Globalization and health: great possibilities, great concerns
Experts discuss some of the progress and setbacks of globalization.
While the globalization of health care offers tremendous possibilities for good, such as a rapid response to catastrophes, it also can give rise to a new concern, such as a quicker spread of disease. Below, experts in the field discuss both the positive and negative impact globalization has on health.
The term globalization can be nebulous, having a range of meanings depending on the individuals or groups defining it. According to the article, Globalization and health, by Nils Daulaire, MD, MPH, globalization is the flow of information, goods, capital and people across political and geographical boundaries.
There is really nothing new about globalization per se. Throughout history people have always shared information, traded commodities and exchanged some form of currency across various borders. What is new, however, is the extraordinary speed and immensity of the numerous components of globalization, primarily driven by advances in communication and transportation technologies.
The effect of globalization on health systems and individuals is complex. At first glance, many people would say that globalization has had an overall positive impact on peoples health. In many ways, that is true. For instance, global transportation and the communications revolution enable rapid response to epidemics and catastrophes, saving thousands of lives. But there also is a downside to the health and well-being of people as a direct or indirect result of globalization. The flip side of the above example is that due to the rapid mobility of people across borders, the spread of infectious diseases is a threat to everyone, particularly the poor. Daulaire wrote, Today, no microbe in the world is more than 24 hours away from the gateways of every industrialized country, and what incubates today in the tropical rain forest can emerge tomorrow in a temperate suburb.
Nevertheless, Daulaire noted that globalization is neither inherently good nor bad, but rather an inexorable force that needs to be understood and channeled for human well-being.
Economics and trade
According to Richard Feachem, PhD, DSc, author of Globalization is Good for Your Health, globalization has had an overall positive impact on health, especially for people in developing nations. In the area of economics, particularly free trade in capital, technology and ideas, he believes that globalization, economic growth and improvements in health go hand in hand.
Economic growth is good for the incomes of the poor, and what is good for the incomes of the poor is good for the health of the poor, he wrote.
Feachem also wrote that because gross national product per capita correlates strongly with national health status, the general conclusion is that openness to trade improves national health status.
But some developing countries are left out of the global economy. According to Daulaire, 20% of the worlds population live in absolute poverty with an income of less than $1 per day and half the people on the planet live on less than $2 a day. The author stated that those living in absolute poverty are five times more likely to die before reaching 5 years of age than those in higher income groups.
You certainly have winners and you have losers, said Greg Martin, MD, MPH, London School of Hygiene and Tropical Medicine in London, and editor-in-chief of the new journal Globalization and Health. By and large, most economies are better off by engaging with the process of globalization. The problem we have is that not all countries have the same capacity to engage in the process on their own terms.
Graham Lister, PhD, senior associate of the Judge Institute of Management, University of Cambridge, London, believes that globalization has resulted in the transformation of economies of middle income countries, those with incomes between the top 20th percentile and the bottom 20th percentile, such as China and India. These countries have experienced rapid growth by manufacturing and exporting goods and services to the rich world, he said.
These countries have grown rapidly and their health has certainly improved, said Lister. If you look at the Pacific Rim countries, for example, it is clear that as their incomes increased, they also got healthier.
Lister said that one could argue that these countries became richer because they got healthier, adding 18 more years of productive life on average.
This has had an enormous impact on their productivity, he said.
Although globalization has led to expansion of economies and hence better health, it has not resulted in straight-line upward growth. There has been a lot of financial insecurity, including the great financial crash in Asia in 1996 and 1997, added Lister.
Financial measures to recover from this crisis imposed by the IMF (International Monetary Fund) resulted in a severe cutback in public sector spending on health, Lister said.
And the negative consequences of living longer include more of the degenerative diseases that generally accompany getting older.
The explosion of information technology in the past 20 years has had a tremendous impact on some of the poorest and most remote areas around the world. We now live in a sort of seamless world in which one can get knowledge and information about health instantaneously, Lister said. But of course, to be able to access the Internet and other means of communication technology, people need to have access to the fundamentals such as electricity and computers.
Most hospitals in the developing world are hard-pressed to find a few books in their library, let alone a computer, Lister said. There is a lot of effort being made in disseminating information that will help people in less-developed countries.
Lister believes that there has been less effort, however, in building the capacity of those countries to actually use the information.
We are rather pushing a piece of string on this one, he said.
Lister would like to see more organizations working with these countries to build research and information networks. That was promised at the 2002 G8 summit in Kananskis, Canada, but little action has occurred since, he said. People have been talking about bridging the digital divide for a while now.
Feachem is hopeful, writing that the communications, data management and administrative capacity offered by the Internet will substantially improve the management and delivery of health care services, the close watch of communicable diseases, the monitoring of antibiotic resistance and several other applications in the health sector.
One of the negative sides of globalization is the increase in emerging and re-emerging infectious diseases. For example, tuberculosis was thought to have been eradicated in the 1950s, only to re-emerge in the 1980s. One of the reasons for this is the increasing resistance to drugs. AIDS also is a great concern worldwide.
According to Martin, there are numerous ways to look at this downside of globalization and one way is to divide it into communicable and noncommunicable diseases. For example, severe acute respiratory syndrome (SARS) virus, a communicable disease, has the capability of rapidly spreading around the world.
Fortunately, there was a vigilant response from the World Health Organization (WHO), as well as individual nation states and the epidemic was controlled, Martin said.
Yet Martin believes that the world is going to see more and more of this type of epidemic.
We are likely to see a flu epidemic in the near future, which could have devastating effects, particularly on the poor, he said.
Martin explained that the flu virus has a natural cycle. Basically, there are two things that occur genetic shift and genetic drift. From one year to the next, he said, the flu virus mutates and is slightly different every year. This is genetic drift. But every so often, about every 20 to 30 years or so, genetic shift occurs and the flu virus is significantly different.
At that point, we have a potential pandemic, he said. Researchers who are in the loop with regard to molecular biology surrounding the flu virus tell us that we are poised for the next flu pandemic. We are living in this globalized world where the flu virus starting anywhere on the globe could within a few days be all over the world.
James Paul, PhD, executive director of Global Policy Forum in New York City, said that his tendency is not to emphasize hospital-based medicine, but rather to look at public health. Preventing disease rather than curing people who are already sick offers the most effective approach.
Noncommunicable diseases resulting from unhealthy lifestyles are now in places in the world where they were either unheard of or rare just 50 years ago. Obesity, hypertension and type 2 diabetes are an enormous health problem today, and the incidences are increasing in developing nations.
Maji Ezzati, PhD, assistant professor of international health at the Harvard School of Public Health, Boston, found that obesity is increasingly becoming an issue in low-income countries. In a paper he and his colleagues wrote titled, Rethinking the Diseases of Affluence paradigm: global patterns of nutritional risks in relation to economic development, cardiovascular diseases and their nutritional risk factors including overweight and obesity, hypertension and elevated cholesterol are among the leading causes of global mortality and morbidity.
Preventing obesity should be a priority from the early stages of a developing countrys economic development, accompanied by population-level and personal interventions for hypertension and cholesterol, Ezzati told Orthopedics Today.
There are more than 800 million people in the world who do not have enough food and more than one-fourth of the worlds children suffer from malnutrition, according to Daulaire. Half of child and maternal deaths in the world are a direct result of malnutrition, which leaves these people susceptible to infectious diseases and several other health problems, he wrote.
Fortunately, due to improved agricultural techniques and productivity combined with increased trade, if there is a crop failure in one part of the world, it does not necessarily mean death and famine for those people involved. According to Paul, global food production has gone up dramatically during the past 50 years.
That has been good because global population has gone up dramatically, Paul said.
Genetically modified food production, for example, can produce more food, but there are some negative aspects to it as well. The methodology for producing those crops, such as the use of pesticides, can have a harmful environmental side effect, Paul said. It also requires a different organization of agriculture, which drives people off the land and into the cities.
If you have a pessimistic interpretation you could see the present system being a disaster for humanity, Paul said. It is already clearly a disaster for most other species and their natural habitat and that is almost certain to have a serious impact on humans sooner rather than later.
Another aspect of agriculture on the global market that Lister noted is the inequality in favor of northern countries.
Both America and Japan, for example, heavily subsidize their producers, which results in dumping products like sugar on the markets of the developing world at rates which totally undermine their agricultural production, he said. If we truly had a globalized market in agriculture, then it would be to the benefit of developing nations. It is not globalization that is bad as such, but how we implement it. You have to do it fairly and with a bit of heart.
Health professionals needed
Another dilemma that seriously affects people in developing countries, as well as poorer communities in the industrialized nations, is a lack of health professionals. If you are a doctor in a developing country, then you have a global commodity called health expertise, Lister said.
And quite reasonably, you want to place yourself on the market so you can get a job in one of the richer countries like the United States or certain countries in Europe, he said.
Lister believes that if we are going to have a global world, then people who have these needed skills should be paid appropriately.
There are numerous organizations, both governmental and private, that are working together to provide assistance to needy people around the world. For example, the multilateral trade agreement called the Trade-Related Aspects of Intellectual Property Rights Agreement enables drugs to be produced much more cheaply. Pharmaceutical companies have donated medications to combat various diseases around the globe. Since the 1940s, the WHO has been an international leader in disease prevention and eradication. Among other health initiatives, The Bill & Melinda Gates Foundation has contributed tremendous amounts of money for HIV research in Africa. Telemedicine technologies enable doctors in one part of the world to make a diagnosis and implement treatment in other parts of the world. The Tobacco Free Initiative, WHOs response to the tobacco epidemic, was established in July 1998 to focus international attention, resources and action on the global tobacco epidemic.
There are researchers working in all sorts of nooks and crannies around the world in places where in times gone by would not have been possible, Martin said.
Feachem wrote that there is an alternative to globalization and it is not appealing. If the tide of globalization were to be turned back, he wrote, national boundaries would likely be erected that would inhibit the flow of ideas, technology and money. There are no widespread examples, but he mentioned some ominous local examples.
They deliver Myanmar rather than Malaysia, North Korea rather than South Korea and Cuba rather than Costa Rica, he wrote.
For more information:
- Ezzati M, Vander Hoorn S, Lawes MM, Leach R, James W, Lopez A, Rodgers A, Murray C. Rethinking the Diseases of Affluence Paradigm: Global Patterns of Nutritional Risks in Relation to Economic Development. PLOS Medicine. 2005:2.
- Feachem R. Globalisation is Good for Your Health. BMJ. 2001:323; 504-506.
- Papers by Dr. Daulaire. Globalization and Health. Available at: www.globalhealth.org/assets/html/drmed3.html. Accessed May 22, 2005.
- World Health Organization. Globalization and Health. Available at: www.who.int/trade/glossary/story044/en/. Accessed May 22, 2005.