Globalization and Public Health. Dr Saman Waqar

Transcription

1 Globalization and Public Health Dr Saman Waqar

2 Definition of globalization A strong and complex global exchange of goods, services, finance, productivity and people. A free, comprehensive and fast movement, exchange and transfer of information, knowledge, finances, goods, services and people between national economies globally.

3 A process that is changing the nature of human interaction across a wide range of spheres (social, economic, political, cultural, technological and environmental)

4 The process is known as global because traditional boundaries separating individuals and societies have become increasingly eroded. These include state boundaries, boundaries dividing different social(health, education) and economic (manufacturing, services) sectors and religious and cultural beliefs seem to be eroded.

5 For economists, globalization is an emerging global economy For international lawyers, it is threatened changes to the legal status of the states and their citizens, For information technologists, it is a global information network For researchers, it is a potential creation of a global culture through e.g. mass media

6 This global change is occurring in three dimensions: a. Spatial dimension: concerns changes in how we experience and perceive physical space. There is a growing sense of the world as a single place as a result of increased travel, communication, trade and other shared experiences.

7 b. Temporal dimension: concerns to the actual and perceived time in which human interaction occurs. In many ways there seems to be a speeding up of time frames e.g.in communication, the development of satellite technology, internet and allows messages to be sent and received in microseconds. There is also intensification of human contact where people are moving around more often via tourism, commuting, business and migration.

8 c. Cognitive dimension: concerns changes to how we think about the world and ourselves. A variety of thought processes e.g. the creation and exchange of scientific knowledge, ideas, norms, beliefs, values, cultural identities are affected by globalizing forces. These forces are varied and include the mass media, educational institutions, think tanks, scientists, consultancy firms, public relations offices and international organizations.

9 On one hand, there is great sharing of thoughts and growth of popular global culture, widespread dissemination of scientific research and adoption of international agreements (human rights, environmental protection and reproductive health). On the other hand, there is resistance to the global spread of thought processes. e.g. resurgence of religious fundamentalism and assertion of ethnic identities.

10 Conceptual model for globalization and health Global governance structures, global market and its communication, diffusion of information, global mobility, cross cultural interaction and global environmental changes are important contextual level of health determinants that influence the distal factors such as health related policies, economic development, trade, knowledge and provision of ecosystem goods and services.

11 In turn, these changes in distal factors have the potential to affect the proximal health determinants and consequently health.

12 Multi-nature and multi-level framework for population health

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14 To understand the conceptual framework in which globalization works, the basic features of the overall process of globalization have to be understood, which consists of: The new global governance structure - globalization generally affects the independence of the sovereignty of national states adhering to the principles and management structures on the global level; World markets - globalization is characterized by changes on global level in the economic structure, world markets and global trading system;

15 Global communication and information dissemination - globalization greatly influences the dissemination of information and exchange of experience on all kinds of problems; Global mobility - is significantly increased. Diversity of cultures- globalization significantly affects the occurrence of interactions between the elements of culture, globally, as well as at the local level, and

16 Global changes in the environment pose a constant threat to the ecosystem, including climate changes, loss of biodiversity, global damage to the ozone layer, and a significant reduction in the natural environment.

17 There are complex linkages between globalizing forces,determinants of health and public health. Some key concerns of public health and the potential impacts of globalizing forces on them are:

18 1.Communicable diseases Continue to account for a large proportion of the global burden of disease especially in low income countries. Since mid 1990 s, these has been renewed attention given to these as emerging and reemerging diseases, after several decades of relative complacency. Globalizing forces are allowing certain diseases like T.B,malaria and cholera to become serious threat to public health once again.

19 These new diseases or strains are emerging as a result of deforestation, water pollution and anti-microbial resistance. Public health is also at risk due to increased mobility of humans, plants and animals across national borders e.g. malaria, influenza, dengue fever, hepatitis B and HIV.

20 Public health officials must rethink existing approaches to preventing, controlling and treating communicable diseases towards a more global perspective. Measures to strengthen national, regional and global surveillance and monitoring will need to focus on building strong capacity across all countries, notably in low income countries.

21 2.Non communicable diseases Large majority of deaths in wealthier countries are due to CVDs, cancers and respiratory diseases especially tobacco related diseases. As the tobacco products markets are shrinking in US and Europe, companies have strategically targeted new markets in Asia and Africa. Tobacco related morbidity and mortality incurs direct and indirect costs that far outweigh any economic gain from employment and taxation.

22 Public health has tackled this issue by health education campaigns assisted by higher taxation of tobacco products and regulation of advertizing and sales. However these efforts have limited effects on global industry advantaged by the marketing budgets and influential links with governments. To promote a variety of measures to reduce production and consumption around the world, WHO s Tobacco free initiative was initiated in 1998.

23 CVD,s, cancers and diabetes are closely related to poor nutrition, obesity and sedantry lifestyles which are contributed by marketing via mass media. Global rise in the rate of TV viewing has been linked with decline in physical activity. Children have been particularly vulnerable to these increasingly globalized lifestyle messages, from marketing of breast milk substitute and widespread promotion of processed and convenient foods.

24 Depletion of ozone layer is leading to rising incidence of skin cancers,asthma and air pollution leading to mental retardation in children due to lead ingestion. Increased work place insecurity,work loads and unemployment are part of new global division of labor.

25 3.Food and Nutrition During the 20 th century, food became an increasingly global industry dominated by multinational companies. There are a number of public health issues raised by global food industry. In agriculture and livestock sector, there has been a trend towards greater production with the availability of fresh fruits and vegetables at all times of year.

26 This has resulted in lower per unit cost and lower costs for the consumers and more support for the livelihood of many poor farmers in lower income countries. Modern production methods have also involved practices such as widespread use of pesticides and genetic modification etc.

27 There is a public health risk from this highly integrated food industry and difficulties are faced by national public health systems of controlling a globally distributed food hazard. Another major concern to public health is increasing incidence of obesity due to unhealthy life styles, global marketing and social trends. Efforts at health promotion and education must not only address lifestyles and patterns of behavior locally but need to tackle global influences in the way we live.

28 4.Environmental health Global environmental conditions and changes can be seen to have short term and longer term effects on public health. Short term effects often derive from natural and man made disasters that can create public health emergencies because of lack of food, water, sanitation and basic care. Displaced populations can migrate into neighboring countries and can destabilize local communities.

29 Sudden and mass migration of people can lead to environmental damage and can create serious health risks as cholera and dysentery etc. Longer term impacts of global environmental change includes nuclear accident at Chernobyl in Ukraine which, in addition to immediate health effects on local communities, illustrates long term and geographically widespread effects of environmental damage on human health including contamination of grazing lands.

30 Global climate change as a result of greenhouse effect, is the most profound longterm change, with average world temperature expected to increase by C over the next century.

31 5.Globalization of health care organizations There is a debate regarding the extent to which health care organizations are changing as a consequence of globalization. Some argue that national health systems remain largely national in terms of service delivery, health care workers, training and regulation, others observe a trend towards an increasingly trans border provision of health care through physical migration of health professionals and development of telemedicine.

32 There are clear changes along cognitive dimensions(how we think about health care). Globalization of information technology has enabled public health professionals to exchange knowledge and experience with dissemination of certain values, beliefs and practices in health care. Sensitivity to the appropriateness of health care practices to other national settings and feasibility of transferring them from relatively affluent settings to those with limited resources is certainly important.

33 6.Public health policy To a larger extent, policy changes have been a reflection of national circumstances and health needs, however the global flow of ideas, values and beliefs about health, health care and health policy has also strongly influenced policy making in both higher and lower income countries.

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35 What can health professionals do? The effect of globalization on health is both positive and negative. The specific balance between the two depends on the individuals or population groups concerned as globalization is a social force, created and controlled by human beings.

36 The key challenge is to manage globalization processes better than they have been managed in the past. This means recognizing that globalization does not have a predetermined trajectory, but is taking a particular form that favors certain interests while disadvantaging others. For globalization to be both socially and environmentally sustainable in the long term, we need a better balance.