Globalization and Health
Abstract—Globalization can be defined as the free-flow of ideas, money and commodities across boundaries that have, until recently, prevented such efficient exchange. This movement is starting to blur the lines separating autonomous states, in effect resulting in an ever-growing international community. Locally, the effects of globalization permeate all facets of society; of chief concern are the inadequacies introduced to the healthcare system. Firstly, free trade and globalization can result in people, often the impoverished, being subjected to hazardous work environments which lead to chronic health issues. Secondly, the profit-driven nature of today’s healthcare industry often results in the failure to effectively relay resources and treatments to the aforementioned, only compounding their unfortunate situation. Finally, the very nature of healthcare administration faces a more general problem. Rather than one of prevention, it is characterized by the costly treatment of advanced diseases – diseases effectively preventable with early, cost-effective screening and other preventative measures. Future considerations in healthcare must be based on these socieoeconomic tendencies that leave many requiring such services in the first place.
“First, in matters of health, I believe our world is out of balance, possibly as never before in history. We have never had such a sophisticated arsenal of technologies for treating disease and prolonging life. Yet the gaps in health outcomes keep getting wider. Life expectancy can vary by as much as 40 years between rich and poor countries. This is unacceptable. An estimated 10.5 million children under the age of five die each year. At least 60% of these deaths could have been prevented by just a handful of inexpensive measures. This is not fair. Nor is it fair that more than one million people still die each year from such an easily preventable disease as malaria.” Dr. Margaret Chan, Director-General of the World Health Organization, at the International Conference on Health for Development, Buenos Aires, Argentina, August 16, 2007.
As many of us sit comfortably in well-ventilated and sanitary areas watching TV, we may oftentimes find ourselves bombarded with commercials flashing pictures of starved children surrounded by dirt and flies, their bellies swollen, indicative of the poverty and malnutrition that they face. The programs that sponsor these advertisements often request donations, so that the children may go to school, or perhaps simply obtain a proper meal. Though noble in cause, these programs often place a divide between the viewer and the impoverished child. By denoting the child as the “other,” many viewers are led to believe that their monetary contribution is the extent of their relations to the child’s dire condition. However, in today’s increasingly globalized world, this is simply not the case.
Globalization is characterized by the rapid, worldwide advance of money, resources, production, and consumer needs (Shapiro 2). This integration of socioeconomic conditions is incredibly complex, and invariably results in the coordination of an expansive network of countries into one single society, giving new meaning to the phrase “no man is an island.” The comprehensive character of globalization has not only extended across oceans and geographical areas, but also through various facets of society, where economic means define the social branches of education, health care and judiciary systems, and vice versa. Within the globalized world, international and macro-scale policies influence the body and an individual’s daily interactions without reprieve, perhaps especially evident in the commodities of health care and physical well-being. The effects of globalization in the prevention of illness and in the preservation of health have been both positive and negative, and will assuredly define the direction of the field for years to come.
The process of globalization has only intensified since the 1990s, with the effects of neoliberal policies becoming increasingly evident on the world scale. At the fundamental level, neoliberal policies are put in place in order create a “good business climate.” Those in favor of the neo-liberal state believe that these standards will consequently “foster growth and innovation and that this is the only way to eradicate and to deliver, in the long run, higher living standards to the mass of the population,” (Harvey 25). In the neoliberal context, areas of the social network like education and healthcare, which were once governed by the state, are privatized or deregulated in order to create a fertile environment for the productivity of the market. Neoliberalism can be further defined on the global scale through trade liberalization, financialization, where the financial market dominates the more traditional exchange of goods and services, and the state’s redistribution of funds for corporate benefit. All together, these practices generate an environment of “uneven geographical development…permitting certain territories to advance spectacularly at the expense of others,” (Harvey 42). The poor physical health of individuals and the broken infrastructure of the healthcare system within impoverished communities have been exacerbated by these political and economic trends.
The globalization of the market is not only evident on a world wide scale, but also on a national basis, as demonstrated by the current state of the health care system in New Orleans. Despite the fact that New Orleans is located within one of the most economically productive countries in the world, the government’s reaction to Katrina is what turned the hurricane into a disaster; the “nature of the response to Katrina – or lack thereof – is indicative of the effects of long-term disinvestment in the social wage on the part of the state and capital and their commitment to neoliberal precepts,” (Katz 18). With the state’s disinvestment in health care provision and subsidization, the people of New Orleans did not have access to adequate health care after the storm. As of March 2007, over a year and a half after the storm, the mortality rate in New Orleans was forty-eight percent higher per capita than before the storm, with many deaths rooted in preventable and treatable ailments such as diabetes and high blood pressure (U.S. House 157). These mortality rates are not entirely surprising, considering that by the middle of 2007, only one of the city’s seven hospitals was operating at its pre-hurricane level (Eaton 1).
The effect of globalization permeates through many different international levels, with the effects of uneven geographical development apparent in economic systems across the globe. Every year, hundreds of thousands of tourists are drawn to New Orleans for Mardi Gras. Over time, the exchange of beads has become a central tradition of the celebration. The production of beads, like many other goods and services within the neoliberal and globalized context, has been outsourced to countries outside of the United States in order to drive down cost of production. Thus, the tourism economy of New Orleans generates a large demand for beads on a yearly basis, giving bead-making companies in China, for example, a profitable market to participate in. Though this economic drive presents a lucrative market, the individual’s health and well being is compromised. Many Chinese workers, consisting mostly of women, are sent to work in factories in order to help support their families, who are ignored and impoverished by the power of the market. The women work more than 12 hours a day, operating dangerous machinery on little sleep. Furthermore, Mardi Gras beads are made from polyethylene and polystyrene, both petroleum products. According to the National Institute for Occupational Safety and Health, styrene itself is a narcotic and central nervous system toxin, and several animal and human studies have shown it to cause cancer when melted and inhaled (Redmon). Workers melt each bead and piece them together, one by one, inhaling toxins and compromising their health in order to drive the tourism economy of New Orleans.
Thus, many of the factors that determine physical well being and health lie outside the framework of biotechnology, genetics and public health, and within the context of social preconditions. When health is sacrificed for economic gains, the issue of medical care becomes one of human rights. And many times, the battle between the rights of economic freedom and physical well being becomes one of the wealthy versus the poor on a global scale. The activity of the World Bank demonstrates such tension, as the organization encourages private entities and health insurance to replace social services from the state, a policy that is utterly detrimental in “developing countries, where most citizens earn less than $2 a day… [and thus] limits access to care of acceptable quality and affordable prices,” (Tulchinski 625). The mortality rate of children in developing countries is also reflective of economic division. About nineteen percent of deaths in the world are of children under the age of five, and almost ninety-eight percent of these deaths occur in the developing world. A baby born in “Sierra Leone… is more than one hundred times more likely to die than a child from a developed European country,” (WHO 8). And many of these deaths are preventable, “pneumonia, diarrhea, malaria, measles, and AIDs account for about half of under-5 deaths,” (Tulchinski 613). This is not to say abnormalities in physical health do not exist outside of developing countries. While impoverished areas battle preventable ailments, developed countries with rising levels of affluence face “overeating, overdrinking, smoking pollution, illicit drugs, and motor vehicle accidents,” (Tulchinski 626).
Many NGOs and other not for profit organizations have developed in response to the dire condition of health care in the globalized, free-market economy. It is within this dismal context that the New Orleans Music Clinic has arisen. Established in 1998, the clinic provides health care to the musicians of New Orleans, who consistently work in high-risk environments, and are therefore prone to many health abnormalities. The clinic is privately funded, and its mission is to “sustain Louisiana’s musicians in mind, body, and spirit.” Clinics such as the NOMC function to catch the unfortunate many that have fallen through the cracks of the shaky, neoliberalist foundation. But the long term effects of non-governmental social safety nets are questionable. “NGOs have…proliferated under neo-liberalism, giving rise to the illusion that opposition mobilized outside of the state apparatus and within some separate entity called “civil society” is the power house of oppositional politics and social transformation,” (Harvey 28). Thus, despite the positive effect of NGOs, they may ironically act to sustain the state to which they are opposed by letting “government organizations off the hook they should be skewered on,” (Katz 27).
The future of health care is dependent on the response to these globalized trends, and the ability of international communities to work together, rather than through independent, privately funded means. The New Public Health will confront globalization in all facets by “including all health activities in any one country… What happens in the rest of the world, including the effects of globalization, is of direct interest to each country, no matter how wealthy, industrialized, or isolated,” (Tulchinski 631). Health care will not only involve physical wellness, but will also carry socioeconomic implications and legal, ethical and technological challenges across the globe. For example, eighty percent of the total burden of chronic diseases in developing countries can be accredited to twenty-three low to middle-income countries. If nothing is done to reduce the risk of these chronic diseases, an estimated eighty-four billion dollars of economic production will be lost from heart disease, stroke, and diabetes in these twenty-three countries alone between 2006 and 2015. An “additional 2 percent yearly reduction in chronic disease death rates over the next 10 years would avert 24 million deaths… and would save an estimate $8 billion, which is almost 10 percent of the projected loss in national income over the next 10 years,” (Abegunde 1929).
Contrary to what many may think, developed countries are not excluded from the interrelatedness of the economic and health transition. Industrialized countries are facing serious financial problems in terms of health care reform, as demographics and globalization have steered every advanced country toward the “perfect storm.” With advancing technology, propagated by the spread of ideas through a globalized market, and greater quality of life, the number of elderly people will rise in every developed country from thirty-five to fifty percent between now and 2020. With many programs guaranteeing care and treatment of the elderly, the cost pressure of health care will inescapably increase, yet the financial demands of health care are not limited to the elderly alone. With expensive medical advances, life-threatening illnesses are becoming chronic conditions. For example, five years ago, patients with colon cancer lived about eight months and were treated with two drugs that cost five hundred dollars. Today, colon cancer patients receive chemotherapy for $300,000 to $500,000 and live for thirteen to twenty months (Shapiro 24).
The future of health care must therefore be based in the context of globalization, and in the interconnectedness between physical well being and the structure of socioeconomic policies. While the lines dividing individual countries break down, the next generation of the medical workforce must be ready to encounter the international nature of health care on a daily basis. As demonstrated, in the globalized world of the 21st Century, no individual or country can act in isolation. The commitment to quality health care must be demonstrated at all levels, and resources, technology and information must be spread cross-culturally and internationally in order to work toward the ideal goal of “Health for All.” No longer is the diseased child on commercials an “other,” but rather a product of the globalized network of which we are all involved.
Abegunde, D. O., Mathers, C. D., Adam T., Ortegon, M., Strong, K. 2007. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet, 370:1929-1938.
Eaton, Leslie. 2007. “New Orleans recovery is slowed by closed hospitals.” The New York Times, 24 July. http://www.nytimes.com/2007/07/24/us/24orleans.html.
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Katz, Cindi. “Bad elements: Katrina and the Scoured Landscape of Social
Reproduction.” Gender, Place, and Culture, 15.1 (2008), 15-29.
Mardi Gras: Made in China. Dir. David Redmon. DVD. 2008.
Shapiro, Robert J. Futurecast : How Superpowers, Populations, and Globalization Will Change the Way You Live and Work. New York: St. Martin's P, 2008.
Tulchinsky, Theodore H., and Elena A. Varavikova. The New Public Health. New York: Academic P, 2008.
U.S. House, Committee on Energy and Commerce. Post Katrina Health Care: continuing Concerns and Immediate Needs in the New Orleans Region. Hearing, March 13, 2007 (Serial No. 110-17). Washington: Government Printing Office, 2007.
World Health Organization. 2003. The World Health Report 2003: Shaping the Future. Geneva: World Health Organization.