For too long, our health care system and economy have marginalized many American communities. Throughout the 116th Congress, the Committee on Ways and Means has explored the root causes of health and economic disparities, inequitable outcomes in national maternal morbidity and mortality, vulnerabilities in our ability to adapt to climate change, and the devastating acts of gun violence tearing apart communities across the country. Most recently, this Committee examined the disproportionate impact of the coronavirus (COVID-19) on communities of color and people with disabilities. The expert testimony and solutions proposed during each of these diverse hearings underscored two key principles: Health does not exist in a vacuum, and achieving health equity will require addressing the economic and social inequities that have long persisted within our country.
For over a century, health services research has demonstrated the irrefutable link between disparities in health and inequities in employment, income, and wealth opportunities. Pre-pandemic data show that on average, Americans can expect to live shorter and less healthy lives compared to people living in every other wealthy democracy – and, yet, we far outspend the average developed country on health care. Now, the COVID-19 crisis has highlighted how unchecked vulnerabilities within the United States (U.S.) health system cause inequities and impact every other aspect of our lives – how we earn, learn, and live in our communities. In light of these lessons learned, we must prioritize efforts to improve the return from our significant investments in the U.S. health system.
Our future depends on transcending traditional health and discrimination frameworks to achieve a 21st century vision that creates the conditions for all Americans to thrive. As the committee with jurisdiction over health, tax, and trade policy, as well as social safety net programs, the Ways and Means Committee is well-positioned to address the role that racism, ableism, and other social, structural, and political determinants play in perpetuating health and economic inequity. This report outlines the intersection between health and economic well-being and describes aspects of policies and practices relevant to the Committee’s jurisdiction and efforts to achieve health and economic equity in the United States.
The excerpt on trade below is from page 20 onwards.
Access to the Benefits of Trade for Individuals and Communities
Commonplace discussions about the objectives of international trade policy generally identify and promote the interests of economic sectors – industrial, agricultural, and services, for example. Seldom have trade’s effects on individuals or communities been considered, much less prioritized as such, beyond in any but the most abstract terms. When trade policymakers have taken the time to make the interests of individuals and communities a priority, however, their efforts have generated substantial political support for those policies. Consequential developments in recent years – and in 2020 in particular – are challenging policymakers to investigate further the role that trade policy has played in either perpetuating or exacerbating unequal access to the benefits of trade for certain individuals and communities – both in the U.S. and worldwide. In 2020, the COVID-19 pandemic has highlighted the fact that these disparities in outcomes among different communities result from structural and systemic inequities U.S. laws and policies create – inequities that emerged as far back as some of the first U.S. international economic policies involving the exchange of goods and people.
Globally, the pandemic has also revealed the fragility of our international supply chains and the inequity in the treatment of workers in low-cost labor countries where manufacturing has become concentrated. Predominantly non-White workers from developing countries and former colonies across the world suffer compromised labor conditions while producing goods for U.S. and global consumers. Unequal contracting and employer relationships that have developed from the arbitrage that conventional trade policies enable have encouraged a spectrum of exploitative practices, including the prevalence of forced labor in certain regions. In their attempts to minimize financial losses related to COVID-19, U.S.- and European-based multinational companies have left already low-wage workers in developing countries – also struggling to survive the pandemic – without pay. In this way, COVID-19 revealed how globalization has incentivized supply chain models that depend on finding the lowest cost workforce for production, regardless of living or working conditions, with dire consequences for public health, supply chain resilience, and a disparate impact on those already bearing the heaviest burdens in the existing global economic order. Indeed, some have called on brands and global retailers to remedy inequitable purchasing practices and commit to support millions of garment workers of color around the world who have enabled substantial industry profits, particularly in light of recent corporate public actions to promote racial justice.
For the last 50 years, the U.S. has pursued a policy of aggressive trade liberalization and experienced a painful decline in manufacturing and redistribution of jobs to the services sector. The loss of manufacturing jobs and the increase in service sector work has exacerbated income inequality more broadly because those manufacturing jobs often had union benefits and wages that supported middle- and working-class families, whereas service sector jobs generally did not. In recent years, U.S. service sector jobs have also faced the pressures of globalization and losses to lower-labor-cost countries. Trade policies favoring financial and corporate interests over those of individuals and their communities have yielded lowered labor conditions and standards for American workers in the form of decades-long wage stagnation, weaker labor protections, limited options for quality jobs, and increased unemployment.
Black workers have faced even harsher obstacles to recover from globalization-related job losses due to systemic and pervasive racial disparities across the labor market and in accessing public services. The loss in manufacturing jobs disproportionately impacted Black workers in a multitude of ways, including negatively affecting their wages, employment, marriage rates, house values, poverty rates, death rates, single parenthood, teen motherhood, child poverty, and child mortality. In addition to increases in precarious work, the decline in union jobs has also been cited as a contributing factor to growing inequality. In fact, union jobs help reduce disparities Black workers suffer by enabling more equitable labor conditions that help protect them from discriminatory practices. At the same time, trade liberalization has impacted immigrant and Latino workers in the U.S. who have also suffered job losses and wage stagnation.
An examination of U.S. policies affecting agricultural production and trade, as well as the historical realities that helped shape them, reveals racial inequities in both their development and impacts. The production of certain commodities in the U.S. can be traced back to the founding of the original colonies as part of trans-Atlantic trade when forced labor powered production and comprised a key element of the triangular trade flow. Those commodities continue to enjoy robust support through U.S. government policies – support that is often strategically sheltered from strict multilateral trade disciplines. U.S. policies and systemic inequities have over time restricted the rights and ability of Black Americans to acquire or retain land for farming; Black farmers currently make up less than two percent of all U.S. farmers. Furthermore, policies and practices have been documented that further restricted the ability of Black farmers to access the government support that other farmers receive. Taken together, it appears that benefits and prosperity that U.S. farmers and agricultural producers enjoy from trade and attendant policies lack inclusivity and reflect significant disparities between communities. Thus, such factors must be revisited to promote economic equity.
Some have criticized the globalization resulting in large part from U.S. trade policies of the past decades for a redistribution of wealth that places costs disproportionately on those that are socially and economically disadvantaged in other countries as well. The current application of U.S. trade policies has contributed to imbalanced economic benefits in developing countries and broader unrealized development goals. The disproportionate benefits for corporate entities over individuals and local communities have dramatically impacted the economies and demographics of some developing countries. The resulting job losses in those foreign nations have in many cases spurred mass forced migration. Similarly, U.S. preference programs have historically benefitted a small set of developing countries and have largely left the least developed countries behind. A thoughtful, probing re-examination of the modes and objectives of U.S. trade policy in light of their domestic and international effects is necessary now more than ever before. Only then can reforms and new approaches be adopted to produce a sustainable and inclusive prosperity that prioritizes meaningful economic benefits for individuals and communities, and others who have been left out, overlooked, and exploited.
To read the full report, please click hereWMD Health and Economic Equity Vision_REPORT