The phenomenon of globalization is as old as organized commerce. In its early days, the wealth generated by globalization was limited to a small elite community. But as modes of transport, communication and remote business organization advanced it has led to sustained living standard improvements in many industrial societies. This has happened to the extent that these days the word globalization has become synonymous with efficiency, economic opportunity and overall human security. While such developments are partially true there is also another side to the story. While the advanced nations of hemispheric West have had benign consequences as a result of globalization, key human development parameters of most Third World countries have fallen proportionately. Hence, it is difficult to present a blanket view of the impact of globalization on public health. In light of this fact, this essay will attempt to attain a nuanced understanding of globalization’s overall effect on public health outcomes across the world. This is done by way of perusing authentic scholarship on the subject.
The litmus test for the efficiency and effectiveness of any public health system is its performance in a crisis situation. Civil societies have come to expect basic protections at the time of these crises. Such emergencies also test a government’s true ability to act under pressure. In other words, “they define a state’s capacity to protect its population while exposing its vulnerabilities to political upheaval in the aftermath of poorly managed crises” (Gorin, 2002). In the context of economic globalization at the turn of the new millennium, more than ever before, the general public demand transparency and accountability in global public health systems during medical and natural disasters. To gauge the robustness of public health systems in this new globalization paradigm, we need to study recent cases of acute public health emergencies. The Indian Ocean tsunami of 2004 and Hurricane Katrina are particularly relevant to this analysis.
“Hurricane Katrina was unique in that the U.S. government accepted bilateral and multilateral relief aid, a rare event in modern times. In the aftermath of the Indian Ocean tsunami, enough formal external resources prevented the public health emergency from developing into a secondary disaster. Rapid deployment of Red Cross Movement emergency response teams prevented any major outbreak of disease from contaminated water and sewage. It was no accident that, once the tsunami hit, a strong public health emphasis from national and international aid thwarted further deaths.” (Burkle, 2006)
Hence, in the instances of Hurricane Katrina and the Indian Ocean tsunami the advantage of a globally coordinated public health arrangement comes forth. Further, as a result of globalization internal security, authority of the state and dispensation of public health have all become intertwined. A case in point was the SARS pandemic that broke a few years ago. Contrary to the successful response to the aforementioned natural disasters, the SARS pandemic “called into question the capacity of the public health infrastructure to meet such challenges, especially when public health is compromised by economic globalization pressures” (Burkle, 2006). This goes on to prove the initial assertion that the impact of globalization on public health can only be evaluated on a case by case basis. Generalizations are usually not accurate and at times very misleading. Further on the down side, there have been attendant trends to globalization, namely their indirect effect on social determinants of health in the Third World. To elaborate, public health systems have not scaled up to meet the challenges of increasing urbanization, which is a direct consequence of globalization. The processes of urbanization, industrialization and globalization have a direct impact on issues such as sustainable development and public health (Eisenberg, et. al, 2007).
Social determinants of health such as geographical location, gender, age, ethnic origin, education level, governance and socioeconomic status are all factors that determine a nation’s public health system. Statistics from World Health Report 2001 supports the veracity of this correlation. Developing nations continue to lag behind in standard of living parameters, which suggest that globalization has had no significant impact on social determinants of health in developing nations. Even as society enjoys technology aided interconnectivity, hundreds of thousands of people are still living under hostile health conditions (Taylor, 2002). While the rich nations are getting richer, complete swathes of sub-Saharan people still confront poverty, hunger, illiteracy and threat of infectious disease on a day to day basis. The biggest threat to people in this region is HIV/AIDS, an ailment that has consumes a million lives every six months in Africa, with sub-Saharan African nations bearing the brunt of this epidemic. This region, according to statistics released by Joint United Nations Programme on HIV/AIDS, is home to seventy percent of people infected with HIV worldwide. Such numbers betray the socio-political realities of the region, with its attendant failure to invest in public health projects (Kazatchkine, 2007).
Many of modern epidemics, including AIDS, polio, and malaria may in a few years’ time even out. But, for a developing nation, new challenges in the form of cancer, road accidents and cardiovascular disease will emerge. Further, although sufficient progress has been made in checking infant mortality rates in the Third World since the 1980s, cases of easily contagious epidemics like tuberculosis have not declined. This goes on to show that the benefits of globalization have not reached all corners of the world. The ailments mentioned in the following table and the mortalities that result from them mostly pertain to developing and under-developed countries of the world.
Top 10 Leading Causes of Death (2000 estimates)
Ranking Specific Cause Percent of Total Deaths
1 Coronary heart disease 12.4
2 Cerebrovascular disease (stroke) 9.2
3 Lower respiratory infections 6.9
4 Unintentional injuries 6.1
5 HIV/AIDS 5.3
6 Chronic obstructive pulmonary 4.5
disease (e.g. emphysema, chronic
bronchitis)
7 Perinatal conditions 4.4
8 Diarrheal diseases 3.8
9 Digestive diseases 3.5
10 Tuberculosis/lntentional injuries 3.0/3.0
Source: The World Health Report 2001 (Geneva: The World Health
Organization, 2001)
Even the former chief of the World Health Organization agrees that there is a disconnection between wealth creation and wider access to public health as a result of globalization. This excerpt is from a speech by Dr. Gro Brundtland, the former Director-General of the World Health Organization, at the World Economic Forum on January 29, 2001, emphasizes this point.
“Technologies are spreading, communication is worldwide, people know what is available, and yet the dramatic gaps and lack of access become greater and greater. We must look upon the world as a shared responsibility so that we deal with the gaps and help those technologies become available for those who don’t have access. That’s the only way to keep globalization from becoming really unhealthy.” (Brundtland, 2001)
Moreover, Public health authorities across the world have concentrated more on such pediatric areas as polio, malnutrition, malaria, etc and have made impressive progress. For example, there is already evidence that people are living longer lives across the socio-economic spectrum. The downside is “exposure to numerous new health threats more commonly associated with old age, namely cancer and heart disease. In India, for example, deaths from heart attacks, cancer, and other non-communicable diseases are projected to double from 4 million a year in 1990 to 8 million a year in 2020” (Levy & Sidel, 2006). Such is the paradox of globalization that during the same period, family-planning initiatives have found wide acceptance. In the last two decades, the usage of contraceptive devices has increased exponentially in many under-developed countries. The birth rates have declined by 15% as a result. This can have negative consequences for these nations in the long term. In a decade or two they may confront the same “demographic imbalance” that the western world presently faces. This would mean that societies in the future will have disproportionately high percentage of elderly men and women who do not contribute to the growth of economy (Levy & Sidel, 2006).
Globalization had affected all allied fields of public health, such as medicine, ethics and human rights. The relationships among these fields are also evolving in response to the new circumstances, events and experiences created by globalization. Alongside epidemics such as HIV/AIDS, many women’s health issues are also brought to light by “the complex humanitarian emergencies of Somalia, Iraq, Bosnia, Rwanda, and now, Zaire” (Levy & Sidel, 2006). From among several aspects of globalization, three of them assume more significance. Firstly, human rights issues and action have become more closely allied to, and have become an integral part of public health work. Next, new standards of public health ethics have gained acceptance. Thirdly, human rights-related duties and responsibilities of healthcare professionals, including doctors, are receiving increased attention (Levy & Sidel, 2006).
Globalization of agriculture has accelerated with newer technologies in the realm of molecular biology. It has both advantages and disadvantages. On the positive side, this has led to increased food security over the last few decades. As a result hunger and starvation have declined. But the question to be asked is not if hunger and starvation have declined (Kazatchkine, 2007). The significant question is: Have they declined proportionate to the production capabilities afforded by newer technologies. The answer is sadly, no. According to Joachim von Braun,
“The main reason for being extremely disappointed with the progress in food security is that such progress has at best followed past patterns and trends but does not at all correspond to the tremendous opportunities offered by the new global wealth and technology. While globalization has successfully included a significant part of the rural and urban food insecure in parts of Asia and Latin America, this is not the case for most of Africa. As agriculture is a knowledge-intensive sector, the facilitation of access to knowledge through globalization is a promising opportunity. At this juncture, carefully designed policies adapted to regional conditions are called for to foster the potential benefits for people and the ecology, and to prevent risks” (von Braun, 2001)
In the final analysis, it is apt to say that the positive effects of globalization have not reached everyone. In the world of today, with rapid progress in communication and transportation, diseases can travel quickly across geo-political borders. In this scenario, contagious diseases can quickly assume epidemic proportions. Health problems can no longer be segregated into local and foreign. As close to two million people travel across national borders each day, a more comprehensive and inclusive approach to the health of general public is called for. It is relevant to note that modern diseases such as cardiac problems, diabetes and cancer have risen in frequency in the era of globalization. This means that the new economic organization of the world has imposed unhealthy lifestyles on people. But there is nothing inevitable about these negative consequences. If the engines that drive globalization can be efficiently tapped into, they can lead to a more egalitarian and healthier global society (Tabb, 2001).
As an acknowledgement of the injustices and disadvantages induced by globalization, a consensus is emerging within the international community toward the formation of a more equitable global health system. Such conceptions as the international development targets, which were discussed in recent WHO meetings try to deal with diseases of poverty head on. Simultaneously, there has been a growing concern from private corporations to involve themselves in civil society organizations. The global health initiative is a product of these developments. If implemented properly, we may see a more equitable global health system in the not-distant future. But for this dream to be fulfilled, private corporations and government health agencies need to put in concerted and coordinated efforts based on shared values. In these times of radical change to economic organization of the world, the need to build bridges between medicine and public health and between ethics and human rights become all the more important (Lietz, 2006).
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