Gorik Ooms, researcher at the Institute for tropical medecine in Antwerp, Belgium, examines the case for stopping development assistance and replacing it with a global system of social protection. This article was published in the Yale Journal for International Affairs, Winter 2010
Gorik Ooms, researcher at the Institute for tropical medecine in Antwerp, Belgium, examines the case for stopping development assistance and replacing it with a global system of social protection. This article was published in the Yale Journal for International Affairs, Winter 2010
Gorik Ooms, researcher at the Institute for tropical medecine in Antwerp, Belgium, examines the case for stopping development assistance and replacing it with a global system of social protection. This article was published in the Yale Journal for International Affairs, Winter 2010
Stop Development Assistance,
Globalize Social Protection
By Gorik Ooms
Why is development assistance not working for the people who need it most?
Because these people, or the countries they live in, are simply too poor.
The ‘bottom billion’ of global society ~ most of whom live in low-income
countries primarily in Africa - ‘enjoyed’ a combined Gross Domestic Prod-
uct (GDP) of US$570 billion in 2008. That is US$570 per person, per year. In
2001, several African leaders signed the Abuja Declaration and committed to
alleviating the suffering of their people by allocating 15 percent of govern-
ment revenue to health services. Ifimplemented, the policy would designate
US$17 per person per year for health services. However, the World Health
Organization estimates that US$40 per person per year is the absolute mini-
mum needed to provide a basic package of primary healthcare. In order to
cover the deficit, the ‘top billion’ people in high-income countries need to
donate approximately US$23 per person per year. But, according to them,
this is too much.
Why? The declared objective of development assistance program is ‘to put
itself out of business’. By filling the gap, rich countries would essentially be
paying two-thirds of the cost of healthcare for the world’s poorest nations.
This would not be sustainable. And so the argument goes: in the name of
sustainability and with an eye to eventual self-sufficiency, the West should
not provide the US$23 per person that in many cases would make the dif-
ference between life and death.
Gor Ooms isa human rights lawyer who has spent the major of his carer working with the Blan
divalon af Medea Sant Fonts ay ieratonal need humasteaa eon eaten
English as Docs Withoue Borden. He became dhe Executive Director of Mot Begum in 2008 For
‘he 2009-2010 academic yea, Mr Ooms ia Global Jusic Fellow athe Whitney ed Betty MacMe
lan Centr fr International and Area Stadia Yale Univesity. He eared his BA fom the Catholic
University of Leuven in 1989 and his PhD. in Medical Scincs rom the University of Chen in 2008
‘Winter 2010 150GORIK Ooms
It is hard to argue against the importance of sustainability. However, self-
sufficiency is not synonymous with sustainability. When it comes to its own
health - and other social services - the Western world has developed a different
concept of sustainability. There is no expectation that any ministry of health
should plan to ‘put itself out of business’. Imagine if you received a medical
check-up, treatment for any health problems, and a decent education - and
then were sent on your way to take full responsibility for your individual
‘wellbeing for the rest of your life.
In the Western world, national social protection mechanisms do not aim for
the ultimate self-reliance of their participants. They aim for a higher goal:
for net recipients - participants receiving more than what they contribute - to
become net contributors, ie. participants who begin contributing more than
what they receive. This relationship is framed as an open-ended relationship
ofmutual support between all participants. Take Belgium as an example. All
citizens pay taxes toward health services, and those resources are distributed
across the country to cover the healthcare of all, making it a mutual relation-
ship. It is open-ended because there is no expectation that this relationship
will ever end - the young will absorb the cost of the old, the healthy that of
the sick - in a cyclical relationship that extends over time.
‘Would itbe possible to expand this approach to sustainability beyond Western
borders? As it stands, development assistance acts as a one directional and
temporary relationship, with every expectation that the assistance will end
as soon as the country is able to sustain its own health infrastructure. Why
not work toward global mutual and open-ended relationships? Could we
not share the equivalent of 0.1 percent of our GDP for a global social health
protection scheme, or 0.5 percent of our GDP for a global social protection
scheme, covering health, education, safe water, food security and housing?
Some will argue that any global social protection mechanism requires a
global government. Social protection, they assert, requires a government
representing the citizens in order to set or renegotiate the terms of the social
contract: should income taxes be raised? If so, by how much? And how will
the money be prioritized and used?
Yet no global government was needed to globalize intellectual property
protection. The members of the World Trade Organization have all agreed
to guarantee a minimum level of intellectual property protection, and are
free to provide a higher level if they want. If we can agree to the global pro-
tection of intellectual property without creating a global government, why
could we not agree to global protection of socio-economic human rights? The
151. Yau JOURNAL OF INTERNATIONAL AFFAIRSSTOP DEVELOPMENT ASSISTANCE, GLOBALIZE SOCIAL PROTECTION
more practical challenge of collecting and redistributing funds could easily
be solved through the creation of a global health fund, a global education
fund, and soon, along the lines of the existing Global Fund to fight AIDS, Tu-
berculosis and Malaria for example. It does not require a global government.
But then the question is: should we?
The risk of dying while giving birth is 100 times higher in most low-income
countries than in the majority of high-income countries. It takes ambulances,
radios or cellular phones, and permanently accessible emergency obstetrics
care services to make a real dent in maternal mortality. This is unaffordable
for low-income countries: USS40 per person per year really is the minimum.
There is no hope for significantly reducing maternal mortality - or improv-
ing healthcare in general -if we are not willing to aim for a different kind of
sustainability. This will take open-ended, mutual support.
The reasons for creating social protection schemes within industrialized
countries at the end of the nineteenth or during the twentieth century are
now valid for the global economy. Social protection was needed to mitigate
the expanding inequities that resulted from a free market economy. Any com-
petition creates winners and losers; if the winners are allowed to invest their
gains in comparative advantages for the next phase of competition, inequities
grow until any form of social cohesion or cooperation becomes impossible.
Social protection redistributes a part of the gains of all in accordance with
the needs of all, and thus allows the continuation of unevenly distributed
gains within boundaries that guarantee universal human dignity. In the
twenty-first century, national free market economies have become increas-
ingly, but not completely, integrated, resulting in cross-border competition
between individuals and companies, but also in competition between states.
The world is witnessing at a global level the same kind of self-amplifying
dynamics, leading to ever-growing inequities, which demanded corrective
‘measures at national levels in the West a century ago.
Last but not least, while social protection schemes were intended to redis-
tribute wealth, they also generate wealth. Improvements in the quality of
health and education in the Western world enhanced the productivity of its
workforce. Social protection has proven to be more than a zero-sum wealth
redistribution game. Why not apply these lessons on a global scale? m
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