Social determinants of health

Stories of positive action from around the world

Story numbers correspond to those in the Report.

The relationship between the market and health equity

12.2: Water privatization in Argentina and Bolivia

Since 1993, the French company Suez-Lyonnaise has been the major partner in the privatized utility company supplying water to Buenos Aires’ 10 million inhabitants, one of the largest water concessions in the world. Utility prices were raised by more than 20% after privatization. Poorer families – if connected to the supply at all – could no longer afford to pay their water bills. In September 1999, the international water-led consortium Aguas del Tunari was awarded a 40-year concession for the water and sanitation system of Cochabamba, the third largest city in Bolivia. Water tariffs increased by up to 200% in order to cover the costs of a massive engineering scheme. Sources: Loftus & McDonald, 2001; Source.

12.3: The costs of smoking

A study using 1998 data in China found that medical costs for premature tobacco deaths amounted to US$ 2.76 billion, or 6% of all Chinese medical costs. In India in 2000, the Indian Council of Medical Research estimated the costs of three major tobaccorelated diseases (cancer, heart disease, and chronic obstructive lung disease) at 270 billion rupees (US$ 5.8 billion), more than the direct contribution of the tobacco industry to Indian government revenue of 70 billion rupees (about US$ 1.5 billion). Source: PPHCKN, 2007c

12.13: Transforming exploitation in the garment industry – Bangladesh

Under the Multi-fibre Arrangement (1974-2004, abolished under the WTO Uruguay Round Agreement), Bangladesh saw massive growth of its garment industry. Ready-made garments are now the leading national export – accounting for around three quarters of annual export receipts, the overwhelming majority of exports – and the industry employs an estimated 2.5 million workers. Garment-manufacturing employers sought women employees because they provided low-cost labour, were perceived to be docile, and had low occupational mobility. Previously there had been little attention to women’s rights, with minimal avenues for women to exercise leadership. Women had few opportunities to access the formal labour market and there was highly discriminatory investment in girls’ education and health compared to boys’.

The garment industry has begun to change women’s position. Approximately 80% of employees in the garment industry are women and women’s employment in non-export industries is estimated to be 7%. Increased female employment is leading to increased attention to women workers’ rights; increased activities aiming to organize women and cultivate female leaders; more workforce options for women with relatively higher and more regular wages; more support in households for girls’ education due to the incentive of future income; greater ability among women to negotiate public spaces when commuting and working; increased empowerment of women as their economic role in households increases their power; and increased preference for delayed marriage and childbirth. But wages in the garment industry are low, there is high stress, and working conditions are poor and hazardous. Research conducted in Dhaka in 2006 reported women regularly working 80 hours per week for 5 pence an hour. The factories included in the research were supplying the United Kingdom stores Primark, Tesco, and Asda, which have all made a commitment to pay a minimum wage of £22 a month – calculated as a living wage in Bangladesh.

Workers in the industry went on strike led by the National Garment Workers Federation and won a 50% rise in the minimum wage to £12 a month – progress, even if still well below a living wage. The case study of the Bangladesh garment industry powerfully illustrates the benefits that can accrue when major companies locate in low-income countries, but also points to the potentially profound social changes that this can trigger even when conditions fall far short of good labour practice. The contribution could be much greater if private sector companies took their ‘corporate social responsibility’ more seriously. As elsewhere, the emphasis here is that globalization can bring tremendous benefits but that, unregulated, it will certainly not benefit all, and will harm many. The implication is not to resist the globalization processes of market integration, but to make them better and fairer. Source: SEKN, 2007

12.18: Evidence for alcohol control

There is substantial evidence that an increase in alcohol prices reduces consumption and the level of alcohol-related problems. In most countries and especially in countries with low alcohol tax rates, tax-induced price increases on alcoholic beverages lead to increases in state tax revenues and decreases in state expenses related to alcoholrelated harms. The effects of price increases, like the effects of other alcohol control measures, differ among countries depending on such factors as the prevailing alcohol culture and public support for stricter alcohol controls.

However, the effects on alcohol-related harms are definite and the costs low, making it a cost-effective measure. In addition, stricter controls on the availability of alcohol, especially via a minimum legal purchasing age, government monopoly of retail sales, restrictions on sales times, and regulation of the number of distribution outlets, are effective interventions. Given the broad reach of all these measures, and the relatively low expense of implementing them, they are highly cost effective. Source.