GlobalizationandPublicHealth

DrSamanWaqar

Definitionofglobalization

• Astrongandcomplexglobalexchangeofgoods,services,finance,productivityandpeople.

• Afree,comprehensiveandfastmovement,exchangeandtransferofinformation,knowl-edge,finances,goods,servicesandpeoplebetweennationaleconomiesglobally.

• Aprocessthatischangingthenatureofhumaninteractionacrossawiderangeofspheres(social,economic,political,cultural,technologicalandenvironmental)

• Theprocessisknownasglobalbecausetraditionalboundariesseparatingindividualsandsocietieshavebecomeincreasinglyeroded.

• Theseincludestateboundaries,boundariesdividingdifferentsocial(health,education)andeconomic(manufacturing,services)sectorsandreligiousandculturalbeliefsseemtobeeroded.

• Foreconomists,globalizationisanemergingglobaleconomy

• Forinternationallawyers,itisthreatenedchangestothelegalstatusofthestatesandtheircitizens,

• Forinformationtechnologists,itisaglobalinformationnetwork

• Forresearchers,itisapotentialcreationofaglobalculturethroughe.g.massmedia

Thisglobalchangeisoccurringinthreedimensions:

a.Spatialdimension:• concernschangesinhowweexperienceandperceivephysicalspace.

• Thereisagrowing“senseoftheworldasasingleplace”asaresultofincreasedtravel,communication,tradeandothersharedexperiences.

b.Temporaldimension:• concernstotheactualandperceivedtimeinwhichhumaninteractionoccurs.Inmanywaysthereseemstobeaspeedingupoftimeframese.g.incommunication,thedevelopmentofsatellitetechnology,internetandemailallowsmessagestobesentandreceivedinmicroseconds.

• Thereisalsointensificationofhumancontactwherepeoplearemovingaroundmoreoftenviatourism,commuting,businessandmigration.

c.Cognitivedimension:• concernschangestohowwethinkabouttheworldandourselves.

• Avarietyofthoughtprocessese.g.thecreationandexchangeofscientificknowledge,ideas,norms,beliefs,values,culturalidentitiesareaffectedbyglobalizingforces.

• Theseforcesarevariedandincludethemassmedia,educationalinstitutions,thinktanks,scientists,consultancyfirms,publicrelationsofficesandinternationalorganizations.

• Ononehand,thereisgreatsharingofthoughtsandgrowthofpopularglobalculture,widespreaddisseminationofscientificresearchandadoptionofinternationalagreements(humanrights,environmentalprotectionandreproductivehealth).

• Ontheotherhand,thereisresistancetotheglobalspreadofthoughtprocesses.e.g.resurgenceofreligiousfundamentalismandassertionofethnicidentities.

Conceptualmodelforglobalizationandhealth

• Globalgovernancestructures,globalmarketanditscommunication,diffusionofinformation,globalmobility,crossculturalinteractionandglobalenvironmentalchangesareimportantcontextual levelofhealthdeterminantsthatinfluencethedistalfactorssuchashealthrelatedpolicies,economicdevelopment,trade,knowledgeandprovisionofecosystemgoodsandservices.

• Inturn,thesechangesindistalfactorshavethepotentialtoaffecttheproximal healthdeterminantsandconsequentlyhealth.

Multi-natureandmulti-levelframeworkforpopulationhealth

Tounderstandtheconceptualframeworkinwhichglobalizationworks,thebasicfeaturesoftheoverallprocessofglobalizationhavetobeunderstood,whichconsistsof:• Thenewglobalgovernancestructure-globalizationgenerallyaffectstheindependenceofthesovereigntyofnationalstatesadheringtotheprinciplesandmanagementstructuresonthegloballevel;

• Worldmarkets- globalizationischaracterizedbychangesongloballevelintheeconomicstructure,worldmarketsandglobaltradingsystem;

• Globalcommunicationandinformationdissemination- globalizationgreatlyinfluencesthedisseminationofinformationandexchangeofexperienceonallkindsofproblems;

• Globalmobility- issignificantlyincreased.• Diversityofcultures- globalizationsignificantlyaffectstheoccurrenceofinteractionsbetweentheelementsofculture,globally,aswellasatthelocallevel,and

• Globalchangesintheenvironmentposeaconstantthreattotheecosystem,includingclimatechanges,lossofbiodiversity,globaldamagetotheozonelayer,andasignificantreductioninthenaturalenvironment.

• Therearecomplexlinkagesbetweenglobalizingforces,determinantsofhealthandpublichealth.Somekeyconcernsofpublichealthandthepotentialimpactsofglobalizingforcesonthemare:

1.Communicablediseases• Continuetoaccountforalargeproportionoftheglobalburdenofdiseaseespeciallyinlowincomecountries.

• Sincemid1990’s,thesehasbeenrenewedattentiongiventotheseasemergingandre-emergingdiseases,afterseveraldecadesofrelativecomplacency.

• GlobalizingforcesareallowingcertaindiseaseslikeT.B,malariaandcholeratobecomeseriousthreattopublichealthonceagain.

• Thesenewdiseasesorstrainsareemergingasaresultofdeforestation,waterpollutionandanti-microbialresistance.

• Publichealthisalsoatriskduetoincreasedmobilityofhumans,plantsandanimalsacrossnationalborderse.g.malaria,influenza,denguefever,hepatitisBandHIV.

• Publichealthofficialsmustrethinkexistingapproachestopreventing,controllingandtreatingcommunicablediseasestowardsamoreglobalperspective.

• Measurestostrengthennational,regionalandglobalsurveillanceandmonitoringwillneedtofocusonbuildingstrongcapacityacrossallcountries,notablyinlowincomecountries.

2.Noncommunicablediseases

• LargemajorityofdeathsinwealthiercountriesareduetoCVDs,cancersandrespiratorydiseasesespeciallytobaccorelateddiseases.

• AsthetobaccoproductsmarketsareshrinkinginUSandEurope,companieshavestrategicallytargetednewmarketsinAsiaandAfrica.

• Tobaccorelatedmorbidityandmortalityincursdirectandindirectcoststhatfaroutweighanyeconomicgainfromemploymentandtaxation.

• Publichealthhastackledthisissuebyhealtheducationcampaignsassistedbyhighertaxationoftobaccoproductsandregulationofadvertizingandsales.

• Howevertheseeffortshavelimitedeffectsonglobalindustryadvantagedbythemarketingbudgetsandinfluentiallinkswithgovernments.

• Topromoteavarietyofmeasurestoreduceproductionandconsumptionaroundtheworld,WHO’sTobaccofreeinitiativewasinitiatedin1998.

• CVD,s,cancersanddiabetesarecloselyrelatedtopoornutrition,obesityandsedantrylifestyleswhicharecontributedbymarketingviamassmedia.

• GlobalriseintherateofTVviewinghasbeenlinkedwithdeclineinphysicalactivity.

• Childrenhavebeenparticularlyvulnerabletotheseincreasinglyglobalizedlifestylemessages,frommarketingofbreastmilksubstituteandwidespreadpromotionofprocessedandconvenientfoods.

• Depletionofozonelayerisleadingtorisingincidenceofskincancers,asthmaandairpollutionleadingtomentalretardationinchildrenduetoleadingestion.

• Increasedworkplaceinsecurity,workloadsandunemploymentarepartof“newglobaldivisionoflabor”.

3.FoodandNutrition

• Duringthe20th century,foodbecameanincreasinglyglobalindustrydominatedbymultinationalcompanies.Thereareanumberofpublichealthissuesraisedbyglobalfoodindustry.

• Inagricultureandlivestocksector,therehasbeenatrendtowardsgreaterproductionwiththeavailabilityoffreshfruitsandvegetablesatalltimesofyear.

• Thishasresultedinlowerperunitcostandlowercostsfortheconsumersandmoresupportforthelivelihoodofmanypoorfarmersinlowerincomecountries.

• Modernproductionmethodshavealsoinvolvedpracticessuchaswidespreaduseofpesticidesandgeneticmodificationetc.

• Thereisapublichealthriskfromthishighlyintegratedfoodindustryanddifficultiesarefacedbynationalpublichealthsystemsofcontrollingagloballydistributedfoodhazard.

• Anothermajorconcerntopublichealthisincreasingincidenceofobesityduetounhealthylifestyles,globalmarketingandsocialtrends.

• Effortsathealthpromotionandeducationmustnotonlyaddresslifestylesandpatternsofbehaviorlocallybutneedtotackleglobalinfluencesinthewaywelive.

4.Environmentalhealth• Globalenvironmentalconditionsandchangescanbeseentohaveshorttermandlongertermeffectsonpublichealth.

• Shorttermeffectsoftenderivefromnaturalandmanmadedisastersthatcancreatepublichealthemergenciesbecauseoflackoffood,water,sanitationandbasiccare.

• Displacedpopulationscanmigrateintoneighboringcountriesandcandestabilizelocalcommunities.

• Suddenandmassmigrationofpeoplecanleadtoenvironmentaldamageandcancreateserioushealthrisksascholeraanddysenteryetc.

• LongertermimpactsofglobalenvironmentalchangeincludesnuclearaccidentatChernobylinUkrainewhich,inadditiontoimmediatehealtheffectsonlocalcommunities,illustrateslongtermandgeographicallywidespreadeffectsofenvironmentaldamageonhumanhealthincludingcontaminationofgrazinglands.

• Globalclimatechangeasaresultofgreenhouseeffect,isthemostprofoundlong-termchange,withaverageworldtemperatureexpectedtoincreaseby1.0-3.50 Coverthenextcentury.

5.Globalizationofhealthcareorganizations

• Thereisadebateregardingtheextenttowhichhealthcareorganizationsarechangingasaconsequenceofglobalization.

• Somearguethatnationalhealthsystemsremainlargelynationalintermsofservicedelivery,healthcareworkers,trainingandregulation,othersobserveatrendtowardsanincreasinglytransborderprovisionofhealthcarethroughphysicalmigrationofhealthprofessionalsanddevelopmentoftelemedicine.

• Thereareclearchangesalongcognitivedimensions(howwethinkabouthealthcare).

• Globalizationofinformationtechnologyhasenabledpublichealthprofessionalstoexchangeknowledgeandexperiencewithdisseminationofcertainvalues,beliefsandpracticesinhealthcare.

• Sensitivitytotheappropriatenessofhealthcarepracticestoothernationalsettingsandfeasibilityoftransferringthemfromrelativelyaffluentsettingstothosewithlimitedresourcesiscertainlyimportant.

6.Publichealthpolicy

• Toalargerextent,policychangeshavebeenareflectionofnationalcircumstancesandhealthneeds,howevertheglobalflowofideas,valuesandbeliefsabouthealth,healthcareandhealthpolicyhasalsostronglyinfluencedpolicymakinginbothhigherandlowerincomecountries.

Whatcanhealthprofessionalsdo?

• Theeffectofglobalizationonhealthisbothpositiveandnegative.

• Thespecificbalancebetweenthetwodependsontheindividualsorpopulationgroupsconcernedasglobalizationisasocialforce,createdandcontrolledbyhumanbeings.

• Thekeychallengeistomanageglobalizationprocessesbetterthantheyhavebeenmanagedinthepast.Thismeansrecognizingthatglobalizationdoesnothaveapredeterminedtrajectory,butistakingaparticularformthatfavorscertaininterestswhiledisadvantagingothers.

• Forglobalizationtobebothsociallyandenvironmentallysustainableinthelongterm,weneedabetterbalance.