2007
Social security: Different strategies for a global problem
Cecilia Alemany
Social Watch Secretariat
Although social security is enshrined as a universal human right, in practice it is a luxury enjoyed by only a few. A mere one in five people worldwide has appropriate social security coverage, while more than half of the world’s population is excluded from any type of social security protection and most of the rest are only partially covered. From a broad perspective, social security encompasses all social services and rights that reduce risks for individuals and communities. Universal coverage could result from policies geared to employment and the reduction of social inequalities, and it is considered crucial for governance and democratic systems. Nevertheless, governments are increasingly transferring their social security responsibilities to the private sector, which is beyond citizen control, or simply abandoning them and dismantling social protection systems and the provision of social services like health care and education.
Social security: a luxury enjoyed by only a few?
The term ‘social
security’ has different meanings in different regions of the world. In this
Report, we use ‘social security’ to refer not only to pensions (that is to
say, traditional social security in a restrictive sense of the term) but also to
health services, education, employment and housing, taking a broad view of
social security as including all social services and rights that reduce social
risk for individuals and communities. As expressed in the Social Watch India
report, from this perspective social security represents a complex
multidimensional issue requiring urgent action.
At the international level, the key actors in the debate on social security have
been the International Labour Organization (ILO), the employers or business
sector, and the trade unions in negotiation with specific bodies (ministries,
secretariats, etc.) of national governments. In 2003, at the 91st ILO
International Labour Conference, the World Campaign for Social Security and
Coverage for All was launched. This reflected the fact that governments,
employers and workers all agreed on the need to widen social security coverage
and extend it in particular to workers in the informal economy, and to raise
awareness in the world about the role that social security plays in the economic
and social development of countries.
When social security was proposed as the theme for the Social Watch 2007 Report,
some members of the ‘watchers’ network (Social Watch members) raised certain
doubts, fearing that this issue was relevant only in developed and middle-income
countries: more a European concern than one of citizens’ groups in developing
countries that form the majority of Social Watch national coalitions. The
enthusiasm with which watchers in poor countries participated in the preparation
of this Report and the quality of their national contributions demonstrate that
social security is a global concern. The enormous inequality between the
different situations around the world was also made evident. More than half of
the world’s population is excluded from any type of social security protection
and most of the rest are only partially covered; it is estimated that worldwide
only one in five people has adequate social security coverage.
There are very marked asymmetries:
• In most European countries that are ‘in transition’ (former members of
the Soviet Union or the Warsaw Pact), coverage is between 50% and 80%, but in
most developed countries there is practically 100% coverage.
• In Latin America coverage varies from 10% to 80%, and development is
stagnant. The report from Paraguay shows that 78.5% of the population is not
covered at all by any kind of insurance and only 30% of the elderly receive a
pension.
• In Southeast Asia and East Asia coverage varies from 10% to 100% and is on
the rise, but in the less developed countries of Sub-Saharan Africa and East
Asia more than 90% of people have no coverage whatsoever.
The watchers identified problems arising from the ageing of societies, as well
as increasing child poverty. In some countries, such as Uruguay, both phenomena
exist simultaneously.
Although social security is enshrined as a human right, the data presented in
the dozens of national reports compiled in this report indicate that in practice
it is a luxury enjoyed by only a few.
In the conclusions of the Resolution on Social Security of the 89th ILO
International Labour Conference (June 2001) it is established that:
There is no single ideal model for social security. It grows and evolves over
time. There are social assistance regimes, universal regimes, social insurance
regimes and public or private systems. Each society has to choose the best way
to guarantee security of income and access to medical care. This choice will
reflect its social and cultural values, its history, its institutions and its
level of economic development. The priority function of the state is to
facilitate, promote and extend social security coverage.
These national reports – many of them prepared by citizens’ organizations
involved in social justice issues who have not traditionally participated in the
debate on social security – not only reveal the diversity of situations and
histories but also enormous similarities in the formulas applied over recent
decades, very often recommended by international financial institutions such as
the World Bank.
Social security and democracy
At a time when the debate seems to be focused on how to further reduce the role
of the state, the national report from Somalia presents a perspective from the
opposite extreme. Where there is no state, “few people can afford school
enrolment, medical attention and other social services in the absence of a
central government, whose role is to collect taxes and duties and convert the
revenue into community development and public welfare.”
In many countries the discussion over social security is intrinsically linked to
the efforts to construct a democratic state. The report on the Arab region
emphasizes that “social security should be perceived as part of a comprehensive system of political, economic, social and
cultural strategies aimed at protecting national security, including human
security and political stability within the society. The lack of freedom prevents people from
establishing unions advocating for their rights to social security. Only
democratically elected trade unions, labour organizations and professional
associations can claim relevant representation of the different interest groups.
They can thus lobby for the establishment of an adequate social security system,
and also monitor the implementation of such a system.”
In
reference to another situation where state authority has collapsed, the Iraq
national report concludes that since “violence and humanitarian crisis have
become a part of daily life… social security is more essential than ever.”
And among its final recommendations its proposes that the country’s
citizenship must be mobilized through a call for national unity amongst Iraqis
by adopting dialogue as the only way to achieve national reconciliation, based
on unity within diversity, non-violence, respect for human rights, and national
independence, to preserve the country’s natural resources from waste and
corruption.
The same emphasis is found in the national report from Burma, “a multiethnic
society with diverse cultures, religions and traditions. Ultimately, peaceful
co-existence and the guarantee of social security for all persons can be ensured
only if the people’s right to self-determination is respected through an accountable, transparent and decentralized
system of governance.” In Burma, stress the watchers, “the right to social security will become a reality when the
inner dynamics, interconnectedness and interaction between the state, civil
society organizations and capable individuals better reflect the dire need of
the Burmese people.”
The need to strengthen democratic institutions is relevant not only in extreme
situations such as these, but also in ‘consolidated’ democracies like that
of India, where it seems that the right to education and health cannot be
fulfilled and that, to judge from its actions, the government is trying to evade
commitments that were made on the international level.
Both popular support for the democratic system and the very legitimacy of
institutions can be endangered if the large-scale problems of inequality and
exclusion are not resolved.
Transparency and access to information are necessary conditions if citizen
participation is to be strengthened, but in some countries dialogue among
public, private and civil society actors is still at a low level, and progress
is impeded by prejudice at the government level.
In this regard, the Morocco country report shows how the growth of associations
has given birth to a new generation of non-governmental stakeholders. The
relations between these associations and the state have been evolving: they have
gone through a phase of mutual distrust and are now coming to recognize that
cooperation and joint action are
possible. Nevertheless, some obstacles that prevent civil society organizations
from participating in joint efforts for development still have to be overcome.
Most importantly, a political and legal framework will have to be consolidated,
one that is favourable to granting NGOs greater autonomy and expanding their
role in formulating, implementing and evaluating decisions and policies that
affect the most disadvantaged sectors of the population.
The report from Argentina
attributes problems with social integration to problems with social and
political rights, which are linked to the construction and maintenance of
citizenship. It follows that social insertion strategies should be designed in
such a way as to foster the transfer of economic, social, political and cultural
resources to strengthen social networks among people who are excluded, to help
them develop socioeconomic and political autonomy. Besides this, strategies
should be geared to making the government’s policies, institutions and actions
accessible and open in the sense of being responsive to society. This
essentially amounts to establishing conditions for citizenship that are based on
respect and on greater individual and social rights.
A need and a right
In this Report, Fernando Cardim de Carvalho puts forward the notion that a real
solution to the problem of inequality and social security would be “to restore
the primacy of full employment as a social goal, as it was in the first two
decades after World War II, which would obviate many of the financial problems
of social security systems. There is also a need to promote a broad debate with
all sectors of society as to the perspectives of the social security system, in
order to make it socially fair and economically sustainable. Unfortunately, the
political climate is still unfavourable to such a debate, since neoliberal ideas
about the virtues of the market are still strong, particularly among influential
political groups.”
Social security can be considered as resulting from policies geared to
employment and to reducing inequality, and can be defended as necessary for
governance and the very survival of a system that would lack popular support
without it. However, social security is also one of the internationally
recognized human rights, and therefore is not only advisable but also a legal
obligation.
In the Philadelphia Declaration of 1944, the ILO Conference recognized the
obligation to extend social security measures to guarantee basic income to those
who needed it and provide complete medical coverage.
It is laid down in Article 22 of the Universal Declaration of Human Rights,
approved by the UN General Assembly in 1948, that “Everyone, as a member of
society, has the right to social security,” and in Article 25 explicit
reference is made to medical care, social services, and security in the event of
unemployment, sickness, disability, widowhood and old age, as well as special
care and assistance for motherhood and childhood.
The right to social security is also laid down in many international and
regional human rights agreements. In the second conclusion of the Resolution of
the 89th ILO International Labour Conference, it is stated that:
Social security is very important for the well-being of workers, of their
families and of society as a whole. It is a basic human right and an essential
instrument to create social cohesion, and thus it contributes to maintaining
social peace and social integration. It is an indispensable part of the social
policy of governments and an important tool to avoid and alleviate poverty.
Through national solidarity and the fair distribution of the burden, it can
contribute to human dignity, equity and social justice. It is also important for
political integration, the participation of citizens and the development of
democracy.
The number of ratifications of the ILO Social Security (Minimum Standards)
Convention (C102) is growing,
but it is still necessary to further strengthen this process. Some countries
have still not ratified essential conventions. For example, in the national
report from Tanzania there is a call for the government to ratify the ILO
Unemployment Convention (C2) of 1919, which proposes measures for “preventing
or providing against unemployment,” and the Unemployment Provision Convention
(C44) of 1934, which establishes guidelines with regard to unemployment
insurance and other forms of relief for the unemployed, and to comply with its
obligation to submit periodic reports to treaty monitoring bodies in order to
maximize and facilitate the fulfilment and implementation of international
treaties guaranteeing the right to social security.
However, even after governments ratify these conventions they tend more and more
to transfer their social security responsibilities to the private sector, which
is beyond citizen control, or simply abandon them and dismantle social security
systems and the provision of social services like health care and education. In
the report from Zambia, for example, there is a summary of the commitments the
government has made and the social security policy instruments that have been
designed, but there is also a warning that there are no mechanisms to ensure
that the right to social security is fulfilled, and the result is that most
people in that country are not able to exercise this right at all.
In one of this year’s thematic reports, Christian Courtis
surveys the panorama and identifies places in which various
aspects of the right to social security are covered by international human
rights tribunals and bodies by virtue of interconnections with other rights and
principles. Experiences in different countries show that the right to social
security – or rather the rights derived from social security regimes
– along with labour rights, constitute areas in which litigation at the local
level is firmly established, not just in developed countries but also in
developing countries. However, the prospects of using legal systems to directly
enforce these rights on an international level are limited.
The informal sector
In the report from Romania we find that “the informal sector has grown
significantly. As a result, while the entire work force was formerly covered by
public forms of social security and trade union representation, today large
numbers of workers are unprotected. Out of an active labour force of roughly 10
million, 1.2 million workers are estimated to be employed in the informal
non-agricultural sector, and the total figure including the agricultural sector
is much higher, according to unofficial estimates.”
In the report from Brazil we learn that many people who are economically active
for most of their lives in the informal labour market, especially in urban
areas, are penalized twice over because of the individual contribution
requirement. They contribute to the wealth of the country at low cost but they
are not covered by the National Social Security Institute nor have they paid
unemployment insurance (and for this very reason they cannot exercise their
labour rights), and then in their old age they suffer again because they are
disqualified from enjoying the right to social security.
Much has been written on the informal or unorganized economy of the
disadvantaged sectors of the population, but there is another large-scale
unregulated economy sustained by “an enabling infrastructure of banks, legal
and accounting businesses, minor legislatures and judiciaries, and related
financial intermediaries, which combine to serve as an ‘offshore interface’
between the illicit and the licit economies.” The report by John Christensen
points the finger at these parallel economies that are run by the wealthiest
groups, and at the game of tax havens and new forms of corruption, and explains
how these under-the-table deals and special treatment are threatening
democracies. This is usually seen as a problem pertaining to countries in the
South, but the countries that are least interested in regulating this sector are
the richest ones, particularly Switzerland, the United States and the United
Kingdom.
Many decision-makers in developing countries who have an economicist or
conservative approach claim that there cannot be social security if there is no
economic growth. ILO Director General Juan Somavía responds that “the
approach that puts growth before distribution creates inequities that are
difficult to re-absorb afterwards.”
Nevertheless, the report on the Arab region makes the realistic point that “if
current trends continue there will be less protection and further
marginalization of the unemployed, the abject poor, and workers in the informal
sector. These negative projections are based on the persistence of existing
budgetary constraints on social security systems and on inefficient public
expenditure.”
In order to influence the
concrete definition of priorities within the actual budgetary restrictions of
their countries, the Social Watch coalitions in the Philippines and Italy have
prepared alternative budgets as an instrument for civil society advocacy in
parliamentary debates. Social policies suffer when demands and pressures are
diffuse or when government implementation of measures is not coordinated. For
example, in Lebanon, despite the implementation of social security programmes,
“the inefficiency of social spending is due to the lack of a clear and
comprehensive national social strategy. Such a strategy needs to address the
current total absence of coordination among the concerned ministries and
stakeholders, which leads to the duplication of efforts and waste of
resources.”
Various national reports reveal a lack of
shared national development strategies and of coordination among government
bodies and programmes.
In most of the Social
Watch national reports from countries in the South, bringing citizens who work
in the informal or unorganized economy into the official system is seen as the
key to expanding social security to give coverage to the whole population. There
are some interesting experiences of attempts to bring sectors of the informal
economy into social security systems, and also instances of governments
incorporating methods and experiences from informal initiatives into public
education and health care services.
Diverse facets of informality
In Africa
Ghana
While the vast majority of workers (especially women) are employed in the
informal economy, only a minority of workers, mostly in the formal sector,
benefit from the current national social security scheme. The Ghanaian
national report calls for a different national social security system that
specifically targets women, the informal sector and other disadvantaged
groups to ensure a minimum safety net for the poor and marginalized.
Somalia
What has happened in Somalia since January 1991 is a kind of spontaneous
privatization of public properties and services which has come about in a
most haphazard way. As the nation began to recuperate from the
disappearance of central rule in the country, people developed coping
mechanisms and private initiatives started to respond to market demands.
New schools, colleges, clinics, hospitals, electricity and water supplies
and other services have been provided, but consumers have to pay for all
of them, usually at exorbitant prices. Currently, 43% of the population
lives below the extreme poverty line of USD 1 per day. In Somalia, there
has never been a social welfare system or even institutionalized coverage
against the effects of unemployment.
Nonetheless, Somalis
have always relied on a traditional system of mutual support, especially
clan associations. Clan members who find themselves destitute are exempt
from contributing to the clan and may even qualify for assistance from a
collective fund of resources. This contribution-based welfare is basically
voluntary, but it helps community members to survive together, and that is
why the impact of the civil war was easily absorbed through clan-based
support. This system is rooted in a centuries-old culture of people living
in nomadic pastoralism in a relatively harsh environment.
Kenya
It has been estimated that between 30% and 35%
of the children who live in informal settlements throughout the country
are not yet in the formal education system even though free primary
education has been re-established. Civil society efforts to provide
alternative education for children in informal settlements have been
imitated by the government. These non-formal education initiatives
constitute a more flexible and economical system. They are geared to
children who live on the street and in settlements who cannot enter the
formal education system because they cannot afford the cost or other
school expenses, or for some other reason. The triennial programme
provides basic instruction in literacy and arithmetic and is followed by a
year of exposure to basic technical skills; it runs parallel to formal
primary education programmes. The report from Kenya also explains that
people who can no longer participate actively in the economy must now
depend on traditional networks for social security, and this often means
depending entirely on their children who work.
In Asia
India
The national report
explains that while there is some kind of social security framework in
place for the organized or formal sector in India, there is a serious gap
in social security policy for the unorganized sector. Out of 399 million
workers in 1999-2000, it is estimated that 371.2 million (nearly 93% of
the entire work force) were employed in the unorganized sector, as
compared to only 27.8 million (7%) in the organized sector.
The government recently finalized the drafting of a social security
bill for workers in the unorganized sector. To supplement existing social
security provisions at the national and state level, the bill offers
social protection measures for workers in the informal economy like health
insurance, maternity benefits and old age benefits. It also addresses the
conservation of natural resources on which workers depend for their
livelihood. This bill is unique in that it is grounded in a rights-based
framework and is legally enforceable.
However, a closer look at the draft bill reveals some glaring gaps. First
of all, the bill is not in harmony with the principles of
non-discrimination and equity that are enshrined in the country’s
constitution and in international covenants ratified by India, such as the
International Covenant on Economic, Social and Cultural Rights. The bill
will cause further fragmentation by excluding people already covered in
existing schemes, and it takes a segmented approach to providing social
security because it makes a distinction between the organized and
unorganized sectors instead of consolidating the two.
Nepal
The report from Nepal states that people working in the informal
sectors of transportation (such as rickshaw pullers), porters, hotel
services, factory and industry services and agriculture are the least
protected against unpredictable circumstances. Women are the most likely
to be victimized, as there is no protection mechanism in the informal
sector, and they are typically paid lower wages than their male
counterparts for the same types of work.
The Philippines
It is estimated that vendors, home workers, and self-employed
agricultural, rural, and other informal sector workers make up about 49%
of the labour force, or 15.5 million people. Many of these workers have no
adequate social protection. Precisely because they are outside the formal
economy and operate outside the scope of regulations, the provision of
health care and other social protection programmes has remained highly
problematic.
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Many kinds of discrimination
The problem of informality is exacerbated by many kinds of discrimination that
aggravate the situation for certain population groups and make them more
vulnerable. The multiplier effect of inequality is rooted in the fact that it
generally involves multiple discrimination for reasons of gender, age,
ethnicity, geographical origin, religion and sexual orientation, as well as the
discrimination faced by people who are differently abled, HIV-positive, or
members minority groups.
People suffering from discrimination cannot exercise their rights or live with
dignity. They are the most susceptible to poverty and are victims of increasing
inequality, a phenomenon that also occurs in the richest countries. For example,
in the report from Canada we learn that in polling undertaken by the Canadian
Centre for Policy Alternatives (part of Social Watch Canada) the majority of
Canadians (65%) indicate that they are not benefiting from economic growth. Many
state they are only “one pay cheque away from poverty.”
In Nepal, “throughout the country, discriminatory practices rooted in
tradition are mainly based on caste, ethnicity, class and gender. As a result, Dalits
(members of the untouchable caste),
Janajati (indigenous nationalities), the poor and women are deprived
of opportunities to meet their basic needs in terms of food, shelter, education
and health services. These discriminatory practices are more prevalent in rural
and remote areas where unequal power relations, the unequal distribution of land
and income and a lack of basic facilities are common.”
In many regions a high proportion of women are still self-employed. In the
developing countries, most work of this kind takes place in the informal
economy, and typically it is badly paid, is carried out under bad working
conditions, and does not involve social protection.
The chapter in this Report on the Gender Equity Index (GEI), written by the
Social Watch Research Team, makes the point that inequity based on gender is a
phenomenon that transcends borders, cultures, religions, nations and levels of
income. Achieving gender equity is a challenge for the whole modern world
because, although gender inequity is manifested in many different ways, there is
still a gap between men and women in all countries.
A recent ILO study
confirms the fact that women are proportionally over-represented in informal
employment. Nevertheless, when the proportion of men and women who are
self-employed is more or less equal, there is a higher concentration of women in
jobs of inferior quality.
In the report from Brazil we learn that rural women workers have been struggling
in vain for years to be officially recognized as small producers. The work they
do cultivating market gardens and medicinal plants and keeping small farm
animals is absolutely vital for the maintenance and survival of their families,
but on an official level it is undervalued or not taken account of, and
consequently their rights as workers are not recognized. The Brazilian report
goes on to say that the most serious case is that of nearly six million women,
mostly in rural parts of the country, who do not possess any kind of
documentation and for this reason are denied their rights as citizens.
The report from Honduras presents a panorama
of violence against women. The government has still not ratified the facultative
protocol of the Convention on the Elimination of all Forms of
Discrimination Against Women (CEDAW), which
is an indispensable resource that would enable women’s organizations and the
victims of violence to report on this situation to the appropriate international
bodies.
Most of the national reports from developing countries show a scenario of
discrimination against women from disadvantaged regions whose only possible
means of support is to work in the informal economy. But there are also some
positive reports, like the news that in Bangladesh “considerable progress has
been made in mainstreaming women in the country’s development process.
Bangladeshi women have played and continue to play an important role in
successful experiences like the use of micro-credits, the ready-made garments
sector, reducing the overall fertility rate, improving child nutrition, greater
participation in education and reducing gender disparity in all spheres of life.
Girls and women in Bangladesh have already achieved parity in the primary
education gross enrolment rate and in life expectancy at birth.”
Policies to gradually bring informal work into the formal economy play a crucial
role in accelerating the reduction of poverty, preventing greater inequality of
income and overcoming discrimination in general and discrimination against women
in particular.
It is vitally important, if more rapid economic growth is to be achieved and if
jobs are to be generated, that governments should implement education and
training strategies to reduce the lack of skills, overcome discrimination and
exclusion, and foster greater buying power among low-income population sectors.
Asia, Africa and Latin America:
HIV/AIDS and what remains to be done
Joyce Haarbrink, from
the NGO Marie Stopes International, comments in her report on sexual and
reproductive health and rights (SRHR) that in the late 1990s the HIV/AIDS
pandemic captured the world’s attention, with funding streams being
diverted from SRHR to the response against HIV/AIDS. There is much work to
do, and it is essential to maximize the effectiveness of resource
mobilization and to attain a synergetic complementarity of the two
strategies. In addition, donors and governments have to recognize that
investing in SRHR has a beneficial impact on the economy and the whole of
society.
Burma: yellow light,
time to act
According to Social
Watch Burma, the Joint United Nations Programme on HIV/AIDS (UNAIDS)
reports that resources made available to combat HIV/AIDS are meagre in
comparison with the magnitude of the problem, which is exacerbated by the
ruling State Peace and Development Council’s reluctance to permit
international non-governmental organizations to work in collaboration with
community-based organizations.
Permits to visit patients are difficult to obtain and access to high-risk
groups and vulnerable groups is restricted. UNAIDS has warned of a growing
epidemic in Burma and indicated that the ruling regime has largely been
ignoring it.
Tanzania: actions
implemented, but still not enough
The Social Watch
Tanzania report states that the country has an HIV/AIDS prevalence of
about 7% (6.3% for males and 7.7% for females) among adults aged 15 to 49.
Urban residents have considerably higher infection levels (10.9%) than
rural residents (5.3%). The estimated number of people living with
HIV/AIDS is two million, and the government has registered two million
AIDS orphans. However, the number of AIDS orphans doubled from one million
in 2003 to two million in 2005, which means the current number is almost
certainly considerably higher and increasing.
In order to address this problem, Tanzania has established social
security ‘safety nets’ incorporated into the country’s ongoing
Economic and Social Action Programme. One of these safety net programmes
is the creation of the Mwalimu Nyerere Educational Trust Fund, which is
being used to sponsor orphans to attend school.
HIV/AIDS: fourth leading cause of death in El Salvador
The Social Watch El
Salvador report states that HIV/AIDS is the fourth leading cause of death
in the country. An average of four people get infected every day and
thousands hide their status fearing stigmatization and discrimination.
The rate of HIV/AIDS infection has been rising since 1984. Recent data
show that in late 2006 more than 18,500 infection cases had been
registered. According to UNAIDS, under-registration is high, so the number
of people with HIV/AIDS could be as high as 25,000 to 50,000.
As for assistance, the Instituto
Salvadoreño del Seguro Social (ISSS) provides care to more than 1,280 people
in the form of antiretroviral therapy, medical attention in case of
opportunistic disease and attention during pregnancy to prevent infection
at birth. However, there is insufficient
compliance with current treatment protocols, a sporadic availability of
drugs, sometimes caused by late delivery, and a constant shortage of
reagents for the CD4 cell count test, all of which exposes many people to
the occurrence, or increased complication, of opportunistic diseases and
to death.
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The thematic report by Susanne Paul and Alischa Kugel highlights the fact that
older women often have important care-provision responsibilities. They may be
raising grandchildren or taking care of the sick or middle-aged people in
communities hit by the HIV/AIDS pandemic, or they may be supporting
grandchildren whose parents have left to work in distant places. As sole
breadwinners, these grandparents may find themselves unable to provide adequate
nutrition, access to health care or education for their children, grandchildren
or themselves.
In the report by Robin Blackburn there is a suggestion that a global
pension and youth grant system should be set up. It is also noted that the usual
link between pension entitlements and employment contributions is not good for
women because women live several years longer than men and therefore constitute
a majority among the elderly. And because women’s unpaid labour in the home
counts for little in public pension systems, and for nothing in private and
occupational schemes, over three quarters of the elderly who are poor are
female. Moreover, a woman’s work of caring for other family members typically
continues into old age, as she cares for her spouse, her grandchildren and the
sick.
Children living in poverty
Uganda: Half of the children live in poverty
The Social Watch Uganda
report highlights a 2005 study by the Chronic Poverty Research Centre
(CPRC), which estimated that 50% of the country’s approximately 15
million children were living in poverty.
The factors identified by the report as responsible for poverty and
vulnerability in Uganda included inadequate social security and protection
against shocks, poor health, HIV/AIDS, rapid population growth, limited
access to land, and lack of markets. Corruption also contributes by
diverting resources necessary for enhancing the well-being of the poor,
including the sick.
Nepal: Alarming situation of
children
The Nepalese Social Watch report explains that although the government
has ratified the UN Convention on the Rights of the Child, the provisions
made in the country’s laws and the government’s policies are
inadequate to ensure the rights of children and youth. The situation is
particularly alarming with regard to children. In the first six months of
2004 alone, the Nepalese organization CWIN collected 10,247 cases of child
labour exploitation, child deaths, missing children, child abuse, child
marriage, child sex abuse, child trafficking, forced prostitution,
children in conflict and juvenile delinquency, and stressed that the
reported cases represent only a very small fraction of the true magnitude
of the problems faced by the country’s children.
For the first time in history, the newly promulgated Interim Constitution
of 2007 has enshrined the rights of the child in the list of fundamental
human rights, but no steps have been taken as yet for the
operationalization of this commitment.
In 2003, the government pledged to provide ‘education for all’ as part
of its Millennium Development Goals (MDGs) commitments, stating that by
2015, every child between the ages of six and ten would have access to
free and good-quality primary education irrespective of gender, ethnicity,
religion, disability and geographic location. Until now, however, there is
no sign of steps being taken towards developing the necessary
infrastructure and systems to ensure that the MDG target can be met in
another eight years. Moreover, there are still roughly one million child
labourers in Nepal who do not go to school.
Morocco: 600,000 child workers
The Social Watch Morocco report states that several vulnerable groups
require support to improve their situation, especially:
• Children: It is estimated that there are 600,000 child workers, many of whom live
on the street and are exposed to physical and sexual violence. About half
a million children are beggars. All of them are victims of school
failure, rural migration and social attitudes that foster child labour.
• Widowed, divorced
and single mothers who are heads of households: Women in these categories
are more prone to poverty, in part because legal statutes and inheritance
laws discriminate against women and make them more vulnerable.
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Various national reports address the treatment that immigrants receive in
terms of social security. For example, in the report on the Arab countries we
learn that a large number of
immigrants (mostly from South Asia and other Arab countries) live in the Gulf
states with their families but do not enjoy the same social services as citizens
of those countries. Benefits have not been extended to the immigrant labour
force who carry out most of the low-skilled work but also occupy a significant
proportion of skilled jobs.
In the report from the United States we learn that, second only to the war in
Iraq, the lack of health
care provision is perhaps the most contentious public policy issue in the
country. As to the situation of minorities and immigrants, it emerges that
certain groups are hit much harder than others when it comes to lack of health
care coverage. African Americans, Hispanics, the poor and women suffer
disproportionately under the current health care system. Lower income levels among minority groups
(at the time of the study, 47% of working adult Hispanics and 44% of working
adult African Americans were living below the poverty line) make them less
likely to receive employee health care and less likely to be able to afford such
services on their own account.
In Europe, the Belgium report notes that on 15
September 2006, the parliament passed legislation that amounted to a
far-reaching change in Belgian law with respect to foreign nationals. Civil
society organizations and trade unions are unanimous that these reforms cannot
guarantee respect for the basic rights of many foreigners residing in the
country, and in no way rectify weaknesses in the previous legal arrangements.
Meanwhile, the report from Germany states that the rights of refugees to
education and even to health care services are being violated in the country. In
seven of Germany’s sixteen federal states, there is no requirement for refugee
children whose deportation has been temporarily suspended to attend school, and
the same applies to some extent to the children of asylum seekers.
Conflicting models
There is no single ideal model for social security, but there are certain
internationally agreed basic principles
that all systems should follow:
• Benefits must be secure and non-discriminatory.
• Regimes must be rigorous and transparent.
• Administration costs must be kept to a minimum.
• Social stakeholders must play an important role.
• The system must enjoy the confidence of the people.
• There must be good administration.
Another principle is that men and women should receive equal treatment. This is
the binding force and central core of social security, the element that makes
for the optimum development of society. There must be recognition of the
enormous unpaid contribution that women make, especially in the care of
children, parents and the disabled.
There are two conflicting trends in the implementation of these principles in
adapting social security to the new realities imposed by globalization:
• Structural or ‘paradigmatic’
reforms. These are far-reaching reforms that involve individual
capitalization and the complete or partial private administration of regimes.
These systems are also known as ‘Washington Consensus’ models, and are part
of the World Bank’s structural adjustment policies.
• Non-structural or ‘parametric’
reforms. These are changes to national public systems while keeping the
basic structure intact. Non-structural reforms are based on the classic
principles of solidarity and state organization of social security and are
applied in most countries, particularly in developed ones. The classic example
is the so-called continental European model of social protection, also known as
‘Social Europe’.
The national reports by the Social Watch groups in Europe describe the current
situation of the European model. For example, in France social protection refers
to all collective benefit mechanisms that give people financial support for
social risks. There are three systems: 1) social security for people who
contribute, which provides protection against loss of income, unemployment,
illness, old age, and work accidents; 2) social assistance (implementing a
solidarity-based system known as minimum income for insertion), benefits for
disabled adults; and 3) universal protection (family allowances). The French
social protection system represents more than 30% of GDP.
Housing: no one should have to live on
the street or in dire conditions
In France more than
three million people live in dire conditions or are homeless, and it is
estimated that there are 600,000 insalubrious housing units. The report
from Belgium tells us that there are serious problems as regards access to
housing since the proportion of social housing in this country is among
the lowest in Europe.
The Social Watch organizations in France propose the following:
• Implement a legally enforceable right to housing, to make it an
effective right that everyone can accede to.
• Make housing a genuine priority, as is the case with employment.
• Reinforce the social effectiveness of assistance programmes for buying
housing, which should continue to be under state administration.
• Guarantee the availability of rental housing that is economically
accessible to the whole population.
• Implement a universal system to provide security against the risks of
renting.
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Non-structural reforms
In general, non-structural reforms share the following characteristics:
• They are implemented progressively, with a medium and long-term perspective,
such as the process towards 2030 in Germany.
• They are widely agreed with the social sectors (as is the case in various
European countries).
• They can bring about an improved correlation between contributions and
benefits, for example through individual hypothetical accounts that first
emerged in Sweden and were then taken up in China and Latvia; or the social
assurance factor in Brazil.
Experts from the World Bank and other organizations that favour compulsory
individual capitalization systems have made a series of criticisms of
non-structural reforms and public systems in general.
World Bank criticisms of non-structural
reforms
• They affect the formal labour market.
• They stimulate evasion and are a disincentive to contribute because of
payment default, non-declaration and under-declaration.
• They erode the supply of experienced workers.
• They lead to injustices through the establishment of ceilings and
privileges.
• They raise labour costs and generate problems of financial
unsustainability.
• They put a brake on economic growth and do not generate a capital
market or national savings.
• They inflate the implicit debt to workers and retirees.
• They do not correct problems stemming from ageing or demographic
evolution.
• They make redistribution more unjust.
• They divert resources away from other social and production policies.
Note:
CINTERFOR/ILO (2003-2005).
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Many of the arguments
against public systems or Social Europe turn on the claim that the model is
unsustainable, either for financial reasons or because of the implications of
the fact that the population is ageing. For example, as is pointed out in the
report from Italy, one of the most critical aspects lies in the fact that as an
ageing country, Italians are now increasingly paying more for their elderly
without a sufficient generational exchange that can produce enough revenue to
cover all social security costs. However, the Italian report argues that it is
not only the ageing population that should be taken into account, but also those
who are currently unemployed, especially since the unemployment rate is not
decreasing. Finally, when the ‘baby boom’ generation retires there will be
an expenditure peak 20 or more years from now, while the reforms introduced are
supposed to reach full application in 2010.
Structural reforms
Antonio Tricarico, in the report on the World Bank perspective on social
security, argues that since the 1980s World Bank-driven structural reforms have
systematically shifted the balance of social risk away from state institutions
and onto the shoulders of the individual. For example, the World Bank’s policy
objective of prioritizing financial system restructuring and development has
increasingly targeted the reform of public social security institutions, and
involves the privatization of old age pension systems.
In addition to providing rhetorical support for the ideological and financial
interests that promote privatization, the World Bank has also provided loans and
technical assistance to nations that have privatized their social security
systems, in particular in Latin America and the Caribbean, and later in Eastern
European countries.
The national report from Nepal explains how industrialization in the country was initially state-led, but in an attempt
to globalize the national economy, the trade, investment, foreign exchange,
financial and industrial sectors were deregulated, de-licensed and subsequently
privatized. Although the Bretton Woods institutions (the IMF and the World Bank)
imposed structural adjustment policies in the 1980s, economic liberalization
actually began in 1992. The privatization of basic services such as water,
education and health care has further increased inequality by decreasing both
the quantity and quality of public health and education services.
Private pension fund administration
Taking the 1981 social security reform in Chile as a model, World Bank
recipes for structural reforms include individual capitalization schemes
and private pension fund administrators (PFAs) as a total or partial
replacement for solidarity-based public pension fund management.
TABLE 1. Countries where some form
of PFA has been introduced
Latin America
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El Salvador
|
Europe and Central Asia
|
Lithuania
|
Asia
|
Argentina
|
Mexico
|
Bulgaria
|
Macedonia
|
Hong Kong
|
Bolivia
|
Panama
|
Croatia
|
Poland
|
India
|
Chile
|
Paraguay
|
Estonia
|
Russian
Federation
|
Africa
|
Colombia
|
Peru
|
Hungary
|
Slovakia
|
Nigeria
|
Costa Rica
|
Uruguay
|
Kazakhstan
|
Sweden
|
|
Dominican
Republic
|
|
Latvia
|
Ukraine
|
|
Irrespective of implementation differences existing between the 28
countries that have incorporated PFAs up to now, the fundamental intention
behind the reforms has been to transfer responsibility for social risk
from state institutions to individuals. In these systems each affiliate
has an individual account in which his or her pension contributions are
deposited and, at the end of their active working life, this capital is
returned to them, or their survivors, in the form of some type of pension.
In theory such pension funds would take on responsibility for providing
pension income levels that public schemes were no longer able to maintain.
But according to Fernando Cardim de Carvalho, the funds were basically
conceived as a way of increasing household savings and channelling them
into public and private securities markets, rapidly converting them into
another form of investment fund.
For Aldo Caliari, the use of pension savings for speculative activities
such as investment in venture capital funds and hedge funds is a cause for
concern, both because of the instability of financial markets and the high
risk and lack of regulation associated with these types of fund.
Additionally, in PFA schemes affiliates do not participate in the
decision-making that determines how and where their savings are invested
or in the daily management of PFAs. The configuration of quadruple
entities where the state, employers, workers and pensioners all
participate has no place in PFA logic.
Several national reports from Social Watch coalitions highlight some of
the more visible characteristics of PFAs. We will look at some specific
cases.
Mexico
The report from Mexico describes that country’s social security
system as being based on an occupational model that benefits salaried
workers and their families, providing health care services, pensions and
some contributory social and economic benefits. But this model does not
cover the unemployed or those working in the informal sector.
A 2006 Alternative Report alerted the UN Economic, Social and Cultural
Rights Committee to the performance of the Pension Fund Administrators
(AFORES) and the precarious situation of the Mexican Social Security
Institute (IMSS) and the Public Employees Social Security and Services
Institute (ISSSTE). In response, the Committee recommended a series of
measures to the government, such as “a thorough evaluation of the
proposed modifications to the current pension system involved in the new
law governing ISSSTE, as well as future modifications to other social
security systems, in order to guarantee that such modifications do not
generate employment insecurity for future pensioners or reduce the value
of future pensions, thus endangering an appropriate standard of living.”
An analysis of the 28 March 2007 ISSSTE Law reform concludes that it is a
regressive measure when compared with the previous legislation and that it
contravenes the Political Constitution of the United Mexican States and
specific provisions of ILO Convention 102 that the state has an obligation
to comply with. Furthermore, this Law is based on an individual
contribution system administered by private institutions, in contravention
of the obligation that the social security system be collectively
financed, as prescribed by ILO Convention 102. Hundreds of thousands of
public employees have politically mobilized and taken legal action against
this reform.
El Salvador
The pension system in El Salvador was privatized 10 years ago. The
government transferred money that had been paid in by workers to PFAs,
while maintaining responsibility for the pensions of workers who were over
35 in 1996 and who remained in the old pension system. Six years after
this privatization a reform was introduced to raise the retirement age.
One of the main pension system problems highlighted by the El Salvador
Report is the wrongful retention of payment instalments by employers who
fail to remit them to the Salvadoran Social Security Institute (ISSS). In
2007 the government has to pay out approximately USD 345 million to
retirees but does not have that money and the state’s debt is three
times greater than the proceeds from tax collection.
The government created a Pensions Trust Fund to pay pensions and PFAs have
authorized the Multisector Investment Bank (BMI) to use money paid in by
their current affiliates to pay the pensions of retirees. The amount lent
for 2007 was USD 345 million. Because the government has such a high level
of debt it is likely to have problems with repaying the PFA, so the entire
system is at risk and the future pensions of affiliates are endangered.
Paraguay
According to the national report from Paraguay, only 30% of senior
citizens there are eligible for pension benefits. In 2005 there were only
93,000 pensioners. There are at least eight contributory funds operating
simultaneously in Paraguay, the largest two being the Fiscal Fund for
central administration public employees and the Social Security Institute
(IPS) for private sector and decentralized administration employees.
One indication of inequity is the required contribution period for pension
eligibility, which ranges from 10 years in the case of the Parliamentary
Fund to 30 years in the general scheme of IPS. The retirement age also
varies, being 40 for female public school teachers and 60 for men and
women in the general IPS scheme.
Colombia
Private pension funds based on individual capitalization have been
established but at the same time the previous system based on a ‘pay as
you go’ (PAYG) scheme and public resource administration was maintained.
Fourteen years after the implementation of social security reform (Law 100
of 1993) with the objective of promoting universal protection, the
Colombia national report emphasizes that health care coverage only reaches
62% of the population and in the area of pensions the situation is similar
to that in 1993 with a coverage of 28%.
Bolivia
According to the Bolivia national report, pension system reform there
was presented as a social necessity – an argument supported by the
clearly dysfunctional state of the existing pension system that had been
in force for several decades – but was in fact designed as a potential
source of profit for private investment. One of the favourite arguments of
government officials and PFAs in defence of the reform is that the new
system has resulted in an enormous increase in coverage. However,
enthusiasm about the unprecedented growth in the number of affiliates,
more than double when compared with the previous system, ignores the fact
that at present the number of workers actually contributing to PFA-managed
funds is substantially less than the number of affiliates.
Available information refutes the theoretical assumption that the new
system’s operations would be subject to market efficiency. It is not
free market forces that determine investment decisions in PFA fund
management. Current regulations require such bodies to maintain a certain
structure in their investment portfolio with a predominance of
state-issued securities. While the regulations limit investment in
foreign-issued securities to 10%, investment in public securities, either
of the National Treasury (TGN) or the Central Bank of Bolivia, has no
limit. As much as 90% may consist of this type of investment which
explains the unusual concentrations in PFA portfolios.
It can consequently be inferred that the objective of an efficient
administration based on transparency in decision-making and investment has
not been achieved, as the affiliates who contribute to the system, the
true owners of the accumulated funds, have no influence in decision-making
over the destiny and profitability of their savings. Instead, it is public
officials and political authorities whose interests are met through
authoritarian impositions on PFAs.
Hungary
According to the Hungary national report, the obligatory public
pension regime has rested on two ‘pillars’ since 1998, the first being
the social security pension scheme, a PAYG system that is financed by
contributions from employers and workers. The second pillar comprises
private pension funds that respond to market laws.
People beginning their working life are obliged to participate in the
mixed regime (the two pillars) and a considerable part of their individual
pension contribution (8% out of 8.5%) goes to the private pension fund of
their choice. This mixed regime currently covers over 60% of the insured
population. Private pension funds will begin to administer their own
services from 2013 and will not constitute a ‘typical’ pension payment
regime until 2020, a situation that leaves the social security pension
regime as the exclusive or predominant actor over the coming decades.
Ghana
The three-tier approach which the Pensions’ Commission has
recommended to the government is basically the World Bank’s template for
managing pensions through scaling down public schemes. The privatization
of pensions will create an opportunity for a very few private individuals
to access cheap funds at the expense of the majority of citizens. Already
a number of US firms are advertising their private pension schemes in
Ghana. This approach has failed in Latin America and is unlikely to work
in Ghana.
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All structural reforms involve basic changes to the structure of pension and
retirement pension regimes with the introduction of compulsory individual
capitalization schemes administered by private sector enterprises, and they
differ from each other only in the extent to which they replace the benefits
regime with individual accounts, and in the definition of benefits.
The World Bank proposes a model with three pillars
The first is a public pillar,
which has the limited objective of alleviating poverty in old age and
providing co-insurance against many risks. It must be a small pillar to
leave space for the other pillars, and it should be financed from the
normal budget to avoid the problems of social security funds administered
by the public sector. There are three possible modalities: it could be
part of a benefits programme geared to the needs of poor people of all
ages with benefits that depend on needs according to age; it could be a
guaranteed minimum pension through a compulsory savings pillar; or it
could provide a universal uniform benefit or one linked to employment.
The second is a compulsory
individual capitalization pillar under private administration. This
could take two forms, personal savings plans and occupational plans. The
total finance generated is supposed to contribute to capital formation and
the development of financial markets, and the stimulation of economic
growth through this means would facilitate the financing of the public
pillar (the real trend has been to promote personal savings plans, making
this pillar more important and characteristic of the model).
The third is a voluntary individual
capitalization pillar under private administration, which could take
the form of either of the two modalities above as a voluntary
supplementary system.
Note: CINTERFOR/ILO (2003-2005).
|
TABLE 2. The World Bank model: the
pillars for economic security for the elderly
Objective
|
Redistribution and co-insurance
|
Savings and co-insurance
|
Savings and co-insurance
|
Modality
|
Depending on need – guaranteed or uniform minimum
|
Personal or occupational savings plan
|
Personal or occupational savings plan
|
Financing
|
Financed from taxes
|
Totally financed, regulated
|
Totally financed
|
Pillars
|
Compulsory pillar administered by the public sector
|
Compulsory pillar administered by the private sector
|
Voluntary pillar
|
Source: ILO-CINTERFOR, 2003-2005. Taken
from Averting the Old Age Crisis: Policies
to Protect the Old and Promote Growth. World Bank, 1994.
The national report from Bulgaria explains that under the financial direction of
the international financial institutions (enforced through the conditioning of
loans) and following the policies implemented in Central and Eastern Europe and
Latin America, a whole new pension system architecture was set up, based on
three pillars. The new architecture combines government and private involvement
as well as compulsory and voluntary elements.
In 1999, criticism started emerging within the World Bank itself about its
ideological approach to the structural reform of pension systems. The World Bank
conceptualized its new approach as Social Risk Management (SRM). In 2000, in the
World Bank’s World Development Report, a policy framework for Attacking
Poverty was presented. Significantly, at the time the Millennium Development
Goals were defined in the UN Millennium Declaration, the Bank clearly stated its
intent to re-conceptualize social policy as social risk management.
The World Bank suggests that the state should provide “social safety
nets for risk coping.” There is a premise that state institutions in
developing countries will never be in a position to provide anything other than
the most limited forms of social protection. This view is problematic as it
appears to deny the possibility of social progress. The social risk management
framework appears to have been built on the premise that developing countries
should actively seek to implement social protection strategies which limit state
action to the delivery of targeted social expenditure only.
These new formulations of World Bank prescriptions have also come in for
criticism. Both Tricarico and the report on the role of the World Bank in the
countries of Eastern Europe give an account of the different criticisms that
have been made of the World Bank model from all over the world. The ILO has also
systematized these criticisms, and recently an independent audit of World Bank
research, which examined over 4,000 World Bank activities in the period
1998-2005, found that rather than policy being formulated on the basis of a
balanced analysis of a wide range of research, policies were often formulated on
the basis of historical preference, and then backed up by selective research and
biased analysis.
The independent panel made telling criticisms of the way that World Bank
research was used to proselytize on behalf of World Bank policy, often without
taking a balanced view of the evidence, to the point that “the
degree of self-reference rises almost to the level of parody.”
On the question of the impact of structural reforms, the report from India
explains that the retreat of the state under the impact of the neoliberal
framework and the forces of globalization have created a policy dilemma in which
the concerns of the welfare state have been left behind. In spite of
constitutional stipulations regarding the provision of social security, the
current system leaves wide gaps, especially in terms of covering vulnerable
sectors of the population like the elderly, women, children, and the millions of
paid and unpaid workers employed in the unorganized sector.
Criticisms of the World Bank model*
• It diminishes national and intergenerational solidarity.
• Policies are often formulated on the basis of historical preference,
and then backed up by selective research and biased analysis.
• Its coverage is limited, and private regimes favour the more
prosperous sectors of the population.
• It is geared to profits, and sometimes administrative costs are high.
• There is the risk of bankruptcy and financial volatility.
• It does not provide complete security unless the state takes the
necessary measures.
• The social actors do not participate in the management or definition
of policies.
• It is more difficult to adjust pensions to economic fluctuations than
in public regimes.
• Complex problems about guaranteeing pension rights arise in cases of
occupational mobility.
*Based on ‘Inconvenientes
del modelo Banco Mundial desde la perspectiva de la OIT’, cited in
CINTERFOR/ILO (2003-2005).
|
In the thematic chapter by the Bulgarian Gender Research Foundation (BGRF) on
the role of the Bretton Woods institutions in Eastern Europe, the point is made
that there have been two kinds of social security reforms. On the one hand there
is the kind that was applied in Poland, Hungary and Bulgaria (similar to those
in Argentina), and on the other hand there is the system implemented in
countries like the Czech Republic, Romania and Slovenia, which is more along the
lines of the European social model in that it has not followed World Bank
recommendations and seems to have been designed taking account of the lessons
learned in Latin America.
In the national report from Latvia there is an outline of the main
characteristics of the structural reforms in that country and how these have
affected the quality of life of older people. In the report from Hungary it is
stated that practically all areas of social policy have been affected by the
transition and the neoliberal policies dictated by the international financial
institutions in accordance with the Washington Consensus, in other words, the
strengthening of individual responsibility and the weakening of public
responsibility. Meanwhile, labour rights have been weakened and joblessness has
increased, so labour security has been seriously undermined.
Fernando Cardim de
Carvalho points out some other risks involved in the role that private equity
funds and hedge funds play. Pensions are not similar to other classes of
financial investment where investors select part of their surplus income to make
a bet. The function of pensions is to guarantee a minimum income level that
allows the retiree to maintain a certain quality of life. The middle classes
and, in the more developed countries, the workers are the final investors in
pension funds, and their future incomes should not be dependent on market games
such as those played by private equity funds and hedge funds.
Aldo Caliari notes that the G8 Summit at Heiligendamm in June 2007 failed to
take any meaningful action. The German finance minister’s attempts to push for
an agreement on tightening regulation of hedge funds were quickly opposed,
mainly by the US and UK governments, and were soon watered down to mere calls
for disclosure in the interest of greater transparency. As the G8 Summit drew
closer, it seemed that even modest transparency requirements of a mandatory
nature were too much to enforce on hedge funds.
Health reforms: the World Bank model
Pro-private health providers
Tricarico explains that
the World Bank deliberately reduces the role of the state and public
intervention on the basis of the unproven ideological assumption that
private health providers are more accountable, of higher quality and more
efficient than public providers. Public sector workers are presented as
corrupt, but there is no analysis of why corruption thus defined occurs
among this group, and no comparative analysis of how and why massive
corruption also occurs in private provider contracts. The strategy ignores
the evidence of successful reforms to strengthen the training, recruitment
and retention of more highly motivated and better-remunerated public
sector health care workers, and proposes bypassing the public sector in
favour of a falsely overvalued private sector.
The Philippines
The PhilHealth programme (also known as Medicare) exemplifies wide
inequities: poor workers subsidizing well-off employees (who have a higher
incidence of serious illnesses requiring more expensive treatment), and
poor regions subsidizing metropolitan Manila. Local-level life insurance
and health insurance are thriving in some urban and rural places, despite
actuarial weaknesses, and they do help mitigate risks and reduce the
vulnerability of poor households. The Filipino report identified
cooperatives, NGOs and mutual benefit associations as vehicles of
micro-insurance programmes in the country.
Hungary
The current Hungarian health care system faces serious structural
problems. Prevention and screening systems in health services are not
reliable from either an organizational or a professional point of view,
and the capacity of rehabilitation centres is insufficient as well.
Structural problems are made more severe by overlaps between certain
services (e.g. health and the social system), and the lack of advanced
communications, which further obstructs the efficient operation of the
health service. Under the slogan of ‘reforms’, the ruling
social-liberal government is closing down hospitals, and this is causing a
significant decrease in the number of hospital beds. Another objective of
this ‘reform policy’ is to open the way for private health insurance
companies.
Romania
The national report explains that in 1990 Romania’s medical system
was exclusively public, highly centralized and financed from the state
budget; services were offered to the population officially free of charge.
During these last 17 years of transition, statistics and research have
shown deterioration in the population’s health, including a drop in life
expectancy and the reappearance or aggravation of poverty-related
diseases. In this context, political decision makers decided to switch to
a system based on health insurance. In general, experts consider that the
whole reform process has led to increased costs, confusion among medical
personnel, delays in the creation of the legislative framework defining
the responsibilities of different actors in the system, and errors in the
disbursement of funds. Many decisions have been taken without a prior
evaluation of their social impact.
The public health system’s problems have been heightened in recent years
by a growing inability to provide free or subsidized medicines for those
who need them. The liberalization of the pharmaceutical market and a
decrease in domestic production have led to a steep rise in prices for
pharmaceutical products, further limiting the poor population’s access
even to vital, obligatory treatments.
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The role of the international community
In the fight against poverty as one of the ‘banners’ of international
cooperation there is less and less emphasis on social justice. Although
emergencies certainly require urgent attention, the approach to poverty solely
as assistance to people who are affected is leading to increasing inequality and
is not tackling the root causes of the problem. Poverty is a problem for all
societies; it is not a ‘disaster’ that affects a small group of the poorest
countries (even though these countries do deserve priority treatment and special
attention).
The international community recognizes the problem of inequality and its
multiplier effects as being as serious as the problem of poverty. Nevertheless,
international organizations continue to rank countries by income – in terms of
per capita GDP – which is an average indicator that conceals inequalities,
because it takes a country’s annual income and simply divides it by total
population.
The Human Development Index (HDI) of the United Nations Development Programme
(UNDP) incorporates health and education as well as income, and it is clear that
countries with similar levels of per capita income may rate very differently on
the HDI. The Basic Capabilities Index (BCI) developed by Social Watch
dispenses with income and compares countries according to their progress in a
number of basic capabilities that are indispensable for a decent life.
The European Commission recently made an effort to develop a governance index,
but this is criticized by Mirjam Van Reisen and Simon Stocker in their report on
the European Union. While issues are hanging over the democratic
scrutiny of the country programmes for Africa, the European Commission is
placing strong emphasis on a governance facility for Africa. The instrument has
come in for serious criticism. Out of a total of 23 indicators, only one is
related to the Millennium Development Goals. Other indicators focus on issues
such as migration, trade liberalization and counter-terrorism, and are aimed at
negotiating a response to European interests in exchange for EU aid. It is
unclear if the signing of European Partnership Agreements arranging new trade
cooperation agreements between the ACP countries and the EU also has an impact
on the assessment of ‘governance’ in the partner country.
The unions organized through the International
Trade Union Confederation have a clear understanding that local and
national problems require international solidarity, and that the challenges
facing the world make it necessary to organize on a global scale. But the major
international campaigns against poverty, or the massive solidarity expressed by
the public worldwide when there is a disaster like the tsunami in December 2005,
have not served to rectify the basic inequities in the world economic system.
There is a lack of international solidarity, and this is clear from the fact
that development assistance is so paltry, that developing countries’ trade is
often impeded, that world opinion is indifferent to the double standards of
transnational corporations from the North in their dealings with the South, and
in how the problem of foreign debt is being handled.
This reality contradicts the promises made by the international community. In
the report by Rebecca Carter and Stephen Lister, it is argued that by signing up
for the Millennium Development Goals (MDGs), the international development
community made a commitment to fulfil the right to social security for all. This
right could become actionable in international courts, as demonstrated in the
report by Christian Courtis,
and its implementation worldwide would be perfectly viable if there were the
necessary political will to achieve it.
Notes:
ILO (2001), Report 4 of the 89th ILO
Conference: Social Security: themes,
challenges and perspectives.
Study conducted by the International
Social Security Association (ISSA) with the Social Policy Research Centre at
the University of Loughborough, the United Kingdom, under the direction of
Simon Roberts.
ILO/Wouter van Ginneken (2003). Extending
social security: Policies for developing countries. ESS Paper No. 13. Geneva,
International Labour Office.
By Ziad Abdel Samad and Diana Zeidan from
ANND.
See UNDP (2004). La
Democracia en América
Latina: Hacia una Democracia
de Ciudadanas y Ciudadanos. 2nd
edition, Buenos Aires.
See the chapter by Fernando Cardim de
Carvalho in this Report.
Detailed information from
CINTERFOR/ILO (2003-2005) Training Units, the “Social Security in the
Southern Cone” Project, 2003-2005, ILO International Training Centre.
ILO/Somavía (2007a). Introduction by the
Director General of the ILO at the International Labour Conference, Decent
work for sustainable development. ILO 96-2007/Annual Report I (A). The
Convention is available from:
<www.ilo.org/ilolex/cgi-lex/convds.pl?C102>.
See the chapter by Christian Courtis in
this Report.
ILO/Somavía (2007b). Director General’s
Report: Equality at Work: Facing the
Challenges. Global report in coordination with follow-up on the ILO
Declaration on basic principles and rights at work. 96th International
Labour Conference.
See the chapter on the Arab region in this
Report.
ILO/Somavía (2007b).
Galli, R. and Kucera, D. (2007).
“Gender, informality and employment flexibility in Latin America”. To be
published. Cited in the Director General’s Report to the ILO, 2007.
ILO/Somavía (2007a).
CINTERFOR/ILO (2003-2005).
ILO/De Regil (2001). Report by the
President of the Employers Group on the Social Security Committee at the
89th ILO Conference.
<www.vie-publique.fr>
CINTERFOR/ILO (2003-2005).
The situation in the East European
countries is dealt with in the report by BGRF/Bulgaria in this Report.
CINTERFOR/ILO (2003-2005).
Banerjee, A. et al
(2006). An Evaluation of World Bank Research, 1998-2005. Cited in the report by Antonio Tricarico
in this Report.
Social Watch (2007). Guidelines for
national reports.
See the section on the Basic Capabilities Index 2007 in this Report.
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