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Reviewed by:
  • Dying for Growth: Global Inequality and the Health of the Poor
  • Richard F. Gillum, MD, MS (bio)
Dying for Growth: Global Inequality and the Health of the Poor. Jim Yong Kim, Joyce V. Millen, Alec Irwin, and John Gershman, editors. Monroe, ME: Common Courage Press, 2000. 585 pages.

Dying for Growth: Global Inequality and the Health of the Poor is an international set of case studies showing how large-scale economic forces come to have their effects on the bodies of the poor and marginalized. Written by "scholars in service to community" in the fields of epidemiology, anthropology, history, and political economy with introduction and afterword by the editors, eight of the studies show different facets of the problem and four illustrate possible solutions. Writing with compassion, humility, dismay, and anger, they share their findings from Haiti to Botswana, Peru to India about issues surrounding the global health enterprise at the beginning of the 21st century.

Despite some cautiously optimistic world aggregate trends, health indicators for the poor have declined in recent decades in places as disparate as Central America, sub-Saharan Africa, and Russia, even as affluence and technological innovation reach new heights for the elites of these same countries and in North America and Europe. Through detailed case studies, the authors show that sustained economic growth, the Holy Grail of such international agencies as the World Bank since the late 1970s, not only does not lead to automatic improvements in the living standards and health outcomes of the poor, but that growth-oriented policies have inflicted additional suffering on vulnerable populations. This evidence is used to support the proposal that the health of the poor should be used to evaluate economic policy at all levels and that data should be collected to conduct such evaluations.

To illustrate this, I will discuss briefly the issue of neo-liberal U.S. and Mexican trade and investment policies and the health of workers on the U.S.-Mexico border, dealt with in the eleventh chapter of the volume under review by Joel Brenner, Jennifer Ross, Janie Simmons, and Sarah Zaidi. At the time of writing, the senior author, Dr. Zaidi, who holds a Doctor of Science degree (ScD) from Harvard School of Public Health, was Science Director at the Center for Economic and Social Rights in New York. The [End Page 653] background for this chapter is provided by an overview of the global economy in Chapter Two by two of the editors, who discuss globalization, trade and transnational corporations (TNC). According to political scientist John Gershman and religious scholar Alec Irwin, the World Trade Organization, which replaced the General Agreements on Tariffs and Trade (GATT) in 1994, is dominated by the interests of rich countries and their TNCs and acts to regulate the flow of (theoretically) free trade to their benefit. Direct investment by TNCs exceeded foreign aid to developing countries by threefold in 1997, making those countries dependent on TNCs seeking profits, and pushing to the side the welfare of the poor. Not coincidentally, 1994 also saw the implementation of the North American Free Trade Agreement (NAFTA), which sparked explosive growth in the number of U.S. TNC-owned assembly plants (maquiladoras) in Mexico, most concentrated near the border.

Beginning with the sad story of Soledad, a maquiladora worker, Chapter 11 aims to show how the rapid growth of maquiladoras has not produced the benefits for the poor promised by NAFTA proponents such as President Bill Clinton, but allowed continued poverty, unsafe workplaces, unfair labor practices, environmental degradation, and resulting ill health in the border region.

The authors provide examples of widespread violations of Mexican environmental and labor laws by maquiladoras in the 1990s. Maquiladora workers suffered occupational injury and illness at rates several times those of U.S. manufacturing workers and were frequently exposed to chemical, physical, and ergonomic hazards. One study found reduced birthweight to be associated with maquiladora work. Industrial discharges, pesticide use, and lack of sewage treatment facilities lead to contaminated surface and groundwater, air, and soil in overcrowded border communities. Rates of infant mortality, tuberculosis illness and mortality, and hepatitis A infection were higher in the border region than in the rest...


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