Globalization: changing the public health landscape.

Abstract

In June of this year trade negotiators from developing and industrialized countries met at the World Trade Organization to discuss intellectual property rights and access to essential medicines for the poor. Several delegations included ministry of health officials, and others had been briefed by public health experts. At about the same time, at the World Health Organization, governments, businesses and nongovernmental organizations were discussing plans for a global health fund, launched earlier this year by Kofi Annan, Secretary-General of the United Nations. This fund may become the basis of a new collective approach to controlling diseases of the poor, particularly AIDS, malaria and tuberculosis. These two examples from a growing number of initiatives reflect widespread awareness of the need for domestic action within the health sector to be complemented by cross-sector and cross-border action. Only with complementary strategies of this kind will it be possible to protect and promote the health of poor populations. In a world of increasing interconnection and interdependence there is an urgent need to scale up combined activities to improve the health of those who have been left behind. It requires a new kind public health workforce with the knowledge and skills to maximize the beneficial effects of globalization on population health status, and minimize the adverse ones. This special issue of the Bulletin is another step towards informing public health professionals about the implications of globalization for their work. The articles cover a wide spectrum of points of view, from international to local, from cheerful to gloomy, from broadly generalizing to highly specific. The major unanswered public health question in this field, despite the firm views held by interested parties, is the health consequences of the economic growth engendered by the current phase of globalization. Two contrasting views appear in this issue. Dollar of the World Bank (pp. 827-833) presents evidence that economic globalization has raised the incomes of poor countries, and that this has generally benefited poor people. Cornia of the University of Florence (pp. 834-841), on the other hand, while appreciating the economic growth-promoting potential of globalization, suggests that the benefits have been restricted to a small number of countries. Importantly, he stresses that where there have been successes they have resulted from a combination of outward orientation and strong domestic regulation. He challenges the view that the impact of globalization on income distribution has been neutral. Two local case studies, on Kerala by Thankappan (pp. 892-893) and Thailand by Sitthi-amorn et al. (pp. 889-890), discuss some specific impacts of various aspects of globalization on health, and in a third, Wyn-Owen (pp. 890-891) illustrates the role of an influential nongovernmental organization in putting the issue of globalization and health high on the political agenda. Again at the local level, Evans et al. (pp. 856-862) find that cost considerations are more important than nutritional knowledge, or even personal preferences, when people shop for food. There is agreement that changes to the international architecture are required to ensure that globalization is beneficial to the poor. …