The true value of what the G8
gives in aid
As leaders of the world’s richest
countries meet, this is the proof that they could do much more for the poor
By Paul Vallely
Published: 04 June 2007
There is something more morally
binding about a promise when it is made by the rich to the poor. There is
something altogether more shocking, therefore, when such a solemn pledge seems
about to be broken.
Two years ago, the leaders of the
rich world met at the G8 summit in Gleneagles and undertook to double annual
aid to poor nations to $50bn (£25bn) a year. Half of that money was to go to
the world’s poorest people in Africa.
But on the eve of the latest G8
summit, in the Baltic resort of Heiligendamm in Germany this week, it is clear
the rich world is well off track to deliver what the world’s eight most
powerful leaders signed up to after the biggest political lobby in history, a
massive global campaign to make poverty history that culminated in 10 Live8
concerts watched by more than half the population of the world.
Overall aid to Africa
has risen by less than half of what is needed to stay on track to reach the
Gleneagles goal to double annual aid by 2010. A report by Oxfam yesterday
suggested that, if present trends continue, the G8 will miss its target by a
Even the country which has done
best in keeping its word, the UK,
is projected to fall short of its promise of $14.9bn by $1.6bn. The country
that has failed most so far, Italy,
will be a whopping $8.1bn short of the $9.5bn it has vowed to give.
To those for whom such huge
figures are meaningless, Oxfam offers some graphic illustrations. Last year,
the rich world spent three times more on bottled water ($58bn) than it did on
aid to Africa ($18bn). We spent 10 times more on
military expenditure ($1trillion) than we did on aid globally ($104bn).
We Britons spent almost twice as
much on champagne and other wine last year as we did on aid. The French spent
more on perfume, German women more on shoes, Italians more on ice cream and the
Japanese spent more on luxury goods such as Gucci bags and Prada sunglasses
than their governments did on the world’s poor.
Despite the Gleneagles promises,
global aid actually fell in 2006 for the first time in 10 years. Aid to Africa
has grown only 2 per cent since 2004.
"This is a very big
potential shortfall," says the man who negotiated the Gleneagles deal from
the British end, Lord Jay of Ewelme, who was then, as Sir Michael Jay, Head of
the Diplomatic Service. He was the prime minister’s personal representative, or
sherpa, in the run-up to the summit.
His is the language of the Whitehall
mandarin. He points out the caveats. Aid was down in 2006 because 2005 had been
a bumper year. The quoted aid figures don’t include the massive amounts of debt
cancellation that were put through in 2006. Even so, the architect of
Gleneagles concludes that, two years on, the outcome is "really
is the honourable exception here. Our aid budget, which is today nearly three
times what it was 10 years ago, went up by a substantial 13 per cent last year,
not including debt cancellations. But aid increased in France
by just 1.4 per cent and in Germany
by less than 1 per cent. Canada,
Japan and the United
States are all substantially down, according
to the Oxfam figures. And Italy’s
aid budget has been slashed by a massive 30 per cent.
Will Heiligendamm change this?
The word from inside the pre-summit negotiations is that Canada
and Italy are
being difficult. The current G8 president, Chancellor Angela Merkel, by
contrast, on Friday announced a $750m boost to Germany’s
aid budget in 2008, with an extra $3bn over the next four years.
There are encouraging signs from Washington
too. President Bush, who, surprisingly to many, has almost tripled American aid
to Africa since he took office, has just announced his
$15bn five-year President’s Emergency Plan For Aids Relief (PEPFAR) will have
its funding doubled from 2009.
"What is needed," says
Lord Jay, "is to reconfirm the Gleneagles promises together with some
specific undertakings on health and education programmes to put flesh on
That means rich nations must come
up with the cash to fully fund the UN Education Fast Track Initiative by
matching the $8.5bn the UK
has pledged over the next 10 years. They need to pay into the replenishment of
the Global Fund to Fight Aids, Tuberculosis and Malaria which falls due in
September too. And they must make long-term commitments to support African
governments’ national plans on education and their strategies against Aids too.
In particular they need to
scale-up initiatives that have already been shown to work. Thanks to the debt
deal done at Gleneagles – which has written off $38bn so far, to 18 African
countries – health care is now free in rural Zambia, says Oxfam, education is
free for all children in Ghana, and Malawi is training 4,000 more teachers each
The Gleneagles promise on Aids
has increased the number of Africans on anti-retrovirals tenfold. Some 1.3
million people – a quarter of those in need – are now receiving treatment,
saving 250,000 lives last year. But, as Oxfam points out, 500,000 more could be
saved if rich nations stump up $16.6bn more, as promised.
Angela Merkel’s first summit as
president of the G8 will be Tony Blair’s last. "Personalities are hugely
important," says Lord Jay. "I’ve been to four G8 summits and 17
European Councils and personal chemistry really does work. Bush is not going to
want to come to Heiligendamm and spoil the party for Blair and Merkel, two
leaders to whom for different reasons he’s very close."
Some agreement has been reached
already on what the final communiqué will say on international trade. But, in
the end, a deal to make trade fairer for Africa can only be done at the world
trade talks which come to their final crunch-point in mid June – which is just
before President Bush’s "fast-track authority" to agree a trade deal
without the approval of the US Congress runs out.
What is needed at Heiligendamm is
for G8 leaders to increase the trade talks momentum by approving a $4bn
"aid for trade" package, agree 100 per cent market access for poor
countries and more and flexible "Rules of Origin" that recognise the
value added to products by Africans.
Lord Jay’s successor and the
other sherpas are still locked in negotiations. "It is always tough, the
last couple of days before a summit," he says. "I was negotiating
with my American sherpa colleague on my mobile phone and he was on the phone in
Air Force One as they were landing in Edinburgh
airport. That was the day before, with the final outcome still unclear."
So it is again, this time in Germany.
The leaders there need to lift their heads from the detail to remember what is
To transform the lives of the
world’s poorest would cost the British government less than its citizens spend
each year on celebrity magazines. The US
could do it for the equivalent of what its people spend on nail varnish each
year. The Germans with just half of what the nation spent last year on pet
In total all the richest nations
need to provide is little more than $1 per citizen per year extra. That would
be enough to fulfil their commitment to the world’s poor. It is a trifling
WHO GIVES WHAT?
* The British spend twice as much
money on wine and champagne as Government does on aid
* German women shell out more on
shoes than their Government spends on aid
aid budget is dwarfed by the amount its women spend on perfume
* Spending by Japanese people on
luxury goods is about the same as country’s aid budget
* The amount the US
gives in aid is less than the annual profits of the ExxonMobil oil company
* Italians spend more on ice
cream than the country provides in overseas aid
aid budget is only half the amount its people spend on beer
does not make figures available for the amount Moscow
donates in aid or debt relief
Sicko? The truth about the US
Michael Moore’s new film is a
damning indictment of the way the world’s richest country looks after those who
fall ill. Andrew Gumbel finds out whether his accusations are justified
Published: 04 June 2007
Cynthia Kline knew exactly what
was happening to her when she suffered a heart attack at her home in Cambridge,
Massachusetts. She took the time to call an
ambulance, popped some nitroglycerin tablets she had been prescribed in
anticipation of just such an emergency, and waited for help to arrive.
On paper, everything should have
gone fine. Unlike tens of millions of Americans, she had health insurance
coverage. The ambulance team arrived promptly. The hospital where she had been
receiving treatment for her cardiac problems, a private teaching facility
affiliated with the Harvard Medical
School, was just a few minutes away.
The problem was, the casualty
department at the hospital, Mount Auburn,
was full to overflowing. And it turned her away. The ambulance took her to
another nearby hospital but the treatment she needed, an emergency
catheterisation, was not available there. A flurry of phone calls to other
medical facilities in the Boston
area came up empty. With a few hours, Cynthia Kline was dead.
She died in an American city with
one of the highest concentration of top-flight medical specialists in the
world. And it happened largely because of America’s
broken health care system – one where 50 million people are entirely without
insurance coverage and tens of millions more struggle to have the treatment
they need approved. As a result, medical problems go unattended until they
reach crisis point. Patients then rush to hospital casualty departments, where
by law they cannot be turned away, overwhelming the system entirely. Everyone –
doctors and patients, politicians on both the left and the right – agrees this
is an insane way to run a health system.
When Elizabeth Hilsabeck gave
birth to premature twins in Austin, Texas,
she encountered another kind of insanity. Again, she was insured — through her
husband, who had a good job in banking. But the twins were born when she was
barely six months pregnant, and the boy, Parker, developed cerebral palsy. The
doctors recommended physical therapy to build up muscle strength and give the
boy a fighting chance of learning to walk, but her managed health provider
refused to cover it.
The crazy bureaucratic logic was
that the policy covered only "rehabilitative" therapy – in other
words, teaching a patient a physical skill that has been lost. Since Parker had
never walked, the therapy was in essence teaching him a new skill and therefore
did not qualify. The Hilsabecks railed, protested, won some small reprieves,
but ended up selling their home and moving into a trailer to cover their costs.
Elizabeth’s husband, Steven,
considered taking a new, better-paying job, but chose not to after making
careful inquiries about the health insurance coverage. "When is he getting
over the cerebral palsy?" a prospective new insurance company
representative breezily asked the Hilsabecks. When Elizabeth
explained he would never get over it, she was told she was on her own.
Everyone in America
has a health-care horror story or knows someone who does. Mostly they are
stories of grinding bureaucratic frustration, of phone calls and officials
letters and problems with their credit rating, or of people ignoring a slowly
deteriorating medical condition because they are afraid that an expensive
battery of tests will lead to a course of treatment that could quickly become
Even when things don’t go
horribly wrong, it is a matter of surviving by the skin of one’s teeth.
Melissa Anderson can’t find affordable insurance because she is self-employed –
an increasingly common affliction. When her son Kasey came down with epilepsy
two years ago, she was saved only by a recently introduced child health
insurance programme specifically tailored to people who aren’t poor but can’t
afford to pay monster medical bills. She herself remains uninsured for anything
short of major care needs.
Over the past 15 years, the
stories have become less about poor people without the economic means to access
the system – although that remains a vast, unsolved problem – and more about
the kind of people who have every expectation they will be taken care of.
Middle-class people, people with jobs that carry health benefits or – as the
problem worsens – people with the sorts of jobs that used to carry robust
health benefits which are now more rudimentary and risk their being cut off for
a variety of reasons.
This is the morass that Michael
Moore has chosen to explore in his latest documentary, Sicko, which goes on
release later this month. Moore
spends much of the film demonstrating that there is nothing inevitable or
necessary about a system that enriches insurance companies and drug
manufacturers but shortchanges absolutely everyone else. His searching
documentary looks at health care in France,
and even Cuba –
still regarded as a model system for the Third World.
has his share of ghoulishly awful stories. The film kicks off with an uninsured
carpenter who has to decide whether to spend $12,000 (£6,000) reattaching his
severed ring finger or $60,000 to reattach his severed middle finger. Later on,
Moore focuses on a hospital worker
whose husband needed a bone marrow transplant to save him from a rare disease.
The couple’s insurance company refused to cover the transplant because it
regarded the treatment as "experimental". The husband died.
Many more stories are collected
in a newly published book called Sick: The Untold Story of America’s Health
Care Crisis, by Jonathan Cohn. A woman in California
called Nelene Fox died of breast cancer after she, too, was turned down for a
bone marrow transplant by her insurance company. In Georgia,
a family whose infant son went into cardiac arrest were forced to take him to a
hospital 45 miles away on their insurance carrier’s orders. He survived, but
suffered permanent disabilities that more prompt treatment might have averted.
In New York, an infant called
Bryan Jones – whose case was trumpeted all over the local media at the time –
died of a heart defect that went undetected because his insurance company
kicked him and his mother out of hospital 24 hours after his birth, too soon to
carry out the tests that might have spotted the problem.
health system offers a tremendous paradox. In medical technology and in the
scientific understanding of disease, it is second-to-none. Since doctors are
better paid than anywhere else in the world, the country attracts the best of
the best. And yet many, if not most, Americans are unable to reap the
advantages of this. In fact, as The New York Times columnist Paul Krugman has
argued, the very proliferation of research and high-tech equipment is part of
the reason for the imbalance in coverage between the privileged few and the
increasingly underserved masses. "[The system] compensates for higher
spending on insiders, in party, by consigning more people to outsider status
–robbing Peter of basic care in order to pay for Paul’s state-of-the-art
treatment," Krugman wrote recently. "Thus we have the cruel paradox
that medical progress is bad for many Americans’ health."
Having the system run by
for-profit insurance companies turns out to be inefficient and expensive as
well as dehumanising. America
spends more than twice as much per capita on health care as France,
and almost two and a half times as much as Britain.
And yet it falls down in almost every key indicator of public health, starting,
perhaps, most shockingly, with infant mortality, which is 36 per cent higher
than in Britain.
A recent survey by the management
consulting company McKinsey estimated the excess bureaucratic costs of managing
private insurance policies – scouting for business, processing claims, and
hiring "denial management specialists" to tell people why their
ailment is not covered by their policy – at about $98bn a year. That, on its
own, is significantly more than the $77bn McKinsey calculates it would cost to
cover every uninsured American. If the government negotiated bulk purchasing rates
for drugs, rather than allowing the pharmaceutical companies to set their own
extortionate rates, that would save another $66bn.
Astonishingly, there hasn’t been
a serious debate about health care in the United
States since Bill Clinton, with considerable
input from his wife Hillary, tried and failed to overhaul the system in 1994.
That, though, may be about to change as the 2008 presidential race heats up.
Everyone acknowledges the system is broken. Everyone recognises that 50 million
uninsured – including almost 10 million children – is unacceptable in a
Even the old, classically
American free-market argument – that "socialised" medicine is somehow
the first step on a slippery slope towards godless communism – doesn’t hold
water, because in the absence of a functioning private insurance regime the
government ends up picking up about 50 per cent of the overall costs for
treatment anyway. The indigent rely on a government programme called Medicaid.
The elderly have a government programme called Medicare. And perhaps the most
efficient part of the whole system is the Veterans’ Administration, a sort of
NHS for former servicemen.
Rather like London
and Paris in the 19th century,
where the authorities belatedly paid attention to outbreaks of cholera once the
disease started affecting the rich and middle classes, so the American health
crisis may be coming to a head because of the kinds of people who are suffering
from its injustices.
Corporate chief executives, for a
start, are gagging under the ever-increasing costs of providing coverage to
their employees. Starbucks now spends more on health care than it does on
coffee beans. Company health costs, as a whole, are at about the same level as
corporate profits. In a globalised world where US businesses are competing with
low-wage countries such as India
and China, that
is rapidly becoming unacceptable.
That explains, perhaps, why the
chief executive of Wal-Mart, Lee Scott, has made common cause with America’s
leading service sector union – more commonly a bitter critic of Wal-Mart’s
labour practices – in calling for a government-run universal health care system
by 2012. It’s going to be a tough battle. The insurance and pharmaceutical
industries bankroll the campaigns of dozens of congressmen and have so far been
brutally efficient in protecting their own interests. The Clintons
were defeated in 1994 in part because of the power of the industry lobbies.
Doing better this time will take singular political courage.
In the meantime, we will hear
ever more crazy stories like the one told by Marijon Binder, a former nun in
Chicago who ended up being sued by a Catholic hospital for $11,000 because her
two-night stay for a heart scare was not considered a worthy charity case.
Binder, who works as a live-in companion to a disabled old woman, wrote on all
her admission forms that she had no insurance and, in her telling at least, was
reassured the hospital would take care of her anyway.
After a year and a monstrous
bureaucratic fight that went nowhere, a civil judge promptly absolved her of
responsibility for her bill – a lucky outcome, for sure. Binder said: "The
whole experience was very demeaning. It made me feel very guilty; it made me
feel like a criminal." She is, though, alive and solvent. Not everyone in
this system catches the same break.
Women can be as violent as men,
By Thair Shaikh
Published: 04 June 2007
Doris Lessing, the novelist and
feminist icon, said that women could be warmongers and as violent as men, in a
Speaking at the Hay on Wye
Festival, Lessing, 87, said that although history suggested women were
peaceful, some of the worst crimes had been committed by females.
"There is a lot of
sentimentality about women. We like to think that women are kind and motherly
and are not going to go to war. But it’s not true, is it?
"History suggests women are
peace loving and law abiding – on the contrary some of the worst crimes have
been committed by women," she said.
Promoting her latest novel, The
Cleft, Lessing was asked by a woman in the audience how men could be stopped
from constantly taking the world to war. "Well, I never noticed that women
who get to be Prime Ministers are particularly peaceful!" she said, in
what appeared to be a thinly veiled reference to Margaret Thatcher, the former
Tory PM who was leader during the Falklands War.
Her latest book is about a
mythical society free of males in which a member suddenly gives birth to a
As an author who has been
strongly identified with feminism, her remarks are likely to offend many of her
fellow female writers. However, Lessing has attacked feminists before – in a
speech at the Edinburgh book
festival in 2001, she defended men against what she called the "unthinking
and automatic rubbishing" by feminists.
Lessing was born in Persia
(now Iran) and
was brought up in what was then Southern Rhodesia. She
came to Britain
in 1949 and became a feminist figurehead with her classics The Grass is
Singing, a story set in colonial Africa, and The Golden
Notebook, about a female writer’s descent into madness. She went on to be
shortlisted for the Booker Prize three times. In April she was nominated for
the international version of the Booker Prize for fiction. And in 2001, she won
the David Cohen literature prize for her lifetime’s achievement.