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

Access to health2001, WTO ruled that the French ban on the import of allproducts containing asbestos was legal on health grounds,despite protests from Canada 15,16 . However, protecting citizensagainst health risks in cases of scientific uncertainty is stilldifficult, as WTO is reluctant to accept precautionary traderestrictions 17 .Economic developmentOpinions differ with regard to the economic benefits ofeconomic globalization. On one side, “optimists” argue thatglobal markets facilitate economic growth and economicsecurity, which would benefit health (e.g. Frankel 18 , BenDavid 19 , Dollar and Kraay 20 and Feachem 21 ). On the otherside, “pessimists” are worried about the health effects of theglobal market. Baum 22 states that “the current forms ofglobalization are making the world a safe place for unfetteredmarket liberalism and the consequent growth ofinequities…posing severe threats to people’s health”. The2005 Human Development Report 23 argues that one of theprevailing “myths” of economic globalization is that openmarkets will result in an era of convergence; tradeliberalization “has done little to slow down themarginalization of sub-Saharan Africa” and the current“trading system favours the developed world”. In fact,notwithstanding some spectacular growth rates, especially inEast Asia, incomes declined between 1965 and 1997 in 16of the world poorest countries 24 .TradeDue to the establishment of global markets and a globaltrading system, there has been a continuing increase in worldtrade. According to the WTO, total trade multiplied by a factorof 14 between 1950 and 1997 25 . More recently, the year2004 saw an impressive growth in trade, which exceededaverage growth recorded over the preceding decade 26 . Todayall countries trade internationally and they trade significantproportions of their national income. The array of productsbeing traded is wide-ranging; from primary commodities tomanufactured goods. Besides goods, services are increasinglybeing traded as well 27 . In addition to legal trade transactions,illegal drug trade is also globalizing.Social interactions: migrationDue to the changes in the infrastructures of transportation andcommunication, human migration has increased atunprecedented rates. According to Held et al. 27 , tourism is oneof the most obvious forms of cultural globalization. However,travel for business and pleasure constitutes only a fraction oftotal human movement. Other examples of people migrating aremissionaries, merchant marines, students, pilgrims, militaries,migrant workers and Peace Corps workers 27,28 . Besides theseforms of voluntary migration, resettlement by refugees is also animportant issue. The UN Population Division estimates theglobal migrant population in 2005 at between 185 and 192million people 29 . However, the concerns regarding theeconomic, political, social and environmental consequences ofmigration are growing 30 and many governments are movingtowards more restrictive immigration policies.Social interactions: conflictsIn the aftermath of the terrorist attacks on September 112001, many questioned the possible links betweenglobalization and the risk on conflicts. On the one side,globalizations can decrease the risk on tensions andconflicts, as societies become more dependent on each.Others argue that the resistance to globalization has resultedin religious fundamentalism, and worldwide tensions andintolerance 31 . According to Huntington 32 , the increasingcross-cultural interactions will result in a “clash ofcivilizations”. Nassar 33 describes globalization as a processthat leads to a “migration of dreams” in which the world’spoor are able to learn of the luxuries of the western world;the increased degree of relative deprivation results in growingtensions. In addition, Zwi et al. 34 identify several other factorsthat are associated with both globalization and the risk ofconflicts, such as increased global trade in arms andinadequate policies.Social interactions: social equity and social networksGlobal communication, global mobility and cross-culturalinteraction can also influence cultural norms and valuesabout social solidarity and social equity. It is feared that theself-interested individualism of the marketplace spills overinto cultural norms and values resulting in increasing socialexclusion and social inequity. Exclusion involvesdisintegration from common cultural processes, lack ofparticipation in social activities, alienation from decisionmakingand civic participation and barriers to employmentand material sources 35 . On the other hand, however, thegeographical scale of social networks is increasing due toglobal communications and global media. Like-mindedpeople are now able to interact at distance through, forexample, the Internet. The women’s movement, the peacemovement, organized religion and the environmentalmovement are good examples of transnational networks 27 .The digital divide between poor and rich, however, can resultin social exclusion from the global civil society.KnowledgeThe knowledge capital within a population is increasinglyaffected by global developments in communication andmobility. The term “globalization of education” suggestsgetting education into every nook and cranny of the globe.Millions of people now acquire part of their knowledge fromtransworld textbooks. Most universities work together withacademics from different countries, students have ampleopportunities to study abroad and “virtual campuses” havebeen developed. In addition, television, film and computergraphics have greatly enlarged the visual dimensions ofcommunication. Many people today “read” the globalizedworld without a book 36 . Overall, it is expected that thesedevelopments will also improve health training and healtheducation (e.g. Feachem 21 and Lee 37 ).Ecosystem goods and servicesGlobal environmental changes are affecting the provision ofecosystem goods and services to mankind. TheGlobal Forum Update on Research for Health Volume 4 ✜ 069