07:53.520 the cash registers, 166 00:07:53.620 --> 00:07:55.920 are ringing in Paris, London and Houston, Texas. 167 00:07:56.540 --> 00:07:59.540 United Water owns Adelaide Supply 168 00:07:59.540 --> 00:08:00.560 and is a joint venture 169 00:08:00.560 --> 00:08:03.860 between the three water multinationals based in France. 170 00:08:04.540 --> 00:08:06.700 And, in fact, it's interesting to note, 171 00:08:06.720 --> 00:08:08.260 in terms of this power and influence, 172 00:08:08.420 --> 00:08:10.340 that just three companies 173 00:08:10.340 --> 00:08:13.320 now control 75% of the world water business, 174 00:08:13.600 --> 00:08:14.760 which is quite scary. 175 00:08:15.840 --> 00:08:17.780 I want to draw your attention to this. 176 00:08:18.300 --> 00:08:19.780 I've just spent three years 177 00:08:19.780 --> 00:08:22.080 working on a World Health Organisation commission 178 00:08:22.080 --> 00:08:23.000 that's called the Commission 179 00:08:23.000 --> 00:08:24.600 on the Social Determinants of Health, 180 00:08:24.700 --> 00:08:25.620 and I'll come back to that. 181 00:08:25.800 --> 00:08:27.240 But you'll see from this quote, 182 00:08:27.320 --> 00:08:29.700 and in a way I'm saying this to... 183 00:08:29.700 --> 00:08:32.400 We actually wrote this bit in our report 184 00:08:33.560 --> 00:08:35.460 before the financial crisis, 185 00:08:35.540 --> 00:08:39.840 and we actually said that such these increasing number of... 186 00:08:39.840 --> 00:08:40.700 We were pointing out 187 00:08:40.700 --> 00:08:42.740 that there were more and more global financial crises 188 00:08:42.740 --> 00:08:45.400 and that they were having a major impact on health. 189 00:08:45.640 --> 00:08:47.560 And, of course, to some extent, 190 00:08:48.160 --> 00:08:50.280 we were foreseeing what was about to happen 191 00:08:50.280 --> 00:08:51.140 just a month... 192 00:08:51.140 --> 00:08:52.000 Well, less than a month 193 00:08:52.000 --> 00:08:52.980 after we launched our report, 194 00:08:52.980 --> 00:08:56.320 at the time our report was launched in August 2008, 195 00:08:56.660 --> 00:08:59.420 The Economist magazine had an article on our report 196 00:08:59.420 --> 00:09:00.440 and said that, 197 00:09:00.460 --> 00:09:02.580 oh, this group of people are baying at the moon. 198 00:09:02.820 --> 00:09:05.580 They didn't quite go so far as to say we were ageing hippies, 199 00:09:05.600 --> 00:09:06.840 but that was kind of the implication. 200 00:09:07.320 --> 00:09:09.300 I wonder if The Economist would still say 201 00:09:09.300 --> 00:09:10.440 that we were baying at the moon. 202 00:09:11.200 --> 00:09:14.600 And much of our work was to say 203 00:09:14.600 --> 00:09:17.680 that many of our regulatory systems 204 00:09:17.680 --> 00:09:19.560 that govern capitalism, 205 00:09:19.880 --> 00:09:21.700 that have set up globally 206 00:09:21.700 --> 00:09:22.960 to control and regulate capitalism, 207 00:09:22.980 --> 00:09:26.740 actually work in favour of big business. 208 00:09:27.300 --> 00:09:29.120 Things like the IMF, 209 00:09:29.180 --> 00:09:30.520 the International Monetary Fund, 210 00:09:30.640 --> 00:09:31.200 the World Bank, 211 00:09:31.440 --> 00:09:33.720 they're very much based on economic contributions. 212 00:09:33.920 --> 00:09:36.240 So while rich countries account for, say, 213 00:09:36.240 --> 00:09:38.120 20% of the IMF members 214 00:09:38.120 --> 00:09:40.460 and 15% of the world's population, 215 00:09:40.880 --> 00:09:43.120 they have vastly the majority of votes 216 00:09:43.120 --> 00:09:45.340 in the World Bank and IMF. 217 00:09:45.420 --> 00:09:46.040 And, for instance, 218 00:09:46.140 --> 00:09:49.240 the CEOs are selected by the US and the EU. 219 00:09:49.580 --> 00:09:51.000 And I think there's a need, 220 00:09:51.080 --> 00:09:52.340 and we say this in our report, 221 00:09:52.340 --> 00:09:54.280 for much more transparency and democracy. 222 00:09:55.560 --> 00:09:57.860 And I think the interests of the TNCs, 223 00:09:57.880 --> 00:09:59.000 the transnational corporations, 224 00:09:59.280 --> 00:10:01.420 have been strongly supported by these bodies. 225 00:10:02.020 --> 00:10:03.900 You just have to take one example, 226 00:10:03.900 --> 00:10:06.920 such as trade-related aspects of intellectual property rights 227 00:10:06.920 --> 00:10:09.240 that have really protected the interests of big pharma. 228 00:10:11.400 --> 00:10:14.900 And, of course, this has led to an absurd situation 229 00:10:14.900 --> 00:10:19.220 where under the supposedly free trade system, 230 00:10:19.380 --> 00:10:22.040 countries such as Australia, the EU, 231 00:10:22.340 --> 00:10:25.920 and the US can actually give this massive amount 232 00:10:25.920 --> 00:10:29.160 of total agricultural support to the agricultural sector. 233 00:10:29.320 --> 00:10:32.380 And the orange bars are how much we give in overseas aid. 234 00:10:32.620 --> 00:10:35.060 So you can see what a big disparity that is. 235 00:10:35.140 --> 00:10:36.080 So bear that in mind. 236 00:10:36.340 --> 00:10:38.320 So we now have the absurd situation 237 00:10:38.320 --> 00:10:42.480 that a Japanese cow gets subsidised by US$7 a day, 238 00:10:42.700 --> 00:10:46.300 and yet something like 40% of the total population 239 00:10:46.300 --> 00:10:48.200 lives on less than US$2 a day. 240 00:10:48.400 --> 00:10:50.920 So there'd be three, three-and-a-half people 241 00:10:50.920 --> 00:10:52.320 living on the same amount of land, 242 00:10:52.320 --> 00:10:52.720 and we'd have the same amount of money 243 00:10:52.720 --> 00:10:54.580 as we subsidise a Japanese cow. 244 00:10:55.100 --> 00:10:57.240 And all that results in this situation. 245 00:10:57.340 --> 00:10:59.780 This is a bit complicated, but just look at the red. 246 00:11:00.040 --> 00:11:03.780 And that's the net transfer of financial resources 247 00:11:03.780 --> 00:11:05.580 to developing economies. 248 00:11:05.900 --> 00:11:08.260 You can see how in the early 90s 249 00:11:08.260 --> 00:11:10.120 there actually was a small net transfer. 250 00:11:10.340 --> 00:11:12.500 By the early 21st century, 251 00:11:12.720 --> 00:11:15.700 those developing economies were actually losing money 252 00:11:15.700 --> 00:11:18.280 to rich countries such as Australia. 253 00:11:18.560 --> 00:11:21.420 And I think that's one of the big perversities of the market 254 00:11:21.420 --> 00:11:22.300 as we've seen it in the past. 255 00:11:22.300 --> 00:11:23.280 In the last 30 years. 256 00:11:24.800 --> 00:11:27.820 The other thing we've talked about in this festival before 257 00:11:27.820 --> 00:11:29.740 is CEO earnings, 258 00:11:29.900 --> 00:11:32.360 and this is another part of the growing inequities, 259 00:11:32.420 --> 00:11:33.860 and I think this is symptomatic. 260 00:11:34.160 --> 00:11:36.980 But you can see whereas at the end of the 80s, 261 00:11:36.980 --> 00:11:38.860 the ratio between full-time adult, 262 00:11:39.460 --> 00:11:40.720 this is for Australia, 263 00:11:41.040 --> 00:11:43.620 full-time adult wages was 18 to 1. 264 00:11:43.720 --> 00:11:47.380 By 2004 to 2005, it was 63 to 1. 265 00:11:47.560 --> 00:11:49.200 This isn't just a small increase. 266 00:11:49.440 --> 00:11:52.200 This is a massive, overwhelmingly large increase. 267 00:11:53.120 --> 00:11:57.220 Around the world, we can see growing inequities across countries, 268 00:11:57.400 --> 00:11:59.140 and this is just showing the ratios 269 00:11:59.140 --> 00:12:00.660 between rich and poor countries. 270 00:12:00.860 --> 00:12:03.680 So I think we're getting growing inequities within countries, 271 00:12:03.820 --> 00:12:07.140 and we're getting growing inequities between countries. 272 00:12:07.220 --> 00:12:09.600 And you can see the ratio, which is the important thing, 273 00:12:09.720 --> 00:12:14.100 the ratio has gone up from 60 to 1 to 122 to 1. 274 00:12:14.200 --> 00:12:16.060 So that kind of pattern. 275 00:12:16.400 --> 00:12:18.180 If we look at global wealth distribution, 276 00:12:18.760 --> 00:12:21.280 which hasn't changed that much over the 20th century, 277 00:12:21.340 --> 00:12:22.020 it was unfair, 278 00:12:22.020 --> 00:12:23.160 and it still is unfair, 279 00:12:23.300 --> 00:12:27.040 and much of the so-called success of global capitalism in the West 280 00:12:27.040 --> 00:12:30.380 has rested on the fact that we've been able to take resources 281 00:12:30.380 --> 00:12:31.800 from a lot of poor countries. 282 00:12:32.080 --> 00:12:33.680 And I think this is shown in this. 283 00:12:33.740 --> 00:12:36.540 So if you take North America, which has 6% of the population 284 00:12:36.540 --> 00:12:42.020 and about $190,000 wealth per population, 285 00:12:42.240 --> 00:12:45.520 they have 34% of the share of the world's wealth. 286 00:12:45.660 --> 00:12:48.360 Look at Africa, which has 10% of the population, 287 00:12:48.640 --> 00:12:49.960 very little wealth per adult, 288 00:12:50.120 --> 00:12:51.520 and has just 1%. 289 00:12:52.020 --> 00:12:52.620 And that's a lot of the wealth share. 290 00:12:52.840 --> 00:12:55.140 So again, a pattern of increased inequities. 291 00:12:56.240 --> 00:13:01.240 In Australia, there seems to appear to be an increased concentration of wealth, 292 00:13:01.380 --> 00:13:05.180 with 95% of total wealth owned by the richest 50%, 293 00:13:05.180 --> 00:13:09.420 and 44% of our wealth owned by just 10% of people. 294 00:13:09.620 --> 00:13:11.200 Now you can see, I haven't put the figures, 295 00:13:11.320 --> 00:13:13.200 but that leaves very little for people at the bottom. 296 00:13:13.420 --> 00:13:18.220 And while there's some debate about what happened to equality of income 297 00:13:18.220 --> 00:13:20.980 in the 90s and the early 21st century, 298 00:13:20.980 --> 00:13:24.880 generally the better off have had much higher increases according to the ABS 299 00:13:24.880 --> 00:13:26.860 and it seems inequity has increased. 300 00:13:27.120 --> 00:13:29.820 And a similar pattern in the US, Canada and the UK. 301 00:13:31.380 --> 00:13:36.300 So the point I'm now going to make very clearly is that how we organise society, 302 00:13:36.520 --> 00:13:39.300 the decisions we make about how we distribute wealth, 303 00:13:39.540 --> 00:13:43.100 how much we rip off poor countries, how much overseas aid we have, 304 00:13:43.200 --> 00:13:48.480 how much agricultural subsidy we give has very real impacts on health. 305 00:13:48.480 --> 00:13:51.960 It gets under our skins, it gets into our brains and our behaviour 306 00:13:51.960 --> 00:13:56.260 and I'd say no man sick, no man or woman is an island. 307 00:13:56.380 --> 00:14:00.900 We all reflect the social, cultural, political and economic systems that we are born in, 308 00:14:00.960 --> 00:14:03.940 that we live in, that we work in and that we play in. 309 00:14:05.680 --> 00:14:08.120 If you look at life expectancy at birth, 310 00:14:08.320 --> 00:14:15.680 you'll see that there was particularly a steep increase I think in the 50s through to the 80s, 311 00:14:16.300 --> 00:14:18.120 sorry through to the 70s 312 00:14:18.120 --> 00:14:18.460 and I think... 313 00:14:18.480 --> 00:14:21.960 that reflected the fact that we were doing much more to regulate global capitalism. 314 00:14:22.060 --> 00:14:24.020 You can see how that's bottomed out since then 315 00:14:24.020 --> 00:14:26.920 and some commentators are now predicting that in the future, 316 00:14:26.960 --> 00:14:28.940 we will have declining life expectancies. 317 00:14:29.180 --> 00:14:33.680 For certain ages of women in the US, there already is a decline 318 00:14:33.680 --> 00:14:36.260 and the projections are that that may continue. 319 00:14:36.720 --> 00:14:40.480 But look at Africa, the bottom line, you can see how Africa hasn't done well. 320 00:14:40.580 --> 00:14:42.560 And you might say, well surely that's AIDS. 321 00:14:42.760 --> 00:14:46.280 But AIDS actually deeply reflects the conditions in which people live, 322 00:14:46.400 --> 00:14:48.300 such as structural adjustment package, 323 00:14:48.480 --> 00:14:49.980 the policies of the World Bank, 324 00:14:50.140 --> 00:14:53.680 the way in which health systems have been privatised and become dysfunctional. 325 00:14:54.340 --> 00:14:57.760 And we can also see that we have growing health inequities. 326 00:14:57.880 --> 00:15:02.580 What this slide shows is that while overall say there's been an improvement in infant mortality, 327 00:15:02.920 --> 00:15:06.480 for OECD countries that's been a 29% improvement, 328 00:15:06.860 --> 00:15:09.900 whereas in Africa it's only been a 9% improvement. 329 00:15:10.180 --> 00:15:12.760 Net result is the inequities have grown. 330 00:15:12.920 --> 00:15:15.240 So we're becoming a less equitable world. 331 00:15:17.040 --> 00:15:17.600 So... 332 00:15:17.600 --> 00:15:18.460 And people might... 333 00:15:18.460 --> 00:15:19.420 I might then ask the questions. 334 00:15:19.680 --> 00:15:23.320 And this is the question that I basically have spent the last three years asking, 335 00:15:23.400 --> 00:15:26.720 together with my colleagues on the Commission on the Social Determinants of Health. 336 00:15:26.920 --> 00:15:28.740 Why do we have health inequities? 337 00:15:28.760 --> 00:15:31.220 And why do we have less than optimum population health? 338 00:15:31.560 --> 00:15:35.600 In Japan, which has the highest life expectancy in the world, 339 00:15:35.640 --> 00:15:37.400 people live to their... 340 00:15:38.660 --> 00:15:41.680 just sort of the earlier, about 84, 85. 341 00:15:42.360 --> 00:15:45.500 In Sierra Leone, people live to less than 40. 342 00:15:45.880 --> 00:15:48.080 And that is purely because of the way 343 00:15:48.080 --> 00:15:49.060 that we organise things. 344 00:15:49.340 --> 00:15:51.880 Now is that about behaviour of Sierra Leoneans? 345 00:15:51.880 --> 00:15:54.600 Is it because Sierra Leoneans aren't taking enough exercise? 346 00:15:55.020 --> 00:15:57.720 Or is it because it's conditions of everyday life 347 00:15:57.720 --> 00:16:01.100 and the way we organise the distribution of goods in our society? 348 00:16:01.520 --> 00:16:04.000 And our Commission considered all of those 349 00:16:04.000 --> 00:16:07.320 and thought that the last two dot points were the most important. 350 00:16:07.560 --> 00:16:11.220 The second dot point was important, having access to healthcare. 351 00:16:11.460 --> 00:16:14.840 But behaviour really didn't make a big contribution 352 00:16:14.840 --> 00:16:17.320 if you just tried to change behaviour on its own. 353 00:16:17.320 --> 00:16:19.380 It's those other things that were so important. 354 00:16:19.780 --> 00:16:22.560 So the basic logic of the Commission was, 355 00:16:22.800 --> 00:16:25.760 what good does it do to treat people's illnesses 356 00:16:25.760 --> 00:16:28.700 but to give them no choice to go back to 357 00:16:28.700 --> 00:16:31.640 or no control over the conditions that made them sick? 358 00:16:31.900 --> 00:16:34.460 And that's the task that we set ourselves. 359 00:16:34.920 --> 00:16:39.020 As I said, we launched our report in August 2008. 360 00:16:39.480 --> 00:16:41.200 It was launched by Margaret Chan, 361 00:16:41.380 --> 00:16:43.260 Director General of the World Health Organisation. 362 00:16:43.620 --> 00:16:47.080 And she said health inequity really is a matter of life 363 00:16:47.080 --> 00:16:47.440 and death. 364 00:16:47.720 --> 00:16:51.900 And that was a very powerful point from our report. 365 00:16:52.400 --> 00:16:55.060 We made a whole series of recommendations 366 00:16:55.060 --> 00:16:58.200 and the whole report is fully downloadable on the web. 367 00:16:58.280 --> 00:17:01.100 If you put Commission on the Social Determinants of Health into Google, 368 00:17:01.180 --> 00:17:02.800 you will find the link. 369 00:17:03.120 --> 00:17:05.020 We looked at daily living conditions. 370 00:17:05.200 --> 00:17:06.680 We looked at how work, 371 00:17:06.980 --> 00:17:09.580 how what happens to you in the first three years of life, 372 00:17:09.820 --> 00:17:15.900 how important it is to have social protection across the life course, 373 00:17:15.960 --> 00:17:16.960 and universal health. 374 00:17:17.080 --> 00:17:20.720 We looked at the underpinning of that, 375 00:17:20.760 --> 00:17:21.900 power, money and resources. 376 00:17:22.360 --> 00:17:26.300 And we particularly looked at market responsibility as one issue. 377 00:17:26.400 --> 00:17:28.480 And that's what I'm really going to talk a bit about now 378 00:17:28.480 --> 00:17:30.720 to link in this question of capitalism. 379 00:17:32.500 --> 00:17:37.300 Now, part of our thinking this question through 380 00:17:37.300 --> 00:17:40.500 was to look at what's increasingly going to be called an epidemiology. 381 00:17:40.680 --> 00:17:42.900 Epidemiology is just how we distribute diseases 382 00:17:42.900 --> 00:17:46.040 or how diseases are distributed and what factors affect them, 383 00:17:46.080 --> 00:17:46.920 of equality, 384 00:17:46.920 --> 00:17:49.360 and there's been some key books in recent years. 385 00:17:49.400 --> 00:17:52.780 Some of you may have seen the work by Richard Wilkinson 386 00:17:52.780 --> 00:17:56.120 and his co-author Kate Pickett called The Spirit Level, 387 00:17:56.220 --> 00:17:58.740 which has had quite a bit of coverage in the Australian press. 388 00:17:58.940 --> 00:18:03.740 And just as an advert that Flinders University is bringing Richard to Adelaide 389 00:18:03.740 --> 00:18:05.780 at the end of August, the 28th of August, 390 00:18:05.860 --> 00:18:09.360 so email me if you want details to hear him yourself. 391 00:18:10.200 --> 00:18:13.160 He has argued very strongly and produced evidence 392 00:18:13.160 --> 00:18:16.900 that the more equal a society is, the healthier it is. 393 00:18:16.920 --> 00:18:19.580 Now, that may be because more equal societies 394 00:18:20.240 --> 00:18:23.820 that distribute their income equally also have better social policies. 395 00:18:24.280 --> 00:18:29.360 But there's certainly a huge evidence that more equity leads to less crime in a society 396 00:18:29.360 --> 00:18:30.240 and more cohesion. 397 00:18:30.380 --> 00:18:32.680 And I think any of you can see why that would be the case. 398 00:18:32.760 --> 00:18:35.400 If you think of cities like Rio de Janeiro, 399 00:18:35.580 --> 00:18:38.560 where the rich people have to lock themselves into suburbs, 400 00:18:38.820 --> 00:18:41.440 build gated communities, you can see how that would work. 401 00:18:41.660 --> 00:18:43.880