The Lugano Report: on preserving capitalism in the 21st century.

Books & Electronic Media The Lugano Report: on preserving capitalism in the 21st century By Susan George. Published by Pluto Press, London, England, 1999. ISBN 0 7453 1532 1, price: UK £9.99, USA $14.99 The relevance of this book has grown since it was published. Susan George hopes that you are chilled by her Lugano Report— I was frozen stiff. She reminds us that the fossil fuel-based economic activity of the present 2 billion ‘haves’ who burn that fuel is destroying the world, and that the 9 billion, who by 2050will want that economic activity, will destroy the world even more. There will be no adequate means of either control- ling or sharing that economic activity in a way that the world might support sustainably. Meanwhile, the ‘have-nots’ who will not enjoy such benefits are likely to become increasingly violent. The market economy is therefore destroyed either way. The sinister conclusion is that we cannot both sustain the liberal free- market economy and continue to tolerate ‘the superfluous billions’. The Lugano report is ingenious. The author imagines that some major commercial companies — the economic masters of the world — have asked an imaginary group of experts to report on the dangers to the survival of the liberal free-market economy — ‘the market’ — and how these dangers might be dealt with. These experts start by reminding us that the biosphere or global ecosystem is a closed system, apart from the energy received from the sun, but that the economic activity within it is an open system, which uses inputs of fossil fuel, materials, labour and capital, to produce goods and services — and waste, particularly CO2. As the major green- house gas, CO2 is already changing the global ecosystem irreversibly. If the economy is small, the ecosystem can contain the waste and environmental destruction that economic activity causes, so that there are few problems, which are mostly local. But if the economy enlarges so that it approaches the limits of the global ecosystem, there are great problems. Economic activity has increased 25fold since 1900, and at present doubles about every 25 years. The limits of the global ecosystem have already been reached — the world is heating up, the weather is changing, glaciers are melting, trees and fish stocks have already mostly gone. Many species have gone for ever. There is also the prospect of much worse to come, especially if the permafrost melts and releases its frozenmethane, an alarmingly efficient greenhouse gas. Once this starts to happen there is the danger of a positive feedback loop which will heat the earth even more. Far from being controlled, economic activity and CO2 production is escalating, as ‘the market’ globalizes. Large firms take over small ones to become transnational corporations (multinationals), some with economies which are larger than those of many states. Globalization is gathering speed. The World Trade Organization (WTO) hopes to make the world into one single economic system, with no barriers to trade in goods and services anywhere. Even health services are to be privatized and made subject to market forces. ‘The market’ has, until now, so hugely bene- fited the 2 billion ‘haves’ who have been able to enjoy its benefits that economic growth has become the global objective, regardless of its disastrous ecological consequences and the impossibility of its being shared by everyone. ‘Nature’ — the well-being of the ecosystem — is therefore the greatest obstacle to the future of economic activity. The message has to be ‘protect the ecosystem or perish’. Somehow, economic activity and ‘the market’, particularly their most harmful aspects (fossil fuel consumption), have to be limited if the ecosystem is to continue to be habitable. Since the quantity of economic activity that the biosphere can tolerate is finite — and has already been exceeded — economic activity will have somehow to be controlled and shared among the 9 billion. Sharing is exactly what the uncontrolled market, especially the globalized market, does not do. Such is its behaviour that, in the absence of vigorous redistribution, the rich get steadily richer while the poor get relatively and often absolutely poorer. That control and sharing have to happen. The report points out that, if it does not happen, the world will be destroyed either by the burning of its fossil fuel or by the violence of the 7 billion ‘have- nots’ who will be unable to burn it. The process would be bad enough were there more hope of controlling global economic activity. As things stand, such agencies as might be supposed to have this responsibility are powerless. Not a happy prospect! So what should the economic masters of the world do to preserve it for the liberal free-market economy for as long as possible? The experts suavely recom- mend a vigorous population reduction strategy (PRS), so as to achieve a global population of 4 billion, by assisting the four horsemen of the apocalypse, conquest, war, famine and pestilence, to which they add a fifth, ecological collapse, to do their worst— a nightmare which the author naturally abhors. What then might be the answers to such gruesome free-market logic? Susan George has little to say. A Tobin tax on financial transfers is long overdue. She is right about the need for population control, but not about the means. The plight of the most miserable have-nots, particularly in Africa, is that they are demographically trapped (search ‘disentrapment’ on the web), and like China need one-child families, if they are to avoid starvation and violence. If they are to be counselled to have one-child families, we should all have them. If so there needs to be a policy for a ‘one-child world’, or more practically, a ‘one-or-two-child world’. A healthy lifestyle now needs to be a sustainable lifestyle and, especially, a low CO2 lifestyle — ‘green health’. So why not update WHO’s definition of health? What about ‘For the sake of our children and their children, and not only for ourselves, health is a state of complete physical, mental, social, and ecological well-being and not merely the absence of disease and infirmity’? n Maurice King Research Fellow University of Leeds. 5 Ashwood Villas Leeds LS6 2 EJ, England (M.H.King@Leeds.ac.uk). 898 # World Health Organization 2001 Bulletin of the World Health Organization, 2001, 79 (9) Human frontiers, environments and disease: past patterns, uncertain futures by Tony McMichael Cambridge University Press, Cambridge, England, 2001. ISBN 0521 004942 UK £14.95 The public health professions are facing unprecedented practical, academic and political challenges. Along with the double burden of communicable and noncommunicable disease, there is increasing recognition of the importance of global environmental change for human health and disease. This ‘third burden’ of disease is especially challen- ging because it requires new methodo- logical approaches outside the realm of those routinely used by public health scientists. This additional challenge comes at a time when public health capacity is insufficient, especially in developing countries, to respond to communicable disease prevention and control needs. McMichael is a professor of epide- miology at the London School of Hygiene and Tropical Medicine, and at the leading edge of debate on the public health response to global environmental change. It is reassuring that the London School is taking a strong interest in these complex global issues, which are much more difficult to deal with than the disease-specific ones which have long been its focus. McMichael is one of the few public health scientists who have found ways to stand back from sectional interests and study the relationship between individuals, socie- ties and the environment in which we live as a whole. The scope of his latest book is broad, beginning with a fascinating historical view of biohistory and ending with concrete suggestions as to how we can and must reduce our ecological impact. Along the way we are treated to a detailed and chilling analysis of the impact we have had and continue to have on the earth’s ecosystem. The information is well organized, well illustrated, easy to read and delivered with a welcome sense of humour. It is essential reading for public health scientists, practitioners, acaemics and students, and for econo- mists of all specilizations and ideological persuasions, given their increasing influence on public health debates. The modern phase of globalization is characterized by freer trade and unfettered flow of capital, and is radically strengthening global patterns of financial interconnectedness. A striking outcome of this process over the last 30 years has been the creation of huge national and personal wealth, especially in the already wealthy countries, and economic growth more generally, notably in South-East Asian countries including China. There are of course major regions of the world which have yet to benefit from this economic growth, notably sub-Saharan Africa and much of eastern Europe, especially Russia and the other countries of the former Soviet Union. The relationship between economic growth and health is by no means simple. It has long been recognized that at low levels of GNP there is a strong relation- ship between increasing national wealth and overall population health status. However as the income level reaches about US$ 5000 per capita, the rise in health status plateaus. There are of course important exceptions to this relationship. For example, it has long been recognized that in the Indian state of Kerala, and in China, Costa Rica, Cuba and Sri Lanka, it was possible to attain high levels of health status with very low per capita income. However, with the notable exception of China, these countries have not been able to convert this health advantage into economic growth. Some economists assume that this continuing low economic growth must be due to lack of the market-based reforms advocated by the World Bank and the IMF. It should be noted, however, that several countries, both wealthy and poor, have followed this prescription with great enthusiasm and still not experienced rapid economic growth. The economic growth that has occurred in the last few decades has undoubtedly led to major health benefits. For example, the proportion of the Chinese population now living below the official poverty line has been significantly reduced, presumably with a concomitant beneficial impact on population health status. But there have also been steep costs, such as the rapid rise in social, economic and health inequalities among and within countries. There is now a flourishing academic literature coming out of rich countries on health inequalities and the appropriate policy responses, though the response of politicians to this concern has not been commensurate with its public health importance. A far higher potential cost of this economic growth is unsustainability. McMichael places this issue, which, unless solved, will overshadow all other health issues, firmly on the public health agenda. The world’s population is on track for 9 billion people by the year 2050. It is irresponsible to ignore the effects this will have on the ecosphere — especially given the expectations the extra billions of people will have for a standard of living well above the poverty line. Health improvement for all is justified on humanitarian grounds alone but must be based on a sustainable and equitable economic system. Health improvement that is sought only for its contribution to economic growth is, at best, shortsighted and at its worst may speed up the global environmental degradation that is taking place. Econo- mists who ignore the central need for redistribution of wealth may in the long run be contributing to, rather than alleviating, human distress and disease. This book makes a major contribution to the debate on health and development and is especially timely given the Rio + 10 summit next year. Robert Beaglehole Department of Health and Development, World Health Organization, 1211 Geneva 27, Switzerland. 899Bulletin of the World Health Organization, 2001, 79 (9) Books & Electronic Media