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

Access to healthThe diverse pathways fromglobalization to healthArticle by Maud MTE Huynen (pictured), Pim Martens and Henk BM HilderinkAchieving good health has become an acceptedinternational goal. In our attempts to realize this goal,however, we have to recognize that our (future) healthincreasingly depends on the globalization process. This was,for example, clearly demonstrated by the rapid global spreadof SARS in 2003. On the other hand, the growing globalinterconnectedness also means that we have more capacitythan ever before to respond to such health treats. Due to theincreasing geographical scale of important health issues, thecall for a global approach to health becomes stronger. Whatthis exactly means, however, remains unclear 1 . The multiplepathways from globalization to health are surrounded byuncertainty 2 . In the resulting polarized debate about thehealth effects of globalization, it is difficult to discuss howglobalization should move forward 3 . In order to improve ourunderstanding of the diverse pathways from globalization tohealth, we describe a conceptual framework for the effects ofglobalization on population health 2 .Conceptual framework for globalization andhealthHealth can be perceived as the integrated outcome of itsmultidimensional determinants 4 . The nature of thesedeterminants (institutional, economic, socio-cultural andenvironmental) and their level of causality (proximal, distaland contextual) can be combined into a basic framework thatconceptualizes the complex multi-causality of populationhealth. Figure 1 and Table 1 provide an overview of the widerange of health determinants that can be fitted within thisframework 2 . This framework illustrates the broader contextwithin which the health of a population develops.Globalization is increasingly perceived as a comprehensivephenomenon that is shaped by a multitude of factors andevents, and that is reshaping our society rapidly. Based on thework by Scholte 5 , Held et al. 6 and Rennen and Martens 7 , wedefine globalization as “a process characterized by a growingintensity, extensity and velocity of institutional, economic,EconomicdeterminantsEconomicinfrastructureEconomicdevelopmenttradeSocio-culturaldeterminantsCulturepopulationsocial infrastructureKnowledgesocialinteractionsInstitutionaldeterminantsInstitutionalinfrastructureHealth policyhealth-relatedpolicyHealthservices–SocioenvironmentallifestylePopulationhealthPhysical livingenvironmentfood & waterEcosystemgoods & servicesEcologicalsettingsEnvironmentaldeterminantsContextualdeterminantsDistaldeterminantsProximaldeterminantsFigure 1: Multi-nature and multi-level framework for population 2Global Forum Update on Research for Health Volume 4 ✜ 067