Inequality is barrier to global development, says World Bank

BMJ 2005; 331 doi: (Published 22 September 2005) Cite this as: BMJ 2005;331:651
  1. Owen Dyer
  1. London

    Inequality is the primary barrier to global development, and only welfare systems providing health and education to the poorest can tackle the problem, the World Bank's annual World Development Report said this week.

    The report echoes the findings of the UN Human Development Report released earlier this month, in criticising the “trickledown” model of international development (BMJ 2005;331: 593, 17 Sep).

    “The dichotomy between policies for growth and policies specifically aimed at equity is false,” the authors argue. “The best policies for poverty reduction could involve redistributions of influence, advantage, or subsidies away from dominant groups.”

    Inequalities within countries are almost as significant as inequalities between them, the report says, citing the example of infant mortality. “In the 45 developing countries for which a demographic health survey was available in 2000, 4.9 million infant deaths could be prevented by bringing their infant mortality levels to the [Organisation for Economic Cooperation and Development] average. But if one eliminated the infant mortality gap between the rich and the poor within each of the same countries by lowering the infant mortality rate for everyone to the level of the top decile, 3.1 million infant deaths could be prevented.”

    In the field of health, “insurance markets for catastrophic health problems are beset with failures… what can work better is public provisioning or regulation that provides some insurance for all. Examples include risk pooling in Colombia, health cards in Indonesia and Vietnam, and Thailand's ‘30 baht’ universal coverage scheme.”

    The authors also urge an end to unfair trade practices, including subsidies given to Western farmers. The TRIPS (trade related aspects of intellectual property rights) agreement, which gives 20 year patent protection to pharmaceutical companies, “is perceived by many to be grossly inequitable.” The losses to Western pharmaceutical companies are negligible when their patents are infringed in developing countries, yet the local gains are considerable.

    The report criticises recent bilateral agreements between the United States and Chile, Jordan, Morocco, Singapore, Vietnam, and others, which grant “patent extensions on pharmaceuticals… it is hard to argue that the parties to these various bilateral and multi-lateral agreements were on a level playing field.”

    Paul Wolfowitz, the World Bank president, echoed the call for fair trade in a speech that he gave at the United Nations' summit in New York last week, and expressed concern that the UN's millennium development goals would not be acheived.


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