By Vicente Navarro, Department of Health Policy and Management
Johns Hopkins University Bloomberg School of Public Health
International Journal of Health Services, Volume 39, Number 3,
Pages 423–441, 2009 doi: 10.2190/HS.39.3.a
This article analyzes the changes in health conditions and quality of life in
the populations of developed and developing countries over the past 30
years, resulting from neoliberal policies developed by many governments
and promoted by the World Bank, International Monetary Fund, World Health
Organization, and other international agencies. It challenges interpretations
by the analysts of “globalization,” including the common assumption that
states are disappearing.
The author shows that what has been happening is not a reduction of state
interventions but a change in the nature and character of those interventions,
resulting from major changes in class (and race and gender) power relations
in each country, with establishment of an alliance between the dominant
classes of developed and developing countries—a class alliance responsible
for the promotion of its ideology, neoliberalism. This is the cause of the
enormous health inequalities in the world today.
The article concludes with a critical analysis of the WHO report on social
determinants of health, applauding its analysis and many of its recommendations,
but faulting it for ignoring the power relations that shape these social determinants.
It is not inequalities that kill people, as the report states; it is those who are
responsible for these inequalities that kill people…..”
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