Globalization and Health Equity, Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Int J Health Policy Manag. 2020 Apr 1;9(4):175-178. doi: 10.15171/ijhpm.2019.111.
Neoliberal logic and institutional lethargy may well explain part of the reason why governments pay little attention to how their economic and development policies negatively affect health outcomes associated with the global diffusion of unhealthy commodities. In calling attention to this the authors encourage health advocates to consider strategies other than just regulation to curb both the supply and demand for these commodities, by better understanding how neoliberal logic suffuses institutional regimes, and how it might be coopted to alternative ends. The argument is compelling as possible mid-level reform, but it omits the history of the development of neoliberalism, from its founding in liberal philosophy and ethics in the transition from feudalism to capitalism, to its hegemonic rise in global economics over the past four decades. This rise was as much due to elites (the 1% and now 0.001%) wanting to reverse the progressive compression in income and wealth distribution during the first three decades that followed World War Two. Through three phases of neoliberal policy (structural adjustment, financialization, austerity) wealth ceased trickling downwards, and spiralled upwards. Citizen discontent with stagnating or declining livelihoods became the fuel for illiberal leaders to take power in many countries, heralding a new, autocratic and nationalistic form of neoliberalism. With climate crises mounting and ecological limits rendering mid-level reform of coopting the neoliberal logic to incentivize production of healthier commodities, health advocates need to consider more profound idea of how to tame or erode (increasingly predatory) capitalism itself.
新自由主义逻辑和制度惰性很可能解释了为什么政府很少关注其经济和发展政策如何对与不健康商品在全球扩散相关的健康结果产生负面影响。作者提请人们注意这一点，鼓励卫生倡导者考虑除监管以外的其他策略来遏制这些商品的供应和需求，方法是更好地了解新自由主义逻辑如何充斥着制度体系，以及如何将其用于替代目的。这一论点很有说服力，因为它代表了可能的中层改革，但它忽略了新自由主义发展的历史，从其在从封建主义向资本主义过渡时期的自由哲学和伦理中的起源，到过去四十年在全球经济中的霸权崛起。这种崛起在很大程度上是由于精英（1%，现在是 0.001%）想要扭转第二次世界大战后最初三十年中收入和财富分配的累进压缩。通过三个阶段的新自由主义政策（结构调整、金融化、紧缩），财富不再向下流动，而是呈螺旋式上升。公民对生活停滞或下降的不满成为许多国家的不自由领导人掌权的燃料，预示着新的、专制和民族主义形式的新自由主义的出现。随着气候危机的加剧和生态极限使得通过新自由主义逻辑来激励生产更健康商品的中层改革变得不可行，卫生倡导者需要考虑更深刻的想法，即如何驯服或侵蚀（日益掠夺性的）资本主义本身。
