An ambitious, worldwide report on the state of social protection was released by the International Labour Organization at the beginning of June. Some 360 pages in length, the report is based on surveys and statistics from more than 200 countries. It ranges over areas such as child poverty, unemployment insurance, access to health care, age pensions, compensation for work injuries and antenatal care.

Overall, it depicts a world in which social welfare is in a bad condition, and getting worse.

Social welfare measures are most lacking in the underdeveloped countries. For instance, the proportion of workers “potentially eligible” for unemployment insurance of some sort is 80 percent in Europe, 38 percent in Latin America, 21 percent in the Middle East, 17 percent in Asia and the Pacific and 8 percent in Africa.

But also in the developed “West”, many social protection measures are woefully inadequate even if they are superior to what exists in poorer countries. In Australia in 2012, only 52.7 percent of the unemployed (60.0 percent of men and 44.4 percent of women) actually received unemployment benefits. In the United States, the figure was 26.5 percent. In Japan (2011), it was 21.5 percent.

Or take child poverty. Child poverty increased in 19 of the 28 states of the European Union between 2007 and 2012. In that year, “more than one-quarter of children in Bulgaria, Greece, Italy, Romania and Spain were living at risk of poverty”.

Coming and going

At the other end of life, nearly half (48 percent) of the world’s older people receive no age pension. “For many of those who do receive a pension”, the ILO report notes, “pension levels are not adequate … the majority of the world’s older women and men have no income security, have no right to retire and have to continue working as long as they can – often badly paid and in precarious conditions.”

This situation is getting worse: “Under existing laws and regulations, only 42 per cent of people of working age today can expect to receive social security pensions in the future, and effective coverage is even lower.” It’s still worse for women, only one-third of whom can expect a pension.

The report notes that publicly provided services, such as health care and transport, raise the real value of an age pension – more than they increase the real value of wages for people still working. Such services are one of the areas most under attack by conservative politicians around the world.

Between childhood and being put out to pasture if not put down, there is working life, if you have a job. If you’re injured at work, the odds may be even less in your favour:

“Worldwide, only 33.9 per cent of the labour force is covered by law for employment injury through mandatory social insurance. If voluntary social insurance coverage and employer liability provisions are included, 39.4 per cent of the labour force is covered by law.

“In practice, actual access to employment injury protection is even lower, largely owing to incomplete enforcement of the legislation in many countries.”

Women are especially disadvantaged here: “Gender differences in legal coverage for employment injury are particularly high in the Middle East and Africa, where the coverage rates for women are respectively 18 and 13 percentage points lower than the overall coverage rates. In Latin American countries, the major gender difference is in access to social insurance, which reflects … the over-representation of women in various types of occupation that are usually excluded from legal coverage …”

Health care

Nominally, 40 percent of employed women worldwide are covered by mandatory maternity cash benefit schemes and another 8 percent by voluntary plans. But because of poor enforcement, only 29 percent of employed women actually receive either mandatory or voluntary maternity benefits.

Of 188 countries for which the ILO had information, only 48 “have provisions in their labour legislation setting out a mandatory period of maternity leave and establishing the employer’s liability for the payment of women’s salary (or a percentage of it) during that period”.

Antenatal care is also inadequate. Overall, only about 51 percent of child-bearing women received attention at a health clinic for four or more visits. “In sub-Saharan Africa, more than a quarter of childbearing women did not receive any antenatal care provided by skilled health personnel; the same is true for one in five women in North Africa, and one in six women in Asia and the Pacific.”

There is a more general lack of access to modern medicine. The ILO found that in 44 countries, including highly populated ones such as India and Bangladesh, more than 80 percent of the population has no participation in any form of health insurance or health maintenance scheme; if these people can’t pay for medical care, they can’t obtain it.

Worldwide, about 39 percent of people lack any right to medical care. This has a greater impact on sections of the population more in need of care. For instance, the report notes: “As older persons in many countries have to pay a substantial proportion of the costs of health care and other care services out of their own pockets, many of them are at grave risk of either exclusion from access to the health care they need or financial ruin for themselves and their families.”

As with other aspects of social protection, the reality can be worse than the appearance: “In nearly all countries … OOP [out of pocket payments] are involved when seeking health care. Such payments … are also common in countries that have not fully implemented and enforced existing legislation or have failed to link eligibility and affordability of health care … for example if the scope of the benefits provided is too limited or co-payments, user fees and others costs associated with taking up health care are high … In these cases legal health coverage is an illusion, masking a lack of effective access.”

Inability to pay is not the only cause of a lack of medical care. According to the ILO, “there is a global shortfall of 10.3 million health workers required to ensure that all in need receive quality health services”.

This shortage affects rich and poor quite differently. Between 2007 and 2012, according to the report, 230,000 health workers migrated to take up jobs in the United States. This “brain drain” means that poor countries around the world pay for the education of health care workers in the US, and receive nothing in return. (The ILO estimates that a minimum of 41 health workers per 10,000 population is necessary to provide the basic minimum of essential care. For many African countries, the existing number is fewer than 5 per 10,000.)

Is progress a myth?

Reading the report’s figures, people familiar with some of Dickens’ novels or Engels’ The Condition of the Working Class in England, published 170 years ago, might have a sense of déjà vu.

Of course, many of the specifics have changed, especially in the rich capitalist countries. Typhus and TB are not an epidemic threat today in Australia, Western Europe or North America. The creature comforts available to ordinary people have multiplied. The majority of workers in the West are not required to work 16-hour days for 6½ or 7 days a week; they can relax after their labours, not only by drinking alcohol, but also by watching television.

But the essential point is the contrast between what is and what is possible in the lives of working people – what is possible right now with existing technology and existing social wealth. When Engels wrote, he could cite statistics showing that English rural people, as they moved into cities to take jobs in capitalist factories, had suffered a huge decline in living standards, general health and life expectancy. They would have been better off staying in the countryside – but the government of the day was driving them into the cities.

There is still a huge gap between reality and what could be; if anything, it has become larger. English children in cities in 1840 died of TB; today children in Redfern or US slums waste away from lead poisoning or petrol fumes or malnutrition, or in Japan from nuclear radiation.

Does this mean that the human race hasn’t gone forward at all in the last two centuries? Is the idea of progress just a myth?

That question can’t really be answered, or can be debated endlessly, unless we realise that progress, like a great many things in society, is a class question. If today the human race produces more than enough food for everyone, whereas some earlier societies suffered famines, that is in some sense progress, but it ignores the people going hungry because they don’t have enough money to buy food. (Throughout the 19th century Irish famine, which caused the loss of a fifth to a fourth of the population through starvation or emigration, food continued to be exported from the country.)

It is a stride forward for scientific knowledge when researchers find a cure for a deadly disease, but if the treatment costs a million dollars, it’s not social progress for uninsured victims who don’t have a million.

Because it’s a class question, progress is also a class struggle question, not something that happens automatically. If some workers today have more material goods than workers 150 years ago, it’s not just because cars and televisions hadn’t been invented then. By fighting against their exploitation, workers have been able, sometimes, to win wages higher than the bosses wanted to pay.

So, yes, some working people enjoy better conditions than they would have if they or their forerunners hadn’t fought for them. But offsetting that progress is the fact that the bosses are still the bosses, and are always scheming today how they can take back concessions they were forced to make yesterday.

A case in point: the report proudly states that the ILO has been working towards establishing universal health care coverage since 1944! That’s a commendable effort, but the goal seems just as far away as it was 70 years ago. And how many people died unnecessarily during those seven decades?

Impact of the crisis

The ILO reports that, after a brief increase in social spending at the outbreak of the economic crisis in 2008, there has been a “worldwide decline” in social protection expenditure as a percentage of GDP – mainly in middle-income and high-income countries. That is, the wealthier capitalists are hell-bent on taking back past concessions:

“When government policies shifted highest priority to servicing debt and achieving fiscal balances in 2010, employment and social protection became secondary priorities. Decisions were taken to reduce public expenditures in most [high-income countries], despite rising unemployment and poverty.”

Overall, since 2010 there have been cutbacks in social protection more or less across the board: to unemployment benefits, health care protection, child allowances, disability benefits, housing support, age pensions. The results are clear:

“In 2012, 123 million people in the then 27 Member States of the European Union, representing 24 per cent of the population, were at risk of poverty or social exclusion, compared to 116 million in 2008, and as many as 800,000 more children were living in poverty than in 2008 … Some estimates foresee an additional 15-25 million people facing the prospect of living in poverty by 2025 if fiscal consolidation [austerity] continues.”

The capitalists’ attacks are literally a matter of life and death: “The European Centre for Disease Control warned that serious health hazards are emerging because of the fiscal consolidation measures introduced since 2008. More specifically, in Greece, Spain and Portugal citizens’ access to public health care services has been seriously constrained, to the extent that there are reported increases in mortality and morbidity. The Lancet speaks of ‘a Greek public health tragedy’ in which citizens are subject to one of the most radical programmes of welfare-state retrenchment in recent times.”

That’s about as plain as it can be stated. The capitalists don’t care if the rest of us live or die, as long as there are enough of us to produce their profits. That has been true for at least two centuries. It will continue to be true as long as capitalism survives.