Combining health and social protection measures to reach the ultra ...
Combining health and social protection measures to reach the ultra ...
Combining health and social protection measures to reach the ultra ...
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Access <strong>to</strong> <strong>health</strong><br />
The diverse pathways from<br />
globalization <strong>to</strong> <strong>health</strong><br />
Article by Maud MTE Huynen (pictured), Pim Martens <strong>and</strong> Henk BM Hilderink<br />
Achieving good <strong>health</strong> has become an accepted<br />
international goal. In our attempts <strong>to</strong> realize this goal,<br />
however, we have <strong>to</strong> recognize that our (future) <strong>health</strong><br />
increasingly depends on <strong>the</strong> globalization process. This was,<br />
for example, clearly demonstrated by <strong>the</strong> rapid global spread<br />
of SARS in 2003. On <strong>the</strong> o<strong>the</strong>r h<strong>and</strong>, <strong>the</strong> growing global<br />
interconnectedness also means that we have more capacity<br />
than ever before <strong>to</strong> respond <strong>to</strong> such <strong>health</strong> treats. Due <strong>to</strong> <strong>the</strong><br />
increasing geographical scale of important <strong>health</strong> issues, <strong>the</strong><br />
call for a global approach <strong>to</strong> <strong>health</strong> becomes stronger. What<br />
this exactly means, however, remains unclear 1 . The multiple<br />
pathways from globalization <strong>to</strong> <strong>health</strong> are surrounded by<br />
uncertainty 2 . In <strong>the</strong> resulting polarized debate about <strong>the</strong><br />
<strong>health</strong> effects of globalization, it is difficult <strong>to</strong> discuss how<br />
globalization should move forward 3 . In order <strong>to</strong> improve our<br />
underst<strong>and</strong>ing of <strong>the</strong> diverse pathways from globalization <strong>to</strong><br />
<strong>health</strong>, we describe a conceptual framework for <strong>the</strong> effects of<br />
globalization on population <strong>health</strong> 2 .<br />
Conceptual framework for globalization <strong>and</strong><br />
<strong>health</strong><br />
Health can be perceived as <strong>the</strong> integrated outcome of its<br />
multidimensional determinants 4 . The nature of <strong>the</strong>se<br />
determinants (institutional, economic, socio-cultural <strong>and</strong><br />
environmental) <strong>and</strong> <strong>the</strong>ir level of causality (proximal, distal<br />
<strong>and</strong> contextual) can be combined in<strong>to</strong> a basic framework that<br />
conceptualizes <strong>the</strong> complex multi-causality of population<br />
<strong>health</strong>. Figure 1 <strong>and</strong> Table 1 provide an overview of <strong>the</strong> wide<br />
range of <strong>health</strong> determinants that can be fitted within this<br />
framework 2 . This framework illustrates <strong>the</strong> broader context<br />
within which <strong>the</strong> <strong>health</strong> of a population develops.<br />
Globalization is increasingly perceived as a comprehensive<br />
phenomenon that is shaped by a multitude of fac<strong>to</strong>rs <strong>and</strong><br />
events, <strong>and</strong> that is reshaping our society rapidly. Based on <strong>the</strong><br />
work by Scholte 5 , Held et al. 6 <strong>and</strong> Rennen <strong>and</strong> Martens 7 , we<br />
define globalization as “a process characterized by a growing<br />
intensity, extensity <strong>and</strong> velocity of institutional, economic,<br />
Economic<br />
determinants<br />
Economic<br />
infrastructure<br />
Economic<br />
development<br />
trade<br />
Socio-cultural<br />
determinants<br />
Culture<br />
population<br />
<strong>social</strong> infrastructure<br />
Knowledge<br />
<strong>social</strong><br />
interactions<br />
Institutional<br />
determinants<br />
Institutional<br />
infrastructure<br />
Health policy<br />
<strong>health</strong>-related<br />
policy<br />
Health<br />
services<br />
–<br />
Socio<br />
environmental<br />
lifestyle<br />
Population<br />
<strong>health</strong><br />
Physical living<br />
environment<br />
food & water<br />
Ecosystem<br />
goods & services<br />
Ecological<br />
settings<br />
Environmental<br />
determinants<br />
Contextual<br />
determinants<br />
Distal<br />
determinants<br />
Proximal<br />
determinants<br />
Figure 1: Multi-nature <strong>and</strong> multi-level framework for population 2<br />
Global Forum Update on Research for Health Volume 4 ✜ 067
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