SOCIAL SECURITY NEEDS NEW DIRECTION

Ed Shepherd

From various UNDP and World Health Organisation reports; and from Third World Network - What does globalisation mean for health? by Diana Smith; and Experts attack shift in global health strategy, by Martin Khor.

Social security implementation began in Germany in 1884. In the early twentieth century workmen's compensation schemes became widespread in industrialised countries.

This time marked growing acceptance that the state should be responsible for health care, and that the poor should receive the same treatment as the rich.

The long established idea of state responsibility for health care is changing under privatisation and globalisation. Government health budgets are being cut, while 'user pays' schemes increasingly limit access to health care to the increasing numbers of poor people in the world.

The minority of the world's rich are increasingly rich, and can afford to pay health care costs, but more and more poor people receive inadequate attention.

In 1978 the World Health Organisation (WHO) adopted a policy of 'Health for All'. Objectives were supposed to be achieved by 2000, targeting at least basic needs, including food and medical treatment for everybody. The project has failed miserably, and has effectively been rejected by governments.

In Where There is no Doctor, David Warner argues that the Health for All project failed because UN agencies replaced the aim for basic needs with selective needs, and because the World Bank and International Monetary Fund control much global health planning. These banks impose welfare cuts in structural adjustment programmes (SAPs) in exchange for new loans and compromises on old debts. This policy has affected many countries, especially those in the Third World. For example in What does globalisation mean for health? Diana Smith argues that the SAP in Zimbabwe caused a reduction in the country's child immunisation programme.

Until recently, 80 percent of the world's children were immunised against the most dangerous diseases.

Reduced government spending under SAPs is particularly aimed at reduced welfare spending as 'market forces' (i.e. profits) determine government budgets.

The price of medicines has rocketed over the past twenty years. Some countries subsidise medicines to make them available to the poor through fixed prescription charges. At the same time some drug companies produce some very cheap effective drugs, so now prescription charges can be MORE than the basic cost of the medicine. But governments insist on the prescription charge if this is higher than the actual cost. For example the UK government took legal action to force chemists to charge the full prescription price when chemists began to charge the 'market' price.

Diana Smith points out that globalisation need not have completely negative effects for ordinary working people. She states that the communications technology that has accompanied globalisation is instrumental in the rapid and comprehensive spread of health related information.

In developed countries, the cost of social security came under attack during the 1970s as unemployment began to take on the unacceptable proportions we are now familiar with. Social security costs for unemployment became a big drain on government spending, and a political campaign was waged attacking those made redundant as 'lazy scroungers'.

A whole variety of education and retraining schemes were and continue to be devised. These schemes had three main effects.

They began to establish the idea of 'working' for social security, as opposed to the original intention of welfare as a human right.
They removed participants in the schemes from unemployment registers, thus reducing some pressure on government to do something effective about unemployment. Such schemes pioneered the way for governments to massage unemployment statistics.
Retraining schemes provided employers with cheap labour. The government gave a fixed amount of money to employers for each trainee they took on. Many bosses exploited loopholes in the schemes by releasing those they had 'trained' and taking on new 'trainees' as soon as a training period was finished, with no intention to employ any of these workers under standard working conditions.

The schemes are sold to the public by advertising and hype on a grand scale with two major claims.

Governments claim the schemes create job opportunities, yet they create few real jobs. This is because governments lack the money to simply create jobs, and as we have seen governments were under economic pressure precisely because revenue was reducing because a) those made redundant no longer pay direct taxes and b) those same workers are claiming unemployment benefit. This lack of investment in jobs is bound to fail the objectives governments set. Trade unionists criticised early claims of job creation as cynical attempts to fool the public, and history has proven them correct.
Governments claim the schemes "enhance competitiveness". Employers love the idea of workers competing rather than co-operating with each other, so they use this kind of antagonistic language. What they meant by 'enhanced competitiveness' was improved skills to make workers more attractive to employers. Yet what good are improved skills without real jobs to apply them in? In any case many 'trainees' end up doing six months of very basic work, learning practically nothing to equip themselves for a career.
Unemployment is rife in almost all countries. Many well intentioned academics and government advisors in Asia are now advocating the same techniques that have continued to fail in the West for more than twenty years. They ignore the failure of schemes they now recommend; in case they have not noticed, unemployment/underemployment is increasing.

Instead these experts encourage cheap labour schemes which force welfare recipients to work for community care services. Companies taking part in these schemes benefit twice over: they are guaranteed cheap labour, and qualify for a range of tax exemptions offered as incentives to participate.

There is an alternative. It has been suggested that investment should be switched from unsustainable short term construction or capital intensive projects to social welfare projects, which are labour intensive and create micro-economies of their own. These are much more likely to be sustainable and successful.

Unfortunately little research and few pilot schemes exist to test the truth of social welfare options. On the contrary, as governments continue to invest in construction projects, the unemployed are forced to staff them. This is particularly destructive when they are forced to do 'social work' without the necessary training. But if trained welfare workers were paid good wages, they and the social security system could be invaluable assets for national economies rather than a drain on them.