Globalization-Is it good for your health?

Globalization-Is it good for your health?

Bernhard H. Liese

International Health Department

NHS, Georgetown University

March 6, 2007

Defining GlobalizationDefining Globalization

• Globalization is a “catch-all” phrase

• Quantitative definitions focus on intensity of interactions: economic measures, physical or cultural connectedness

• Qualitative definitions focus on the nature of the interaction: urbanizing, consumerist, human ecology, change of perspective

Globalization is not exactly new!Globalization is not exactly new!

• Trade and migration always bound people together

• Globalization’s first wave:The Industrial Revolution 1870 to 1917

• Isolation phase 1917 to 1950

• Globalization’s second wave 1950 to 1980

• The third wave:Globalization today 1980 to present

Globalization TodayGlobalization Today

The third wave’s pace and intensity have

virtually annihilated time and distance

Today’s ChallengesToday’s Challenges

• Balancing benefits of global integration against new forms of social exclusion

• Making globalization work for the poor: The controversy about growing income inequalities

• “Openness to trade” as a means to give the poor a bigger stake in global prosperity

H5N1 – Avian FluH5N1 – Avian Flu

Grand Princess vs. U.S. CapitolGrand Princess vs. U.S. Capitol

Emerging DiseasesEmerging Diseases

Hypothetical Flu Pandemic vs. 1968 Flu Pandemic

Hypothetical Flu Pandemic vs. 1968 Flu Pandemic

Conceptual Framework Conceptual Framework

A. International transfer of health risks• Infectious diseases and international travel• Risks associated with transfer of lifestyles• Health and safety standards

B. Globalization of health care services• Movement of health providers (incl. “brain drain”)• Health tourism• Cross border establishment of facilities

C. International governance• The major players: WTO, WB, IMF, WHO

The Nutrition TransitionThe Nutrition Transition

• Rising incomes mean higher fat diets

• Shift from local foods towards mass-produced, processed, convenient, inexpensive foods

• Increase in saturated fats, trans-fatty acids and salt

• Obesity increased 50% over the past seven years, affecting 18% of the global population (WHO)

“McWorld”“McWorld”

Fast food factoids – McDonalds

• Five new restaurants per day

• $1 billion spent on advertising per year

• Largest purchaser of beef worldwide

• Runs more playgrounds then any other private entity

TobaccoTobacco

• Leading cause of preventable deaths in the world today (5 million deaths per year)

• Doubling by 2020

• Tobacco consumption falling in industrialized countries

• Rapidly rising in the developing world due to aggressive marketing

• Reduction of trade barriers allows multinationals access to new markets

Occupational Hazards:The Silent Epidemic

Occupational Hazards:The Silent Epidemic

• 16 people in the U.S. will go to work today and will not come home

• 260 in China

• 1.1 million deaths worldwide each year from workplace accidents and work-related diseases

• Manufacturing shifting to low wage, unregulated environments – “race to the bottom”

North-South Trade in Health Services

North-South Trade in Health Services

• Medical tourism

• Movement of health professionals – “brain drain”

• Direct investment in facilities and services in middle income countries

Asia’s Exploding Medical Tourism

Asia’s Exploding Medical Tourism

• India: Average 15% growth over

the past five years

• Malaysia:175 000 health tourists in 2000; tripled in 2003

• Thailand: Cost of bypass surgery 30% of U.S.

Medical Tourism – Malaysia Medical Tourism – Malaysia

Source: Malaysia Ministry of health; Health tourism report October 2003

Breakdown of Health services provided by private hospitals to health tourists in 2001, 2002, and 8 months of 2003

International Migration of Health ProfessionalsInternational Migration of Health Professionals

• Serious problems for Africa• Kenya retained only 20% of physicians trained• Zambia and Ethiopia lost 50% of physicians• Ghana lost 2,500 nurses to Europe (1999-2003)• 600 Ghanaian medical practitioners are

working in New York

• “Carousel effect”

Governance – WHOGovernance – WHO

• International Treaty for Tobacco Control• Regulates advertising, packaging, exposure to

smoke and illicit trade• Treaty came into force Nov. 2004• Binding for signatories – EU signed Jan. 2005• First international treaty brokered by WHO

• New International Health Regulations• Adopted May 2005

Governance – WTOGovernance – WTO

• WTO established in 1995, replaced General Agreement on Tariffs and Trade (GATT)

• Regulates multi-lateral trading system

• Four relevant agreements that influence public health – TBT, SPS, GATS and …

• TRIPS (Trade-Related Intellectual Property Rights) – The most contentious one

The TRIPS AgreementThe TRIPS Agreement

• Minimum standards of IPRs protection

• “Transitional arrangements” for “developing” and “least developed” members

• IPRs protection balanced with public health needs

• Aggressive and unjustified interpretation of TRIPs by Pharma industry led “developing members” to demand WTO affirm the right to use the “flexibilities”

The Doha DeclarationThe Doha Declaration

• Confirms the TRIPS Agreement does not limit the grounds on which WTO members may issue compulsory licenses

• Each member determines whether a national emergency or circumstance of extreme urgency exists

• Members are free to permit “parallel importation” of medicines

• Provides maximum flexibility for least developed members to dis-apply patents at least until January 1, 2016

ConclusionConclusion

• Ensuring the “public’s health” has been a key function of the nation state;Today, executing this function effectively requires a global perspective.

• “New global health governance challenges” need to be addressed by the international community