"The poor you will always have among you." ^[1]

Jesus’ comment to Judas was not just a statement of fact, but also an indictment. Poverty is as real and horrifying in our day as it was in the first century, but the scale has grown beyond all imagining.

Facts

• The growth of the world economy doubled in the twenty five years before 1998
• 1.3 billion people live in grinding poverty (income < US$ 1 per day)
• Developing world population numbers 4.4 billion
• Significant proportions of this population lack
• Sanitation (3/5)
• Clean water (1/3)
• Health care (1/5)
• Enough dietary energy and protein (1/5)^[2]

The economic disparities both within and between countries have grown over the past decade, and incomes are lower in real terms in about 100 countries. According to the International Poverty and Health Network (IPHN), the link between economic growth and health is not automatic. Poverty is multidimensional. Improving the average health of a nation may widen inequalities, with the rich getting healthier, and the poor getting increasingly unhealthy.^[3]

There are broadly speaking two main schools of thought on the impact of economic globalisation on the poor. These can be separated roughly into the anti- and pro-globalisation lobbies.

The first school holds that economic globalisation is inherently unjust, that it perpetuates the rich/poor gap by forcing poor nations to trade on the rich nations’ terms. So, for example a cup of coffee in your local coffee shop may cost you £1.75, but the coffee producer in Latin America or Africa may only see 5p of that as international coffee prices plummet due to (mainly Western led) market pressures.

Naomi Klein^[4] is the guru of this school of thought, and with George Monbiot and many others has helped pave the ideological way for the anti-globalisation movement that has been so evident at recent G8 and World Trade Organisation [WTO] meetings.

The other school, typified by the WTO and the World Bank, etc. argues that only through trade liberalisation can the poor be positively affected by 'economic uplift'. In fact, the cause of world poverty, they argue is too little globalisation rather than too much^[5], ^[6].

The one point at which both the schools of thought would broadly agree is that wealth affects health. If a nation is wealthy as a whole, it can (theoretically) afford better health infrastructures, so more people can access adequate healthcare. If people are wealthier, they can afford to pay for healthcare (either directly or indirectly through taxation). More fundamentally, they can afford to eat better, and can afford better housing and sanitation.

In practice, increases in national wealth often tend to benefit the health of those who are already wealthy instead of benefiting the poor. New wealth tends to congregate around those already better off, while healthcare services, as they improve, become more costly - both factors tending to disadvantage the poor^[7].

However, health also affects wealth. As the overall health of a community improves, so the ability of individuals to earn a living improves, and the drain on their incomes of medical bills is reduced. This also affects the wealth of the nation as a whole because the drain caused by an overburdened health system and a large unproductive population is reduced. A recent report^[8] suggests that if the basic health inequalities in the poorest nations of the world were met, over US$ 186 billion per annum could be added to the global economy and the resultant economic uplift could take many nations out of poverty. More significantly, eight million lives would be saved each year.

The focus of the pro-globalisation development agenda is primarily economic and at the macro level. For example, a recent initiative (The Global Health Initiative [GHI], which came out of the World Economic Forum [WEF]) seeks to get businesses to tackle the health needs of both their employees and the communities in which they operate - on the basis that investing in health would yield economic benefits in the long-term. This initiative is being seen as a major driver in the international fight against HIV, Malaria and TB^[9].

Opponents of economic globalisation argue that this is naïve, as the major causes of poverty in the developing world are these self-same businesses, and that ‘enlightened self-interest’ is unlikely ultimately to benefit the poor.

In response, as the WEF was meeting in New York in February of this year, an even bigger gathering in Porto Alegre Brazil was looking at how to tackle corporate power on behalf of the poor. One clear example of this is the issue of Intellectual Property Rights (IPR) for pharmaceuticals. IPR rules mean that developing countries that manufacture or purchase cheaper versions of many drugs (most topically, HIV Anti-retrovirals) are breaking international law. A recent campaign and international court ruling has encouraged the WTO to allow patented drugs to be manufactured at low cost in developing nations, and has encouraged the pharmaceutical companies to begin to supply drugs at cost to developing nations^[10], ^[11].

The anti-globalisation school, having realised how powerful companies are in affecting the health and wealth of nations, increasingly target the practices of trans-national business rather than governments to seek justice for the poor.

Economic globalisation is a hot topic, either as the cause or cure for world poverty, and health inequalities. However, it is not the only factor.

Globalisation and Global Health

Globalisation in its wider sense also has a major impact on health, and always has done. The movement of people through trade, exploration, world mission and (latterly) tourism, has ensured that many infectious diseases are moved from one corner of the globe to another - hence the devastation wrought on the native Amerindians by 16th century Spanish explorers carrying small-pox, and more recently the rapid spread of HIV and AIDS. These movements are also tied in with wealth and poverty.

The poor increasingly move into overpopulated urban areas looking for work as rural economies collapse (e.g. because of the fall in coffee and cocoa prices in recent years). This increases their vulnerability to infectious diseases, waterborne illnesses and conditions usually thought of as diseases of affluence such as cardiovascular disease and cancer. An example of the latter is the alarming rise in smoking related illnesses. Smoking is heavily advertised by international tobacco firms who pump a large part of the advertising budget into the developing world and is now a growing health problem among the world’s poor, especially in cities^[12]. Meanwhile, sex tourists from the West have introduced HIV and other STDs (most notably into Haiti and Thailand), and are now also acting as vectors to bring those diseases back to the West^[13].

Furthermore, people moving to rural areas to escape war, famine, or overpopulation make themselves vulnerable to illnesses such as Leishmaniasis, Ebola, Kayasanur Forest Disease, etc. These are exacerbated by environmental damage. For instance, Kayasanur Forest Disease (like Lyme Disease) is transmitted by ticks, whose normal hosts (small mammals and birds) were driven from their habitats due to extensive de-forestation. At the same time, many people were moving into the affected areas looking for land to farm or for work, thus exposing themselves to a previously rare disease^[14].

In short, the complex dynamics of human global relationships have a major impact on the social and environmental causes of disease, and on access to healthcare.

Christian responses

‘Heal those who are sick and say 'the Kingdom of God has come near to you’^[15].

‘Learn to do good, seek justice, rescue the oppressed, reprove the ruthless, defend the orphan, plead for the widow’^[16]

‘I have become all things to all people, so that I might by any means save some’^[17]

Healthcare has historically been a key part of Christian Mission to the poor^[18]. Jesus sent out the disciples with a mandate to heal the sick as well as to preach the gospel^[19]. Healing is one of the signs of the Kingdom of God^[20]. Yet today, global changes are impacting health as never before, and the issues being faced by those caring for the sick are far more complicated than even a generation ago^[21].

For example one mission leader recently told me that his organisation’s work in Africa was now so impacted by AIDS that they were having to refocus on HIV prevention and care, even though their primary emphasis has always been on church planting and training church leadership.

We cannot ignore how these large-scale forces are affecting the communities for which we care. However, in tackling the health problems being faced by the poor, how do we try and tackle the root causes? What is the role of Christian Mission in confronting the issues of economic justice that contribute to ill health? Isaiah seemed to think that it was a proper part of worshipping God to stand up for the poor and vulnerable and to plead their case^[22].

Should we be campaigning on the Intellectual Property issue, for example, ensuring that the poor get access to life saving drugs?

The challenge for us is not just to bandy trendy terms like "globalisation" around, but rather to act like the men of Isaachar who ‘understood the times and knew what Israel should do’’^[23]. The twenty-first century world is moving faster than ever before and we need to understand the times and how to act in them even more acutely than ever because people’s lives are at stake. Statistics and charts can hide the simple truth that every number is a man, woman or child made in the image of God who is suffering and dying needlessly. Such suffering breaks God’s heart - should it not break ours also?