Impact of Globalization on Health

 
Abdolghayoum Nematinia

Research student in Sociology 

What is globalization

‘Globalization is the flow of information, goods, capital and people across political and economic boundaries’ . As that definition implies, it is not new: people have always carried information, goods and capital across countries. Indeed the globalization of disease is usually said to have begun in 1492 when the Europeans discovered the Americas, and inflicted one of the earliest examples of genocide on the American peoples through the importation of smallpox, measles and yellow fever, as well, of course, as the use of force and firearms. Not all this early globalization was negative, however, as ideas and cultures, spices and cashew nut trees. What is new is its scale and pace. Kelley Lee (2000) has defined globalization as ‘the process of closer interaction of human activity across a range of spheres, including the economic, social, political and cultural, experienced along three dimensions: spatial, temporal and cognitive’.

Globalization in historical context

Globalization is the flow of information, goods, capital and people across political and geographic boundaries. The concept of globalization has received increasing attention over the past few years, and is often characterized as a new and uniquely modern force. Yet the generation of vast fortunes from tea and tobacco trade in the 18th and 19th centuries, the spread of potatoes and maize as food staples from the Americas to the rest of the world in the 16th and 17th centuries, the introduction of plague from the Orient into Europe in the 14th, the explosion of commercial trade that followed Viking routes in the 10th, and even the spread of humankind itself across the face of the globe tens of thousands of years earlier, can all be considered examples of globalization with vast and historic consequences.

So globalization is not new. What is new, however, is its rapidly accelerating pace and scale as we move toward the closing days of the 20th century. This pace and scale are driven by technology, principally in communications and transportation. They have transformed globalization from a gradual process, one of many factors affecting economies and individuals, to a predominant factor, just as the natural slow process of radioactive decay can generate an accelerating energy cascade once a critical mass has been reached.

This change has been so rapid over the past decade that the process of normal societal response and adjustment - historically requiring a time period of one to two generations - has been swamped. To some it looks to be beyond societal influence, a runaway chain reaction. More soberly, it calls for thoughtful and analytic approaches to dealing with globalization, particularly as it affects the health and well-being of those with the least access to its tools and benefits.

It is pointless to engage in debate about whether globalization is good or bad. Globalization is a force, a dynamic, which is in itself morally neutral. It is also inevitable. Even if some judge it to be bad, they might as well try to hold back the tide. It is driven by what today is possible that never was before: instantaneous communications, the virtualization of financial markets and the ability to move people and goods at low relative cost at near the speed of sound. Clearly, this is a trend which will increasingly be at the center of humankind's common reality in the 21st century, and is likely to accelerate further.

So our fundamental challenge is to understand this force, to recognize its potential benefits as well as its threats to human well-being, and to develop thoughtful and effective responses that harness the forces of globalization and guide them toward supporting health and equity for people around the world.

Globalization in the present context

For the past decade, we have seen growing manifestation of the central role of this dynamic. Today we are all aware of the globalization of economics, driven home by the recent Asian economic collapse, which started in Thailand, and its effects around the world. Our economic interdependence was underlined by the global consequences of that collapse.

We recognize the importance to domestic and international well-being of global trade, in food and raw materials as well as in manufactured goods. Increasingly, that trade now also encompasses services, as, for example, computer programmers in Bangalore feed code via the internet to software businesses in Seattle while eating meals from American fast-food chains in front of their Taiwan-manufactured monitors.

Global transportation now allows us to get to any country on earth within a day's travel, and to get vaccines and drugs there just as fast. It has also opened unimagined channels of human migration that often skips over half the globe. This migration has deeply affected the domestic realities of affluent countries, and across the globe health care and social service providers have experienced the new challenges of this growing cultural diversification.

And of course the globalization of communications has opened remarkable vistas for the exchange of information - and even, on occasion, of knowledge.

The speed of this change process even in far-flung areas is remarkably swift. A decade and a half ago I began work in a field research project in a remote district of Nepal. In the area we had chosen for its lack of confounding variables as well as for its lack of health services, we found a society virtually cut off from the rest of the world. One in three children died before reaching the age of five. Situated five days' walk from the nearest road, lacking in any means of internal transportation other than by foot, lacking communication other than by hand-carried letter or chain of gossip, any activity undertaken in our health project required massive efforts at logistics and communications. At the time, despite the difficulties it posed, this isolation served our project's purposes well since we could more readily assess the direct health impact of our intervention.

It was a significant impact despite its simplicity and low cost, reducing child deaths by more than a quarter. Yet today, we could not hope to carry out the same "clean" study in this remote location. Despite its continued poverty, the district headquarters is now served by satellite telephone service that can be direct-dialed from the U.S., and satellite television reaches newly established privately owned village theaters. Trade and commerce with the outside world have grown substantially, and small private village pharmacies now stock and sell essential drugs. The effect of these changes of globalization on the daily lives of poor farmers and their families eking a hard living from the rocky hillsides of the district is still small, but the living link with the outside world presents an unprecedented opportunity to lower barriers to the effective mobilization of essential health services. It is no longer a place apart.

Within the next few years, virtually every place in the world will become accessible by telephone and the internet. Exchanges with far-flung corners of the world will be routine, and long-distance training and supportive supervision of health providers will be entirely feasible. If well thought through, the impacts on health are likely to be profound.

Of course, telecommunications can be a mixed blessing. The promotion of violence as entertainment, the direct and indirect marketing of tobacco and other health scourges, the glamorization of self-serving and unsustainable life-styles all owe at least part of their parentage to commercial media. Mass media have a profound effect on social norms which directly influence health; global health researchers and practitioners need to recognize and act on both the positive and negative effects.

Current trends in health and society

Some of the changes that have taken place in the world, and in its health, over the last several decades and how they relate to globalization.

At the time of the founding of the World Health Organization in 1948, the average global life expectancy was 46 years. Today, life expectancy has risen to 65 years. This huge increase has come in part from a global health revolution in which public health institutions have played an important role. It has also come in part from globalization. Dramatic growth in communications, agricultural productivity, and trade has meant that a crop failure in one part of the world no longer automatically means unanswered famine and death for those involved. The past 50 years' unprecedented expansion of the global economy has resulted in a progressive decrease in the proportion of humanity - although, it should be noted, not as yet a decrease in numbers - living in absolute poverty and unable to produce or purchase the means for their survival, including their health care.

These important health gains have not, however, come without consequences. From 2 billion human beings at the start of this century, the world's population will this year surpass 6 billion. We perch today on the very crest of the largest human wave in history. This decade will see the largest cohort of children born in any decade since the beginning of the human species: nearly 1.4 billion. Even more striking, however, is the likelihood that this will be the largest generation cohort the human species will ever see. This is largely due to voluntary reductions in family size around the world that have come about as a result of the development of a growing set of contraceptive options and the expansion family planning services in almost every country. This has finally slowed the seemingly inexorable acceleration in population growth. In other words, the globalization of the norms of smaller family size, and the concurrent globalization of the means of achieving these norms, has already had a profound and positive impact.

But the price to date has been enormous. Pressures on our global ecosystem have risen both due to absolute numbers of humans and to the changing patterns of consumption that accompanies economic growth. The growth in numbers has also resulted in a dramatically changing pattern of human settlement and distribution across the face of the earth, with major consequences for health.

Urbanization rivals globalization as a fundamental trend with enormous implications for humankind. The 21st century will mark a global transition to an urbanized human race. From fewer than one third of the world's people living in cities in 1950, today half do. This proportion will rise to two thirds by 2050. At the same time, a growing proportion live in cities of over a million, and even of over 10 million.

Urbanization offers both risk and promise. We know, for instance, that urban crowding directly effects the dynamics of infectious disease transmission and its risk of explosive spread. Rapid person-to-person transmission of pathogens is facilitated by overcrowding and poor water and sanitation systems. Amplification of outbreaks and epidemics to catastrophic proportions is promoted by lowered host resistance which improves the efficiency and speed of microbial reproduction. Host resistance is heavily influenced by poverty, malnutrition, and co-infection with other diseases - the conditions prevalent in the teeming slums of developing world cities.

With more than five billion people likely to be living in these cities within the next 50 years, failure to address urban infrastructure and assure adequate standards of living will create human culture media ideal for the selection, mutation, and transmission of deadly and resistant microbes. And once these microbes have established a firm toehold in a critical mass of human hosts, no one, no matter where they live or how affluent they are, will be free of risk. We have already experienced this with AIDS, the resurgence of TB, and the spread of antimicrobial resistance; we can only guess at the infectious threats waiting to emerge.

However, cities are the breeding ground for more than disease. From the dawn of civilization, they have been a powerful force for social, political and economic change. Development is about change and the growth of opportunity, and cities have been the crucible of development. Most cities of the developing world have higher immunization coverage, lower fertility, better access to emergency obstetrical services, and better availability of basic health care than do most rural areas. And of course they have far better access to the global economy. Ultimately, cities grow because people vote with their feet, and find that opportunities for a better life are often greater there than in the villages from which they came.

Mobility is a central reality of our time. This is not without its risks. Trade and transportation contribute substantially to the growing threat of rapid global spread of infectious diseases. 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.

This highlights a fundamental change in our world reality. Over the centuries, infectious diseases have had a substantial braking effect on the economic development of tropical countries, while in temperate countries the likelihood of disease transmission was lower and economies grew more rapidly. This effect has been estimated by Professor Sachs of Harvard to account for differences of from 1 to 2 percent per year in per capita economic growth. Today, thanks to globalization, infectious diseases pose a risk to all of us. It is apparent that attention to global health is necessary for successful global economic growth.

Yet trade and transportation, for all their risks, are the cornerstones of an integrated and vital global society. Economists point out the improved efficiency that comes from countries and societies exercising their comparative advantages - of growing and producing what they are best able and buying on the world market what they need but produce less efficiently from the proceeds of their own unique bounty. They make the case that this heightening of productive efficiency is the engine of increasing economic growth which is necessary, although not sufficient, for the elimination of absolute poverty. And we all recognize the elimination of absolute poverty as one of the most fundamental changes needed to dramatically improve global health.

With more than 800 million people in the world currently lacking secure food sources, and more than a quarter of the world's children suffering from malnutrition, hunger is clearly one of the key determinants of health. Half of all child deaths and maternal deaths around the world are associated with malnutrition, which also leaves its survivors far more susceptible to infectious diseases and vulnerable to the increased metabolic demands of pregnancy and early development. And billions suffer from lifelong cognitive impairment resulting from malnutrition in childhood which affect at least a third of all people in the developing world.

In the food arena, globalization plays a growing role. We are rapidly moving away from a model of agricultural production based on local self-sufficiency and towards the commoditization of agriculture. Again, there are both clear benefits and clear risks. In principle, reducing pressures from marginal, degraded and over-farmed lands, parallel with the generation of alternative economic opportunities for the former small farmer, can be coupled with the substantial over-capacity of agriculture in many other countries to produce more food at less cost. However, if these markets are monopolized, or if those alternative opportunities for livelihood generation fail to materialize for the poor who now need to purchase rather than grow food, the risks of enormous dislocation and suffering are greatly magnified.

Challenges for constructive action

Responding constructively to the forces driving globalization requires both hard-eyed realism and an understanding of the human imperatives of equity and justice.

If globalization is historically inevitable, it is important for those of us who care about its impact on the poor to understand in detail its mechanisms of action. The old organizing principle of national norms and actions will no longer predominate, and it is likely that strictly nationally-bound structures and forces will become progressively less effective and relevant. However, the rules regulating the flow of resources, humans and ideas around a borderless world will be increasingly important.

The business community has recognized this reality, and has moved nimbly to become global in mind-set and approach. Business associations have dedicated energy and intellect to understanding the consequences of basic global policies, and to establishing global trade and financial rules responsive to their joint interests. They have seen that relatively small marginal advantages are magnified by the scale of globalization into enormous profit potential.

The public health community must organize to do the same, based on our commitment to uphold and strengthen the basic requirements of reducing the global burden of disease and realizing human potential.

This is at times framed as a battle; it does not need to be. Globalization is not synonymous with a lack of regulations directed at protecting human health and well-being. In fact, many responsible business associations would welcome a transparent and universally applied regulatory regime. This is not a matter of humanitarianism; it is a clear business fact that globalization, and its economic benefits, are likely to hit a glass ceiling if the parts of human society currently outside the global economy become progressively poorer and unhealthier. And while it may be comparatively disadvantageous for the individual corporation to take unilateral action toward protecting the interests of the poor, an even playing field does not penalize responsible action while it builds the prospects for political stability and market growth.

Any fair analysis must cede that there are numerous examples where the reality of globalization has to date fallen short of the promises of neoliberal economic theory. In some cases, economic dislocations and social disruptions have been exacerbated by the pressures imposed by exposure to a complex global marketplace which could be deciphered only by the privileged few. Clearly, what we are seeking is not the efficiency of the jungle. This is particularly salient in view of the inevitability that the unrestricted flows of goods and capital will, probably in the next 25 years, be accompanied by an unrestricted opening of human movement. Tens or hundreds of millions will migrate in search of economic opportunities. There will be no safe havens in the sea of globalization.

There is also growing recognition that globalization means that health threats will also be globalized, and that the wealthier are themselves facing increasing risk. Remarkably, in a recent poll commissioned by the Global Health Council of a representative sample of American voters, 84% said they were worried about the spread of global infectious diseases, and 90% said that fighting diseases at their source before they spread was the most important strategy. This is clear indication that we are not engaged in a hopeless battle for public opinion.

Conclusion

The forces that have driven globalization can be directed and channeled to the benefit of all humankind, not just the privileged few. This generation's human tidal wave presents us with unprecedented challenges, but if we address these challenges now, we stand a very high chance of riding the wave rather than being crushed by it. If answers can be devised to meet the needs of this generation, particularly the needs of this generation's girls and women, it will become easier to meet the needs of each successive decade's generation.

The process of globalization has been driven by possibilities unleashed by technology. However, it is also a process that can and should be shaped by human creativity and respect for the capacity and dignity of the individual. We have the opportunity to work together, in the type of loose-knit global alliance of civil society organizations bound by common principles of commitment to improved global health which fits the realities of our emerging technologies. We need to work closely with WHO as the leading normative authority for global health

References:

1)http://www.who.int

Bulletin of the World Health Organization

2) Daulaire N 1999, Globalization and health Development

3) Sutherland P 1998 Answering Globalization’s Challenges

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