Promoting Universal Human Rights: Dilemmas of Integrating Developing Countries - Part II

B.  Child Labor

Now a widespread and growing problem in the developing world, child labor is generally defined as regular participation of children in the labor force to earn a living or supplement household income.  Is child labor a denial of human rights or essential to confronting crushing poverty?  How is the poverty trap idea related to child labor and schooling? What is the relation between ILO standards and child labor? And finally, what are the consequences of cuts in social spending, prescribed by neoliberal economic development packages, for child labor?  In the long run, the solution for alleviating child labor conditions lies in elevating living standards and improving human capital.  This solution presupposes that schooling and child labor are contradictory approaches for all children in the developing world.  This may not be the case.  Moreover, in the short run, the closure of sweatshops raises serious ethical concerns about the plight of child laborers with less income available.

The consequences of globalizing labor standards for child labor in developing countries are varied.  According to International Labour Organization estimates, approximately 250 million children work full or part time, with the majority of them in developing countries: 61% in Asia, 32% in Africa, and 7% in Latin America.  While in South Asian countries child labor is predominantly in the manufacturing sector, in Africa 90% of the children are involved in unpaid work and at household level agricultural activities.  In Ghana, national household surveys conducted between 1987 and 1992 showed that of the 28% of children involved in child labor more than two-thirds were also simultaneously attending school.  This survey casts doubt on the commonly held view that poverty pushes children into the labor market; it also shows that the link between poverty and child labor is strong but not essential.  Poverty, however, is significantly correlated with the decision to send children to school, because there is a significant negative relationship between going to school and working and thus a resultant loss of income.

An examination of the responses to an enrollment subsidy in Bangladesh calls into question the “poverty trap thesis”—that is, that child labor is a major factor perpetuating poverty by keeping children from poor families out of school. Using a targeted school stipend to compare how much child labor income substitutes for schooling, this study finds strong effects on school attendance of the incentive provided by Bangladesh’s Food-for-Education program: “A stipend with a value considerably less than the mean child wage was enough to assure nearly full school attendance amongst participants? .? .? .? . The enrollment subsidy also reduced the incidence of child labor.”  This effect, however, accounted for a small proportion of the surge in school enrollment.  The reduction in the practice of child labor by boys (and girls) represented about one quarter (and eighth) of the increase in their school enrollment rate.  This is accounted for by the fact that “parents [were] clearly substituting other uses of their children’s time, so as to secure the current income gain from access to the program with modest impact on earnings from their children’s work.”

An ethical absolutist approach, which insists on abolishment of the so-called “sweatshops” and imposing universal labor standards across the globe, would not necessarily alleviate poverty.  It could actually aggravate it in the short run.  Contrary to popular perceptions, one study has shown that the effect of minimum wage legislation to prop up adult wages has the potential to exacerbate the problem of child labor.  This complication would pose a dilemma for the insertion of the “social clause” in international trade agreements, not to mention strong resistance from developing countries that consider such standards a form of protectionism.

Without denying that the case for achieving minimal labor standards for workers is compelling, some economists question the wisdom of using minimum wage as a form of international labor standard.  Raising adult wages through a minimum wage law, they argue, can in some cases have the contradictory effect of increasing the amount of child labor.  If the increase in wage causes adult unemployment to soar, it is likely that unemployed adults will send their children to work.  This is a plausible outcome given that in most developing countries unemployment benefits are non-existent.  Thus, “a minimum wage can result in a higher supply of child labor.”  It should be understood, however, that any reference to “universal labor standards” in this context is directed at a particular standard—that of minimum wage and its effects on another human rights issue (child labor)—and not all universal labor standards, which would include banning child labor.

On balance, arguments against child labor point to the fact that the problem is multifaceted: (1) factory owners, who take advantage of vulnerable children, are intent on promoting their economic self-interest; (2) politicians, media, and other public institutions, who treat child labor as a non-issue, are publicly indifferent to it; (3) government export promotion policies tend to gloss over the impact of such policies on child labor; (4) government officials not only condone but in many cases benefit from child labor; and (5) societal prejudice perpetuates the situation because major portions of the more fortunate classes of society consider child labor of the underprivileged a part of the natural order.

While some children work for survival, others, who are in bonded labor, work to repay debts incurred by their parents.  Still others are either kidnapped or recruited by unscrupulous agents to work away from home as a source of cheap labor. The lack of a federal requirement in many countries for compulsory education is also a major factor contributing to the continued use of child labor.

Some ethical relativists tend to stress the hard realities facing these children and their families.  “In poor families,” Shahidul Alam writes, “it is simply understood that everyone has to work.”  Other apologists for child labor have reflected the similar concern: “The choice for many families in developing countries is not between sending a child to a factory and sending a child to school, but, rather, between a factory that sells goods for export and a factory that serves only the internal markets.”  Under such circumstances, the families give priority to subsistence—by far the most urgent priority—rather than the education of their children.  The latter is an important goal, but for those mired in poverty it falls further down the ladder of priority.  The logic of the situation is best captured in oft-heard phrase: “The sad truth behind child labor is that for millions of poor families, children are an economic asset, and often their only one.”

To argue that the only way to confront child labor is for consumers and governments to apply pressure through sanctions and boycotts is simplistic.  Following the introduction of the Child Labor Deterrence Act in 1992 by U.S. Senator Tom Harkin, the so-called “Harkin Bill,” garment employers dismissed an estimated 50,000 children from their factories, approximately seventy-five percent of all children in the industry.  The mere threat of such an act panicked the garment industry, sixty percent of whose products—nearly $900 million in value—were exported to the United States in 1994.  A series of follow-up visits by UNICEF, local NGOs, and the ILO revealed that children went looking for new sources of income and found them in less or non-regulated work such as stone-crushing, street hustling and prostitution—jobs far more hazardous and exploitative than garment production.  In other cases, the mothers of laid-off children had to quit their jobs to look after their children again resulting in less household income.
Increasingly, however, global economic and legal convergence trends toward condemnation of child labor.  The U.N. Children’s Fund (UNICEF), International Labour Organization (ILO), the International Labour Program on the Elimination of Child Labour (IPEC), and the Convention on the Rights of the Child (CRC) all point in this direction.  A minimum age on when a child can begin working is now a near universality feature of the domestic laws across the world.  But the plain reality is that global governance has failed to prevail over the widespread local exercise of child labor.  Arguably, as countries industrialize, they tend to use child labor initially, but they are likely to abandon it subsequently.  Also, as the world develops under the logic of global and industrial capitalism, economies become increasingly interdependent.  This trend in turn influences not just the practice of child labor, but also other policy choices of far-reaching implications for business and government decision-makers.  Such trends are certain to uphold the argument for universality of human rights in general and the rights of children in particular.  Although the argument that use of child labor is inexorably linked to a country’s current stage of economic development holds to reason, it is equally true that developed nations have grown beyond their massive dependency on child labor.  The case can therefore be made that heavy reliance on child labor is not necessary to economic development.

The fact remains, however, that education will significantly reduce child labor over the long run.  Cuts in social spending worldwide have severely undermined educational opportunities, raising hard questions about such neoliberal policies.  The majority of children’s rights advocates contend that the immediate abolition of all child labor is unrealistic.  The first priority, they note, should be to abolish the most abusive forms of child labor, such as prostitution, bonded labor, and hazardous working conditions.

C.  Health as a Human Right

Health and human rights are interconnected and their promotion fundamentally and inextricably intertwined.  The effects of violations of dignity and physical integrity on health (mental or otherwise) are as crucial as the effects of poor health on dignity.  Both the Universal Declaration of Human Rights and the International Covenant on Economic, Social, and Cultural Rights recognize that health is central to the dignity of the person and that state commitment to the health of the population is a fundamental human right.  The realization of other rights is not possible if an individual cannot maintain his/her own health: “Particularly crucial health needs include the prevention of stillbirths and infant mortality; the improvement of environmental and industrial hygiene; the prevention, treatment, and control of diseases; and the provision of medical care to the sick.”

It is a central argument of this paper that combating poverty, addressing basic needs, and preventing and treating illness must be seen as part of an integrated process of protecting and promoting human rights.  It is also important to keep in perspective the tension between globalization and the right to health.  One billion people are unable to secure clean water and basic nourishment, “the most basic measure of disease prevention.”  An estimated three million people are dying each year from tuberculosis, an infectious disease that is completely curable.  In 1995, 17.3 million people died of bacterial, viral, or parasitic infections, giving further credence to the thesis that “the disparities of risk and outcome are embedded in complex biosocial realities.”

At issue is access to health care.  The broadest social determinants of health—such as income inequality—must be considered in this discussion. The field of social epidemiology elucidates the way discrimination, oppression, exploitation, and degradation of human dignity harm health, and how foundational social justice is to public health. 

Considerations of dramatic income inequities have forced a change in approaches to the key question, as commentators now ask, “Why are some societies healthier than others?” rather than, “Why do some individuals get sick while others stay healthy?”
Earlier medical anthropologists regarded cognitivist approaches to culture as essential to the treatment of epidemics.  However, recent debates in the clinical and epidemiologic literatures have refocused attention on the social causation of disease.  As Paul Farmer explains: “Poverty has long been the chief risk factor for both acquiring and dying from tuberculosis.”  Questioning the immodest claims of causality made by medical anthropologists, Farmer writes,

Almost unexamined has been the relationship between the social reproduction of inequalities and the persistence of tuberculosis.  To my knowledge, there have been no studies of the mechanisms by which steep grades of inequality might exacerbate resistance to antituberculous drugs.  Our failure to discern a political economy of risk both for the development of [multiple drugs resistant tuberculosis] MDRTB and also for suboptimal treatment may be related to a desire to link our (perfectly legitimate) investigations of the shaping of personal experience by culture to (inaccurate) claims of causality.

Farmer deflates the myth of an exaggeration of personal agency in favor of examining the social inequalities in health, positing that in a very real sense, “inequality itself constitutes our modern plague.  The burdens of inequality are primarily borne by the poor and marginalized, for not everyone can claim victimhood, despite the self-serving identity politics and ‘soft relativism’ of our times.”

The right to health and health care as an obligation of governments to establish and meet health standards is often a point of controversy between those who support an activist role for the state and those who wish for minimal interference with the free market.  An alternative view emphasizes the role that individuals and non-governmental
organizations can play in promoting public health.  The transnational support for the right to health has dramatically risen.  Many NGOs have committed themselves to collecting accurate epidemiological data and information on health conditions throughout the developing world.  Since the 1980s, the Philippines’ NGOs, like the Medical Action Group (MAG) and the Philippine Action Concerning Torture (PACT), have become connected with international solidarity in relation to facilitating forensic technology transfer.

Pressures to improve workplace and environmental conditions throughout the world have given developing countries a voice on the world stage and highlighted the inequities and biases of globalization’s politicoeconomic structure.  By most accounts, the world’s health has improved.  The World Health Organization (WHO) has reported important gains in public health on an international scale: “We now have the technical capacity to eradicate nearly all nutritional deficiencies and infectious diseases.”  Such dramatic improvements, however, have either bypassed the poor of the developing world or have been unevenly distributed throughout the world.  In 1998, the director of the WHO declared: “The developing world carries 90 percent of the disease burden, yet poor countries have access to only 10 percent of the resources that go to health.”  Increasingly, practicing physicians, public health officials, and social scientists call attention to social forces, processes, and conditions that determine the health of the poor by largely affecting the patterns of morbidity and mortality: “We are only now beginning to understand the mechanisms by which social inequality is in and of itself pathogenic.”

Similarly, experts argue that AIDS in developing countries—especially in Africa, the continent most dramatically affected so far—is primarily a welfare and education issue, not merely a medical one.  Many of those at risk of AIDS cannot read, have never used a condom or been tested, and cannot afford the drugs that Americans have. It is vitally important to put in perspective how poverty impacts and accelerates the spread of HIV/AIDS: “An HIV-positive American can focus on his T-cell counts; an HIV-positive African in a rural village still has to focus on finding clear water and food.” In the latter’s case, “They have to do high-risk things to put bread on the table.”

As noted in the section on economic and financial dilemmas, structural adjustment programs (SAP) policies, by failing to curtail poverty, have contributed to accelerating the pandemic. Many SAP measures, such as currency devaluation, not only take resources away from the fight against AIDS but also cause social problems and reactions that can make people more vulnerable to HIV.  Under such circumstances, the risks to women’s biomedical health care are even higher.  Demonstrating this grave injustice, some public health experts observe:

Women, and especially adolescent females, are more vulnerable than men to sexually transmitted diseases (STDs), for both biological and social reasons.  They are heavily stigmatized if their affliction becomes known.  Because many health services primarily target married women or mothers, and are unable to provide private examining spaces, or even treat women courteously, at-risk women are often discouraged from seeking care.  User fees are even greater deterrent to successful STD treatment.
SAP-related currency devaluation has raised debt levels by 40 to 50 percent in most African countries.  These debt burdens are unsustainable. In virtually every case, African experts note, spending cuts, as directed by SAPs, are “concentrated on politically easy targets—health, education, and support for small farmers—while the interests of the powerful and the wealthy are protected by the state.”

Neoliberal economic globalization, which emphasizes the privatization of state-run social programs in developing countries, is certain to have negative consequences for upholding certain rights such as the right to health.  The privatization of health services in developing countries affects rich and poor quite differently.  Peru is typical.  About half of the Peruvian population survives on less than two dollars per day.  They have very limited say in determining social policy and surely not much stamina to endure the negative consequences of the privatization of the health care system.  Peru’s Health Law of 1997, which aimed at bolstering the Peruvian health-care system through promoting efficiency and choice, has done little to forego disease and mortality among the poor Peruvians. Critics warn about the moral and physical hazards of privatization: “By imposing the criterion of choice on people who are in no position to exercise it, health-care reformers have prioritized financial outcomes over health outcomes, and further imperiled the health of the poor.”

The rising economic and political clout of transnational corporations (TNCs) and multinational corporations (MNCs) has undermined governments’ efforts to make policy independent of corporate interests.  Since governments are now vying with each other to attract MNCs, the balance of power has definitely tilted in favor of the MNCs and away from host governments.  States, for instance, have been forced to lower their labor and environmental standards as well as the taxes foreign companies are required to pay.  This has led to a downward, standard-lowering bidding cycle known as the “race to the bottom.”

In both the developing and developed world, the fear that increasing pressures in industry are driving standards into a race to the bottom are understandably widespread.  Fierce international competition threatens job security, lowers wages and erodes both environmental and labor protection standards.  Greater economic openness could lead countries to relax environmental standards, seeking to attract firms by reducing their cost of doing business.  Many trade unions in Europe fear the search for greater competitiveness will bring about a downward spiral in pay in a race to the bottom that will threaten the living standards of their members.

Large pharmaceutical, biotechnology, for-profit health-care providers, and health insurance corporations have played an enormous role in the corporatization and commodification of health.  That is to say, achieving higher returns for shareholders has become a greater priority than protecting the public health.  The commercial interests of pharmaceutical TNCs override the goal of combating diseases that routinely afflict the world’s poor.  Few transnational pharmaceutical firms have attempted to develop new treatments for the world’s most threatening infectious diseases, such as malaria or tuberculosis.

In what amounts to “the race to the bottom,” TNCs in many industries tend to locate near or in low-income areas.  TNCs in extractive industries locate where the resources are, and probably in some industries have to locate in relatively well off areas because of infrastructural and technological needs.  With little or no control over their activities and also with little incentive to regulate their environment practices, TNCs’ operations have had devastating consequences for rural lands and local subsistence patterns.  All this is not to deny the complicity or greed of government officials, as the case of environmental degradation caused by TNCs such as Royal Dutch Shell in Nigeria has demonstrated.  Royal Dutch Shell’s oil exploration and production since 1958 have resulted in deadly environmental damages to the 6 million people living in the Niger River Delta named “Ogoni” after the area’s dominant ethnic group.  The Shell’s operations were illegal under the environmental laws of most industrial countries: constant gas flaring, open and unlined toxic waste pits, aged and corroding pipelines carrying oil above ground at high pressure, and chronic oil spills.  In addition to suffering enormous environmental destruction, the residents of the Ogoni region who protested against such operations were subjected to systematic violence by the country’s military regimes.  In 1995, Ken Saro-Wiwa, an author and activist who organized a protest movement called Movement for the Survival of the Ogoni People (MOSOP), along with eight other tribal leaders who protested against continued environmental damage were arrested by the government and subsequently killed.

This case clearly illustrates that government interests and those of Royal Dutch Shell were symbiotically intertwined. Exaggerating the TNCs’ role in developing countries, some experts have noted that “the expansion, consolidation, and rising power of TNCs are a major—in many contexts the chief—obstacle to improving health among the poor.”  The corrupt ruling elite of Nigeria and their unwillingness to account for how they used oil tax revenue also played an important role in the country’s failure to secure financial assistance from the IMF.  It was, to a large extent, the extreme inequalities in the distribution of resources and economic power that allowed corporate practices inflict enormous harm on the most marginalized segments of the society.

In short, broader access to and availability of resources for the most economically and socially disadvantaged remain the key concern.  Lessons of the Cuban case demonstrate that the distribution of resources within a country is far more significant than the overall GNP in affecting health outcomes; that there are economic options that distribute sacrifices the poor are expected to make differently; and that massive social change to improve the health of the poor is more effective that targeting vulnerable sectors with specific programs.  Despite its low per capita GDP, Cuba has the lowest infant mortality and under 5 years old mortality rates in Latin America.  Cubans enjoy a longer life expectancy at birth, are among the most educated in the Latin American region, and have achieved health standards rarely matched in the region.

Notwithstanding variations in income levels among provinces, Cubans in general have are well provided for in terms of health care.  During the past 20 years, the Cuban government has effectively mobilized its human, material, and scientific resources to attended to several health problems, including an outbreak of dengue fever in 1981, the discovery of AIDS in Cuba in 1986, and an epidemic of neuropathy in 1993.

VI.  Conclusion

How to protect human rights in the face of global changes remains a nagging question.  Globalization of human rights standards tends to overlook the complexity of the local dilemmas and politics of developing countries.  Despite the pervasive effects of globalization, both as a process and ideology, local variables have a major impact on success or failure of adaptation.  Domestic politics and political institutions will, to a large extent, determine how countries manage to absorb the shocks of globalization.  Any theoretical global consensus will do little to curb the deprivation of human rights on the ground in the developing world.

Globalization presents more dilemmas than choices for developing countries.  Will the adoption of global human rights standards constrain states’ choices at a time when politics are national, business is global, and civil society is rapidly becoming transnational?  There exists, some scholars have cautioned, “a broad cumulative trend toward the social disempowerment of the state.”  The social re-empowerment of the state is imperative. The erosion or disintegration of state authority in many developing countries has been responsible for the breakdown of order and the ensuing egregious human rights violations.  Many experts have argued that instituting the rule of law as a prerequisite for norm-abiding behavior requires effective state authority.  They have particularly noted that “[h]uman rights campaigns should be about transforming the state, not weakening or even abolishing it.”

The dynamics of health provision and child labor demonstrate that government intervention is necessary.  The processes of sustainable development and democratization support the argument that state strength cannot be separated from their political legitimacy and coherence.  States should be empowered to protect socioeconomic rights.  Unless the state is mandated to protect these rights, strong elites cannot be justified. Such a protection cannot be divorced from the political economy of development.  The difficulty is how to balance growth, equity, and competition as states become further integrated into the global economy.  Effective governance by states when faced simultaneously with globalizing and localizing dynamics remains a formidable task.

The globalizing neoliberal culture of consumerism and individualism creates tensions for the kind of social order sought by many in the developing world.  Despite a theoretical optimism that globalization will enable poverty-stricken, non-industrial nations to pull out miracles of economic and social development, there is growing evidence that in reality no groups are more adversely affected by the unforeseen disruptions brought by globalization than women, children, and the poor.

Neoliberal globalization renders the choice between an activist state and the free market contentious, leaving NGOs with much power in defining the contours of moral discourse in the developing world.  Economic globalization leads to the loss of “economic” sovereignty, subjugating states to capital flows and compromising their democratic potential.  There is no consensus on the relationship between democracy and the free market.  That relationship is unclear and complicated.  Unlike those of the developed world, stable regimes in developing countries traditionally are those that have had interventionist policies.  The growth of the market economy appears more dynamic than that of democracy, with corporate economic rights taking precedence over individual human rights.

Global economic pressures undermine the ability of the developing countries’ governments to protect minorities or to preserve important cultural and social elements within communities.  These influences increase the possibility of the fragmentation of states as decision-making powers are relinquished to globalized economic institutions and transnational corporations that have a dubious interest in and commitment to the sociocultural welfare or the human rights of the people in developing countries.

One of the most daunting questions facing the international human rights community is how a commitment to the full range of human rights is possible given unequal economic circumstances and priorities.  Such a commitment—if and when it exists—remains unrealistic at best.  Human rights activists must come to grips with the question of how best to protect and promote human rights in the developing world given the realities and dynamics of developments in international political economy.  Without taking such realities and dynamics into account, they will ultimately be helpless to enhance the human rights conditions of the world’s poorest people. Global standards must be enforced while taking account of the complexity and diversity of contexts, especially as they relate to the most fragile and vulnerable social groups and states.