Globalization, health crisis and health sovereignty

(translation)

Rubén Darío Gómez-Arias rubengomez33@gmail.com

Pedro Villasana pedro.villasana@ulagos.cl

This paper was published originally in Spanish as: Gómez-Arias RD; Villasana P. Globalización,
crisis de la salud y soberanía sanitaria. Salud y Bienestar Colectivo. 2022; 1-19.
https://revistasaludybienestarcolectivo.com/index.php/resbic/article/view/169/179

Abstract The world gets organized as a tightly integrated system.

The first step in solving public health problems is to
understand their dynamics, and this cannot be done from
piecemeal perspectives. Humanity is currently
experiencing an intense and accelerated process of
forced integration that some authors call globalization,
and this has given new forms to existence, but also to
suffering, Illness and death. In this article we will review
this process, its background, its conceptualization, and its
consequences on health. Both globalization and its
conceptualization can be considered the reflection of
relatively recent conditions of an economic and political
nature, and with a heavy load of ideological content.
Thus, it should come as no surprise that they are also the
subject of ideologized debates. This article aims at
allowing academics and other social agents to advance
in the discussions on health in globalization from a critical
perspective that generates practices that benefit the
health of the population.
Keywords: Global Health, Health Sovereignty,
Neoliberalism, Public Policies, Public Health, Health
Crisis, Collective Wellbeing, Global Damage, Good Living,
Globalization
Biological conditions forced the human species to live in
society. But human society is not the product of a natural
biological process; it is the product of interaction
processes among people and groups that have not only
changed throughout history, but also have strengthened
and accelerated in recent years [1],[2]. It is difficult to
imagine humanity disregarding its social status. Every
society gets organized through interaction relationships
among its members, which confer identity to the group
and define its attributes as a whole. These relationships
materialize in everyday life, and are especially important
in the economic sphere, where people face their needs
for survival and personal fulfillment. Amidst these
relationships, essentially political, cooperation stands
out; but form of domination, submission, and
resistance do as well. [3]. The quantitative growth and
the qualitative changes of social groups (some of which
have been conceptualized as “development”) determine
each other, but not in a mechanical or unidirectional way
[4]. On the contrary, the permanent change that every
society undergoes is due to particularly complex
processes that define multiple, and often unpredictable,
paths. Based on these general premises, we may analyze
the attributes of societies that have been articulating and
integrating in different historical contexts, from the
dispersed nomadic groups of antiquity, the settlements
that gave rise to cities, the accelerated urbanization of
the last two centuries, to the world interconnected by air
 transport and internet networks. In this document we
will focus on understanding the changes that have been
taking place in the world in recent decades and that have
given rise to the concept of "globalization".
Background of global changes
The integration of social groups, different in their origin,
structure, location, and dynamics is not a new process. It
has happened throughout human history, often by
violent means. The formation of empires in antiquity, the
instances of colonization, and the origin of Nation States
in Europe in the 17th century are a good example of the
conflictive nature of forced social integrations whose
consequences persist until today. The history of these
integration processes is usually told from the perspective
of the winners as successes for humanity as a whole.
Since the second half of the 20th century, the integration
of human groups in different regions of the world has
accelerated remarkably from three converging
situations: The strengthening of capitalism after the
postwar period; the weakening of the socialist bloc; and
the technological advances, especially in
communications and transportation [5].
• Strengthening of capitalism as the economic model to
follow. Between the 13th and 15th centuries, the
violent concentration of wealth in Europe that gave
rise to capitalism, also generated Modernity as an
ideological, political, and economic system that
supports and expands its model of social organization
[6]–[9]. According to this model, the meaning of human
life is to get money, accumulate wealth, buy material
things, spend without control, to have fame and
power... to succeed... to progress... and to use natural
resources and even other people as means to achieve
individual goals. Since the political triumph of
Modernity in the French Revolution, capitalist societies
have been organized as free markets, directed by
democratic States responsible for ensuring property,
individual liberties, and the public order required for
transactions. This is the model of life and human
development that official ideologues, political groups,
mass media, and international organizations have
taught us since we were children. It is the pattern that
governs our lives since school, from the education we
receive from our families, and even from the
universities. This model experienced a severe setback
during World War II, when capitalism suffered the
worst crisis in its history. By then, mortality, hunger,
unemployment, and production focused on the
military sector spread across Europe. The destruction
of infrastructure and the widespread poverty drove
consumption of goods and services to collapse, and
weakened markets. The salvation of capitalism was
brought about by the interventionist governments
(Keynesian governments) that, in less than 15 years,
recovered the consumption capacity in countries
affected by the war, reactivated markets in the
countries of the West and the Pacific, and
strengthened financial entities. Never before had
wealth concentrated so rapidly, and analysts called this
period "the golden age of capitalism" [10]. Supported
by Keynesian governments, capitalism seemed to be
the salvation of a world in crisis. Behind the scenes, the
Keynesian model had also strengthened the State,
which had financed public services to see to the needs
of the affected population, and administered them
directly [11]. In the 1980s, and backed by academia
headed by Milton Friedman, the owners of capital saw
in the public goods and services administered by the
State a source of enrichment that had not been
discovered before. To appropriate these resources,
and with the support of the US government and
financial organizations (the World Bank and the
International Monetary Fund), the owners of the
capital designed two particularly powerful strategies
that were initially implemented in Latin America, and
later expanded to the rest of the world until today: the
weakening of the State, and the privatization of goods
and services that were in its care. This model, whose
guidelines are very well summarized in the Washington
Consensus [12], [13], takes up the principles of
orthodox capitalism of the 18th century and is called
neoliberalism [14]–[16]. Currently, the neoliberal
paradigm of capitalism has achieved to impose itself in
the official discourse of most of the world, in
government decisions, and even in academia, as the
only legitimate model for managing the economy and
society.
• Weakening of the socialist bloc. Since the 15th
century, the liberal economic model on which
capitalism is based has spread to the countries
of Europe and their colonies. Liberalism
defended private property and the freedom of
markets, favored individual liberties as human
rights, promoted representative democracies,
 and organized the modern State around the
three branches of public power: legislative,
executive, and judicial. These institutions had
the function of ensuring individual liberties and
maintaining public order, while refraining from
regulating the spontaneous dynamics of the
markets. The American independence, the
French Revolution and the Napoleonic wars
turned this model into the organizational
standard of civilized societies, and expanded it
to Western countries and their colonies. A
different historical situation existed in Eastern
Europe where, at the beginning of the 20th
century, the Russian Revolution overthrew the
tsarist regime and imposed a different state
model, based on socialist principles, which
subordinated property and individual liberties
to the public interest and recognized state
competence to regulate and control the
economy. This economic and political model,
contrary in its foundations to the capitalist
paradigm, also spread throughout the world
after World War II, with the support of Russia
and the other countries of the Soviet Union.
Between 1945 and 1980, both systems,
capitalism and socialism, maintained a very
conflictive relationship that is known as the Cold
War, and that dragged the other countries with
it. The world was then divided into two blocs
that defended opposite models of societal
organization. In the 1980s, the countries of the
Soviet Union faced strong external pressure
sponsored by the capitalist bloc, and an internal
crisis generated by economic and political
corruption, and profound leadership errors in
economic management. The crisis of the
socialist bloc came to a head with the
disintegration of the Soviet Union, and left the
capitalist regime without an adversary, able to
expand throughout the world without a
counterweight, as the only model of society.
• Technological development. The confluence of
the two previous processes gave rise to an
accelerated development in science and
technology, initially at the service of weapons of
mass destruction and military expansion; and
also, in the field of information, transportation,
and communications. In the late 1950s, the
development of high-performance integrated
circuits (microchips) revolutionized electronics
and laid the foundation for the development of
computers, the Internet, mobile phones, and
the automation of manufacturing equipment
and production, distribution and transportation
processes [17]. In a few decades, electronic
development made it possible to organize,
systematize, disseminate, and use most of the
knowledge stored by humanity throughout its
history. Advances in communication, and the
reduction of time and space, turned the world
into a global village [18].
Attributes of globalization
It is difficult to summarize in a few words the attributes
of such a complex and dynamic process of Societal
organization. However, some authors consider that
the social system furthered by globalization has the
following attributes:
1. The subordination of local economies to a world
market model controlled by multinational companies.
Currently, five large monopolies hold sway over
essential goods power over essential goods for the
development and survival of humanity: new
technologies; financial flows; media and social networks;
the natural resources of the planet; and weapons of mass
destruction [5].
2. The restructuring of borders as porous boundaries that
favor the free movement of goods, capital and
consumers, and restrict the movement of impoverished
groups [5] [19][20].
3. The promotion of merchandise consumption as an
indicator of human development.
4. The development of means of connectivity that
facilitate the movement and transport of goods,
consumers, and information.
5. The homogenization of beliefs, values, and behavioral
patterns in a unifying culture; culture that McLuhan
called a global village [18] and whose changes are largely
due to the development of information and
communication technologies, which streamline the
management and control of the different forms of
knowledge. In this homogenizing process, the influence
of cultural elements of the politically and economically
strongest societies dominates; Westernization and
“Americanization” of culture have contributed to the
devaluation of the cultural heritage of societies in the
periphery [5] [19][20].
6. The weakening of national states, fragmenting their
institutional structures and reorganizing their functions
at the service of unregulated market economies [21].
The architects of the world system
The accelerated integration that world society is
experiencing is not a spontaneous natural process. It is
the convergent result of complex social practices, not
always intentional; these actions are apparently subtle
and peaceful, but deep down they are violent and
impositive, and they would not have occurred without
the active participation of social agents that promote and
support them. Among these architects are transnational
corporations, international government agencies, and
mass media.
Transnational companies. This term refers to groups of
predominantly private companies that operate in various
countries to reduce tariff and production costs, although
their headquarters are usually based, for strategic
purposes, in the country where they obtain the best
guarantees. Their origin dates back to the 16th century,
but their development has expanded since the late 20th
century with the opening of markets through mergers
and acquisitions. They have acquired enormous power
over world society, since their easy access to capital and
their presence in different countries ensure their
knowledge and control of local political processes; in this
sense, they defeat competitors dispersed in the regions
of operation more easily, and they have access to the
best contracts [22]. Additionally, the desire of
governments to attract this type of transnational
companies to their countries generates a precariousness
in the conditions of local workers, and opens the way to
the destruction of ecosystems. Ultimately, the enormous
wealth generated by transnationals is concentrated in a
small group of investors, at the expense of the
elimination of local competitors, the exploitation and
violation of workers' rights, the reckless exploitation of
natural resources, and the weakening of democracies
through both legal and corrupt economic pressures.
International government organizations. They are
heterogeneous organizations, with a defined structure
and purposes, formed by two or more States through
treaties or agreements, and governed by international
law. Its roots go back to antiquity, but it experienced a
notable development after World War II, when the
United Nations System was created. Although these
organizations are formally directed by the Member
States, in practice their policies reflect the interests and
influence of the economic elites that control the
governments of the day. In this sense, they behave as
political agents that move the goalposts of the game
worldwide. All international organizations have played
their own role in globalization, but among them the
World Trade Organization (WTO), the World Bank (WB)
and the International Monetary Fund (IMF) stand out.
The WTO is an international organization that replaced
the General Agreement on Tariffs and Trade (GATT),
created in 1947. It arose from the Uruguay rounds (1986-
1994) and was officially established in 1995, its
headquarters is based in Geneva, with the function of
defining and supervising the rules that govern trade
among countries. The WTO acts based on Agreements,
negotiated and signed by the vast majority of the
countries that participate in world trade, and they are
ratified by their respective parliaments [23]. Its
regulations and interventions, which frequently restrict
the legal frameworks of the countries, aim to make it
easier for producers, exporters, and importers of goods
and services to carry out their activities under common
rules. This organization has been the object of multiple
criticisms for its role in the world situation, especially
with regard to the transparency of its actions, national
sovereignty, the fairness of transactions, human rights,
and its lack of democratic sense [24], [25]. Although it is
a different body, the WTO works closely with the
International Monetary Fund (IMF), an organization
created in 1945 to ensure the stability of the global
financial and monetary system. The IMF also promotes
the development of trade, while additionally regulates,
through agreements, exchange rates, and balance of
payments problems, with the power to impose trade
sanctions on some countries. The IMF has been the
object of multiple criticisms that highlight the
unfavorable effects of its drastic impositions on poor
countries while it acts in a benevolent way regarding the
errors and responsibilities of creditors and industrialized
countries [26]. Several critics consider that, as a
consequence of their measures, poor countries finance
the consumption of the largest economy in the world,
which constitutes a conceptual and ethical contradiction
that denies the foundations of multilateralism, making
the IMF "the extended arm of the USA” [26][27].
Globalization basically involves a forced homogenization
of inequitable trade rules that promote and favor the
concentration of world wealth. The trade agreements
promoted by the WTO and the IMF function as a political
device pushed by economic elites, which forces
countries, through imposed agreements, to gradually
reduce their trade barriers and open their current and
capital accounts to those private groups that concentrate
wealth.
The mass media. These are also one of the agents
responsible for forced globalization, that in its wake
imposes the unquestionable belief that the world
situation is a natural, necessary, irreversible, and
convenient phenomenon. Before public opinion, the
media present themselves as independent, neutral, and
impartial organizations, at the service of the truth. The
truth behind this facade is that mass media are
particularly profitable businesses, owned by the same
economic and political elites that concentrate the
wealth. Since the end of the last century, traditional
media have experienced a strong crisis related to the
development of Internet networks, the decrease in
advertising revenue, the drop in the print media, and the
loss of credibility in the eyes of the public [26]. Despite
this, mass media represent today one of the most
powerful businesses worldwide and its influence is
growing in society. The large media groups depend more
and more on institutional advertising that subjects them
to the political power of the day, and on direct or indirect
financing from the banks that subjects them to the
interests of current economic power. The global media
oligopoly is in the hands of private companies; six US-
based conglomerates (Time Warner, Disney, NewsCorp
merged with 21st Century Fox, NBC Universal, Viacom
and CBS) control 70% of the global business and own
some 1,500 newspapers, 1,100 magazines, 2,400
publishing houses, 9,000 radio stations and 1,500
television channels around the world [26]. The
concentration of the business has also occurred in the
digital sphere, spearheaded by Google (who bought the
main video channel in the world, YouTube); Facebook
(which acquired WhatsApp and Instagram); Amazon;
Yahoo; Microsoft and Apple (who competes with Netflix
and HBO) [26]. The nouveau riche see the media as a way
to increase their economic and political power. In 2013
Jeff Bezos, founder of Amazon, bought the Washington
Post; John Henry, owner of the Red Sox baseball team,
acquired the Boston Globe and Warren Buffet bought, in
2012 alone, 63 newspapers from the Media General
group [26]. In this context, the independent media
capable of presenting a critical vision of world events
have more and more difficulties to make their way in the
public opinion plagued by false news and the propaganda
of the official discourse. In this context entrepreneurial
liberty often trumps freedom of the press. By
disseminating information on current politics, and on
negotiations and agreements held outside the formal
democratic process, media owners can influence the
public policy-making process [26], and their
homogenizing thinking turns society into a mass that
clings to globalization as its only destiny and its lifeline.
Globalization as discourse
Since the second half of the 20th century, human groups
have been configuring themselves based on a world
model - homogenizing in its rules, but heterogeneous in
its conditions of application - which from the official
discourse has been called "globalization" or " worldwide
globalization". This term usually refers to an accelerated
economic, technological, political, social and cultural
process that has spread worldwide, and consists of the
growing interdependence, communication and influence
among individuals and human groups in most of the
world. [27]–[29].
More than an isolated term, globalization involves a set
of strategies and a complex and ideological discourse,
aimed at legitimizing, maintaining, and expanding the
essential attributes of a new societal model, and
especially the primacy of non-regulated markets focused
on concentration of wealth. Like every discourse,
globalization acts as a device of power that determines
the way in which social processes should be understood,
delegitimizing and repressing those interpretations and
practices that question its legitimacy.
Among its contents, the globalizing discourse defends:
1. The principle of the scarcity of goods and
services which is proposed as an absolute and
natural condition of humanity. This argument,
the axis of liberal economic theory, stems from
a misconception of human needs, which the
ideologues of the model define as desires.
According to his approach, human needs are
subjective desires, which materialize in
demands for goods and services; said desires are
infinite and completely legitimate individual
elaborations; but the resources to satisfy them
are finite and scarce. Consequently, we are
eternally doomed to scarcity because we will
never have enough resources. The general
principle of scarcity is considered an
unquestionable axiom, on which economic
dynamics, poverty, and inequalities are
interpreted [30][31], [32].
2. Inequalities among individuals and groups are
defined as unavoidable conditions generated by
nature and the initiative of human beings. This
argument, closely linked to the scarcity
principle, should be thoroughly discussed. It is
undeniable that resource scarcity occurs under
multiple specific conditions; but turning relative
scarcity into an absolute and inevitable principle
is an ideological generalization that allows
liberal economists to justify poverty and
inequality, and conceal the responsibility of the
economic model: We will always have poor
people; the poverty of some groups is a natural
condition and is not the fault of the economic
model. Since poverty is a consequence of
scarcity, to solve it, it is necessary to increase
production and wealth even further. In this
sense, employers and large producers of goods
and services are doing us a great favor and
deserve all our support...
3. The appropriation of resources by private
agents (private property) is defended as an
absolute, unquestionable, legitimate and
foremost right in any situation. This approach,
which is part of the liberal ideology since the
origins of Modernity, assumes that private
property is an inalienable natural right, which
must be protected by the State. The expansion
of capitalism spread this ideology throughout
the world as an irrefutable principle: private
property is always legitimate; and the way in
which people took possession of the goods that
today they consider their own is also presumed
legitimate until proven otherwise. Within the
framework of globalization, criticisms to the
origin and validity of the principle of private
property are considered uncomfortable, absurd,
and politically incorrect, even in academic
spaces.
4. Competition is considered the optimal
relationship among human beings. The
globalizing paradigm considers that a society
must be fair; and this does not depend on
everyone having the same thing, but on all
people having the same opportunities to access
social and economic goods; this last condition is
achieved by establishing a system of an even
playfield for everyone. Whether or not people
have access to available goods is not a
problem of the norms of justice but of the
capacities of the very people to face challenges
and access opportunities. One who is poor is so
because they want to be. The globalized world is
full of opportunities for anyone; so, the key is to
compete with the others and get to those
opportunities first! The globalizing ideology has
turned struggle and competition into the ethical
standard that ensures success, minimizing the
social value of generosity and solidarity.
5. The regulatory State, and the control devices on
the markets, are considered contrary to the
principles of any society and must be
dismantled. In this sense, States as political
institutions and other instances from which
society could control capital, should be
decentralized and restricted, limiting their
functions to protecting individual liberties and
public order. Deregulation is proposed as the
ideal of public management. This development
model promoted by Modernity in its colonies
and expanded by globalization is also supported
by many governments around the world, which
promote and favor the unlimited enrichment of
a few, and apply extremely low taxes to the
richest people and companies, generating
 multiple social inequalities in its wake [33]. By
the very fact of applying policies that favor the
concentration of wealth and protect the richest,
governments that apply this model do not
obtain sufficient income to alleviate poverty and
inequality, perpetuating impoverishment
[34][33].
Like all discourse, globalization is supported by other
power devices that act synergistically to expand its
content; among them:
1. The cooptation of the institutional framework by
private agents, who use their wealth to control political
groups, democracies, education, and communication.
This cooptation that controls not only micro-institutions
such as the family, but also the academy and state
agencies, is achieved through financial, ideological, legal,
and military strategies.
2. The privatization of knowledge management. This
device implies the development, appropriation and
control of the media by the agents that concentrate
wealth: internet networks, mass media, and even
academic and scientific publications [35]. Privatization
recognizes the political and economic power of
knowledge, and includes the development of political,
legal, and ideological mechanisms aimed at ensuring the
private appropriation of information, science, and
technology, which are configured and managed as high-
value merchandise. Controlling the knowledge market
through mass media, academic institutions and research
centers, and patents, assures economic groups power
over ethics, values, and social conscience.
3. The creation in different countries of spaces and
mechanisms supported by ad hoc rules that protect
enrichment, remove it from social controls and hide its
origin (tax havens, confidentiality clauses, selective tax
exemptions, creation of consortiums, hiring criteria).
4. The strengthening of positive and formal law in the
internal regulations of the countries and in international
agreements, with the consequent weakening of the legal
current that defends natural law and the social spirit of
the Law. This strategy allows economic groups to adjust
the legal structure of countries to the formality that best
suits the rationality of the markets, prioritizing the form
over the meaning of regulations.
5. Trade agreements. This mechanism, whose scenario
involves backstage alliances, blackmail, pressure, and
perks, constitutes an especially powerful device to force
integration to the benefit of the owners of capital.
Inequity as an attribute of the globalized world
Despite its homogenizing claim, the globalized society is
characterized by profound inequalities and inequities. It
is true that the colonialist model of development that
many governments have adopted has generated more
wealth than ever in history, but it has also increased
poverty to levels that we should consider shameful [36].
Various sources agree that the wealth generated by the
world population has been increasingly concentrated in a
few hands. Oxfam studies reveal that in recent years the
ten richest men in the world have doubled their wealth,
while a large part of the world's population has had to
face a reduction in their income [37]. A small group of 252
people have appropriated wealth greater than what
more than 100 million inhabitants of Africa, Latin
America and the Caribbean have managed to achieve
through effort [37]. According to reports from the World
Bank, in 2017 almost half of the world's population was
sunk in poverty; 43.6% of the people on the planet were
forced to survive on less than 5.5 dollars a day, and a
quarter of humanity (24.1%) had to subsist on less than
3.2 dollars; this situation is even more serious among
women and children, and in rural areas where 4 out of 5
poor people live [38][39]. Social inequality is even more
serious in countries of the southern hemisphere, such as
those of Latin America. The 2015 Oxfam report [40]
showed that 48% of the wealth produced by people in
the world is controlled by less than 1% of the population;
in the remaining 99% of the population, the
concentration is also advancing, and in the end, 80% of
the people in the world are forced to subsist and survive
with only 5.5% of the wealth. The study warned that at
this rate, the 1% of the population that is rich today will
increase its control over more than half of the world's
wealth, which constitutes a threat not only for those who
are poor today but also for those who today consider
themselves rich in their countries. The bulk of the poorest
population survives in extremely poor places with
exaggerated inequalities (Africa, Asia, and Latin America).
Only 10 families control much of the wealth produced in
the world.
According to different studies consulted by Oxfam, the
concentration of wealth in a few hands, which had been
speeding up since the beginning of the 21st century,
accelerated even more since the Covid-19 pandemic. This
annual increase in the enrichment of billionaires is the
largest observed since records have been kept [37] and,
according to economic analysts, it is the result of the
exorbitant increases stock markets prices, the growing
development of unregulated companies, the
privatization of public goods, the strengthening of
monopolies, the deterioration of wages and labor rights,
and tax policies that exempt big businesses and burden
the poorest classes [37].
Poverty does not refer only to low income. There is also
a poverty of useful knowledge for daily life; around the
world, at least 750 million adults, including 102 million
young people (between 15 and 24 years old) lack basic
literacy skills; two thirds of the people subjected to
illiteracy are women [41]; one in five children in the world
does not have access to school [42]. Inequity also refers
to the quality of education; the World Bank estimates
that, by the time they finish primary school, 53% of all
children in low- and middle-income countries cannot
read or understand a short story [43]. Accessing
knowledge that ensures survival, health, and autonomy
is even more difficult for women; This fact is especially
serious because, in most societies, mothers are the first
source of education for their children. The education gap
is particularly important because people unable to
acquire the necessary skills to survive and support their
families become increasingly dependent, and this
aggravates the vicious cycle of impoverishment [44]. The
socioeconomic inequities that are advancing throughout
the world are not the product of chance; they are the
result of economic violence, generated by political
decisions of a structural nature that economic elites
impose through governments and trade agreements to
favor the concentration of wealth, directly harming the
entire population, and, specially, the most impoverished
people, women, and racialized ethnic minorities [37][45].
The inequities derived from the colonialist development
model have also expanded to knowledge management.
In most countries, the few privileged groups that have
access to higher education are encouraged to produce
knowledge and technologies to respond to the
expectations and interests of the private sector, rather
than to solve the problems of their communities. In the
field of health, it is considered that world resources
allocated to research are scarce (less than 1% of funds
used in health). Additionally, these resources are
distributed very unequally: Rich countries have almost
three times as many health researchers. For their part,
poor countries invest less resources in research, they
have 6 times fewer computers per institution, less than
90% Internet access, and less than 40% of their research
projects are aimed at solving long-term problems. In the
same sense, researchers from impoverished countries
focus on studying the health problems of rich countries,
underestimating the importance of diseases in poor
populations; their research is concentrated (>70%) on
studying treatments for the pharmaceutical industry, and
it undervalues research on health policies and social
programs that are less than 0.27% of the studies [12]
[13]. Supported by intellectual property laws and
agreements, technological innovation has been
controlled by the private sector, and its resources are
concentrated in a few hands, responding to the economic
interest of an elite group of companies and well-trained
professionals for this new environment, but relegating to
the background the well-being of society as a whole [48].
According to the scientist Stephen Hawking, the situation
is worrisome because technological innovations are
being carried out with the purpose of generating
economically profitable products for their owners, and
not for the benefit of the population; in this way,
researchers increase inequities rather than reducing
them [49]. This situation occurs with the support of many
governments that have not only left innovation in the
hands of the private sector, but also support the
privatization of knowledge through intellectual property
and free trade agreements. Although these inequalities
have been widely documented and proven,
paradoxically, the neoliberal discourse does not deny
them…it relies on them to justify itself. That is why it is so
important to differentiate inequalities from inequities,
defined as unfair and avoidable inequalities, where the
key to the analysis is not the statistical distribution of the
differences but the ethical assessment of their
consequences.
Health crisis
Since the 1960s, the systematic collection of information
from different countries revealed the profound inequity
in health across world population where the poor died
early from deficiency, infectious, and parasitic diseases;
while the richest survived longer and developed chronic
and degenerative diseases. Annual reports from the
World Health Organization and other agencies showed
that the burden of morbidity and mortality that was
declining in industrialized societies continued to hit
impoverished groups [50],[51][52][53]. In 2017, close to
half of the world's population did not have access to
health services, and around 270,000 people slipped into
poverty every day because they paid for medical care out
of their own pocket [37]. Every year, around the
world, 5.6 million people die due to lack of access to
services, and 2.1 million due to hunger [37]. About
3.4 million African Americans in the United States would
be alive today if they had had the life expectancy of the
white population of their country [37]. Inequalities count
because they contribute to the deaths of at least 21,300
people every day – one person every four seconds [37].
The rules imposed by the globalized model shape not
only the priority problems that affect the health of the
world population, but also their determining conditions.
The public health crisis became even more evident as of
2020 with the expansion of the Covid-19 syndemic [37],
which not only aggravated previous problems, but also
revealed the mercantilist nature of health policies, and
the lack of interest of governments and companies to
protect the health of groups unable to pay [37]. More
than 80% of the first vaccines were hoarded by the G20
countries, and only 1% reached impoverished countries
[37], [54]. Against a humanity in need of vaccines
accessible to the world population that could save both
lives and economies, Big Pharma opposed what they
considered a violation of their patent "property
rights"[37], in light of the "rules" imposed on world trade
by the Agreement on Trade-Related Aspects of
Intellectual Property Rights (TRIPS) of the WTO [21][55].
Several of these companies cling to their monopolies and
sell their vaccines at 24 times the cost of production [56]
with the tacit acquiescence of governments that are
members of the International Trade Organization.
Inevitably, the deaths that have been generated by the
application of these trade measures constitute acts of
violence as serious as those generated by other wars.
The COVID-19 pandemic has exacerbated the inequality
of the development model. The growing social inequality
generated by the economic development model -that
political and economic elites have violently imposed on
us since colonial times- has worsened even more after
Covid-19[37]. During the first 12 months of the
pandemic, poverty increased in the world by a figure that
could go from 200 to 500 million new poor individuals.
Among them, women had to shoulder an enormous
burden of unpaid care for the sick, which plunged them
even deeper into poverty [37]. Millions of people lost
their jobs, and more than 1.7 billion students stopped
going to school [57]. However, the rich have gotten
richer; in the last 9 months the fortunes of billionaires
recovered rapidly, while for the world's poorest people
this recovery could take more than 10 years [57]. The
new poor generated by the pandemic will most likely
concentrate in urban areas where poverty will increase,
they will abandon agriculture, and they will be forced to
work in informal services and manufacturing. This
situation will put agriculture and food security at greater
risk, not just in the poorest countries but throughout the
world [38].
The colonialist model of development not only
produces inequality: it destroys nature. The
development model that is applied in our countries has
not only been unfair to a large part of our population, but
also to the environment and to life forms on the planet.
Since 1990, economic activities promoted by the
colonialist development model have destroyed more
than 178 million hectares of forest [58]. All over the world
every minute a forest the size of five football fields is
destroyed. The International Union for Conservation of
Nature (IUCN) declared at least 160 species extinct in the
last decade, both animal and plant. According to their
research, 21% of known mammals, 30% of known
amphibians, 12% of known birds, and 28% of reptiles,
37% of freshwater fish, 70% of plants and 35% of the
invertebrates evaluated so far are seriously threatened
by the accelerated exploitation of natural resources [59].
We have polluted the air we breathe and the water we
drink and have turned the oceans into garbage dumps.
According to data from the World Resources Institute
[60] a quarter of the world's population will face water
scarcity in the coming years; we currently waste and
contaminate sources, but our children will have to face
bloody wars for control of water sources. Today we are
no longer talking about climate change but about an
"environmental crisis" that threatens the survival of the
younger generations. The short-term profitable business
of fossil fuels has generated an increasing dependence of
the prices of food and basic supplies, compared to the
value of oil; and the business ideologues present us the
search for clean energy as an unattainable dream, and as
a threat to social development. This superficial and
idealized analysis of the world economy confronts us Reflections to continue the debate
with a fallacious dilemma: either destroy the planet or
survive. Additionally, the irrational exploitation of natural
resources has increased the vicious circle of Around the idea of “development”, the colonialist model
impoverishment. Currently, more than 127 million that many countries currently apply to organize society
people live in areas of high flood risk [38]; the has articulated a powerful system of concepts and
environmental crisis will affect agricultural and livestock practices aimed at maintaining the concentration of
production, and will push between 68 and 135 million wealth. This development model has been configured as
people to poverty and hunger in the coming years. a political control device, which regulates life and social
processes worldwide, and privileges individual interests
over collective ones; it establishes as a rule that the
Health sovereignty as an emerging discourse meaning of life depends on personal enrichment, the
accumulation of power and material goods,
Since the political consolidation of capitalism in the
consumerism, and the unlimited exploitation of natural
French Revolution, most societies have been organized
resources, practices that are considered legitimate,
as modern, national, and autonomous States,
acceptable, and valuable, even if they cause harm and
responsible for their conduct and security. These
suffering to other people. The notion of development
competencies have been displaced by economic elites
expanded by the empires to the colonies has become the
that control -behind the scenes- both knowledge and
objective of all civilized society. To achieve this, the
information, as well as political groups and democracies
economic elites that control governments in most
[61]. “In this context, democratic States have lost their
countries have provided a set of resources, budgets,
sovereignty and their capacity to ensure the massive
strategies, political norms, and sanctioning devices that
consumption required by current market models, and to
ensure compliance at national and international levels.
face the social demands of impoverished groups” [55].
Examples of this are the international cooperation rules,
The loss of sanitary sovereignty is particularly critical in
free trade agreements, intellectual property agreements,
the pharmaceutical field; but it also extends to the
the 2020 Agenda, and the Sustainable Development
protection of essential conditions to sustain life forms on
Goals. From this perspective, the development of
the planet: the population's access to water and food
humanity is considered an eminently economic matter
security, control over the irrational exploitation of
that is measured according to the Gross Domestic
natural resources, the substitution of polluting energy
Product and the Per Capita Income, without taking into
sources for clean sources, and the defense of biodiversity
account inequality, impoverishment, the violation of the
[55][58][59][60][38]. The seriousness of this situation has
fundamental rights of broad sectors of the population,
been denounced for several years by analysts who insist
nor the protection of the environment. The development
on promoting health sovereignty as an urgent priority on
policy that has defined the way of facing the lives of our
the agendas [62][63]. The notion of sanitary sovereignty
peoples has spread strongly throughout the world for
refers to "the capacity of democratic societies to ensure,
500 years, but especially since 1980. For this reason,
through their state organization, equity in the
many people have come to believe that development, as
production, distribution, and access to essential
it is understood by colonialism, obeys a natural law,
resources to maintain the life and health of populations...
which has always been like this and cannot change.
it is the goal and sustent of any democratic society; it
cannot be separated from the autonomy of the peoples This is a big mistake.
to make their own decisions; and its development
The truth is that human society has been organized in
requires defending participatory democracies, purging
many different ways throughout history, with successes
them of particular interests that act against collective
and failures that we know better today when we study
interests.”[55].
their contexts. The economic, social, and health crisis -
that has been generated by the forced integration of
peoples under the rules of an unregulated market that
simultaneously promotes the concentration of wealth in
a few and the impoverishment of many- is in no way a
natural or an unchangeable fatality. It is the result of the
political action of the economic elites with the support of
various rulers, their media, and their voters. This
situation does not represent the end of history as
predicted by some of the ideologues of the model. On the
contrary; it can and should be reversed. The effort will be
great; it cannot be limited to fragile statements, and it
should include the following actions: a) to assume a
personal ethical position in favor of justice, the common
interest, and the protection of the most vulnerable; this
is the basis for all other actions and it is the least we could
do to resolve the humanitarian, environmental, and
health crisis in the globalized world; b) to defend
participatory democracy against all forms of
manipulation and violence applied by economic groups
and their representatives in governments; c) to promote
a greater access of the population, especially women,
children, and young people, to a critical education that
allows them to understand their history, and to organize
themselves to defend social interests; d) to strengthen
social sanctions against those who threaten fundamental
human rights, public goods, and the environment; e) to
support the efforts of social leaders who, from different
community, labor, union, academic, and political arenas,
fight for the collective interest and transparency in public
management; f) to demand from our leaders and
authorities that they support health sovereignty in the
international arena, the elimination of property
agreements that not only threaten human health, but
also the protection of the environment, and the careful
regulation of markets essential to health.
It is not difficult to reconcile health sovereignty with the
ethical, legal and political foundations of the social States
of law and participatory democracies, but it is difficult to
make it compatible with the globalized model that
privatizes assets, resources and rights, turning them into
privileges; co-opted by the global economic elites. The
governments of the day would not have the interest or
ability to counteract these trends in their countries,
unless they have strong social support that can only be
achieved by expanding participatory democracy. This
participation could be the key to change.
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