Monday, May 22, 2006

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Globalization is the flow of information, goods, capital and people across political and economic boundaries (Daulaire 1999; 22). 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'

Our perceptions of physical space have changed - the 'death of distance' has made the world feel smaller - more people travel, and more often (in 1950 there were 2 million international airline passengers a year; today 1.4 billion)

Our perceptions of time have changed - the communications revolution has heightened our expectations of quick turnarounds - anyone who has experience of email knows that answers are expected immediately as we no longer rely on postal systems; even remote 'backpacker' beaches in Thailand are on the internet.

The spread of ideas, cultures and values covers not simply worldwide availability of Japanese cameras, Finnish mobile phones (Nokia), Asian clothes, Colombian coffee, but also the transfer of culture through films and other media, and of political ideas - the neo-liberalism of the 1980s, which in turn fostered the health systems reform movement


I, the health and environment expert would touch on its effects on our health.

A growing poverty gap: rising health inequalities
The basic facts are known: 20% of the world's population live in absolute poverty, with an income of less than $1 per day. Surviving on less than $2 a day is a reality for almost half the people on the planet. The resulting inequalities in health outcomes are stark. Those living in absolute poverty are five times more likely to die before reaching five years of age than those in higher income groups. Life expectancy gains from the 1950s on are falling in some countries - due to AIDS and growth in poverty. In Botswana life expectancy has fallen from 70 to around 50 years. Even in rich nations socio-economic inequalities in health have grown in the last 20 years.

In many countries of the world health systems have deteriorated: access is poor, quality is poor, drugs are not available. In some low income countries over 70% of the health budget is coming from external sources.

As public health systems have broken down, so has the spread of infectious diseases become increasingly labile - hitting the poor disproportionately. Attention on emerging and re-emerging infectious diseases has risen over the past decade, partly because of growing drug resistance, partly because of new diseases such as AIDS, and partly because of self-interest: tuberculosis, for example, was described as 'conquered' in the industrialized world in the 1950s, but has re-emerged in the late 1980s. (There were also unexpected outbreaks of cholera, dengue, ebola, E.coli, diphtheria - even the dreaded plague - just to mention a few in 1997). While the response in the rich world is often couched in terms of a new threat to the health of their populations, it has drawn attention to problems which were never absent from low income and some middle income countries: TB and malaria for example, and, with a change in leadership at WHO, have led to concerted action around these diseases, as evidenced by some public-private partnerships and by campaigns such as Roll Back Malaria. Nevertheless, the balance is far from redressed.


Conclusion
Globalization is both an opportunity and a threat. We need to examine both aspects and decide what we can do. I conclude with:

Globalization may feel inexorable, but I do not subscribe to the view that there is nothing we can do about it. The shape and form of globalization is contestable, and open to local and global political challenge. We can be, and should be, researching, discussing, and acting on the threats to health, and taking advantage of the opportunities.

brought to you by: xiu (health and environment expert)
Posted by xiu at 10:14 am
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