1. Introduction
The term "Globalization" has become a buzzword in today's world of
revolutionized systems of Information technology and of travel &
communication. The global processes have affected human societies in many aspects
for the last many centuries but the practical realization and analysis
of these processes at a global level is possible only recently because
of the revolutions in telecommunications and media.
Globalization is
the process whereby nations increase their inter-relatedness and
interdependency through the spread of democracy, the dominance of market
forces, the integration of economies in a worldwide market, the
transformation of production systems and labor markets, the spread of technological
change and the media revolution that results in sets of increasingly
transnational and multinational economies and political structures and
processes.
Globalization is not country based but company based and
participation in global economy is not a choice but becomes a necessity. It
is a transformation of global society resulting in the negation of
territorial frontiers. There are various transnational factors that are
considered as determinants of globalization such as macro-economic
prescriptions, trade & travel, migration, food security, environmental
degradation, technology & communication and foreign policy.
2. Effects of Globalization
The effect of globalization is felt in various sphere of the services
sector of a nation. The major effects of globalization are international
transfer of risks and trade liberalization.
2.1 International transfer of risks:
There are five main issues under international transfer of risks
such as:
2.1.1 Overuse of environmental resources: e.g. exploitation of oil
resources, logging of forest as in Cambodia and Nepal, Bangkok pollution cars.
2.1.2 Cross border movements: Cross border movements between states &
nations does affect transmission of communicable diseases such as
malaria, yellow fever, SARS and HIV
2.1.3 Trade in harmful products: In developed countries, tobacco and
medicines are banned while there is limited restriction on its transfer
and sale in many developing countries making these countries at
potential risk of drug addiction and misuse of certain medicines.
2.1.4 Drug Trafficking: The Golden Triangle, Golden Crescent and Latin
American countries like Columbia have become the major drug trafficking
centers in the world and illegal drugs are being trafficked through the
international highways affecting many vulnerable regions that share
their borders with such countries.
2.1.5 Technology: Newer technological products like biological,
chemical, nuclear weaponry and nuclear plants are developed, processed and
sold.
2.2 Trade Liberalization:
Due to trade liberalization, some pertinent issues are encountered
that have adverse effects especially in developing nations.
2.2.1 Multinational dictates trade conditions: The phenomenon of
globalization has
led to rapidly growing international trade in services, both in
developing as well as developed countries. GATS (General Agreement on Trade in
Services) constitute one of the new domains of competence that is
assigned to WTO (World Trade Organization).
It is the first set of
multilaterally agreed and legally enforceable rules to cover international trade
in services. They are in fact binding on all members of WTO. MFN (Most
favored nation treatment) requires Members States under GATT (General
Agreement on Tariffs & Trade) to comply with a general obligation to
apply most favored nation treatment.
2.2.2 Search for cheap labor: There is major influx of laborers from
the developing countries where labor is cheap to developed ones.
2.2.3 Sales of harmful products to developing countries: As a result
of MFN, there is less restriction on sales of harmful products to
developing countries.
2.2.4 Arms sales: There is increasing production and selling of
weaponry from the developed countries to developing countries.
2.2.5 Promotion of non-essential drugs
3. Globalization is Shaping the World
In other words, globalization is shaping the present and future state
of the world. No nation is truly independent and we live in an era of
economic colonialism as reflected on the role of IMF (International
Monetary Fund), WB (World Bank), UN (United Nations) etc. Almost all the
nations face the political and economic pressure from WTO such as
imposition of economic sanctions, increased role and interference from human
rights activism i.e. gender issues, child labor, drug trafficking etc.
There is more regional integration like SAARC, APEC, ASEAN and also in
the health sector like Act-Malaria, South to South Collaboration Project
which was formed to build capacity in reproductive health, etc. To
highlight and to address some of the cross border issues like malaria,
HIV/AIDS, drug trafficking, exchange of surveillance information, lobbying
at international level like WHO & UN, transfer of technology and
capacity building etc, we need international health collaborative efforts and
cooperation. A global civilization is the need of the hour that is
based on respect for multiculturalism and mutual respect.
4. Public health & Globalization
Globalization has a far-reaching consequence on the health status of
individual and the population. The health status of the population and
the economic condition of a nation is closely related and health is one
of the major indicators of the developmental, economic progress of any
nation. The population of developed nations is undoubtedly healthier
than the developing nations.
The definition of "Health" as given by WHO
"as a state of complete physical, mental and social well-being and not
merely an absence of disease or infirmity" has never been the ideal
definition and people relate that health is dynamic in nature and besides
the three dimensions, there are also spiritual, vocational, behavioral
and environmental dimensions that need to be considered. The modern
concept is that health can be considered as a package that can be bought.
"Public health" is the art and science of preventing disease, promoting
health, prolonging life through organized efforts of society. Medicine
and public health are two complimentary and interacting approaches for
promotion and protecting health. Yet medicine and public health can,
and must be differentiated, because they are not the same in many ways.
Public health gives emphasis on population while medicine essentially
focuses on individuals. Public health identifies and measures threats to
the health of populations, develops government policies in response to
these concerns, and seeks to assure certain health and related services.
In contrast, medical care focuses upon individuals-diagnosis, treatment
and rehabilitation. In short, public health and medicine are
principally distinguished by their focus on collectivities or on individuals,
with a series of subsidiary differences involving methods of work, systems
of analysis & measurement, emphasis on primary versus secondary or
tertiary prevention, types of expertise and relevant skills, setting in
which work is conducted and client /public relationships and
expectations. There are six essential elements of public health theory and practice
as follows:
Emphasis on collective responsibility for health and protecting and
promoting health is the prime role of the state.
It focuses on the whole population rather than individual cases.
Emphasis on prevention, especially the population strategy for primary
prevention.
Different determinants of health and disease like socio-economic,
environmental, etiological agents and other risk factors are taken into
consideration.
Involves multidisciplinary approach incorporating qualitative and
quantitative methods that is appropriate.
Partnerships with the populations served
4.1 Public health issues related to Globalization
There are many pertinent public health issues related to globalization.
In the 1950's the main public health problems used to be communicable
diseases while in 21st century, we face more of non-communicable
diseases but in developing countries we see multiple burdens such as
non-communicable diseases, communicable diseases, new infections, re-emerging
diseases like TB, aging and HIV/AIDS.
Due to irrational use of drugs by
health personnel and patients alike, there is alarming rise in the drug
resistance of certain drugs like anti-tubercular drugs, malaria drugs,
common antibiotics and ARV for AIDS. The new emerging drug resistance
calls for the need to invest in new products more sophisticated
involving tedious and expensive research.
Moreover, the developing countries
suffer from lack of specialized staff, advanced technology and state of
the art laboratory infrastructure, which makes it unsuitable for these
countries. Extensive transport and better communication facilitates
trade, massive cross border movements of people rendering the local people
vulnerable to harmful goods, disease and harmful lifestyles that
directly or indirectly affect the health of the individual and community.
Today, many different international players are setting the global scene
in public health such as UNDP, UNODC, UNICEF, UNFPA, WTO, WB, IMF, EC,
and NATO etc.
4.2 Impact of Globalization on Public Health
Globalization includes a web of phenomenon and risks that affects the
sustainability of health systems and public health. National health
systems have become trans-nationalized. Governments and MOPH (Ministry of
Public Health) are no longer the solely actors in national health
systems and various actors such as WHO, UNICEF, WB, WTO, UNFPA, UNDP etc.
next to regional cooperation affect directly or indirectly the functioning
of national health systems.
The various risks pertinent to
globalization may undermine national health systems and public health, e.g. The
spread of HIV has been fueled by extensive travel and migration making
them vulnerable to indulge in high-risk practices etc, adoption of
unhealthy life styles and behaviors promoted through cross border
communication means does adversely affects communities.
Some of the impacts of globalization on public health problems are as
follows:
4.2.1 Dealing with triple burden of diseases and HIV/AIDS: The
developing countries will face the triple burden of a combination of
communicable diseases, non-communicable diseases and other new infections along
with the worldwide burden of HIV.
4.2.2 Increases in health expenditure: The triple burden of disease
and the fact that people can afford more and more expensive care and
treatment results in an increase of health expenditures that confronts
countries with real challenges on the ways to reduce or freeze health
expenditures rather than utilizing the country's resources on the disease
prevention programmes.
4.2.3 Inequity between and within countries: Private health care and
the trend to launch autonomous public health care result in less access to basic health
care for the poor within countries. There is widening gap between the
developed and developing poor countries in terms of health care equity and
mobilization & utilization of resources.
Developed countries, which
comprised of hardly 10% of the world's nations, are consuming nearly 90%
of research resources while the case is vice versa in developing
countries. There are very limited research works and public health programmes
focusing on primary prevention of diseases in these countries since
most of the resources are being utilized for treatment of the vast sick
population.
4.2.4 Inefficient and low quality of care: There is lack of access to
basic health care services and inefficient utilization of tertiary care
within the countries.
5. Public Health Responses to Globalization
The global health council was established to seek for global
co-operation and support in dealing with public health issues at the global
level. The Mexico conference on global health co-operation beyond 2000
developed a strategic framework for revitalizing global health
cooperation and arrived at identifying 6 essential global health functions or
areas for international cooperation.
They are communicable diseases
control & surveillance such as SARC, regularization of public health laws,
knowledge management such as research in public health, targeted
problem solving as in brining research into action, vulnerable populations
such as migrants, refugees, women & children and lastly health systems
development/capacity building with international support of public
health.
6. Conclusion
There is a need for international actors to remove the inefficient
overlap of efforts, focus on all key functions, and establish improved
dialogue with NGOs and transnational cooperation and support in
national health systems reforms. The regional based organization such as APEC,
ASEAN, Act Malaria are binding the concerned regions on public health
at policy, research and actual programs & activities levels through
negotiation, collaboration and cooperation, training, technical assistance
and research.
Almost all the countries have a role to play in setting
goals, priority setting, mobilization of funding and promote, advocate
and develop mechanisms for international cooperation to gear up
surveillance in public health besides strengthening institutional resource,
human resource and technical development. The trade liberalization and
economic globalization, although may seems both desirable and inevitable
in today's changing world, yet they present formidable challenges and
uncertainties in the promotion of health is many developing countries
specially.
Lastly but not the least, the role of WHO in international
trade agreements under WTO in ensuring that health is taken into account
when trade policies are being framed, and in setting appropriate
standards or formulating policies for promotion and protection of public
health, needs to be re-emphasized and reviewed as per the necessity arises.
References:
Frenk J., Gwin C., Michaels B., Suwanela C., Walth G. (1998)
Rx for the global health cooperation beyond 2000. Washington DC: ODC Publications
International Trade Agreements and their implications on Health:
Regional Committee. Provisional Agenda item 10. RC-51. The Fifty First Regional Committee of the South-East Region. 2nd September 1998.
http://www.whosea.org Accessed on 14th October 2003
Micklethwait, J., Wooldridge, A. (2000) A future perfect: The challenge and hidden promise of globalization. NY: Times Books
Narula I.S. (1998) Globalization and the impact on health: An overview.
Paper for the Regional Consultative Meeting on International Health Development. Bangkok Thailand 16-18 November 1998
Walt, G. (1998) Globalization of international health. World Health, The Lancet Vol. 351 Feb. 7, 1998 pp. 434-437.
* Dr. Suchitra Lisam is a Public Health Specialist and writes to e-pao.net for the first time.
She is presently working as Research Officer (Medical) under Indian Council of Medical Research
(ICMR) Project on HIV/AIDS & Drug Abuse, based at Imphal.
She has an MBBS (Delhi), a PDCE (UCLA/USA) and an MPH (Chula/Bangkok)
She can be contacted at [email protected]
This article was webcasted on 12th March 2006.
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