Ebola and Inequality

by Joseph E. Stiglitz Joseph E. Stiglitz, a Nobel laureate in economics, is University Professor at Columbia University. His most recent book, co-authored with Bruce Greenwald, is Creating a Learning Society: A New Approach to Growth, Development, and Social Progress. 10.11.2014

NEW YORK – The Ebola crisis reminds us, once again, of the downside of globalization. Not only good things – like principles of social justice and gender equality – cross borders more easily than ever before; so do malign influences like environmental problems and disease.

The crisis also reminds us of the importance of government and civil society. We do not turn to the private sector to control the spread of a disease like Ebola. Rather, we turn to institutions – the Centers for Disease Control and Prevention (CDC) in the United States, the World Health Organization (WHO), and Médecins Sans Frontières, the remarkable group of doctors and nurses who risk their lives to save those of others in poor countries around the world.

Even right-wing fanatics who want to dismantle government institutions turn to them when facing a crisis like that caused by Ebola. Governments may not do a perfect job in addressing such crises, but one of the reasons that they have not done as well as we would hope is that we have underfunded the relevant agencies at the national and global level.

The Ebola episode holds further lessons. One reason that the disease spread so rapidly in Liberia and Sierra Leone is that both are war-ravaged countries, where a large proportion of the population is malnourished and the health-care system has been devastated.

Moreover, where the private sector does play an essential role – vaccine development – it has little incentive to devote resources to diseases that afflict the poor or poor countries. It is only when advanced countries are threatened that there is sufficient impetus to invest in vaccines to confront diseases like Ebola.

This is not so much a criticism of the private sector; after all, drug companies are not in business out of the goodness of their hearts, and there is no money in preventing or curing the diseases of the poor. Rather, what the Ebola crisis calls into question is our reliance on the private sector to do the things that governments perform best. Indeed, it appears that with more public funding, an Ebola vaccine could have been developed years ago.

America’s failures in this regard have drawn particular attention – so much so that some African countries are treating visitors from the US with special precautions. But this just echoes a more fundamental problem: America’s largely private health-care system is failing.

True, at the top end, the US has some of the world’s leading hospitals, research universities, and advanced medical centers. But, though the US spends more per capita and as a percentage of its GDP on medical care than any other country, its health outcomes are truly disappointing.

American male life expectancy at birth is the worst of 17 high-income countries – almost four years shorter than in Switzerland, Australia, and Japan. And it is the second worst for women, more than five years below life expectancy in Japan.

Other health metrics are equally disappointing, with data indicating poorer health outcomes for Americans throughout their lives. And, for at least three decades, matters have been getting worse.

Many factors contribute to America’s health lag, with lessons that are relevant for other countries as well. For starters, access to medicine matters. With the US among the few advanced countries that does not recognize access as a basic human right, and more reliant than others on the private sector, it is no surprise that many Americans do not get the medicines they need. Though the Patient Protection and Affordable Care Act (Obamacare) has improved matters, health-insurance coverage remains weak, with almost half of the 50 US states refusing to expand Medicaid, the health-care financing program for America’s poor.

Moreover, the US has one of the highest rates of childhood poverty among the advanced countries (which was especially true before austerity policies dramatically increased poverty in several European countries), and lack of nutrition and health care in childhood has lifelong effects. Meanwhile, America’s gun laws contribute to the highest incidence of violent deaths among advanced countries, and its dependence on the automobile underpins a high rate of highway fatalities.

America’s outsize inequality, too, is a critical factor in its health lag, especially combined with the factors mentioned above. With more poverty, more childhood poverty, more people without access to health care, decent housing, and education, and more people facing food insecurity (often consuming cheap foods that contribute to obesity), it is no surprise that US health outcomes are bad.

But health outcomes are also worse in the US than elsewhere for those with higher incomes and insurance coverage. Perhaps this, too, is related to higher inequality than in other advanced countries. Health, we know, is related to stress. Those striving to climb the ladder of success know the consequences of failure. In the US, the rungs of the ladder are farther apart than elsewhere, and the distance from the top to the bottom is greater. That means more anxiety, which translates into poorer health.

Good health is a blessing. But how countries structure their health-care system – and their society – makes a huge difference in terms of outcomes. America and the world pay a high price for excessive reliance on market forces and an insufficient attention to broader values, including equality and social justice.

Copyright: Project Syndicate, 2014.

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