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Globalization is one of the key challenges
facing health policy makers. Globalization is the
intensification of global flows of capital, trade, information,
knowledge, culture and people across country borders.
While there is a growing literature on the
importance of globalization for health, there is no consensus
either on the pathways and mechanisms by which globalization affects the health of populations or on the appropriate policy
responses. There is, however, an increasing tension between the
new rules, actors and markets that characterise the modern phase
of globalization and the ability of countries to protect and
promote the health of their populations.
The Department of Health in Development is
using a new framework for analysing globalization, especially
its economic aspects. This framework identifies the pathways by
which globalization impacts on health and appropriate policy
responses.
Outline Conceptual Framework for
Globalization and
Health
The relationship between the three processes
of globalization is circular: increasing flows stimulate the
development of global rules and institutions, which promote the
opening of economies, which increases the scale and scope of
cross-border flows. The globalization process is influenced by a
number of driving and constraining forces: technological
developments, political influences, economic pressures, changing
ideas, and increasing social and environmental concerns. The
framework emphasises that the indirect effects of globalization operating through the national and household economies are
important for health outcomes, as well as the more obvious and
direct effects on health risks and the health sector.
There are multiple direct and indirect
linkages between globalization and the proximal determinants of
health. This model highlights five key linkages from globalization
to health; three direct effects and two which
operate through the national economy. The direct effects include impacts on health systems and
policies operating directly (e.g., the effects of the WTO
General Agreement on Trade in Services (GATS)) and through
international markets (e.g., the effect on pharmaceutical prices
of the WTO Agreement on Trade-Related Aspects of Intellectual
Property Rights (TRIPs)); and direct effects on other influences
on health at the population level (e.g., cross-border
transmission of infectious disease, and marketing of tobacco).
The second category includes effects operating through the
national economy on the health sector (e.g., effects of trade
liberalisation and financial flows on the availability of
resources for public expenditure on health, on the cost of
inputs,); and on population risks (e.g., the effects on
nutrition and living conditions mediated by impacts on household
income).
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