We can tackle climate change, jobs, growth and global trade. Here’s what’s stopping us

We must leave behind established modes of thinking and seek creative workable solutions.

Another tumultuous year has confirmed that the global economy is at a turning point. We face four big challenges: the climate transition; the good-jobs problem; an economic-development crisis, and the search for a newer, healthier form of globalization.

To address each, we must leave behind established modes of thinking and seek creative workable solutions, while recognizing that these efforts will be necessarily uncoordinated and experimental.

Climate change is the most daunting challenge, and the one that has been overlooked the longest — at great cost. If we are to avoid condemning humanity to a dystopian future, we must act fast to decarbonize the global economy. We have long known that we must wean ourselves from fossil fuels, develop green alternatives and shore up our defenses against the lasting environmental damage that past inaction has already caused. However, it has become clear that little of this is likely to be achieved through global cooperation or economists’ favored policies.

Instead, individual countries will forge ahead with their own green agendas, implementing policies that best account for their specific political constraints, as the United States, China and the European Union have been doing. The result will be a hodge-podge of emission caps, tax incentives, research and development support, and green industrial policies with little global coherence and occasional costs for other countries. Messy though it may be, an uncoordinated push for climate action may be the best we can realistically hope for.

Inequality, the erosion of the middle class, and labor-market polarization have caused significant damage to our social environment.

But our physical environment is not the only threat we face. Inequality, the erosion of the middle class, and labor-market polarization have caused equally significant damage to our social environment. The consequences are now widely evident. Economic, regional, and cultural gaps within countries are widening, and liberal democracy (and the values that support it) appears to be in decline, reflecting rising support for xenophobic, authoritarian populists and the growing backlash against scientific and technical expertise.

Social transfers and the welfare state can help, but what is most needed is an increase in the supply of good jobs for the less-educated workers who have lost access to them. We need more productive, well-remunerated employment opportunities that can provide dignity and social recognition for those without a college degree. Expanding the supply of such jobs will require not only more investment in education and more robust defense of workers’ rights, but also a new brand of industrial policies for services, where the bulk of future employment will be created.

The disappearance of manufacturing jobs over time reflects both greater automation and stronger global competition. Developing countries have not been immune to either factor. Many have experienced “premature de-industrialization”: their absorption of workers into formal, productive manufacturing firms is now very limited, which means they are precluded from pursuing the kind of export-oriented development strategy that has been so effective in East Asia and a few other countries. Together with the climate challenge, this crisis of growth strategies in low-income countries calls for an entirely new development model.

Governments will have to experiment, combining investment in the green transition with productivity enhancements in labor-absorbing services.

As in the advanced economies, services will be low- and middle-income countries’ main source of employment creation. But most services in these economies are dominated by very small, informal enterprises — often sole proprietorships — and there are essentially no ready-made models of service-led development to emulate. Governments will have to experiment, combining investment in the green transition with productivity enhancements in labor-absorbing services.

Finally, globalization itself must be reinvented. The post-1990 hyper-globalization model has been overtaken by the rise of U.S.-China geopolitical competition, and by the higher priority placed on domestic social, economic, public-health, and environmental concerns. No longer fit for purpose, globalization as we know it will have to be replaced by a new understanding that rebalances national needs and the requirements of a healthy global economy that facilitates international trade and long-term foreign investment.

Most likely, the new globalization model will be less intrusive, acknowledging the needs of all countries (not just major powers) that want greater policy flexibility to address domestic challenges and national-security imperatives. One possibility is that the U.S. or China will take an overly expansive view of its security needs, seeking global primacy (in the U.S. case) or regional domination (China). The result would be a “weaponization” of economic interdependence and significant economic decoupling, with trade and investment treated as a zero-sum game.

The biggest gift major powers can give to the world economy is to manage their own domestic economies well.

But there could also be a more favorable scenario in which both powers keep their geopolitical ambitions in check, recognizing that their competing economic goals are better served through accommodation and cooperation. This scenario might serve the global economy well, even if — or perhaps because — it falls short of hyper-globalization. As the Bretton Woods era showed, a significant expansion of global trade and investment is compatible with a thin model of globalization, wherein countries retain considerable policy autonomy with which to foster social cohesion and economic growth at home. The biggest gift major powers can give to the world economy is to manage their own domestic economies well.

All these challenges call for new ideas and frameworks. We do not need to throw conventional economics out the window. But to remain relevant, economists must learn to apply the tools of their trade to the objectives and constraints of the day. They will have to be open to experimentation, and sympathetic if governments engage in actions that do not conform to the playbooks of the past.

Dani Rodrik, professor of international political economy at Harvard Kennedy School, is president of the International Economic Association and the author of Straight Talk on Trade: Ideas for a Sane World Economy (Princeton University Press, 2017).

This commentary was published with the permission of Project Syndicate — Confronting Our Four Biggest Economic Challenges

More: Biden administration’s antitrust victories are much-needed wins for consumers

Also read: ‘Dr. Doom’ Nouriel Roubini: ‘Worst-case scenarios appear to be the least likely.’ For now.

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Europe’s Silicon Valley? No thanks

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CAMBRIDGE, England — This city wears many crowns: the fastest growing in Britain, the world’s most intensive research cluster and the university with the highest number of tech founders.

It also has Britain’s second highest level of inequality and one of the lowest amounts of rainfall of any U.K. city.

The tension between those titles has come to a head in the government’s bid to turn Cambridge into “Europe’s Silicon Valley.” Housing Secretary Michael Gove wants to build more than 150,000 new homes there by 2040, more than doubling the city’s size and triple the number local planners had earmarked for the area.

“Nowhere is the future being shaped more decisively than in Cambridge,” Gove said in a speech in December. “Its global leadership in life sciences and tech is a huge national asset. But until now… its growth has been constrained.”

He envisaged a new quarter with “beautiful Neo-classical buildings, rich parkland, concert halls and museums.” A new development corporation would be established to deliver the vision “regardless of the shifting sands of Westminster,” Gove said.

But in the face of mass house-building and water shortages; the investors, city leaders, businesses and environmentalists POLITICO spoke to for this article were skeptical of the scale of the government’s ambitions for their city.

They say they have other ideas.

Growing in a drought

The biggest obstacle to the city’s growth plans is a shortage of water. 

Plans for 9,000 homes and 300,000 square meters of research space, including a new cancer hospital, are being held up after the Environment Agency raised fears about water scarcity. Meanwhile, the area’s local water utility, Cambridge Water, is having to rework its latest management plan to account for the government’s inflated target.

The city pumps its water from underground chalk aquifers, but its rivers and streams are drying up. Levels in the River Cam have been 10 centimeters below their 2013 average for the last four summers.

“There is absolutely no point talking to us about expansion… unless you can solve the water problem,” said Cambridge Science Park director Jane Hutchins.

The science park wants to build a new campus and Hutchins said “we need to be able to accommodate growth at pace and in a timely manner, but we are all very conscious that we can’t do it at the cost of the environment.”

The Conservative MP for South Cambridgeshire has expressed similar concerns.

Plans for 9,000 homes and 300,000 square meters of research space are being held up after the Environment Agency raised fears about water scarcity | Cambridge City Council

The government has put £3 million into a water scarcity group and hopes a new reservoir in the Fens will solve the problem. But that is at least ten years away. In the meantime it is looking to rainwater harvesting, reducing consumption and a new pipeline.

Gove said in December that “new steps to help manage demand for water in new developments” would come in the new year.

Investors, tech founders and university leaders told POLITICO the water supply problem can be overcome, but environmentalists see it as an existential threat.

Sitting in a rooftop restaurant above the Cam, Tony Eva, whose film Pure Clean Water examines the city’s water crisis, said: “How many times can you say we will solve the problems caused by growth with more growth?”

“The shortage of water is not a new feature, we have known [about it] for 60 to 70 years… These clever people have sat on their hands and now they are having to do something. In one sense it is too late.”

Grow your own way

Wendy Blythe, chair of the Federation of Cambridge Residents’ Associations, agreed.

She argues that Cambridge has had enough growth and the “goodies” should go to less affluent parts of the country. Critics of Gove’s plan point out that the minister in charge of “leveling up” is putting forward a policy that could do the opposite.

“Lots of things are happening to Cambridge to become a ‘Silicon Valley,’ and ordinary residents are paying for it,” Blythe said.

Grappling with these problems is Tabitha Goldstaub, a tech entrepreneur and executive director of Innovate Cambridge, a group set up by the university and investors to come up with a more sustainable innovation strategy.

“We’d like to be as successful [as Silicon Valley] but we don’t want to be as socially unequal,” she said.

Income inequality in Cambridge, measured as the gap between the poorest and richest residents, is the second highest in England and Wales, only behind Oxford, and it is widening.

But Goldstaub said the city had “woken up” to the challenge and that supporting local people was a key pillar of an innovation strategy which it unveiled in October.

Income inequality in Cambridge is the second highest in England and Wales | Cambridge City Council

Innovate Cambridge hopes to get the wider population behind that strategy by showing the benefits of living close to so much research, such as better cancer survival rates at Addenbrooke’s Hospital.

It has also set up a community fund for founders to pledge a percentage of money they make from selling their startups in the future. 

Pro-vice-chancellor for enterprise at Cambridge University, Andy Neely, said: “We need to make it clear to people why the research and cluster is improving the quality of their lives.”

The Department for Levelling Up, Housing and Communities says investing in Cambridge will reduce regional inequality. A spokesperson for the department told POLITICO: “We must be ambitious and expand the city and we will only do that through sustainable development.”

We’ll think, you’ll make

On the three-minute walk from the city’s main railway station to the office of VC firm Cambridge Innovation Capital (CIC), you pass offices for Apple, Microsoft and Amazon. But the city is more proud of the startups which have spun out of its university.

New arrival Gerard Grech, who has joined the university to lead a program supporting tech founders, said he was astounded by the innovation in the city. “In my first week here I met someone who had sold businesses to Google, to Apple and to Microsoft. I could not believe it,” he said.

The area around the station is also where Goldstaub hopes to build a new innovation center, where she sees VCs, researchers and startups mingling and coming up with new ideas.

But despite its concentration of creativity, some say the government’s “Silicon Valley” ambitions should be spread across larger parts of the country, rather than focusing on Cambridge.

The city has recently signed a partnership with Manchester to pitch their respective tech hubs as a single cluster to investors, and Goldstaub says such deals should be “the exemplar” going forward.

Semiconductor firm Pragmatic provides a model for this type of development. The company is aiming to become the U.K.’s biggest semiconductor manufacturer, and its founders moved from Manchester to Cambridge for its talent. It is still headquartered in Cambridge, but does most of its manufacturing in Sedgefield, north-east England.

CIC was an early investor in Pragmatic, which completed a £500 million funding round this month.

Andrew Williamson, managing partner at CIC, said this was an example of “a hub and spoke” model which Cambridge excels in.

A report on the university’s economic impact suggests it is generating £30 billion of economic value in the U.K. and supporting 86,000 jobs | Cambridge City Council

“Where the model differs from Silicon Valley is Cambridge is 150,000 people… so we are tiny. What we can do here is fundamental research and the first few steps of the commercialization of that research, but we’re clearly not going to do manufacturing at scale.”

Sai Shivareddy has learned that over the last two years. He co-founded Nyobolt, which designs and manufactures super-fast chargers and batteries for EVs.

The company spun-out from the university and was valued at £300 million last year, but it has struggled to find suitable manufacturing sites in Cambridgeshire. Shivareddy said he is now looking to manufacture in north England or Scotland, as well as Asia.

Giving out the goodies

A report on the university’s economic impact suggests it is already helping the leveling up agenda by generating £30 billion of economic value in the U.K. and supporting 86,000 jobs, more than 30,000 of which are outside the east of England.

“The way the U.K. will compete with Silicon Valley is to think in large clusters,” Neely said, pointing to the Oxford-Cambridge Arc and the Manchester partnership. 

“Cambridge can play a really powerful role providing the boosters but it can’t just be Cambridge.”

Rebecca Simmons, chief operations office at Cambridge quantum firm Riverlane, agreed. “I don’t think Cambridge can do it all,” she said. “If we want to get bigger, we have to do it across the country. Particularly in the quantum world — Oxford, Bristol, Sheffield, Manchester, Liverpool, they’ve all got good hubs mostly based around universities.”

“It’s important that we step up and connect the dots between the various cities in this country,” said Grech, who led startup incubator Tech Nation for a decade. “For me, Silicon Valley is a mindset. I think we should basically adopt its mindset and apply it everywhere.”



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Speed is everything for patients: together we can bring medicines faster

Working in our industry brings huge responsibility. We deal with people’s lives, and our  medicines give people an opportunity to improve their health, often at the most overwhelming time for them. I had a strong reminder of that recently.

Last month, I met with a colleague, Heiko, who lives in Germany. His young daughter has central nervous system (CNS) neuroblastoma — a type of cancer that tends to affect children under the age of five.

Heiko and his family have been navigating the health system for months, including an overload of information in the form of complex ‘oncological-speak’, treatment guidelines and health insurance claims. They have also been dealing with constant travel to specialist centers — all while juggling the emotional burden of caring for a sick child and the daily challenges of home and work life.

He shared something that stuck in my mind the night I spoke with him, which serves as an important reminder for all of us working in health care.

“Trust must be bigger than fear.”

When their health is at stake, friends, families and colleagues put their trust in their local health care system — every part of it, including industry — in the hope of protecting the future for them and their loved ones.

As Heiko put it to me, “Speed is everything. If you gain enough speed, you gain enough time. And if you have time, you have the hope of more options that can help you.”

Faster, more equitable access to new, life-saving medicines for people living in Europe is a goal that I believe we all share. There are challenges in achieving this, but we at Roche are committed to addressing these, together with everyone involved.

It is the inequality in access to medicines that is untenable.

Teresa Graham, CEO, Roche Pharmaceuticals, and chair EFPIA’s Patient Access Committee | via EFPIA

The average time that patients in the EU wait to get access to a new medicine is around 517 days. Uptake of new technologies can be low and slow, but it is the inequality in access to medicines that is untenable. If you have cancer in Germany, you may need to wait, on average, 128 days to access a new medicine, but if you are a patient in Romania it will take you 918 days to receive the same treatment.

I am concerned that Europe’s policymakers believe this can be fixed with legislation alone. And, even if it could, families like Heiko’s do not have the luxury of waiting four to five years for the ongoing revision to the EU pharmaceutical legislation to attempt to resolve these issues.

Improving access to medicines requires solutions that are developed in partnership with everyone who has a stake in their delivery: industry, member states, health regulators, payers, patients and health care providers. With the right ambition and desire for collaboration, we can act now.

The crucial first step is for governments and policymakers to treat spending on health care and innovation as an investment in economic growth and societal advancement. Improving health care and expanding access to innovation are vital for reducing pressure on health care systems, maintaining a healthy and productive society, and driving future economic growth.

Governments and policymakers have a pivotal role in enabling and encouraging this cycle of improved health and economic benefit. We must take a strategic view of investing in innovation, acknowledging the wider societal value it provides, and find sustainable ways to manage immediate fiscal challenges that do not limit or delay access to new medicines and technologies.

The industry is also driving changes. One concrete commitment pharmaceutical companies have made is to file new medicines for pricing and reimbursement in all member states within two years of EU approval of a new medicine. This will improve timely access to the latest innovations.

The industry has also established a portal for tracking access delays and ensuring companies are held accountable in meeting the two-year filing commitment.

With the right ambition and desire for collaboration, we can act now.

With multiple ongoing legislative changes currently taking place in Europe — from the revision of the EU’s Pharmaceutical Legislation, to the EU’s reform of Health Technology Assessment (HTA) and the introduction of the European Health Data Space (EHDS) — we have a unique opportunity to build a stronger and better European environment for life sciences and health care that serves patients’ best interests. One major opportunity for collaboration is the implementation of the EU’s HTA regulation. This aims to address access delays by streamlining and accelerating highly fragmented HTA processes across Europe. There is only one year to go before this either becomes a meaningful contributor to faster access decisions for patients or — if not adequately in focus during 2024 — risks becoming an additional hurdle for patient access to essential treatments. In order to avoid this scenario, industry involvement in the implementation of EU HTA is crucial to leverage expertise, co-design relevant processes, and ultimately ensure a workable system.

Such actions can reduce some of the delays in accessing new medicines, but they will not solve everything. The majority of delays come from the variation and delays in individual countries’ reimbursement and health care systems. That is why it is critical that member states, payers and health systems collaborate with industry to develop tailored access solutions. 

However, there are also proposals on the table today that are concerning and at face value will not lead to improved access for patients. For instance, the EU Commission is proposing to reduce a company’s intellectual property rights — specifically regulatory data protection (RDP) — if a medicine is not available in all member states within two years of receiving marketing authorisation. This would only hinder innovation, without delivering faster, more equitable access to new medicines.

If this were to go ahead as proposed, Europe would become a less attractive place for research. A recently-published study on the impact of the European Commission’s proposal estimated that it would reduce Europe’s share of global R&D investment by one-third by 2040.

I firmly believe this proposal must be reconsidered and focused on policy solutions that ensure patients in Europe continue to benefit from innovation.

As Heiko says, speed, time and hope are all people have. Often, patients are waiting for the next innovation, during which time, their disease progresses or their condition deteriorates. This makes the next clinical trial, the next regulatory approval, the next standard of care, the next reimbursement decision absolutely vital for those who simply cannot wait.

Across industry, there are more than 8,000 new medicines in the global pipeline today. This is the hope Heiko needs, and families like his are trusting us all to deliver.

Speaking with Heiko reminded me that the most effective treatment is the one that makes it to the patient when they need it. It is now our collective responsibility to find the path to making this happen for patients everywhere in Europe.



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BRICS hypocrisy on offshore reform

Andrea Binder is a Freigeist fellow and research group leader at the Otto Suhr Institute of Political Science at Freie Universität Berlin and the author of “Offshore Finance and State Power.” Ricardo Soares de Oliveira is professor of the International Politics of Africa at Oxford University and is currently writing a monograph titled “Africa Offshore.”

Of all the challenges in global governance discussed at the latest BRICS summit in Johannesburg, the role of offshore financial centers should have loomed large. Instead, the issue barely got a noncommittal half paragraph on page eight of the summit’s 26-page declaration.

In an example of breathtaking hypocrisy, BRICS countries rail against the global financial architecture but offer no collective action on offshore banking, and they also continue to be among its major users themselves.

Data leaks such as the Pandora Papers and Panama Papers have shown just how vast amounts of cash end up in jurisdictions that cater to wealthy nonresidents by offering secrecy, asset protection and tax exemption. And according to economist Gabriel Zucman $7.8 trillion — or about 8 percent of global wealth (and 40 percent of corporate profits) — are currently hidden in such tax havens.

What’s interesting is that a considerable share of this originates from BRICS and other developing countries. The U.N. Conference on Trade and Development, for instance, estimates that $88.6 billion leave Africa every year in the form of illicit capital flight, much of it ending up offshore.

The fact that this offshore world is underpinned by the interests of the rich world and also a majorly exacerbates global inequality should fire up BRICS countries.

And certainly, they are quite vocal in denouncing the role of offshore finance: In the 2020 Moscow Summit declaration, for instance, BRICS member countries reiterated their “commitment to combating illicit financial flows, money laundering and financing of terrorism and to closely cooperating within the Financial Action Task Force (FATF) and the FATF-style regional bodies […], as well as other multilateral, regional and bilateral fora.” They have also rightly called out the West for setting up these mechanisms decades ago.

In practice, however, whatever global multilateral action is currently being taken is at the level of the G7 and the Organisation for Economic Co-operation and Development — even if these ambivalent reforms are often protective of the West’s offshore interests. BRICS countries, meanwhile, do almost nothing, despite being the largest global source of capital flight, according to a 2014 report by Global Financial Integrity.

And this lack of multilateral action perfectly aligns with the way individual BRICS countries have engaged with the offshore world thus far.

Brazil currently stands as the world’s second largest borrower from offshore financial markets. India long accepted a double-taxation agreement with Mauritius, which enabled significant foreign direct investment and tax avoidance by the wealthy until 2016. The country also created of an offshore financial center in Gujarat. Meanwhile, Russia’s hydrocarbons are traded through opaque offshore jurisdictions, and its elites have notoriously thrived in such systems. Then, there’s perhaps the most significant — and counterintuitive — stakeholder in the offshore world, which is China. Its state-owned enterprises are major users of jurisdictions like the British Virgin Islands, where they register secretive subsidiaries.

In short, BRICS countries are just as implicated in the offshore world as the Western economies they lambast. The reality is that their governments and political elites both benefit from and need the offshore financial world — and there are four reasons for this:

First, these countries engage in institutional arbitrage by accessing more efficient institutions — and, sometimes, institutions that don’t exist domestically, like credible contracts or a non-political judiciary — offshore.

They also seek access to cheaper and less constrained financing in offshore money markets, where they get access to the U.S. dollar and international investors that are unavailable onshore.

Heavily hit by sanctions — as in the case of Russia since 2022 — the offshore world is also a lifeline for BRICS countries, allowing for the circumvention of punitive measures.

And finally, BRICS elites frequently use such facilities for their own personal purposes, including hiding illicit money and assets.

Thus, closing these discretionary offshore avenues may well have implications for their personal survival — or the survival of their regimes.

This is why multilateral action from BRICS members remains rhetorical at best. And unilaterally, they either do nothing, or selectively implement anti-offshore measures as political tools of regime consolidation and to punish rivals. While continuing to criticize the West, they also voice few qualms regarding the thriving offshore roles of Hong Kong, the United Arab Emirates or Singapore.

The latest summit declaration’s vague language of “international cooperation” and “mutual legal assistance” simply highlighted all this once more, and it even eschewed the previous declaration’s references to the FATF or anything smacking of coordination with the West.

And while de-dollarization was again bandied about, BRICS countries remain keen on access to offshore dollars. Moreover, several of the bloc’s newly admitted states have deeply problematic records when it comes to money laundering and illicit financial flows. This is especially true of the UAE — an aggressively growing offshore financial center with dense layers of secrecy, and which the FATF placed on its “grey list” due to “strategic deficiencies” in its efforts to counter money laundering.

Given all this, what are the chances of BRICS-initiated reform in this area? Realistically, the only reason they would take action is because they care about their own regime stability. Though offshore mechanisms may seem like useful short-term levers, their long-term impact is likely to have troubling consequences for their economies. In time, offshore finance supercharges inequality and begets financial instability, which can lead to the toppling of regimes. Brazil experienced this first-hand in the 1982 financial crisis, which had a significant offshore component.

Of course, Russia’s dependence on offshore financial facilities to circumvent sanctions means it can be written off as reformer. But one would hope that some of the others might belatedly come to see an enlightened self-interest in going beyond their rhetoric.

For now, however, even this seems highly unlikely as, in the immediate future, the availability of offshore services continues to come in handy, while their negative impact on domestic inequality remain largely hidden from public view.

Besides, fighting domestic inequality isn’t really a major concern for many of these governments anyway.



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Players took unpaid leave and played on unsafe pitches en route to World Cup, report finds

The global players’ union FIFPro has called on FIFA and its six member confederations to drastically improve the conditions, compensation and medical care for all players competing in future Women’s World Cup qualifiers after a new report found myriad problems with the path towards the 2023 tournament.

Compiled over a two-year period, the inaugural report surveyed 362 players who took part in World Cup qualifiers, focusing on both the global perspective as well as the specific contexts of each confederation: the OFC (Oceania), AFC (Asia), CAF (Africa), UEFA (Europe), CONMEBOL (South America), and CONCACAF (North & Central America and the Caribbean).

Through anonymised online and in-person surveys, they were asked about various aspects of their experiences including travel and accommodation, pre-tournament health checks, pitch quality, recovery facilities, food, mental health support, match scheduling and payment.

The report found various qualifying paths fell short of minimum standards in many categories, with “multiple inconsistencies in the scheduling, duration, format and conditions between tournaments”. 

Sixty-six per cent of respondents said they had to take unpaid leave from other jobs in order to participate in their respective confederation competitions, which also double as qualifying pathways for World Cups and Olympic Games, with almost one-third saying they had not been paid to play at all.

Only 40 per cent of those surveyed said they viewed themselves as “professional” players, defined by FIFA as anyone who has a written contract with a club and is paid more for football than the expenses they incur.

Thirty-five per cent of players identified as amateur, 16 per cent as semi-professional, while nine were uncertain of their status.

In every confederation, match payment and prize money were two of the biggest issues of the qualifying phases, with the vast majority of respondents saying payment needed significant improvement.

Last week, players from the World Cup-bound Jamaican women’s national team posted public statements saying a lack of investment had led to abandoned camps and missed compensation.

“We are not financially supported enough,” said an anonymous UEFA player.

“Some of our girls had to take unpaid vacation at work and it wasn’t sure if they can even attend the tournament.”

Over half the players surveyed were not provided with pre-tournament medical checks, while 70 per cent were not given ECG heart-health checks.

“Any stat that is below 100 per cent in terms of access to important medical checks is completely unacceptable,” said Sarah Gregorious, director of global policy and strategic relations for women’s football at FIFPro.

“We just want to work with whoever wants to work with us, particularly FIFA and the confederations, to understand why that is the case and how that can be prevented, because that is certainly not something that should be acceptable to anybody.”

Almost 40 per cent of players surveyed did not have access to mental health support, while one-third of those surveyed said there was insufficient recovery time between games, which was exacerbated by the sub-standard quality of training and match pitches, particularly outside of Europe.

Sixty-six per cent said recovery and gym facilities were not of an elite standard or did not exist at all, making it more difficult to recover from games as well as from international travel, with 59 per cent saying they flew economy — even over long distances.

Another major issue highlighted was inconsistent match scheduling.

Only UEFA has a stand-alone World Cup qualifying process separate from their continental championship, which affords players more high-quality matches and opportunities for remuneration, while the other five confederations rely on a single tournament for multiple purposes.

Some of those tournaments — like the AFC Women’s Asian Cup, in which Australia participates — are shorter in length (the 2022 tournament ran for just 18 days), and also operate outside designated FIFA windows, forcing players to choose between playing for club or country, with the tight turn-around between games also heightening risk of injury and fatigue.

One-third of players said they did not have enough recovery time between matches, with 34 per cent saying that had one rest day or fewer between arriving in camp and playing a qualifying match. Further, 39 per cent said they had one day or fewer between the end of the international window and resuming training at their clubs.

FIFPro has used the report to call on FIFA to have greater control and oversight over World Cup qualifying pathways, highlighting the need to implement global standards for player conditions in international tournaments, as well as for each confederation to conduct stand-alone qualifying tournaments outside of their continental championships.

The lack of domestic player unions in many federations — particularly those from less privileged confederations such as Oceania and Africa — had made organising and collective bargaining difficult, but ABC understands one suggestion is to establish a confederation-wide union membership system so that players can still be protected even if they don’t have their own country-specific union.

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