New Millennium. Impact of TradeWe import and consume goods from developing countries, which provides them with much-needed foreign capital, but means that our prosperity and health are linked to their poverty and illness. Global inequalities have created a trade situation in which we depend on the countries of the South to supply us with low-wage, labor-intensive goods, while we export high-wage, high-cost, capital-intensive goods to them. If we had to produce their goods ourselves, doing so would impede our own economic growth and lower our standard of living. The prosperity we enjoy, then, is in part made possible by trade with developing countries, whose workers fail to earn even a subsistence-level wage.

Child labor in the developing world may be the most heinous example of the human toll of this relationship. The International Labor Organization estimates that 200 million to 300 million children in developing countries ages 5 to 14 are laborers. About half of them work full-time, foregoing any chance of developing skills that would improve their life circumstances. Millions of them work under abusive and dangerous conditions for starvation-level wages or in indentured servitude.

In 1996, the plight of working children suddenly captured national attention when the media reported that the soccer balls used in the multimillion-dollar soccer indus try, the same soccer balls that healthy, well-fed, well-educated US kids kick around on well-maintained suburban playing fields, are made by Pakistani children, some no older than 5, whose circumstances have forced them to forfeit their futures to labor for a pittance under horrific conditions. As the concept of comparative advantage suggests, soccer balls are heavily labor-intensive products exported exclusively from poor countries. Pakistan, where one-third of the population live in absolute poverty, produces 75% of the world’s soccer balls (71% of US soccer balls come from there); the rest are made in China, India, and Indonesia. No soccer balls are produced in the US.

Despite the media attention, follow-up reports suggest that the soccer ball industry still employs child labor, with little indication that this is going to change. The conditions that these children endure mirror the conditions of a quarter of a billion children in the developing world. We are major consumers of their output.

Implications for Action

It is precisely because global health and economic issues are so densely intertwined and interdependent that they are so difficult to address. Well-meaning policies can have devastating consequences at worst, and merely maintain the status quo at best. Initiatives addressing the plight of Pakistani school-age soccer ball producers, for example, brought favorable publicity to Nike and other corporations, but did not meaningfully change the children’s circumstances; children merely moved into other areas of manufacture, to factories making soccer balls in other villages, or to home-based labor. Pre-NAFTA efforts to industrialize the US/Mexico border area led to overpopulation, poverty, and pollution there, leading the American Medical Association to declare the area a breeding ground for infectious disease.
Nevertheless, the very complexity that makes global public health so difficult also tells us what we must do. We cannot expect to end child labor without providing poor families with alternative sources of income. We cannot support industrialization without supporting effective environmental protections. We cannot rely on medical care without improving education. We cannot expect improved health status without investing in public health infrastructure. And we cannot hope to improve wages in the developing countries if we are unwilling to pay fairer prices for their goods.

In the long term, we must work with the health/ economy/environment equation, not against it. As the experiences in Pakistan and the Mexican border show, we waste money and perhaps do more harm than good when we invest only in pet projects. That approach leads to waste, not real, sustainable change. We need a new approach, one of systemic change. When we make investments and champion policies that support developing countries in building capacity, including the establishment of an effective public health infrastructure, then we will see long-term, sustainable improvements that lead to economic advancement, better health, and improved global living conditions.

In the short term, we can fulfill our immediate responsibilities to our own people by improving our ability to inspect imported goods and food and insist that imports meet our own public health standards. As we did when we boycotted grapes and bought only union lettuce, we can each choose to spend a few extra cents to buy goods made by union labor or from companies that respect worker health and safety standards. We can insist that our government make massive grants to and investments in the WHO. We can insist that our government pay off as soon as possible its UN dues, which are nearly $1 billion in arrears, according to the US (the UN believes we owe billions more). We can work toward finding common ground between the North and South on environmental issues so that we don’t see another breakdown in negotiations like that in Novembers summit on global warming at The Hague. And we can curb our own appetite for polluting vehicles, chemicals that destroy environments, and drugs like cocaine whose production distorts rural economies.

We have a tradition in this country of rebuilding without malice. Had President Lincoln lived to fulfill the promise of his second inaugural address, “to bind up the nations wounds,” we might have had a less punitive Reconstruction period and might have avoided the corruption that followed it. When General George Marshall announced the Marshall Plan under the Truman Administration in 1947, he said, “Any government that is willing to assist in the task of recovery will find full cooperation.. .on the part of the United States.” The same Europe that 50 years ago was on the verge of starvation was soon the site of stable democracies and flourishing economies. Many trace the emergence of the European Union back to the Marshall Plan, which emphasized free trade across borders and international cooperation even with the vanquished.

As we so generously assisted those we defeated in war, so let us assist our trade partners. Let us help them set standards for democratization of decision-making, for fair wages and improved working conditions, for cleaner environmental practices, for cross-border cooperation. Let us support them in investing in public health, education, economic development, and other activities that will lead to sustainable change and humane living conditions. The earliest Americans understood the wholeness of the universe, the relationship between people and the earth, the connection of all things. Without the technology of space travel, they had a clear view of our globe. We would do well to see the world through their eyes.