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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.