Supporting Global Ecological Integrity in Public Health - Research Paper Example

GLOBAL The phenomenon of globalization is as old as organized commerce. In its early days, the wealth generated by globalization was limited to a small elite community. But as modes of transport, communication, and remote business organization advanced, it has led to sustained living standard improvements in many industrial societies. The development of monetary systems preceded and brought about early globalization, which was actually more local; soon, however, standards of weight and measure had to be developed for commerce, which could be used by empires that traded with each other. This has happened to the extent that these days the word globalization has become synonymous with efficiency, economic opportunity and overall human security, and is often contrasted against domestic protectionism and made out to be the same thing as free trade. While such developments are partially true there is also another side to the story. While the advanced nations of hemispheric West have had benign consequences as a result of globalization, key human development parameters of most Third World countries have fallen proportionately. Hence, it is difficult to present a blanket view of the impact of globalization on public health. In light of this fact, this essay will attempt to attain a nuanced understanding of globalization’s overall effect on public health outcomes across the world, looking at how globalization and free trade affect both advanced post-industrial and developing nations. This is done by way of perusing authentic scholarship on the subject, looking at such issues as globalization and how it affects public health. The litmus test for the efficiency and effectiveness of any public health system is its performance in a crisis situation. Civil societies have come to expect basic protections at the time of these crises. Such emergencies also test a government’s true ability to act under pressure. In other words, “they define a states capacity to protect its population while exposing its vulnerabilities to political upheaval in the aftermath of poorly managed crises” (Gorin, 2002). In the context of economic globalization at the turn of the new millennium, more than ever before, the general public demand transparency and accountability in global public health systems during medical and natural disasters. To gauge the robustness of public health systems in this new globalization paradigm, we need to study recent cases of acute public health emergencies and how they were seen in terms of global response. The Indian Ocean tsunami of 2004 and Hurricane Katrina are particularly relevant to this analysis. Hurricane Katrina was special in that the U.S. government and FEMA, after delaying for days in a hurried and unorganized response to the hurricane locally and nationally, accepted international aid, a rare event in modern times. Similarly, in the aftermath of the Indian Ocean tsunami, enough formal external resources prevented the public health emergency from developing into a secondary disaster. “Rapid deployment of Red Cross Movement emergency response teams prevented any major outbreak of disease from contaminated water and sewage. It was no accident that, once the tsunami hit, a strong public health emphasis from national and international aid thwarted further deaths” (Burkle, 2006). In terms of relations to globalization, these disasters show the interconnectedness of world aid, including health aid. In the instances of Hurricane Katrina and the Indian Ocean tsunami, the advantage of a globally coordinated public health arrangement comes forth. Further, as a result of globalization internal security, the authority of the state and dispensation of public health have all become intertwined. A case in point was the SARS pandemic that broke a few years ago. Contrary to the successful response to the aforementioned natural disasters, the SARS pandemic “called into question the capacity of the public health infrastructure to meet such challenges, especially when public health is compromised by economic globalization pressures” (Burkle, 2006). This goes on to prove the initial assertion that the impact of globalization on public health can only be evaluated on a case by case basis. Generalizations are usually not accurate and at times very misleading. Further on the down side, there have been attendant trends to globalization, namely their indirect effect on social determinants of health in the Third World. To elaborate, public health systems have not scaled up to meet the challenges of increasing urbanization, which is a direct consequence of globalization. The processes of urbanization, industrialization and globalization have a direct impact on issues such as sustainable development and public health (Eisenberg, et. al, 2007). Social determinants of health such as geographical location, gender, age, ethnic origin, education level, governance and socioeconomic status are all factors that determine a nation’s public health system. Statistics from World Health Report 2001 supports the veracity of this correlation. Developing nations continue to lag behind in standard of living parameters, which suggest that globalization has had no significant impact on social determinants of health in developing nations. Even as society enjoys technology aided interconnectivity, hundreds of thousands of people are still living under hostile health conditions (Taylor, 2002). While the rich nations are getting richer, complete swathes of sub-Saharan people still confront poverty, hunger, illiteracy and threat of infectious disease on a day to day basis. The biggest threat to people in this region is HIV/AIDS, an ailment that has consumes a million lives every six months in Africa, with sub-Saharan African nations bearing the brunt of this epidemic. This region, according to statistics released by Joint United Nations Programme on HIV/AIDS, is home to seventy percent of people infected with HIV worldwide. Such numbers betray the socio-political realities of the region, with its attendant failure to invest in public health projects (Kazatchkine, 2007). Many modern epidemics, including AIDS, polio, and malaria may in a few years’ time even out. But, for a developing nation, new challenges in the form of cancer, road accidents and cardiovascular disease will emerge. Further, although sufficient progress has been made in checking infant mortality rates in the Third World since the 1980s, cases of easily contagious epidemics like tuberculosis have not declined. This goes on to show that the benefits of globalization have not reached all corners of the world. The ailments mentioned in the following statistical presentation and the mortalities that result from them mostly pertain to developing and under-developed countries of the world, once called the third world. Top 10 Leading Causes of Death (2000 estimates) Ranking Specific Cause Percent of Total Deaths 1 Coronary heart disease 12.4 2 Cerebrovascular disease (stroke) 9.2 3 Lower respiratory infections 6.9 4 Unintentional injuries 6.1 5 HIV/AIDS 5.3 6 Chronic obstructive pulmonary 4.5 disease (e.g. emphysema, chronic bronchitis) 7 Perinatal conditions 4.4 8 Diarrheal diseases 3.8 9 Digestive diseases 3.5 10 Tuberculosis/lntentional injuries 3.0/3.0 Source: The World Health Report 2001 (Geneva: The World Health Organization, 2001) The former chief of the World Health Organization (WHO) agrees that there is a disconnection between wealth creation and wider access to public health as a result of globalization. This excerpt is from a speech by Dr. Gro Brundtland, the former Director-General of the World Health Organization, at the World Economic Forum on January 29, 2001, emphasizes this point. IT and communication technology is spreading, as in the modern world communication is worldwide, and, in addition, “people know what is available, and yet the dramatic gaps and lack of access become greater and greater. We must look upon the world as a shared responsibility so that we deal with the gaps and help those technologies become available for those who dont have access. Thats the only way to keep globalization from becoming really unhealthy.” (Brundtland, 2001). One can see the pros and cons of globalization in this quote, in terms of its relation to public health responsibilities. Moreover, public health authorities across the world have concentrated more on such pediatric areas as polio, malnutrition, malaria, etc and have made impressive progress. For example, there is already evidence that people are living longer lives across the socio-economic spectrum. The downside is “exposure to numerous new health threats more commonly associated with old age, namely cancer and heart disease. In India, for example, deaths from heart attacks, cancer, and other non-communicable diseases are projected to double from 4 million a year in 1990 to 8 million a year in 2020” (Levy & Sidel, 2006). Such is the paradox of globalization that during the same period, family-planning initiatives have found wide acceptance. In the last two decades, the usage of contraceptive devices has increased exponentially in many under-developed countries. The birth rates have declined by 15% as a result. This can have negative consequences for these nations in the long term. In a decade or two they may confront the same “demographic imbalance” that the western world presently faces. This would mean that societies in the future will have disproportionately high percentage of elderly men and women who do not contribute to the growth of economy (Levy & Sidel, 2006). Globalization had affected all allied fields of public health, such as medicine, ethics and human rights. The relationships among these fields are also evolving in response to the new circumstances, events and experiences created by globalization. Alongside epidemics such as HIV/AIDS, many women’s health issues are also brought to light by “the complex humanitarian emergencies of Somalia, Iraq, Bosnia, Rwanda, and now, Zaire” (Levy & Sidel, 2006). From among several aspects of globalization, three of them assume more significance. Firstly, human rights issues and action have become more closely allied to, and have become an integral part of public health work. Next, new standards of public health ethics have gained acceptance. Thirdly, human rights-related duties and responsibilities of healthcare professionals, including doctors, are receiving increased attention (Levy & Sidel, 2006). Globalization does not just affect healthcare, but other domains as well. The globalization of agriculture has accelerated with newer technologies in the realm of molecular biology. It has both advantages and disadvantages. On the positive side, this has led to increased food security over the last few decades. As a result hunger and starvation have declined. But the question to be asked is not if hunger and starvation have declined (Kazatchkine, 2007). The significant question is: Have they declined proportionate to the production capabilities afforded by newer technologies. The answer is sadly, no. According to von Braun (2001), the chief reason for being very disappointed with the progress in food security is that “such progress has at best followed past patterns and trends but does not at all correspond to the tremendous opportunities offered by the new global wealth and technology.” However, there are opportunities to meet the challenge of the future. Globalization has also affected economics. Most people agree that we are living in an increasingly global society in which national barriers are often less important than the propagation of a type of hegemonic, non-national capitalism that is global by nature It seems to many to be an age of disappearance of traditional boundaries and expansion of international opportunity, especially in the export of goods and services. Nevertheless, the world is not a place in which free and unrestricted trade is universally recognized by all nations, as evinced by the bitter battles currently raging between protectionist and free-trade advocates over globalization. Opponents of free trade represent one key problem faced by global trade deregulation, and they have many arguments, many of which are quite possibly valid. If global trade deregulation is to be implemented by an individual, compromises would most likely need to be made regarding some of the finer points of beneficial trade barriers in specific situation. For non national actors the process of global deregulation could take a long time. The positive nature of this type of deregulation is often emphasized, highlighting the optimal nature of free trade for the individual non national actor or consumer, who often pays for protectionism, but obstacles also must be assessed in terms of efficiency and the effects of such deregulation on the world marketplace into which the actor is often flung. “We are seeing increased demands for solutions that leverage application outsourcing, business process outsourcing and offshore delivery to achieve significant cost reductions and business improvement” (Devraj). The argument for and against outsourcing is basically a reflection of bigger argument about theoretical issues of protectionism and globalization. Those who are proponents of free trade tend to view the regulation or blockage of cost-effective outsourcing as being prohibitive and over-protective of national interests that may or may not be motivated by government revenue rather than industrial or technological capacity. They state, for example, that free trade enables people to sell their goods to those who are willing to pay the highest price for them, and thus capture a larger proportion of the value of the product. The public is also not subject to sudden mark-ups often engendered by protectionism in a free-trade global marketplace. Those who are proponents of regulation would add that in certain situations, protection is necessary for the growth of industrial and technological capacity. Economics, as well as healthcare, is affected by globalization. Community healthcare works in a different way than a system with a business model in which profit is the main concern. In terms of corrective action, the best global plan is to base conclusions on the quality of care received by the patient. This, not the financial bottom line, should be the main goal of corrective action in healthcare: to correct lapses in treatment of the patient, which also relates to cost effectiveness because if the patient is not satisfied or treatment is shoddy and quality of care is low, the patient is going to be in a position of caveat emptor and the healthcare organization is just going to pay attention to premiums instead of offering premium service to all, not just who can afford it. Special community access and outreach programs only began to become more widespread in the latter half of the 20th century and the early 21st century, as the public perception of institutions began to change and worldwide, governments began to shift the parameters used for classifying disabilities. A shift towards community based health programs became more popular, especially for high-functioning individuals, and community services became more widespread as well, leading to a decrease in the number of functioning individuals with disabilities being constrained to institutional life. This gradually progressive process is spoken of in terms of deinstitutionalization as well as globalization, socialization, and the inclusion of the community healthcare model that seeks to place people in a stable environment. Often, the stability of this environment is relevant to the community. In terms of the final analysis, it is apt to say that the positive effects of globalization have not reached everyone. In the world of today, with rapid progress in communication and transportation, diseases can travel quickly across geo-political borders. In this scenario, contagious diseases can quickly assume epidemic proportions. Health problems can no longer be segregated into local and foreign. As close to two million people travel across national borders each day, a more comprehensive and inclusive approach to the health of general public is called for. It is relevant to note that modern diseases such as cardiac problems, diabetes and cancer have risen in frequency in the era of globalization. This means that the new economic organization of the world has imposed unhealthy lifestyles on people. But there is nothing inevitable about these negative consequences. If the engines that drive globalization can be efficiently tapped into, they can lead to a more egalitarian and healthier global society (Tabb, 2001). As an acknowledgement of the injustices and disadvantages induced by globalization, a consensus is emerging within the international community toward the formation of a more equitable global health system. Such conceptions as the international development targets, which were discussed in recent WHO meetings try to deal with diseases of poverty head on. Simultaneously, there has been a growing concern from private corporations to involve themselves in civil society organizations. The global health initiative is a product of these developments. If implemented properly, we may see a more equitable global health system in the not-distant future. But for this dream to be fulfilled, private corporations and government health agencies need to put in concerted and coordinated efforts based on shared values. In these times of radical change to economic organization of the world, the need to build bridges between medicine and public health and between ethics and human rights become all the more important (Lietz, 2006). REFERENCE Birdsall, N. (2003, Spring). Asymmetric globalization. Brookings Review, 21, 22. Braun, J. V. (2001, September/November). "Good" Globalization. UN Chronicle, 38, 54. Brown, V. A., Grootjans, J., Ritchie, J., Townsend, M., & Verrinder, G. (Eds.). (2005). 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