Political Economy - Liberia
What crop did Firestone dominate in Liberia, and how did this shape the economy?
Firestone dominated rubber, turning Liberia into a mono-crop economy dependent on a single export. This created jobs but diverted land and resources away from food security and broad development. The wealth largely flowed outward to Firestone’s U.S. operations, leaving little investment in national infrastructure. (Mitman, Empire of Rubber, 2021)
Which institutions promoted SAPs in the 1980s and 1990s?
The IMF and World Bank. They tied loans to neoliberal reforms, including privatization, liberalization, and cuts in social spending. These programs profoundly reshaped health systems worldwide. (World Bank, 1987)
What does TRIPS stand for?
Trade-Related Aspects of Intellectual Property Rights. Adopted in 1994 under the WTO, TRIPS enforced strict 20-year patents on medicines worldwide.
Which organization sets international health rules and coordinates global response?
The World Health Organization (WHO). However, WHO often lacks enforcement power and depends on member funding.
Firestone have control many land in Liberia
Firestone had control of much land in Liberia.
Firestone controlled a large amount of land in Liberia.
Firestone was given control over vast areas of land in Liberia.
Firestone held control of extensive land concessions in Liberia.
What barrier do floating hospitals in Indonesia address?
Geographic access. Indonesia’s 17,000+ islands make healthcare uneven. Floating hospitals (like doctorSHARE’s Nusa Waluya II) bring surgery and care to remote islands (Maluku, Papua).
Why it matters: Illustrates how geography creates structural barriers in health.
How much land did Firestone control in Liberia under its concession?
Firestone secured control of about one million acres under a 99-year lease in 1926, one of the largest land concessions of its kind. This created an enclave economy where vast resources were under foreign control, limiting Liberia’s sovereignty. (Mitman, 2021)
What controversial policy in health and education did SAPs introduce?
User fees, requiring people to pay out of pocket for services. This reduced access for poor households, leading to declines in maternal and child health. (Pfeiffer & Chapman, 2010)
What did TRIPS mean for essential medicines?
It gave pharmaceutical companies monopoly control, driving up drug prices and limiting access in low- and middle-income countries. This especially impacted HIV/AIDS medicines in the late 1990s.
Which three diseases does the Global Fund primarily target?
HIV, tuberculosis, and malaria. While impactful, this vertical funding model has been critiqued for sidelining broader system strengthening.
SAPs was introduce by the IMF and World Bank.
SAPs were introduced by the IMF and World Bank.
The IMF and World Bank introduced SAPs.
SAPs were first implemented under IMF and World Bank policies.
The IMF and World Bank brought in SAPs as part of economic reforms.
During COVID-19, what was China’s largest health-related export?
PPE, especially masks. In 2020, China exported over 220 billion masks, making it the global PPE hub.
Why it matters: Shows how China’s industrial capacity shaped global pandemic response.
How did Firestone’s dominance affect Liberia’s public health system?
Firestone invested in clinics for its workers but left the broader public health sector neglected. This dual system meant the plantation had relatively better care, while the national system was chronically underfunded. The state became reliant on an extractive corporate structure, setting the stage for systemic fragility. (Farmer, Fevers, Feuds, and Diamonds, 2020)
What was the broader economic rationale behind SAPs?
To force debtor nations to reduce public spending, liberalize trade, and open markets in order to repay debt. While framed as modernization, the impact often deepened poverty and reduced public service access.
Which country resisted TRIPS with compulsory licensing of HIV drugs?
Brazil. In 2007, it issued a compulsory license for efavirenz, breaking Merck’s monopoly. This reduced costs dramatically and expanded treatment access. (Galvão, 2012)
Which crisis most clearly exposed WHO’s weaknesses in governance and response capacity?
The 2014–16 Ebola epidemic. WHO’s delayed response revealed its limited resources and political constraints.
Brazil fighted against TRIPS for medicine access.
Brazil fought against TRIPS to secure access to medicines.
Brazil challenged TRIPS in order to expand access to medicines.
Brazil resisted TRIPS regulations to improve medicine access.
Brazil took action against TRIPS to defend public health.
Which infectious disease remains endemic in Pakistan?
Polio. Pakistan and Afghanistan are the last two countries with wild poliovirus. WHO still records environmental positives and new cases in 2024.
Why it matters: Highlights persistent health inequities and governance challenges.
Which epidemic exposed the long-term effects of Firestone’s economic dominance and structural adjustment programs?
The 2014–16 Ebola epidemic. While Firestone managed to protect its plantation workers with strict controls, Liberia’s national health system collapsed under the epidemic, showing decades of underinvestment and dependence on outside actors. (Farmer, 2020)
What was the main effect of SAPs on health equity?
SAPs increased inequities, shifting costs to individuals and widening gaps between rich and poor. The poor bore the brunt of reduced subsidies, while wealthier classes could still access care.
Why was Brazil’s action significant globally?
It set a precedent that public health can override intellectual property rights. Brazil’s action encouraged other countries to use compulsory licensing in crises.
During COVID-19, debates around TRIPS focused on what issue?
Waiving patents on vaccines and treatments to allow wider global access. Donor states and pharma resisted, while activists and many LMICs pushed for equity.
WHO set the rules of health global.
WHO sets the rules of global health.
WHO establishes global health regulations.
WHO creates the rules that guide global health.
WHO develops frameworks for global health governance.
India is the world’s largest supplier of what type of medicines?
Generic medicines. India supplies ~20% of the world’s generics, earning the title “pharmacy of the world.”
Why it matters: Connects political economy (IP rights, pharma markets) to access to medicines.
Firestone’s presence in Liberia is an example of what type of economic structure?
A resource extraction enclave: foreign firms extract natural resources for global markets, reinvesting little locally. This pattern left Liberia vulnerable to poverty, weak institutions, and public health crises.
Which global health scholar is best known for critiquing the health effects of SAPs?
Paul Farmer, who described SAPs as a form of structural violence that denied the poor access to care while claiming to enforce fiscal discipline. (Farmer, Pathologies of Power, 2003)
What legal mechanism allows countries to bypass patents for health emergencies?
Compulsory licensing, permitted under TRIPS for public health needs. This mechanism balances intellectual property rights with the right to health.
What does “donor dominance” mean in global health governance?
Powerful states and philanthropic foundations (e.g., Gates Foundation) set priorities, often pushing vertical programs. Recipient countries have limited voice in agenda setting, reinforcing global inequities. (McCoy et al., The Lancet, 2009)
Poor peoples pays the price of user fees.
Poor people pay the price of user fees.
Poor households bear the burden of user fees.
Poor families carry the costs of user fees.
Poor communities suffer the impact of user fees.
Which country comes to mind when you see the below fact:
1 - NAFTA linked to rising obesity/diabetes through U.S. food imports (corn syrup, processed foods).
2- Challenged TRIPS with compulsory licensing of ARVs, lowering HIV treatment costs globally.
Mexico: NAFTA opened borders to U.S. agricultural products. Cheap corn syrup and processed foods fueled rising obesity and diabetes rates.
Brazil: Challenged TRIPS through compulsory licensing of ARVs, cutting prices and expanding HIV treatment.
Why it matters: Demonstrates two different faces of political economy in health: trade shaping diets in Mexico, intellectual property shaping medicine access in Brazil.