The global context of health
Session aims
• To demonstrate how the global context
influences individual health
• To demonstrate how inequality on a global
scale affects and determines health
• To illustrate how globalisation impacts upon
health in a number of contradictory ways
Why is global health important?
• Health is bound up in global relationships; the global
context in which we are located influences our health
• The notion that we live in a global society is supported
by evidence showing that trends and relationships exist
between health and well-being in many societies
across the globe
• Individual health is increasingly conditioned and
determined by both global processes and relationships
(Yuill et al 2010)
• There are a number of health problems and issues that
require tackling on a global scale, hence the need for
global solutions
Global health challenges
• The World Health Organisation (2008c) has identified a number of
global health challenges
– One fifth of all global deaths in 2004 were children under five, often as
a result of malnutrition
– Smoking related lung cancer is the leading cause of cancer-related
death for men
– Ischemic heart disease and cardiovascular disease are the leading
causes of death in the world
– In Africa, the main cause of death amongst 15-59 year olds is the
HIV/AIDs virus. HIV/Aids is responsible for forty per cent of female
deaths in Africa
– The global burden of mental illness is also increasing, with depression
resulting in many instances of disability
– Road traffic accidents are also increasing across the globe as a result of
increased car numbers and urbanisation
Globalisation
• Godden's (2009:126) defines globalisation as ‘the fact that
we all increasingly live in one world, so that individuals,
groups and nations become ever more dependent’
• Globalisation is defined in a number of ways but it
encompasses economics as well as social and cultural
aspects and hence is important in relation to health
• The idea of an interconnected global society raises several
questions about health especially as many more health
issues are now being conceptualised as ‘global’ and
therefore in need of global solutions
• Debates continue in relation to whether globalisation is
good or bad for health
Areas where globalisation impacts
upon health (Lee 1998)
• The spread of disease within and across countries (are
epidemiological patterns changing and what implications
are there for the prevention and treatment of disease?)
• The global financing of health care (how has the
globalisation of finance influenced health care funding?)
• Global trade and production (are more regulations needed
to protect health?)
• Global information (are there inequalities in access to
health care information?)
• Global governance (who are the key players and is their
role positive in terms of improving health?)
• Global law (what global health issues need to be dealt with
via the legal system?)
Globalisation and migration
• Threats from emerging and re-emerging
infectious diseases are increased by globalisation
(Feacham 2001) and the movement of people
around the world
• Migration has resulted in ‘brain drain’; high
proportions of doctors and nurses who are
trained and educated in their own countries leave
to work elsewhere for better pay.
• Health consumers are patients are also
increasingly travelling to access medical care. This
is called health tourism
Globalisation and trade
• Bettcher & Lee (2002) discuss the negative health
impacts of financial liberalisation and trade such as the
extended marketing and promotion of harmful
products such as tobacco
• Macdonald (2007) argues that as a result of neo-liberal
globalisation, many companies have worked
unethically to increase their profits and therefore have
had a negative impact upon health
• The drive for economic growth has also increased the
consumption of processed food and cigarettes (Graham
2010)
Trade and health – global
pharmaceuticals
• The common diseases affecting lower income countries do not
attract research funding because market forces determine levels of
spending (Macdonald 2006)
• Only 5% of the money spent on medical research and development
is directed towards diseases which affect lower income countries
(Shuklenk 2003)
• In the last quarter of a century there have been 1400 new drugs
launched but only four of these were for malaria and just thirteen
for tropical diseases (Kaufmann 2007)
• The costs charged by large pharmaceutical companies for essential
medication means that those who are least able to afford such
costs are paying them (WHO-WTO 2002) or not getting access to
them
• The existence of trade agreements means that prices of some drugs
have risen to unaffordable levels (Stiglitz 2006)
Globalisation and the environment
• Globalisation is a massive threat to the
environment, causing both environmental and
health damage (Feacham 2001)
• Globalisation contributes to climate change in
several ways for example, as a result of increased
travel and pollution, the increased demand and
use of energy sources and the consumption of
products and associated waste
• Wilkinson (2005) argues that new environmental
threats are emerging through complex and
extended pathways that are global in their reach
Global inequalities
• There are massive inequalities globally in relation
to health
• Despite economic growth large variations still
exist across the globe in relation to life
expectancy
• The relationship between income and health is
complex with those living in high income
countries tending to experience much better
health and life chances than those in lower
income countries
Global poverty
• Poverty and the powerless that is associated with it negatively affect the
health of those experiencing it.
• Extreme poverty is the most serious cause of disease, with 70% of deaths
in developing countries attributable to five causes that can be easily and
cheaply combated; pneumonia, diarrhoea, malaria, measles and
malnutrition (WHO 1995).
• In 2001, the deaths of two million people could have been prevented
simply if they had been given access to uncontaminated food and clean
drinking water (Kindhauser 2003).
• Women and children bear the brunt of global health inequalities.
• In 2007, women made up sixty one per cent of HIV infections in SubSaharan Africa (UNAIDs 2007).
• Within all societies death rates are typically highest amongst the poorest.
• The global burden of disease is disproportionately experienced by those in
lower income countries
Higher death rates in poorer countries
• Africa accounts for the majority of HIV infections. Not only are the
numbers of infected individuals unequal across the globe, the
implications of such a diagnosis also vary massively according to
location, those in lower income countries have more negative
outcomes (Macdonald 2006)
• 4, 500 children die every day from preventable diseases (WHO
2007b)
• Malaria is a huge global killer, infecting one child in Africa every
thirty seconds
• Infectious diseases remain a large global problem.
• Kaufmann (2009) argues that figures are simply abstract because it
is impossible for most people to grasp the fact that fifteen million
people die as a result of infectious diseases every year
Global financing and health care
• Poorer countries have far less money available to spend on
health care, less developed health care infrastructure, staff
shortages and in many cases a lack of basic supplies such as
drugs
• Spending on healthcare is incredibly unevenly distributed
globally
• The poorest countries spend the equivalent of $11 per year
per person, compared to an average US spend of $2000
(WHO 2000)
• The thirty most developed nations (all members of the
Organisation for Economic Cooperation - OCED), are made
up of 20% of the world’s population yet they account for
90% of the world’s total health expenditure (WHO 2007b)
Low income countries and health
service provision
• People in lower income countries tend to have far less
access to modern technology and adequate healthcare and
are often reliant upon donor aid to provide health care
• Health care systems found in some lower income countries
do not perform well. Thirty five of the fifty worst health
care systems are found in Sub-Saharan Africa (Macdonald
2007)
• Just to meet the most basic of health needs, the World
Health Organisation suggests that at least $66 billion should
be invested in low income countries (WHO 2002a)
• Financing health care is a complex task associated with
managing difficult budgets and making ethically challenging
decisions
Global governance
• The forces of globalisation have led to an
increased range of global policy actors, shaping
health policy, funding and provision
• Many organisations assume a role in creating and
maintaining the conditions required for good
health and health care on a global level (Davies
2010)
• Global actors affect our abilities to improve both
national and local health too (Labonte 2010)
Key global actors
Organisation
Remit
World Health Organisation
•
•
•
•
The World Bank
• Provision of loans and grants
• Public sector reform
• Encourages user charges
The World Trade Organisation
• Promotion of free trade
International Monetary fund
• Public sector reform
• Reduced public spending i.e. on health
Non-governmental organisations
• Each has a remit e.g. The Gates
Foundation, Aid agencies, charities
Immunisations
Disease eradication
Development of primary health care
Annual world health reports
The work of global players questioned
• The overall impact of such organisations in
shaping better health outcomes has been
questioned (Fidler 2007)
• Some critics have suggested that the list of
global health priorities simply reflects the
issues that are threatening to the interests of
the industrialised western world (Ollilia 2005)
• The need to tackle social inequality remains
(CSDH 2008)
Positive global governance
• The Millennium Development Goals to deal with poverty and
inequality, to improve health, to develop a cleaner and more
sustainable environment and promote a fairer world are positive
• The goals are an attempt to promote global collective responsibility
for health threats, defined in the broadest possible sense as they
include poverty, preventable communicable disease and
environmental degradation (Davies 2010)
• The work of global health actors has also led to
– large scale vaccination schemes
– education and health promotion to try to combat the HIV/Aids
epidemic
– strategies to deal with tuberculosis and malaria (Kaufmann 2009)
– some notable successes such as the impressive global eradiation of
the smallpox virus by the WHO (Macdonald 2008)
Summary
• Globalisation as a social process is influencing health in a
number of ways, with debates about whether this is
positive or negative on-going
• The global governance of health has expanded in recent
years, with a large number of global actors working on
health issues and problems. There have been some
successes and targets are often set however, the neoliberalist framework underpinning the work of some of
these organisations does not result in positive health
outcomes for the poorest people in most instances
• There are major health problems across the globe but
these are spread unequally as inequality means that the
global burden of disease is borne by the world’s poorest
inhabitants.