Neoliberal meritocracy and financial capitalism: consequences for social protection and health

Viana, Ana Luiza d’Ávila; Silva, Hudson Pacifico da

doi:10.1590/1413-81232018237.07582018

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ARTICLE • Ciênc. saúde colet. 23 (7) • July 2018 • https://doi.org/10.1590/1413-81232018237.07582018 copy

Neoliberal meritocracy and financial capitalism: consequences for social protection and health

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

There is inherent tension between the idea of health as a social right and of health as a private good. From the latter perspective, healthcare provision is brought closer to the logic of ownership, where access depends on ability to pay. The prioritization of markets (over governments), economic incentives (over social or cultural norms), and entrepreneurship (over collective or community action), one of the hallmarks of neoliberalism, constitutes a project to dismantle the welfare state, defined as a set of policy mechanisms designed to meet collective needs. This article examines the above process and its consequences for social protection and health by reflecting upon two phenomena that threaten the principle of health as a social right: neoliberal ideas and policies; and financial capitalism. We argue that the common good must be defended or insulated from the negative effects of financial capitalism and from the erosion and fragmentation of public institutions and social protection systems caused by neoliberalism.

Capitalism; Commodification; Public policy; Public health

Dimension	Consequences
Society	More individualistic, materialistic and socially antagonistic
The economy	Slower economic growth, greater concentration of income, greater financial insecurity
Politics	Middle and lower classeshave less political power
Social protection	Children, adults and the elderly do not have adequate social protection
Health status	Obesity, self-harm, eating disorders and mental illness (depression, anxiety, social phobia)

Company	Net revenue	Activity
1. Bradesco Saúde	18,273.1	Health Insurance
2. Amil	16,765.2	Health Plans
3. Sul América Saúde	12,091.4	Health Insurance
4. Rede D’Or São Luiz	7,912.5	Medical Services
5. Unimed Rio	5,040.3	Health Plans
6. Hospital São Paulo	4,777.8	Medical Services
7. Central Nacional Unimed	3,922.4	Health Plans
8. Grupo Notre Dame Intermédica	3,894.2	Health Plans
9. Unimed Belo Horizonte	3,057.4	Health Plans
10. Dasa – Diagnósticos da América	3,040.8	Medical Services
11. Hapvida	3,036.5	Health Plans
12. Hospital Albert Einstein	2,520.0	Medical Services
13. Hospital e Maternidade São Camilo	2,326.7	Medical Services
14. Fundação do ABC	2,249.2	Medical Services
15. Unimed FESP	2,208.8	Health Plans
16. Santa Catarina	2,144.0	Medical Services
17. Fleury Medicina e Saúde	2,096.1	Medical Services
18. Unimed Saúde	1,972.6	Health Insurance
19. Esho	1,968.5	Medical Services
20. Unimed Porto Alegre	1,947.8	Health Plans

General	Children	Working-age Population	Older persons	Health
55% of the world’s population (around 4 billion people) is not covered by any social protection benefit . 71% of the world’s population is not protected by social protection systems that include a wide range of benefits . Coverage problems are associated with low levels of investment in social protection, especially in regions of Africa, Asia and Arab States . Lack of social protection makes people more vulnerable to poverty, inequality and social exclusion throughout the life cycle, constituting a major obstacle to social and economic development . The Sustainable Development Goals (SDG) call for universal social protection and countries have the responsibility to guarantee at least a basic level of social security (a social protection floor) for all as part of their social protection systems	65% of the world’s children do not have access to social protection, most of them living in Africa and Asia . On average 1.1% of GDP is spent on child benefit for children aged between 0 and 14 years, pointing to significant underinvestment in children, which affects not only the children’s overall well-being and long-term development, but also the future economic and social development of the countries they live in. . There has been an expansion of income transfer schemes targeting children in lower and middle-income countries in recent years. However, coverage and benefit levels remain insufficient . Many countries have reduced social protection for children in the wake of fiscal consolidation policies often narrow-targeting child benefits to the poor and leaving many vulnerable children without adequate protection	41% of women with newborn children receive some type of maternity benefit. 21.8% of unemployed workers are covered by unemployment benefit . Only a minority of the global labor force have effective access to employment injury protection. 27.8% of persons with severe disabilities worldwide receive a disability benefit. Worldwide only 3.2 % of GDP is spent on public social protection to ensure income security for persons of working age. Although there has been an expansion in coverage of maternity and work accident benefit in some countries, there are significant gaps in coverage and adequacy in others. Many countries have reduced social protection for persons of working age as part of austerity policies at a time when social protection is most needed.	68% of people above retirement age receive a pension, which is associated with the expansion of both non-contributory and contributory pensions in many middle and low-income countries. A number of developing countries have achieved universal pension coverage, while others are close to universal coverage. However, benefit levels are often low and not sufficient to push older persons out of poverty. Expenditures on pensions and other benefits for older persons account for 6.9% of GDP on average, with large variations across regions. Fiscal austerity policies in many countries continue to jeopardize the long-term adequacy of pensions. There is a tendency to return to public solidarity-based systems in some countries because privatization initiatives have not delivered the expected results	The right to health is not yet a reality in many parts of the world, especially in rural areas where 56% of the population lack health coverage as compared to 22 5% in urban areas. An estimated 10 million health workers are needed to achieve universal health coverage and ensure human security, 7 million of which in rural areas . 48.1% of the world’s population lives in countries that do not offer any kind of coverage for long-term care (LTC); 46.3 per cent of the older global population are largely excluded from LTC due to narrow means-testing regulations; only 5.6 per cent of the global population live in countries that provide LTC coverage to the whole population . An estimated 57 million unpaid “voluntary” workers are filling in the LTC workforce gap, many of whom are women who have to provide informal care for family members

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[1] Collaborations

ALA Viana participated in the design of the article, review and systematization of the literature, writing of the manuscript; HP Silva’s review and systematization of the literature, writing the manuscript, critical review.