Combining health and social protection measures to reach the ultra ...

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
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