• Both rich and poor countries enjoyed rapid improvements in living standards and health in the decades after World War II, but their paths have diverged markedly since the 1980s
• The current global economic system (and the power structures that support it) appears to be largely responsible for the immense economic and health disparities that have developed between rich and poor countries over the past 25 years
• “This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics.” (WHO 2008 Commission on the Social Determinants of Health, p.1)

Why do we need reform of global economic governance?

• The shift in the global economy after 1980 was the product of a series of deliberate policy decisions taken through global economic institutions – principally, the International Monetary Fund (IMF), the World Bank (WB), the General Agreement on Tariffs and Trade (GATT), and the World Trade Organization (WTO)
• The wealthiest countries in the world (and the powerful financial interests they represent) dominate all of these global economic institutions, resulting in policies that favor the rich, with predictably detrimental results for the poor

What reforms are needed?

• If we hope to achieve global health equity, we must first restore democracy and fair play to global economic governance
• “It is imperative that the international community re-commits to a multilateral system in which all countries, rich and poor, engage with an equitable voice. It is only through such a system of global governance, placing fairness in health at the heart of the development agenda and genuine equality of influence at the heart of its decision-making, that coherent attention to global health equity is possible.” (WHO 2008 Commission on the Social Determinants of Health, p.19)
• The surest path to a genuinely democratic system is through a genuinely democratic process, free from the undue influence of wealth and power; to this end, the existing institutions (especially the G20, WTO, and IMF) must step aside in favor of a “New Bretton Woods” process – one grounded in inclusiveness, equality of voice, transparency and accountability

For anyone interested in reading further, we suggest:

• The EG4Health 8-page backgrounder on – ‘Why Economic Governance for Health’?
• WHO Commission on the Social Determinants of Health (2008)
• Global Health Watch 2 (2008): An Alternative World Health Report (in particular, section A: “An Alternative Paradigm for Development”)
• Jubilee Research (2005) “Physician, Heal Thyself! The World Bank’s World Development Report, 2006: Equity and Development”. Jubilee Research, 27 September.

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