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Access to healthIntergovernmental Panel on Climate Change (IPCC) 38concludes that climate change can result in significantecosystem disruptions and threatens substantial damage tothe earth’s natural systems. In addition, several authors haveargued that maintaining a certain level of biodiversity isnecessary for the proper provision of ecosystem goods andservices 39-42 . The Millennium Ecosystem Assessment warnsthat the ongoing degradation of ecosystem functions poses agrowing health risk 43 . Several ecosystem functions areimportant to sustain our physical health. First, ecosystemsprovide us with basic human needs like food, clean air, andclean water. Second, they prevent the spread of diseasesthrough biological control. Finally, ecosystems provide us withmedical and genetic resources, which are necessary toprevent or cure diseases 44 .Globalization and proximal healthdeterminantsFigure 2 shows that the impact of globalization on eachproximal health determinant is mediated by the abovediscussedchanges in distal factors. The most importantrelationships will be discussed in more detail below.Health servicesHealth services are increasingly influenced by globalizationinducedchanges in health care policy, economicdevelopment and trade, and knowledge, but also bymigration. Although WHO aims to assist governments tostrengthen health services, government involvement in healthcare policies has been decreasing and, subsequently, medicalinstitutions are more and more confronted with the neo-liberaleconomic model. According to Collins 45 , populations oftransitional economies are no longer protected by acentralized health sector that provides universal access toeveryone and some groups are even denied the most basicmedical services.The increasing trade in health services also has someprofound implications. Although it is perceived as improvingthe consumer’s choice, some developments are believed tohave long-term dangers, such as establishing a two-tierhealth system, movement of health professionals from thepublic sector to the private sector, inequitable access tohealth care and the undermining of national healthsystems 9,11 . The illegal trading of drugs and the provision ofaccess to controlled drugs via the Internet are potentialhealth risks 46 . In addition, the globalization process can alsoresult in a “brain-drain” in the health sector as a result oflabour migration from developing to developed regions 47 .However, increased economic growth is generally believed toenhance improvements in health care. Increased(technological) knowledge resulting from the diffusion ofinformation can further improve the treatment andprevention of diseases.Social environmentOne central mechanism that links the social environment tohealth is “social support”, the transfer from one person toanother of instrumental, emotional and informationalassistance 48 . Social networks and social integration areclosely related to social support 49 and, as a result,globalization-induced changes in social cohesion, integrationand interaction can influence the degree of social support ina population.Another important factor in the social environment isviolence, which often is the result of the complex interplay ofmany factors. WHO 50 argues that globalization gives rise toobstacles as well as benefits for violence prevention. Itinduces changes in protective factors like social cohesion,EconomicsGlobal marketsGlobalizationprocessSocio-culturalGlobal communication &diffusion of informationglobal mobilitycross-cultural interactionInstitutionalstructuresGlobal governanceHealth policyhealth-relatedpolicyEconomicdevelopmenttradeHealthservices–SocioenvironmentallifestylePopulationhealthKnowledgesocialinteractionsPhysical livingenvironmentfood & waterEcosystemgoods and servicesGlobalenvironmentalchangeEnvironmentalContextualdeterminantsDistaldeterminantsProximaldeterminantsFigure 2: Conceptual framework for globalization and population health 2070 ✜ Global Forum Update on Research for Health Volume 4
Access to healthknowledge and education levels, and global preventionactivities. On the other hand, it also influences importantrisk factors associated with violence such as incomeinequality, collective conflict, and trade in alcohol, drugsor firearms.LifestyleDue to the widespread flow of people, information and ideas,lifestyles also spread throughout the world. It is alreadywidely acknowledged that several modern behavioural factorssuch as an unhealthy diet, physical inactivity, smoking,alcohol misuse and the use of illicit drugs are having aprofound impact on human health 51-54 . Individuals respond tothe range of healthy as well as unhealthy lifestyle options andchoices available in a community 55 , which are in turndetermined by global trade, economic development andsocial interactions. Although the major chronic diseases arenot transmittable via an infectious agent, the behaviours thatpredispose to these diseases can be communicated byadvertising, product marketing and social interactions 56 .Global trade and marketing developments drive, for example,unhealthy developments in diet 53,55 , tobacco use 53,57 , andalcohol consumption 58 .However, health education can play a role in promotinghealthy lifestyles by improving an individual’s knowledgeabout the health effects of different lifestyle options. Besideshealth education, (global) policies can also directlydiscourage unhealthy behaviour by means of economicincentives (e.g. charging excise on tobacco) or otherlegislation. An effective implementation of WHO FrameworkConvention on Tobacco Control (FCTC) 59 is expected to haveprofound implications on tobacco related-policies and,hopefully, tobacco use.Physical living environment: infectious disease pathogensThe spread of infectious diseases is probably one of the mostmentioned health effects of globalization and past diseaseoutbreaks have been linked to factors that are related to theglobalization process (e.g. Newcomb 60 ). The SARS outbreakdemonstrated the potential of new infectious diseases tospread rapidly in today’s world. The combination ofmovement of goods and people, and profound changesaffecting ecosystem goods and services all contribute toincreased risk of disease spread. For example, theglobalization of food production, trade and consumption hasbeen associated with the increased spread and transmissionof food born diseases 61 .The global spread of knowledge and technologies,however, can improve the outbreak surveillance andmonitoring of antibiotic resistance 21 , increasing the speedof responses in some cases. Wilson 28 states thatresponding to disease emergence requires a globalperspective. Hence, the policies and actions undertakenby WHO are becoming increasingly important incontrolling infectious diseases at a global level. Forinstance, WHO played a critical role in controlling SARSby means of global alerts, geographically specific traveladvisories and monitoring 62 .FoodFood trade has become an increasingly important factor withregard to food security worldwide. At present, however, thedeveloped countries still subsidize their agricultural sectors,and tariffs for agricultural products remain relatively high.Economic liberalization policies are expected to haveprofound implications on food trade and, subsequently foodsecurity 63 . Some argue that free trade will create access tobetter and cheaper food supplies via food imports and canstimulate more efficient use of the world’s resources, as wellas the production of food in regions that are more suitable todo so. Accelerated economic growth can also contribute tofood security 63, 64 . According to The State Of Food Insecurity inthe World 2005 65 , accelerating the progress towards an openand more equitable trading system is one of the key elementsin the worldwide reduction in hunger.On the other hand, trade could also endanger food security(e.g. Lang 66 ). For many countries the increasing dependenceincreases their vulnerability to shocks arising in globalmarkets, which can affect import capacity and access to foodimports 63 . Many food insecure countries are not able to earnenough with exporting goods in order to pay for the neededfood imports 67 .At the global level, there are increasing international effortsto achieve widespread food security. In 1996, the World FoodSummit, for example, stressed the right of everyone to haveaccess to safe and nutritious food. Globalization can alsoenhance the knowledge of foreign nations about theusefulness of food aid. Additionally, the globalization processcan facilitate the worldwide implementation of bettertechnologies and improved knowledge. At the same time,however, the natural resource base for food production isincreasingly threatened by compromised ecosystemfunctioning due to global environmental change.WaterGlobalization also raises concerns over water security. Theglobalization process is accompanied by privatization policiesaffecting the provision of water. Governments andinternational financial institutions promote privatization, asthey believe it will promote market competition and efficiency.Others are less optimistic about the effects of privatization. Infact, some cases show that prices and inequalities in accesseven rise 68 . The virtual trade of water is also believed to be ofincreasing importance, The water that is used in theproduction process of a commodity is called the “virtualwater” contained in that commodity. Therefore, the increasingglobal trade of commodities is accompanied by an increasingtrade in virtual water 69 .In addition, the globalization process can increase watersecurity by facilitating the worldwide implementation of bettertechnologies and improved knowledge. At the same time, thenatural resource base is increasingly threatened as, forexample, global climate change and deforestation profoundlyaffect our ecosystems’ ability to provide us with sufficient andadequate fresh water. On a global scale, there are increasingefforts to set up global guidelines or policies with regard tofresh water, however, none of the international declarationsGlobal Forum Update on Research for Health Volume 4 ✜ 071
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Editorial Advisory Board:Luis Gabri
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Contents096 Child immunization: acc
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IntroductionResearch contributions
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IntroductionType IType IIType IIIPr
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