Et si la santé guidait le monde?
Picking up from where his previous works left off, the economist Éloi Laurent, whose teaching positions include Sciences Po and Stanford, argues that life expectancy and full health “should become our shared compasses, able to guide us, eyes wide open, in a world in which human well-being and the vitality of the ecosystems are inextricably linked and are both being hurled at speed into an increasingly vicious downwards spiral that we must reverse at all costs” (our translation throughout). The author, who rejects the dogma of growth, suggests building a “socio-ecological State” aiming for full health, which he defines as human health taken in all its ramifications and implications: physical health, mental health, social connections, happiness, social health inequalities, environmental health, environmental inequalities.
“It is hard to understand why it is not life expectancy that guides public policy in the 21st-century rather than the flawed gross domestic product and its blinding growth”, Laurent writes, adding: “it is the two major unintended consequences of GDP and growth – social inequality and ecological crisis – can be perceived at least partly through the prism of life expectancy. Life expectancy is not only susceptible to injustices, it lays them bare. It is capable of highlighting a range of inequalities (education, income, sex, socio-professional category, territory, etc.) while GDP camouflages them all. The same goes for ecological crises, which growth feeds, but neglects to account for, whilst life expectancy reacts instantly to them via their consequences for human health. Furthermore, it is an indicator of flux as much as it is of stock, while GDP provides an imperfect measurement of income, not of wealth. To sum up, life expectancy has virtually all the qualities of a good indicator of development in the 21st-century, while GDP growth was not even fit for purpose last century. There is something dizzying about having to observe that demographic fiction says more, and more accurately, about our world than its economic reality. There is something reassuring in being able to think that if we get away from growth, we can move towards expectancy”.
Over the course of the book, the author stresses the importance of human health to the economy. For instance, he points out that it allows people to work and thus to ensure a balance in the welfare budgets, but also that investments in prevention, welfare and reducing pollution help to reduce recourse to the healthcare, extend healthy life expectancy and reduce the cost of hospitalisation and the cost of long-term care. The socio-economic State he is calling for to “extend the life of the provident State” would be based on a “logic of economies rather than spending guaranteed by taxation, itself based on income”. He goes on to elucidate: “this means that the financing of the socio-ecological State could come from the enormous savings in social expenditure that would be achieved by attenuating ecological crises and their devastating consequences for human health. Just think about the savings that could be made by a rational, i.e. non-destructive, treatment of the ecosystems and biodiversity, which would have allowed us to avoid the epidemics of AIDS, Ebola, MERS, SARS and, course, Covid 19. Just think about the social expenditure that could have been saved by progressively mitigating the ozone layer crisis (…), bringing about its regeneration thanks to effective global governance, thus avoiding tens of millions of cases of skin cancer throughout the world. Just think about the savings in social expenditure that could have been achieved by attenuating climate change and air pollution, to say nothing of the health – and therefore also financial – consequences of improving food practices, sports practices and urban mobility”. For obvious reasons, no figures have been put to this and the author is probably getting ahead of himself by suggesting that all epidemics could have been avoided by better management of the ecosystems. Even so, it cannot be denied that preserving the biosphere and improving human health are interlinked and the source of potential savings.
Laurent recalled that in February 1972, the European Commissioner for Agriculture, Sicco Mansholt, wrote a letter to the President of the European Commission, stating that “it is clear that tomorrow’s society cannot be concentrated on growth, at least not as far as material goods are concerned”. He added: “we would do well to examine how we could help in establishing an economic system which is no longer based on maximum growth per inhabitant”. This does not seem to have prevented the Commission from presenting its Green Deal of December 2019 as a “new growth strategy”, the author regrets, calling for attention to be paid to the European Environmental Agency “which, in its ‘State of the European Environment 2020’, published exactly one week before the draft Green Deal, states that ‘Europe will not achieve its sustainability vision of living well within the limits of our planet simply by promoting economic growth”. (Olivier Jehin)
Éloi Laurent. Et si la santé guidait le monde? (available in French only) Les liens qui libèrent. ISBN: 979-10-209-0927. 183 pages. €15,50
L’avortement dans l’Union européenne
This remarkably documented study sets out the state of abortion in the European Union, with the various legal frameworks, states, players and narratives. These little snippets garnered from the book will never be able to give more than a brief glimpse of the quality of the work carried out by Bérengère Marques-Pereira. The question is a very delicate one and requires a better understanding of the various lines of argument. There is no doubt that this is facilitated by this work, with the hope (mine, at least) that dialogue will become possible and empathy will start to take precedence over theory.
Although Europe is the continent in which access to safe and legal abortion seems to be making the most progress, “the authorities of several countries of the European Union, in particular Hungary, Italy and Poland, are calling this access into question” and “attempts at restrictions upon it, whether or not they are successful, highlight” the possibility of reversing it all together, as per the laws adopted in recent years in Alabama, Georgia, Louisiana, Ohio and Texas (our translation throughout).
And yet “Europe as a region has one of the lowest abortion rates in the whole world: in Europe, out of every 1000 women aged between 15 and 44, 29 have had an abortion”, the author reveals, noting that “this puts the Old Continent into third place behind North America (17) and Oceania (19), and ahead of Africa (34), Asia (36) and Latin America (44)”.
Marques-Pereira goes on to point out that apart from the differences in legal frameworks (various restrictions, some or no reimbursement, etc.), there is a very wide range of factors impacting women’s access to abortion. “The abuse of the Use of a conscience clause is widespread in countries such as Italy: more than 70% of the country offers no access to abortion. In Spain and Portugal, the abuse of the conscience clause is on the rise in public hospitals. The same is true in Austria: four regions provide no access to abortion and it is difficult to get one at all outside major cities. In France, abortion is not available in many hospitals and a rising number of doctors among the younger generations refuse to carry them out (…). The countries of Central and Eastern Europe have also seen the increasingly frequent and abusive use of conscience clause”.
The author unpicks the doctrine of the Roman Catholic Church, which continues to be a major voice in the debate and whose narrative feeds into the arguments of the 500 self-proclaimed “pro-life” associations in the European Union. The author shows that the “stances taken by the Holy See, be they doctrinal or ethical-political, are based on naturalisation, alterisation and prioritisation that make men the norm for the reference and reverence of women”. “These positions betray a structural anti-feminism, proposing a ‘new feminism’ which is nothing more than a reactivation of traditionalist materialism”, Marques-Pereira argues, going on to analyse the discourse of those in favour of a right to abortion based on women’s right to health, physical and emotional integrity, self-determination/autonomy and equality. “Those for and against all invoke human rights and use language that is both consensual and conflictual”, the author notes, stressing that “in the case of conservative and reactionary discourse, women’s rights to make their own decisions is denied, whilst in the case of progressive discourse, it is instrumentalised in the name of public health”. To sum up, “women’s rights of self-determination over their own bodies remains very much an afterthought”. (OJ)
Bérengère Marques-Pereira. L’avortement dans l’Union européenne (available in French only). CRISP. ISBN: 978-2-87075-252-4. 281 pages. €22,00
Manuel de droit européen de la protection sociale
This work aims to trace the evolution of social protection law in the European Union, showing that social protection has not escaped the influence of EU law. “Indeed, although still and almost completely a matter for the competence of the member states, the organisation of the social protection systems is not disconnected from the guidelines of the EU in the framework of its social policy and European economic governance. On top of this underground and disparate influence of European law comes a more direct and substantial intervention in the form of the coordination of national social security regimes in the framework of the free movement of people”, explains Ismaël Omarjee, lecturer at the Université de Paris Nanterre (our translation throughout). He also points out that the challenges are the same for all the member states: ageing population, although this varies from one country to the next, a rise in exclusion and changing family structures.
At this stage, however, harmonisation is proving particularly hard in view of, on the one hand, the states’ determination to retain control over the organisation of their own social protection systems and the conditions under which benefits are paid and, on the other, the disparities that exist between the systems in place at the moment, affecting such things as the organisation of healthcare, family policy and pensions. “The road to harmonisation could have been taken, for instance under the impetus of the European Commission which, at a European conference on social security in 1962, clearly expressed a desire to take this path, considering that harmonisation was the natural successor to the coordination already in place”, the author points out, nonetheless stressing that this harmonisation stumbled in the 1970s over concerns, then the outright opposition of a majority of member states from the mid-1980s onwards. Although a legal basis for harmonisation has existed since the Treaty of Maastricht (art. 153 c and k), the scale of the disparities between the national systems “makes any realistic prospect of harmonisation extremely unlikely”, Omarjee argues.
In the absence of harmonisation, rapprochement is possible by means of coordination, which is “a false neutral”. “Coordination has seen a gradual and surreptitious transformation of the national systems, for instance under the influence of the Court of Justice. In this way, referring the coordination regulations to the national legislations for a definition of ‘worker’ has not prevented the emergence of a European definition specific to the implementation of the regulations which the states cannot ignore. Similarly, the advent of the notion of non-contributory social benefit, referring both to social aid payments and social security benefits, is a category specific to European law which the states have had to adopt to avoid blurring the traditional distinction between social aid and social security”, explains the author, who goes on to stress the significant part that the open method of coordination has inevitably played in the Europeanisation of social protection. (OJ)
Ismaël Omarjee. Manuel de droit européen de la protection sociale. Second edition. Bruylant. ISBN: 978-2-8027-6852-4. 412 pages. €80,00
Lexique de mes villes intimes
Yuri Andrukhovych is the rarest of travel guides. The intimate yet lively travel into which he draws the reader is of an unbelievable diversity and wealth. History, culture, literature, memories, fiction, poetry, humour, sex, irony and geopolitics rub shoulders endlessly in a trail that takes the reader from Aarau to Zurich, in an almost total absence of geographical and chronological order, due to the French alphabetical order followed by this lexicon, brilliantly translated into French from the original Ukrainian by Iryna Dmytrychyn.
Some stages of the journey are short, such as its stopover in Antwerp and its diamond-merchant district. Others, much longer and shot through with memories dating from different points in time, like Berlin, “basically an ugly city where, despite its lack of beauty, there’s so much water and so many trees [that] you suddenly like to think that there is a place for you” (our translation throughout). Paris, Prague, Venice and Warsaw are paraded before our eyes with all their attractions and faults, as are Detroit and New York. Strasbourg provides the author with the opportunity to recount a visit to the European Parliament, or rather, how the author went there in 2004 to present the orange revolution. For politics are never far away in the work of this Ukrainian poet and essayist, who climbed the barricades of Maidan in 2013-2014. “Resourcefulness and agility, a priority for survival, total indifference, crass, flagrant provincialism, all this complex of Kiev that I thought bound to eternity suddenly disappeared, in the space of just a few days the city became a hub of insubordination, condensed courage, the epicentre of heroism and acts of solidarity and voluntarism”, he writes, describing the insurgent Kiev. Ukraine is also represented by Lviv and Drohobych, allowing the author to reflect on the trauma of history, particularly displacements of the population and Stalinist repression, which have made Kharkiv into a “museum of tragedy”. Leningrad is recounted to us in the company of the Ukrainian poet Chevchenko, while Moscow “desperately deserves to be loved”, according to Andrukhovych, who adds: “how I would have loved to freely enjoy the great Russian culture, all the cosmopolitan pleasures of the mind, rather than have to bristle every minute against its imperial claws continually bared in our direction”. (OJ)
Yuri Andrukhovych. French translation from the Ukrainian by Iryna Dmytrychyn. Lexique de mes villes intimes – Guide de géopoétique et de cosmopolitique (available in Ukrainian and French only). Noir sur blanc. ISBN: 978-2-88250-674-0. 361 pages. €24,00