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Access to health socio-cultural and ecological interactions, resulting in transborder processes and effects” 2 . In order to focus the conceptual framework, however, the following important features of globalization are identified: ✜ global governance structures; ✜ global markets; ✜ global mobility; ✜ cross-cultural interaction; ✜ global environmental changes. Based on Figure 1 and Table 1, it can be concluded that these features all operate at the contextual level of health determination, influencing the distal health determinants. In turn, the changes in distal factors have the potential to affect the proximal determinants and, consequently, health. Figure 2 links the above-mentioned features of the globalization process with the identified health determinants 2 . Globalization and distal health determinants Figure 2 shows that the processes of globalization can have an impact on the identified distal health determinants. Below, the implications of the globalization process on these distal determinants will be discussed in more detail. Health (-related) policies Global governance structures are increasingly gaining importance in formulating health (-related) policies. Important institutions in global health governance include the World Health Organization (WHO) and the World Bank (WB) 8 . The latter plays an important role in the field of global health governance, as it acknowledges the importance of good health for economic development and focuses on reaching the Millennium Development Goals. The WB also influenced health (-related) policies together with the International Monetary Funds through the Structural Adjustment Programmes 9 and the Poverty Reduction Strategy 10 . In addition, the policies of the World Trade Organization (WTO) are also increasingly influencing population health 9,11,12 . Fidler 13 argues that “from the international legal perspective, the centre of power for global health governance has shifted from WHO to WTO”. Opinions differ with regard to whether WTO agreements provide sufficient possibilities to protect the population from the adverse (health) effects of free trade or not 14 . In Level/ Nature General determinants More detailed determinants Contextual level Institutional Institutional infrastructure Governance structure Political environment System of law Regulation Economic Economic infrastructure Occupational structure Tax system Markets Socio-cultural Culture Religion Ideology Customs Population Population size Structure Social infrastructure Environmental Ecological settings Ecosystems Climate Distal level Geographical distribution Social organization Knowledge development Social security Insurance system Mobility and communication Institutional Health policy Effective public health policy Sufficient public health budget Health-related policies Effective food policy Effective water policy Effective social policy Effective environmental policy Economic Economic development Income/wealth Economic equity Trade Trade in goods and services Marketing Socio-cultural Knowledge Education and literacy Health education Technology Social interactions Social equity Conflicts Travel and migration Environmental Ecosystem goods and Habitat services Proximal level Information Production Regulation Institutional Health services Provision of and access to health services Economic – – Socio-cultural Lifestyle Healthy food consumption patterns Alcohol and tobacco use Drug abuse Unsafe sexual behaviour Physical activity Stress coping Child care Lifestyle-related endogen factors (blood pressure, obesity, cholesterol levels) Social environment Social support and informal care Intended injuries and abuse/violence Environmental Food and water Sufficient quality Sufficient quantity Sanitation Physical living environment Table 1: Determinants of population health 2 Quality of the living environment (biotic, physical and chemical factors) Unintended injuries 068 ✜ Global Forum Update on Research for Health Volume 4
Access to health 2001, WTO ruled that the French ban on the import of all products containing asbestos was legal on health grounds, despite protests from Canada 15,16 . However, protecting citizens against health risks in cases of scientific uncertainty is still difficult, as WTO is reluctant to accept precautionary trade restrictions 17 . Economic development Opinions differ with regard to the economic benefits of economic globalization. On one side, “optimists” argue that global markets facilitate economic growth and economic security, which would benefit health (e.g. Frankel 18 , Ben David 19 , Dollar and Kraay 20 and Feachem 21 ). On the other side, “pessimists” are worried about the health effects of the global market. Baum 22 states that “the current forms of globalization are making the world a safe place for unfettered market liberalism and the consequent growth of inequities…posing severe threats to people’s health”. The 2005 Human Development Report 23 argues that one of the prevailing “myths” of economic globalization is that open markets will result in an era of convergence; trade liberalization “has done little to slow down the marginalization of sub-Saharan Africa” and the current “trading system favours the developed world”. In fact, notwithstanding some spectacular growth rates, especially in East Asia, incomes declined between 1965 and 1997 in 16 of the world poorest countries 24 . Trade Due to the establishment of global markets and a global trading system, there has been a continuing increase in world trade. According to the WTO, total trade multiplied by a factor of 14 between 1950 and 1997 25 . More recently, the year 2004 saw an impressive growth in trade, which exceeded average growth recorded over the preceding decade 26 . Today all countries trade internationally and they trade significant proportions of their national income. The array of products being traded is wide-ranging; from primary commodities to manufactured goods. Besides goods, services are increasingly being traded as well 27 . In addition to legal trade transactions, illegal drug trade is also globalizing. Social interactions: migration Due to the changes in the infrastructures of transportation and communication, human migration has increased at unprecedented rates. According to Held et al. 27 , tourism is one of the most obvious forms of cultural globalization. However, travel for business and pleasure constitutes only a fraction of total human movement. Other examples of people migrating are missionaries, merchant marines, students, pilgrims, militaries, migrant workers and Peace Corps workers 27,28 . Besides these forms of voluntary migration, resettlement by refugees is also an important issue. The UN Population Division estimates the global migrant population in 2005 at between 185 and 192 million people 29 . However, the concerns regarding the economic, political, social and environmental consequences of migration are growing 30 and many governments are moving towards more restrictive immigration policies. Social interactions: conflicts In the aftermath of the terrorist attacks on September 11 2001, many questioned the possible links between globalization and the risk on conflicts. On the one side, globalizations can decrease the risk on tensions and conflicts, as societies become more dependent on each. Others argue that the resistance to globalization has resulted in religious fundamentalism, and worldwide tensions and intolerance 31 . According to Huntington 32 , the increasing cross-cultural interactions will result in a “clash of civilizations”. Nassar 33 describes globalization as a process that leads to a “migration of dreams” in which the world’s poor are able to learn of the luxuries of the western world; the increased degree of relative deprivation results in growing tensions. In addition, Zwi et al. 34 identify several other factors that are associated with both globalization and the risk of conflicts, such as increased global trade in arms and inadequate policies. Social interactions: social equity and social networks Global communication, global mobility and cross-cultural interaction can also influence cultural norms and values about social solidarity and social equity. It is feared that the self-interested individualism of the marketplace spills over into cultural norms and values resulting in increasing social exclusion and social inequity. Exclusion involves disintegration from common cultural processes, lack of participation in social activities, alienation from decisionmaking and civic participation and barriers to employment and material sources 35 . On the other hand, however, the geographical scale of social networks is increasing due to global communications and global media. Like-minded people are now able to interact at distance through, for example, the Internet. The women’s movement, the peace movement, organized religion and the environmental movement are good examples of transnational networks 27 . The digital divide between poor and rich, however, can result in social exclusion from the global civil society. Knowledge The knowledge capital within a population is increasingly affected by global developments in communication and mobility. The term “globalization of education” suggests getting education into every nook and cranny of the globe. Millions of people now acquire part of their knowledge from transworld textbooks. Most universities work together with academics from different countries, students have ample opportunities to study abroad and “virtual campuses” have been developed. In addition, television, film and computer graphics have greatly enlarged the visual dimensions of communication. Many people today “read” the globalized world without a book 36 . Overall, it is expected that these developments will also improve health training and health education (e.g. Feachem 21 and Lee 37 ). Ecosystem goods and services Global environmental changes are affecting the provision of ecosystem goods and services to mankind. The Global Forum Update on Research for Health Volume 4 ✜ 069
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Global Forum Update on Research for
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Editorial Advisory Board: Luis Gabr
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Contents 096 Child immunization: ac
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Introduction Research contributions
Page 9 and 10: Introduction Type I Type II Type II
Page 11 and 12: Introduction making), takes account
Page 13 and 14: Access to health Strengthening heal
Page 15 and 16: Access to health raising public awa
Page 17 and 18: Access to health Recent trends in r
Page 19 and 20: Access to health districts with a p
Page 21 and 22: Access to health Understanding heal
Page 23 and 24: Access to health This study investi
Page 25 and 26: Access to health References continu
Page 27 and 28: Access to health combining particip
Page 29 and 30: Access to health 2002 2005 Diff. SU
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Page 33 and 34: Access to health Americans think th
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Page 39 and 40: Access to health Open access to res
Page 41 and 42: Access to health References 1. Rose
Page 43 and 44: Access to health national and globa
Page 45 and 46: Access to health Senior Research Fe
Page 47 and 48: Access to health ✜ Rights alone a
Page 49 and 50: Access to health meaningful communi
Page 51 and 52: Access to health Inequality, margin
Page 53 and 54: Access to health questions, develop
Page 55 and 56: Access to health reasonable in abou
Page 57 and 58: Access to health References 1. Kohn
Page 59: Access to health The diverse pathwa
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Page 67 and 68: Innovation 076 Towards the developm
Page 69 and 70: Innovation ✜ Creating a viable va
Page 71 and 72: Innovation Natural sciences and env
Page 73 and 74: Innovation References 1. Morel C et
Page 75 and 76: Innovation The changes in internati
Page 77 and 78: Innovation promoting health in deve
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Page 85 and 86: Innovation Health system strengthen
Page 87 and 88: Innovation Being healthy: the role
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Page 91 and 92: Innovation The role of Knowledge Tr
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Research resources References 1. Co
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Research resources investigated the
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Research resources A new landscape
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Research resources 13 + 1*- HIV/AID
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Research resources References 1. Da
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Research resources international le
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Research resources Partnership dyna
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Research resources that many public
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Research resources compounds from m
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Research resources References 1. So
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Decision-making Delivering evidence
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Decision-making Equitable access: g
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Decision-making years’ experience
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Decision-making Policy-makers Compl
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Decision-making interview studies),
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Decision-making References 1. Haine
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Decision-making reviews in this fie
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Decision-making Inequities in healt
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Decision-making Deaths Crude death
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Decision-making Group I Group II Gr
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Decision-making Low- and middle-inc
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Decision-making Europe and Central
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Decision-making Europe and Central
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Decision-making References 1. Banni
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Decision-making irresponsible-to be
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Decision-making Several strategies
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To achieve better health, particula
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